S12524 CONGRESSIONAL RECORD — SENATE December 6, 2009 what did they do? They decided to take The ACTING PRESIDENT pro tem- permitted to speak for up to 10 min- the money they need out of Medicare, pore. Without objection, it is so or- utes, with the majority controlling the and that has only made their health dered. first 60 minutes and the Republicans care plan even less popular with the f controlling the next 60 minutes. American people. The Senator from Florida. The Gregg amendment, which we will HEALTH CARE REFORM Mr. NELSON of Florida. Mr. Presi- vote on later this afternoon, will help Mr. DURBIN. Mr. President, Senator dent, I wish to speak on the bill and, in reverse the damage of last week’s REID contacted me earlier today and part, respond to the minority leader. votes. The Gregg amendment says said he was unable to be here for the At the end of the day, why are we stay- Democrats can’t raid Medicare, which opening of the session, and I told him I ing around the clock discussing this is already in serious trouble, in order would be here to open. bill with the intent that we are going to pay for their $2.5 trillion bill. The I would like to say, briefly, in re- to pass the bill? It is simply that we money going out of Medicare’s hospital sponse to the comments that have been cannot continue as we are. We are in a insurance trust fund already exceeds made by the minority leader, Senator system whereby insurance is not solv- its annual income. It is already drying MCCONNELL, who continues to raise the ing the Nation’s health needs. up. By 2017, the hospital insurance question about the future of Medicare, All you have to do is talk to a doctor. trust fund will not be able to pay full that I hope the Senator is sensitive to If they haven’t already pulled their benefits, and that is before our col- the fact that this last week, on Decem- hair out, they are about to, in that leagues get their hands on it. This pro- ber 3, we voted 100 to 0 for the amend- when they want to give a certain treat- gram needs to be fixed, not pillaged to ment offered by Senator BENNET of Col- ment to a patient, they feel like they create another one. orado, which said nothing in the have to negotiate with the insurance So the Gregg amendment prohibits amendments to this act shall result in company. In fact, the insurance com- using money from Medicare to pay for the reduction of guaranteed benefits pany often is dictating to them what any new government programs, for ex- under the Social Security Act provi- treatment and what drugs they can or panding existing programs, or for sub- sions related to Medicare; and we went cannot use or look at the simple little sidies. Instead, it directs that any on to say any savings would be used to cases we hear about. money from Medicare be put back into extend the solvency of the Medicare They are absolutely simple cases but Medicare to strengthen and preserve it trust fund, reduce Medicare premiums end up with catastrophic results be- for future generations so we can keep and other cost sharing for benefits and cause someone is in the middle of a our promises. Frankly, this is common improve or expand guaranteed Medi- treatment for something and then they sense. care benefits and protect access to get a notice that their insurance com- Americans don’t want this bill to Medicare providers. pany is going to cancel them or, per- pass, and they certainly don’t want it We voted 100 to 0, in a bipartisan haps, they have lost their job and they to pass at the expense of the roughly 40 fashion, to make certain we protect the are desperately trying to get health in- million American seniors who depend Medicare Program. That is the way it surance again and an insurance com- on Medicare. The Gregg amendment should be, and that is the way the Sen- pany uses, as an excuse, that they had would keep that from happening. A ate voted. a preexisting condition. It may be a vote for the Gregg amendment is a vote flimsy excuse. I gave the example yes- to keep our promise to seniors. f terday of a reason for denial being We are also going to have a vote RESERVATION OF LEADER TIME something as silly as a skin rash as a today on the Ensign amendment. The preexisting condition and so they can’t The ACTING PRESIDENT pro tem- amendment is simple: It is designed to get health insurance now on their own. pore. Under the previous order, the ensure that injured patients—not their We have a system that is out of con- leadership time is reserved. lawyers—receive the vast majority of trol. any settlement in a medical mal- f We hear a lot about cost out here. We hear a lot about cost. Indeed, if we practice suit. It says that since law- SERVICE MEMBERS HOME don’t do something about the cost of suits should benefit patients, not law- OWNERSHIP TAX ACT OF 2009 yers, lawyers can’t take more than health care, none of our people are one-third of the recovery their clients The ACTING PRESIDENT pro tem- going to be able to afford it. Talk to receive. In other words, the lawyers pore. Under the previous order, the corporate America and the CEOs and can’t take more than one-third of what Senate will resume consideration of listen to them as they describe what the client gets. H.R. 3590, which the clerk will report. the insurance companies are saying to These are responsible limits. More- The legislative clerk read as follows: them and how they are jacking up over, they were written by a Democrat A bill (H.R. 3590) to amend the Internal their rates on their employer-spon- and supported in the past by 21 of our Revenue Code of 1986 to modify the first-time sored group policies. Please, pray that current Democratic colleagues, as well home buyers credit in the cases of members you are not an individual who can’t get of the Armed Forces and certain other Fed- a group policy and you are having to go as the Vice President, and they would eral employees, and for other purposes. drive down costs, which was the origi- out there and try to find an individual Pending: nal purpose of reform. policy because the likelihood is you are The independent Congressional Budg- Reid amendment No. 2786, in the nature of not going to be able to afford it. et Office has said comprehensive liabil- a substitute. So cost is a critical factor. It is a fac- Lincoln amendment No. 2905 (to amend- tor also to the Government because the ity reforms would save the taxpayers ment No. 2786), to modify the limit on exces- more than $50 billion. The Ensign sive remuneration paid by certain health in- U.S. Government cannot afford the amendment is a step in that direction. surance providers to set the limit at the cost of Medicare as it keeps exploding We will offer a better, step-by-step same level as the salary of the President of into the future. We have to bring these reform to end junk lawsuits against the United States. costs under control. When you mix doctors and hospitals later in the con- Ensign amendment No. 2927 (to amendment that in with the horror stories that we sideration of this bill. I am hopeful my No. 2786), relative to limitation on amount of hear of the 46 million people who don’t Democratic colleagues will support it attorney’s contingency fees. have health insurance but who, when again, since so many of them have sup- The ACTING PRESIDENT pro tem- they get sick, end up in the emergency ported it in the past. pore. Under the previous order, the room, we know they are getting that I yield the floor. time until 3:15 p.m. will be for debate care at the most expensive place while The ACTING PRESIDENT pro tem- with respect to amendment No. 2905, the rest of us pay. That is a hidden tax. pore. The Senator from Illinois is rec- offered by the Senator from Arkansas, On average, in this Nation, that hid- ognized. Mrs. LINCOLN; and amendment No. 2927, den tax is $1,000 per family’s health in- Mr. DURBIN. Mr. President, I ask offered by the Senator from Nevada, surance policy. I can tell you, in my unanimous consent to speak as in lead- Mr. ENSIGN, with the time equally di- State of Florida it is even higher. It is er time. vided and controlled, with Senators $1,400. In Florida, a family with a group

VerDate Nov 24 2008 01:08 Dec 07, 2009 Jkt 089060 PO 00000 Frm 00002 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.001 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12525 insurance policy is paying $1,400 more come back to your $80 billion real fig- of the recovery. If there is no recovery, per year to take care of those folks ure over 10 years. One way to get there there is no fee. Beyond the absence of who do not have insurance but end up is the amendment I offered in the Fi- the fee, the plaintiffs characteris- getting sick, and that bill is paid by ev- nance Committee that was rejected on tically cannot afford the costs of liti- erybody else. a narrow vote of 13 to 10. Out here on gation. When depositions are taken or What I have described is a system the floor it is my intention to offer filings are made or various other costs that is in tilt. It is not working. The that amendment. I filed it. It would arise, it is up to the plaintiff’s lawyer whole purpose of this bill is to try to produce, according to the CBO, $106 bil- to pay those fees and those are not re- make it work so, No. 1, it is affordable; lion of taxpayer fund savings over 10 imbursed. No. 2, that health insurance is avail- years because the discounts would have An effort is being made now to have able. At the end of the day, we are to be there for the Medicaid recipients those deductions on an annual basis. going to pass it. At the end of the day, who are entitled to discounts, but now, The plaintiff’s attorney cannot even poor old HARRY REID, our majority since they buy their drugs through take them in the year when they are leader, is going to figure out a way to Medicare, they can’t get those dis- paid. So if you see a situation where, in get 60 of us to come down here to shut counts. That is because we changed the absolute dollars plaintiffs’ lawyers on off the filibuster so we can go to final law 6 years ago in the prescription drug contingent fees are paid less than de- passage and get it down to a conference benefit. That is just simply not right. fense lawyers, and you have added to committee in the House. At the end of I am not out here to try to punish that the risk factor that the plaintiff’s the day, after that conference com- anybody. I am out here to try to make lawyers may get nothing, there should mittee comes back, we are going to get this work and to get 60 votes so we can even be a greater compensation for those 60 votes again because this is so go to final passage. But everybody has plaintiffs’ lawyers than defense law- desperately needed, despite all the sup- to do their part. Everybody has to con- yers. As these statistics show, it is less. posed arguments we hear from the tribute for their part. Most of my experience in the court- other side. I look forward to the future discus- room has been as a prosecuting attor- Can this product be improved? Of sions as we close in on what probably is ney, but some experience—I worked for course it can. I certainly wish to share, going to end up being the final passage a big law firm, Barnes, Dechert, Price, as I did in the Finance Committee, an of this, probably a week or 8 days down Myers and Rhoads, representing the amendment that would cause the phar- the road. Pennsylvania railroads, defendants, maceutical industry to come up with The ACTING PRESIDENT pro tem- representing insurance companies. In some more money. pore. The time of the Senator has ex- the firm practice in that kind of rep- They have made a pledge, to their pired. resentation, there is frequently a sen- credit. Let me just say that Billy Tau- The Senator from Pennsylvania is ior lawyer, junior lawyer, associate, zin, the head of the pharmaceutical as- recognized. paralegal, and multiple tiers running sociation, is smart. He knows what he Mr. SPECTER. Mr. President, the up the costs. is doing, and he is trying to play ball schedulers have allocated 15 minutes to Most plaintiffs’ lawyers do not have with the leadership and the White me, so I ask unanimous consent at this large firms. Many are single practi- House. I want the pharmaceutical in- time that I may speak for up to 15 min- tioners. To postulate a situation where dustry to know this Senator appre- utes. the fees be cut even further is just not ciates that because with everybody The ACTING PRESIDENT pro tem- reasonable or not realistic. else, such as the insurance industry, pore. Without objection, it is so or- When the contention has been trying to kill it deader than a doornail, dered. made—it was just made by the Repub- at least they are helping. But the phar- Mr. SPECTER. Mr. President, I have lican leader, repeated earlier conten- maceutical industry said they were sought recognition to speak in opposi- tions—that there are Senators who coming forth with $80 billion over 10 tion to the Ensign amendment. The au- voted in favor of the Kennedy bill on li- years that they were going to con- thoritative statement on attorney’s ability reform, it is not so as rep- tribute. The hospital industry said fees has come from the National Asso- resented. First of all, Senator Ken- they were going to contribute about ciation of Insurance Commissioners in nedy’s bill in 1995 was a much different $150 billion over 10 years, and so forth. a 2008 document entitled ‘‘Countrywide bill. Second, it was a tabling motion. But, in fact, the pharmaceutical indus- Summary of Medical Malpractice In- Those who voted against tabling were try is not contributing $80 billion. surance.’’ These are authoritative fig- willing to consider the issue, not that Here is a Morgan Stanley analysis for ures on how much the defense lawyers they agreed with what was in the bill. investors of pharmaceutical stocks. have taken and how much the plain- Procedurally, when there is a motion This is their analysis of what is going tiffs’ lawyers have taken. to table, if it is passed the bill is off the to happen to the pharmaceutical indus- It shows that the plaintiffs’ lawyers, floor. If a motion to table is defeated, try in the future. Morgan Stanley has on this state of the record, are under- then the bill remains on the floor for said these guys are so smart, they are paid—paid less than defense lawyers— consideration. But it does not mean not contributing $80 billion. They are hardly the cause for an amendment to that people who want to consider the contributing only $22 billion. Why? Be- lower attorney’s fees even more for bill are in agreement the bill ought to cause when they say they are going to plaintiffs’ lawyers. be enacted. contribute discounts to allow half of These are the statistics by the Na- The issue of attorney’s fees and the this so-called doughnut hole to be tional Association of Insurance Com- issue of malpractice litigation ought to filled, that means there is going to be missioners as to the attorney’s fees. be left to the States in our Federal sys- a lot more drugs sold. The attorney’s fees for defendants were tem. Pennsylvania, my State, is illus- Oh, by the way, the bill takes Med- $2.110 billion. The total recovery by trative of the way State governments icaid from 100 percent to 133 percent. plaintiffs was $4.09 billion. Calculating can handle the issue and deal with it to That is going to mean a lot more drugs attorney’s fees at one-third would avoid excesses. In Pennsylvania there sold as a result of this bill. mean that the attorney’s fees were, for was a rule change made to require that So the real loss, or contribution, if the plaintiffs’ attorneys, $1.340 billion, before a malpractice suit could be you will, of the pharmaceutical indus- substantially under the $2.110 billion brought, there had to be a certification try is $22 billion over 10 years, not $80 for defense attorneys. from a doctor that the case fell below billion. That does not even include—re- Attorneys who take on cases on a applicable standards of care. A second member, they just raised their prices 9 contingent fee do so because, unlike in- major change was made which required percent, three times the rate of infla- surance companies which have the that the medical malpractice action be tion. So they are going to make up a funds to retain lawyers on an hourly brought only in the county where the lot of that anyway. basis, most plaintiffs are unable to pay cause of action took place. That was a What I want to plead with the leader- attorney’s fees, do not have the capital move aimed at eliminating so-called ship in the White House and the leader- to do so. The arrangement is worked venue shopping, to go to a venue where ship of the pharmaceutical industry— out that the fee will be paid by a share there is likely to be a better result.

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00003 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.002 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12526 CONGRESSIONAL RECORD — SENATE December 6, 2009 As a consequence of these two rule That has been thoroughly debunked. That is totally ineffective. But if there changes, the number of filings in Penn- There has been a context that there were jail sentences imposed, that sylvania dropped dramatically. With would be cuts in Medicare. We argued would be a deterrent to others, some- the comparison of the years 2000 to an amendment a few days ago on the thing I learned years ago as a pros- 2002, it was noted that the rates contention that there would be very ecuting attorney. We can also come to dropped by more than 37 percent in substantial cuts in Medicare. The terms on the abortion issue, allowing 2003, continued to decline in every suc- AARP opposed that amendment be- women to pay for abortion coverage in ceeding year, and in 2008 had dropped cause it was fallacious. It was untrue. their medical care. There is no reason 41.4 percent. AARP is an outstanding guardian of they should be denied in maintaining The improvement in the picture was the interests and rights of senior citi- the principles of the Hyde amendment further illustrated by the fact that the zens, and AARP opposed that amend- with no federal payment for abortion reforms resulted in the reduction of ment. services. premiums on malpractice insurance. The contention has been made that I thank the Chair and yield the floor. These reductions are in sharp contrast there will be a government takeover of The PRESIDING OFFICER. The Sen- to 2002, when one leading carrier in- medical care which has also been dis- ator from Illinois. creased its rates an average of 40 per- puted and pretty well disproved. When Mr. DURBIN. Mr. President, I thank cent and a second leading carrier in- the government option is offered, it is the Senator from the Commonwealth creased its rates by 45 percent. Then just that. I believe America would be of Pennsylvania for his opening re- the rates have been decreased consist- well served by having a robust public marks. He has addressed an issue rel- ently and in ensuing years. option. But the option is nothing more ative to a pending amendment offered Other indications in the success of or less than what it says. It is one al- by the Senator from Nevada. He makes Pennsylvania was the renewed interest ternative. Private insurers would still note of a very critical flaw in this of companies that want to sell medical be in the picture. amendment. The Senator from Nevada malpractice insurance in Pennsyl- There have been repeated conten- is restricting the ability of the victims vania—57 newly licensed entities are tions that there will be an increase in of medical malpractice to go to court now writing medical malpractice cov- the deficit. President Obama is pledged to recover by restricting the attorney’s erage since April, 2002. This is illus- not to sign a bill which will add to the fees that can be paid, contingency fees, trative of the way the States can deal deficit. I am pledged not to vote for a because people usually don’t have with this issue. It ought to be left to bill which will add to the deficit. When enough money to buy an attorney. The the States. you take a look at what this bill will attorney takes the case and says: If Interestingly, the Senator from Ne- accomplish, there are very substantial you win, then I get paid. If you lose, I vada, who has proposed this amend- savings in the current cost of medical don’t get paid. Contingent fee basis. ment, has filed legislation this year, S. care, which is $2.4 trillion. I will be spe- The Senator from Nevada is restrict- 45, and in S. 45 he has a different ap- cific in what they are. With annual ex- ing the ability of these attorneys to proach. He allocates for some recov- aminations available and incentives for represent plaintiffs, victims, on a con- eries up to 40 percent. Why there is a people to take annual examinations, tingency fee basis, but does not restrict difference now, cutting it back to 33 they will be catching what could turn the defense attorneys and the amount percent, and then down to 25 percent, is out to be chronic ailments, very dis- they are paid. As the Senator from unexplained. But when an amendment abling, very expensive. Catching a Pennsylvania noted, the record is of this sort is offered on a bill for com- problem with a cardiac issue, with a clear, the amount of money being paid prehensive health care reform, it is not heart problem, or catching breast can- to defense attorneys in medical mal- germane to the issues before the Sen- cer at an early stage or catching Hodg- practice cases is 50 percent higher on ate. The standard of being germane kin’s at an early stage—I speak with an annualized basis than that paid to means whether there is any provision some experience about this issue—will those representing victims. in the bill now which relates to this cut down medical expenses tremen- I won’t question the motive of the matter. dously. When there are advance direc- Senator from Nevada, but the effect of Had this really been a serious effort tives, there will also be additional sav- his amendment is to reduce the likeli- to get legislation, the process or re- ings. This bill provides for counseling hood that an injured victim will be course to be followed would have been for people who want to know about ad- able to go to court and be represented considerably different. The way to get vance directives. No one should tell by an attorney to make their claim. legislation enacted is not merely to anyone else what they ought to do Our system of justice has a courtroom come before some bill and offer it with- about end-of-life medical care, but it is and jury and a judge there to make out hearings before the committee of fair to say consider it, make a decision, that final decision. What the Senator jurisdiction, without the consideration have a living will, do not leave it to the from Nevada does is preclude and re- of witnesses. There have been no hear- last minute when someone is rushed to duce the possibility that victims can ings on the amendment offered by the the hospital and the burden then falls recover. How many people die each Senator from Nevada. Had there been on family members. Estimates range as year in America from medical mal- hearings we would have been in a posi- high as 27 percent of Medicare costs in practice? The Institute of Medicine tion to make a determination as to the last few days, few weeks of a per- told us 10 years ago the number was what are the real facts. son’s life. 98,000 people a year. Many more are in- Are the fees collected by plaintiffs’ There are also very substantial sav- jured because of medical malpractice. attorneys on a contingent basis exces- ings available for changes in lifestyle. How many lawsuits, claims are suc- sive? What is the reality for the jus- Safeway has demonstrated lower insur- cessfully filed each year in America for tification, in terms of the time it takes ance premiums for people who stop medical malpractice, for injuries and and the expenses involved? But no re- smoking, lower insurance premiums for deaths? About 11,000. A very small per- quest was made, to my knowledge, for people who have lower cholesterol. centage of the actual victims of mal- a hearing before the Judiciary Com- That is another major area of savings. practice go to court. It doesn’t happen. mittee. I do know that no hearing was An additional area of savings would Those who try to go to court are usu- held. So we do not have a factual basis be to change the current approach of ally not rich people so they do it on a for making an evaluation of this having fines imposed for Medicare. contingency fee. What the Senator amendment at this time. I ask unanimous consent for 30 addi- from Nevada is trying to do, unfortu- It is my hope that we will move from tional seconds. nately, is to close the courthouse door this amendment and take up the issues The PRESIDING OFFICER (Mr. to favor the defense of a malpractice which are in dispute. We need to elimi- BINGAMAN). Without objection, it is so case over the victim. That, to me, is nate and reject the false rumors which ordered. unfortunate, and I hope we are success- have been advanced. The contention Mr. SPECTER. Currently the crimi- ful in defeating it. For those who are has been made that there would be nal justice system results most of the following the proceedings of the Senate death panels as a result of this bill. time in fines for health care fraud. today, either in person or through C–

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00004 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.003 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12527 SPAN, it is an unusual—not unprece- highest amounts to their CEOs each the temple down upon the heads of our de- dented but unusual—meeting on Sun- and every year. What we are trying to scendants. day. But it is appropriate that we do is to make sure they don’t turn We know that when former Senator would do something extraordinary down people when they need help the from Ohio Robert Taft was addressing when you consider the matter at hand. most. Too many of these insurance the effort by President Harry Truman This 2,000-page bill is the health care companies, as has been noted many to have universal health care in Amer- reform bill that has been in the works times, raise the issue of preexisting ica, he said: now for a year. It has been considered conditions and say: We are not going to I consider it socialism. by three committees in the House and cover that particular surgery or that It was used against Lyndon Johnson. two in the Senate. The Presiding Offi- particular drug because you had a pre- That same charge was used against Bill cer from New Mexico has the dubious existing condition you didn’t disclose. Clinton. It is virtually being used distinction of having been privy to all They game the system against the per- today. When we hear the Republicans of the Senate committee proceedings son who is sick. That is going to who are opposing this bill come to the and some extraneous proceedings. He change. This bill will provide for cov- floor, I have a basic question to ask has probably been subjected to more erage despite preexisting conditions, them. We have been at this debate for debate on this issue than any other and we won’t allow the insurance com- a year. Where is your bill? What do you Member. panies to assert a limit, a lifetime want to do? A lot of hard work has gone into this limit on what they can pay. Oh, they tell us: We have some bills, bill. Some critics say it is too long. You know what happens. You get se- and you are going to see them any day There are too many pages. When you riously ill, and they cut you off. What now. Well, I would like to. I would like consider that we are tackling our is happening today is that two out of to see the comprehensive health reform health care system, which comprises three people who file for bankruptcy in bill from the Republican side of the one-sixth of our gross domestic prod- America do so because of medical bills, aisle. This is ours, and it has been on uct—$1 out of every $6 spent in Amer- bills they can’t pay. That tells us that the Internet for 2 weeks for everybody ica—it is understandable that we would the number of people facing this threat in this Nation to read word by word, need to work carefully and try in a is huge. But even worse is the fact that line by line. Sadly, there is no Repub- comprehensive way to address all the some 74 percent of those filing bank- lican bill. issues. ruptcy already have health insurance. I know there are two possible reasons So what does this bill do? First, it is It turns out the health insurance was for that. This was hard work. This was historic in that it moves us toward 94 not worth much when they needed it. not easy politically or otherwise and percent of the American people having The last thing this bill does—and one they have not engaged in that hard health insurance. Today about 50 mil- of the most important things—is it work. What we have seen are press re- lion people don’t have health insur- doesn’t add to the deficit. President leases and speeches, graphs and pic- ance. That is not counting the people Obama told us to do this job but don’t tures, but no bill, no comprehensive with bad health insurance. These are make the deficit worse. The Congres- health care reform bill from the Repub- people who have no health insurance. sional Budget Office, which is the ref- lican side. Secondly, there are many on Some have lost jobs, some worked for eree and umpire when it comes to the that side of the aisle who like this sys- businesses that can’t afford insurance, cost of bills, came back and said our tem of health care. They agree with and some can’t afford to buy it them- bill will actually reduce the Federal the health insurance companies: Let’s selves, 50 million of them. Thirty mil- deficit by $130 billion over the first 10 keep it the way it is. lion are going to move toward coverage years and $650 billion over the next 10. But Americans know better. We are in this bill. It will be the largest per- Bringing down the cost of health care going to work today in the Senate on centage of Americans with the security brings down the cost of government this bill, as we should. While we are of health insurance protection in our health programs. It saves us money, working today, 14,000 Americans are Nation’s history. That is what this bill saving families and businesses money, going to lose their health insurance. does. saving the government money. It is the Mr. President, 14,000 Americans lost Secondly, this bill makes health in- largest deficit reduction bill ever con- their health insurance yesterday, and surance premiums more affordable. For sidered by Congress. It is before us 14,000 will lose it tomorrow, and every over 80 percent—some say over 90 per- now. single day of the year. That is how cent—of the people in America, they It is no surprise—we heard this morn- many people, despite their best efforts, will see either a reduction in premium ing from the Republican Senate leader, lose their coverage. or a slowdown in the rate of growth in and we have heard before—that there We have to stop that. It is time for us health insurance premiums. That is are those who are arguing this is a dan- to provide the kind of peace of mind something that is absolutely essential gerous bill and this bill should not be that every single family deserves in because health insurance premiums are passed. I asked my staff to do a little America when it comes to quality and breaking the bank. Ten years ago, the bit of work on previous debates right affordable health care. average health insurance plan for a here on the floor of the Senate and Mr. President, I yield the floor. family of four cost $6,000 a year. That what was said. The PRESIDING OFFICER. The Sen- is a lot of money, $500 a month. That In 1934, when Congress was consid- ator from Pennsylvania is recognized. was 10 years ago. Now it has doubled. ering the Social Security Program, AMENDMENT NO. 2927 The average is $12,000 a year, $1,000 a which gave everybody a basic retire- Mr. CASEY. Mr. President, I rise this month for a family of four for health ment plan, an insurance plan for retire- afternoon to speak about one of the insurance coverage. That is the aver- ment, even after the Social Security amendments we are going to be voting age, to work and earn $1,000 a month bill came to the Senate floor, not in- on later today. As we stand here today, strictly for health insurance. What is cluding health insurance, a Republican we are debating the bill on the floor, the projection in 8 years? That it will Senator from Delaware, Daniel the health care bill, where we are try- double again to $24,000, that you will be Hastings, said on the floor about Social ing to do a couple things at one time, working and earning $2,000 a month Security: and I think we can, and I think this just to pay for health insurance. That I fear it may end the progress of a great bill does it, even though we will make is unaffordable for so many people. country. some changes to it. That is why that is one of the highest A Congressman from the State of We are trying to improve the quality priorities in this bill. New York, James Wadsworth, in the of care for Americans, whether they The third thing this bill does is to same debate over Social Security, said get their health care through a public give people across America a fighting that the passage of Social Security: program or through a private insur- chance against the health insurance . . . opens the door and invites the en- ance company or a private plan. We are companies. These private insurance trance into the political field of a power so trying to finally use preventive meas- companies are some of the wealthiest vast, so powerful as to threaten the integrity ures to make people healthier and have companies in America and pay the of our institutions and to pull the pillars of better health outcomes.

VerDate Nov 24 2008 01:14 Dec 07, 2009 Jkt 089060 PO 00000 Frm 00005 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.005 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12528 CONGRESSIONAL RECORD — SENATE December 6, 2009 We are also working to reduce costs. represent injured workers. That was In conclusion, in terms of what hap- If you want to talk about it in terms of his law practice. I wonder what he pens in our States, States regulate the a doctor and a patient or a health care would say if he were here talking about conduct of lawyers. They do it all the system and an American, who should what happens to victims when they time. But we also have evidence from benefit from the health care system, have an injury they want redress for. the States about what happens in these we basically want to have people get Like on so many other things in this kinds of cases. In Pennsylvania, for ex- the care they need from the doctor debate, I think the other side of the ample, in most counties, as to cases they choose. aisle is carrying water for the insur- going to trial because of medical mal- What we are engaged in now is a de- ance companies. Just my opinion, but I practice claims—those kinds of law- bate about an amendment which the think that is the case. Yet in the case suits—in most counties in Pennsyl- other side says is about the fees going of medical negligence and what hap- vania, 90 percent of those cases are won to trial lawyers. That is the way they pens in the real world, we know that by the defense, won by the insurance like to talk about it, and I know that 98,000 deaths a year are from prevent- company. That is the evidence in Penn- is popular. When the other side makes able medical errors. Let me say that sylvania. an amendment such as this, they like again. We know there are 98,000 deaths I know we have others who are ready to have a target, so their target is trial in America a year, according to the In- to speak on this and other amend- lawyers. But, unfortunately, for this stitute of Medicine, from preventable ments. But I think we should make it debate, I think it is misleading because medical errors. very clear. On this amendment, this is this amendment, which I would urge So what this amendment does is deny a debate about two parties: victims of people to vote against, is not about patients the attorney of their choice. It medical negligence versus insurance lawyers. It is about victims and wheth- further restricts access to the courts. companies. It is time to choose up er we are going to ensure that victims It drives up costs for victims. When we which side you stand on. Unfortu- have a shot, a fair chance, when they talk about bringing a case and the bar- nately, this amendment is very clearly have a claim for medical negligence riers to doing that, that is not some fu- drafted and intended to help insurance when they have been injured as a result ture result of this amendment. Oh, I companies, not victims of medical neg- of negligent conduct. think this amendment will make that ligence. I said before, we are debating the problem a lot worse. But right now—no I yield the floor. health care bill and we are talking matter what happens in this debate, no I suggest the absence of a quorum. about costs. This amendment will do matter what happens on the vote on I withhold that suggestion. nothing to lower costs. What it will do this amendment—there are barriers The PRESIDING OFFICER. The Sen- is not lower anyone’s costs. What it right now for people to bring a lawsuit. ator from Montana is recognized. will do is increase the cost or the bur- It costs, in many cases, thousands, if Mr. BAUCUS. Mr. President, for the den a claimant has to bear when they not tens of thousands, to bring a case. benefit of all Senators, I want to take have a claim against any kind of hos- And then to see a case all the way a moment to review today’s program. pital or doctor in the case of a medical through costs a lot more than that. This is the seventh day of debate on negligence case. So the question is, are What are we talking about here? We the health care reform bill. It has been we going to enable people who do not are talking about allowing someone nearly 21⁄2 weeks since the majority have the means to bring cases versus who has a claim for a serious injury to leader moved to proceed to this bill. very powerful interests? That is one of go see a lawyer and to sit down with We have now considered 14 amend- the basic questions we will answer with that lawyer and enter into an agree- ments, and we have conducted 10 roll- regard to this amendment. ment for the fee, whatever that fee will calls. I would hope if a member of my fam- be, whatever that will be. If that law- Between now and 3:15 this afternoon, ily or any family—and I think this is yer and that person, that patient or the Senate will continue to debate the true of everyone in this Chamber—if a victim, goes forward with the case, amendment by the Senator from Ar- member of your family, as a result of they bear a risk. The victim bears a kansas, Mrs. LINCOLN, on insurance medical negligence, had to bring a risk that they will not be successful company executive compensation and, claim, you would hope that individual and that at the end of that they will at the same time, we will debate the could walk into a courtroom or file a have no recovery at all. amendment by Senator ENSIGN lim- claim with someone who has the skill But because of the way the contin- iting attorney’s fees. The majority con- and the ability to be their advocate. gent fee works, the lawyer bears a risk trols the first 60 minutes, and the Re- Because I will tell you one thing, they as well that he or she will not be paid, publicans will control the next 60 min- are going to be up against a very pow- and they also stand a risk of having to utes. At 3:15 p.m., the Senate will con- erful interest: insurance companies pay for costs the victim cannot pay— duct back-to-back votes on or in rela- that write medical liability policies, an and the lawyer will bear those costs tion to the Lincoln amendment and the incredibly powerful interest. throughout the pursuit of that case. Ensign amendment. A lot of us come at this question So here is what we are talking about. Thereafter, we expect to turn to an- through our own personal experience, This is basically a debate about vic- other Democratic first-degree amend- through the experiences of our fami- tims and whether they are going to ment and another Republican first-de- lies. I had a grandfather who I never have the kind of representation they gree amendment. That is the lineup at met, my father’s father, Alphonsus need. If I were going in to have surgery this time. It is possible the Senate may Casey. He, like a lot of people in north- in a hospital, I would hope the surgeon vote on those next two amendments eastern Pennsylvania, as a young kid, would be someone of the best, the high- today. As a result, additional votes are went into the coal mines at a very est skill possible. I would want the best possible following the two votes at 3:15. young age. He worked as a mule boy. surgeon, as I take on that battle. Any- Once again, I thank all Senators for One of the days he was tending to the one would. their cooperation and courtesy on this mules in that mine, just as a kid, 11 or I would hope we would not do some- extraordinary weekend session. 12 years old at the time, he was kicked thing in the debate to reduce the Mr. President, I suggest that Senator by a mule. He got a scar that started chances that a victim of medical neg- HARKIN be next recognized for 7 min- above his eyebrow and went across his ligence could go into a courtroom or utes. face, split his lip, and went down file a claim with the best, most highly The PRESIDING OFFICER. The Sen- through one side of his chin. So he un- skilled lawyer they can find. I would ator from Iowa is recognized. derstood injury as a child, injury in the hope we would not want to do anything Mr. HARKIN. Mr. President, I will course of working. I think he also un- that would injure that basic right. have more to say about this later. But derstood that when he became a law- It is interesting that this amendment there has been so much talk about fear, yer, many years later, well into his applies only to patients—it does not fear, fear. Everybody has a fear. Let’s adulthood. He understood what it is apply to anyone else—patients who get away from that. It is time to quit like to suffer an injury and to make a would become victims of medical neg- talking about fear. Let’s talk about claim for an injury. But what he did is ligence. hope. Let’s talk about the realities of

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00006 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.007 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12529 what is affecting people out there, If you are a 62-year-old woman with a Is there anybody among the 535 of us what we are trying to do to make their serious heart condition such as the one who ever worries about whether we will lives better. Why do we always want to Eleanor has, high blood pressure, you be able to afford health care insurance? inject fear into people? Let’s talk just don’t have a prayer, you are on I don’t know of anyone who ever wor- about hope. Let’s talk about real peo- your own, and the odds of premature ries about that, of the 535 who are here. ple and what this bill does. death are disturbingly high. We can Has anyone ever been up late at As shown in this picture, this is and must do better. That is what we night with a child or a loved one, won- Sarah Posekany of Cedar Falls, IA. Let ought to be talking about: hope for the dering whether they are going to be me tell you her story. It is incredible. future, not fear. able to afford the treatment that child She was diagnosed with Crohn’s disease Mr. President, I yield the floor. may need, or that loved one? I would when she was 15 years old. During her Mr. BAUCUS. Mr. President, I yield go so far as to say I don’t think that first year in college, she ran into com- to the Senator from Connecticut all happens here. God forbid if we are con- plications from the disease and had to the remaining time, and if he wants to fronted with a child or a loved one who drop classes. Because she was no longer speak for a little longer, I know we can needs that care. We may worry about a full-time student, her parents’ pri- make some accommodations with the that, but we are not going to worry vate health insurance company termi- other side. about whether the insurance will be nated her coverage. Then the medical Mr. DODD. How much time remains? there or whether we will have the abil- The PRESIDING OFFICER. Eight bills piled up. Four years later, she ity to pay for it. Not one of us ever minutes is remaining. worries about that. found herself $180,000 in debt, and was Mr. DODD. I thank my colleagues. forced to file for bankruptcy. Has anybody ever spent hours being Mr. President, some of these numbers bounced from voice mail to voice mail Sarah has undergone seven sur- get thrown around so much that it is geries—seven. Here is what is dis- to voice mail trying to find out why almost dizzying. I wonder how the av- the insurance company you pay thou- turbing. Two of those came as a direct erage person, even someone who is in- result of not being able to afford medi- sands of dollars to every year suddenly tently listening to these debates, can refuses to pay for your spouse’s cancer cation. So again, it is an incredible sort it all out: 47 million who have no story, but it is a true story. treatments? Has that ever happened to coverage; 14,000 people every single day anyone here? I doubt it. I sincerely So many people have to go through in our country who lose health care this. Our bill says: Look, you can stay doubt it. coverage either because they are Is there anyone stuck in a job that on your parents’ coverage until you are thrown into personal bankruptcy or be- age 26, and—guess what—no pre- pays very little because you can’t af- cause of medical costs or job loss ford to change jobs because you have a existing conditions will apply to you around the country—14,000 a day, every from here on out. Think about Sarah preexisting condition and you know if day, 7 days a week. Just do the math. you go to that new job that may pay when we are talking about this bill and For 7 or 8 days, we have been debating the hope she needs—and so many like more, you are going to find yourself this legislation. You can run the num- without the insurance coverage to take her—that we are going to change this bers yourself to determine over that care of that preexisting condition? No system to make her life better. period of time how many citizens one here worries about being in that Second, this is a picture of Tasha across the country have found them- Hudson of Des Moines, IA. She is a sin- particular predicament. selves in that free fall, that dreaded Has anyone been driven into bank- gle mother, with three kids. She had a fear that a child or a loved one may ruptcy, any Members of Congress, be- job which provided health insurance, end up needing care. It is not as though cause they had a medical crisis? We but she took a new job that paid her you can postpone the decision to some now know that 62 percent of all bank- more, 50 percent more. You would later time, as you can about whether ruptcies this year alone are medical think: Isn’t that the American way? to take a vacation or to buy that new crisis related, and 70 percent of that 62 You learn, you get better, you get a car or maybe to spend more than you percent have health care insurance—70 better paying job. The problem is, the thought you would over the holidays percent of that 62 percent. private sector job did not come with coming up. If you now have a medical Is anybody here a small business health insurance. Despite the higher emergency and you are one of those owner who has had to choose between pay, she could not afford the coverage. 14,000 a day who have lost coverage, cutting coverage or putting your em- Ironically, her higher pay led to cuts what do you do? So sometimes the ployees out of work? in her Medicaid benefits and the loss of sheer magnitude of these numbers can Well, the answer to all of these ques- childcare services. As a result, Tasha is cause us to lose sight of the individual tions obviously is a resounding no. now in the process of returning to a stories, anecdotes that are not exclu- None of us have ever had to grapple lower paying job, despite its limited sive or isolated but commonplace sto- with what 14,000 people do in this coun- opportunities, for one reason: because ries that are happening as we speak try every day: losing their coverage, or it will provide health insurance for her here on this Sunday, on a rare Sunday the underinsured who discover all of a family. These are real people. These session in the Senate because of the sudden that the coverage they thought are the people to whom we need to give importance of this issue. they had doesn’t quite cover the prob- hope. So I rise today to share a few stories lems, or the out-of-pocket expenses you Here is one last one. Eleanor Pierce from my own State that I think put a have to pay before getting to insurance lives in Cedar Falls, IA. She lost her face on these issues and why we are are so high that you can’t possibly job when her company was eliminated. here. Let me start by asking some meet them. That goes on every minute She had the option of purchasing questions because I think too often of every day all across our Nation, and COBRA, but she couldn’t afford it. So when we debate these issues, some- it is why we are here on this Sunday in she searched for coverage, but because times we are so removed as Members of December, to try to finally see if we of high blood pressure—preexisting this body, from what goes on in the cannot come to terms and start moving condition—she was denied access. So daily lives of the people we represent on a coverage program, a health care age 62, suffering from high blood pres- that we fail to appreciate what is hap- and health insurance coverage program sure, she had no choice but to go with- pening right outside these doors from that makes it possible for all of our fel- out insurance. this very Chamber on a daily and an low citizens to be in the same position That is why we need this bill. Not for hourly occasion. The 535 of us who have we are. fear—let’s quit talking about fear. the privilege of serving in the Con- None of us are immune from health Let’s talk about hope for the people I gress, including Members of the other care crises. Every one of us here has just talked about, the hope that their body, none of us here are worrying grappled with that at one time or an- lives will be better, that they will get about losing our health care. Not a sin- other. The difference is, we don’t ever the insurance coverage they need, that gle Member here ever spent a nano- worry about the ability to pay for it, they will be able to get on with their second worrying about whether they losing our coverage, having to go lives and not have to go so far in debt are going to be dropped from their through what every other citizen does that they have to go into bankruptcy. health care coverage—not one. every single day.

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00007 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.008 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12530 CONGRESSIONAL RECORD — SENATE December 6, 2009 These are real people who go through ular doctor. If one of them has a child tions in spending in Medicare are going this. We can get so lost in the weeds on with an ear infection—— to translate immediately and unques- this debate. I am not suggesting the de- The PRESIDING OFFICER. The ma- tionably into a reduction in service and tails are unimportant—they are impor- jority time has expired. coverage for Medicare-recipient senior tant—but we are losing sight of the Mr. DODD. I ask unanimous consent citizens. The money from that—the $1⁄2 whole; that is, for 80 years every single for 1 additional minute, I ask my col- trillion in the first 10 years, the $1 tril- Congress, whether it has been con- leagues. lion in the 10 years that we are doing trolled by Republicans or Democrats, Mr. BAUCUS. I ask unanimous con- the implementation, and the $2.5 tril- whether a Democrat or Republican has sent for 1 additional minute. lion over the next 20 years—is being been in the White House, has been un- The PRESIDING OFFICER. Is there taken out of the senior citizen program able to even come close to solving this objection? Without objection, it is so called Medicare, and it is going to be problem. ordered. moved over into a brandnew entitle- We are now that close—closer than Mr. DODD. I thank my colleagues. ment program and into the expansion we have ever been in our history—to Kevin has three employees in their of Medicaid. coming up with a health care system twenties and thirties. This is Kevin Those dollars will be used to create that can begin to take care of that here, by the way, running this mainte- new Federal programs for people who basic right every American ought to nance shop in Hartford, CT. He has em- have never paid, for the most part, into have—and it is a right—that if you are ployees in their twenties and thirties the Medicare hospitalization fund; for a citizen of the United States and you who have never had a physical or a people who are not senior citizens and get sick, you ought not to be shoved dental cleaning by a hygienist. One of therefore do not, arguably, deserve to into bankruptcy, lose your job, or have them, age 28, with two children to sup- receive the benefit of the Medicare hos- your family suffer because of your eco- port, was out of work for 12 weeks and pitalization fund. As a result, seniors nomic circumstances. The privilege of nearly died from a staph infection he will see their benefits reduced and getting good health care ought not to got from an untreated cavity. other people will get a new benefit be based on wealth; it ought to be Kevin has been working hard to try through the Federal Government. Iron- based on the fact that we live in the to provide for these people, but he has ically, the new benefit, this new enti- United States of America and we are recently lost people who worked for tlement, will not be adequately funded able to take care of our fellow citizens him for more than 20 years because either, but large portions of part of when they reach those difficult times they got a job that paid less than he that funding are going to come from every one of us will at one point or an- pays them but they can get health in- the Medicare trust fund. other. surance coverage. So here is an em- The problem here is that the Medi- There are stories, and I know my col- ployee who leaves a job in order to get care trust fund is insolvent. It has $30 leagues have them as well. a job where he can have health insur- trillion of outstanding exposure to the A young woman in Connecticut, ance. Medicare trust fund, which we don’t Maria, diagnosed with non-Hodgkins Again, small business owners who go know how we are going to pay for as lymphoma, asked her insurance com- through this are all across our country. seniors retire over the next 20, 30, 40 pany to cover her treatments. The in- My simple point is this: Anyone who years. Thus, there will be a reduction surance company found out that Maria suggests this bill is the end-all obvi- in the benefits to Medicare, a reduction had once gone to a doctor for what she ously hasn’t been through this process to Medicare recipients, a reduction in thought was a pinched nerve. Even over the last several years. There will the Medicare trust fund to the tune of though no tests had been done for can- be a lot more work that needs to be $1⁄2 trillion in the first 10 years, $1 tril- cer, they denied her claim based on a done in the years to come. But we need lion when it is fully implemented, and preexisting condition. How many have to do what no other Congress has done $2.5 trillion over the next 20 years. heard these stories? She passed away, before: We need to start. That is why I by the way, from that illness. feel so passionately about getting this That type of reduction shouldn’t go A young man named Frank disclosed bill passed and moving it forward. I ask to create new Federal programs. If it is on his insurance application that he my colleagues to join us. going to be done at all, it should go to sometimes got headaches. Some I yield the floor. making the Medicare trust fund more months after he got his policy, he went The PRESIDING OFFICER. The Sen- solvent. Well, that has been essentially in for a routine eye exam. The doctor ator from Wyoming. the tenure of some of the proposals saw something he didn’t like and sent Mr. ENZI. Mr. President, I yield 5 from the other side of the aisle. We him to a neurologist, who told him minutes to the Senator from New have heard a lot of people on the other that he had multiple sclerosis. The in- Hampshire and 10 minutes to the Sen- side of the aisle say: All right, we are surance company told him he should ator from Texas. not going to cut Medicare. We are not have known his occasional headaches Mr. GREGG. Mr. President, I ask going to cut Medicare. We are just 1 were a sign of MS and took away his unanimous consent that during the going to reduce it by $ ⁄2 trillion, and coverage retroactively. Frank’s doctor next hour which we control we be al- then we are going to create a new pro- wrote them a letter saying there was lowed to enter into colloquies on our gram with it. We are not going to do no way anyone could have known that side of the aisle. this to the seniors. We are not going to an ordinary headache was related to The PRESIDING OFFICER. Without take their money and start a new pro- multiple sclerosis. But the insurance objection, it is so ordered. gram. left Frank out to dry, sticking him Mr. GREGG. Mr. President, we have We have heard that statement in dif- with a $30,000 medical bill he couldn’t certainly heard a lot of talk about ferent levels of machinations from the afford. Frank’s condition got worse. He Medicare over the last few days, and we other side of the aisle quite regularly. had to leave his job and go on public have actually even voted on a few I do, however, for the record, want to assistance. amendments, but they have all had no say—because I have immense respect Kevin Galvin is a small business force of law, and they have just been for him, and he has been totally forth- owner in my State. I have met with statements of purpose. They are called coming on these issues, and very accu- Kevin a number of times, and we have sense of the Senate. Every one of these rate—that the chairman of the Finance talked over the last year or so during sense of the Senate has had as its pur- Committee has not represented that is my Connecticut Prescriptions for pose to try to give political cover to what is happening with the Medicare Change listening tour. Kevin owns a Members on the other side relative to funds. small business, a maintenance com- the issue of the fact that this bill re- He has represented on the floor that pany. He employs seven people, some duces Medicare spending by close to $1⁄2 those Medicare funds that are being re- older, some younger. He can’t afford to trillion in the first 10 years, $1 trillion duced—those reductions in Medicare insure them. He would like to, but he when it is fully implemented over a 10- spending will go to create a new pro- can’t afford it. His younger employees year period, and $2.5 trillion over the gram. But a lot of folks on the other use the emergency room as their reg- first 20 years, and that those reduc- side have said they don’t agree with

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00008 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.009 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12531 that, that is not what they are intend- the public statements that Republican As I mentioned, under the CBO score, ing to do. Some of the sense of the Sen- ideas are welcome, they have been re- the average premium for families in ate have clearly had that implication jected at every stage of the develop- the individual market will go up by in their passage. ment of this 2,074-page bill. There were $2,100, not go down by $2,500—another So what does that amendment do party line votes in the HELP Com- promise made that will not be kept if that I am going to be offering? It mittee and the Finance Committee and this bill is passed into law. shoots real bullets. No longer is it a po- virtually every Republican idea was re- Then the President talked about defi- litical statement, a sense of the Sen- jected. The President is coming to cits. There has been a lot about this ate, a thought process, a virtual event rally our Democratic friends to basi- bill being so-called deficit neutral. If saying you want to protect the Medi- cally do it in a ‘‘my way or the high- you cut enough benefits for seniors and care trust funds. This amendment is way’’ sort of way. They are going to raise taxes enough on everybody, you real. It protects the Medicare trust own it 1,000 percent. can produce a deficit-neutral bill. This fund. It is real hard language, which I think it is perhaps very timely to bill will spend $2.5 trillion over the says that if you vote for this amend- recall some of the President’s promises next 10 years with full implementation. ment, you are voting not to move because, frankly, if the President fol- President Obama’s chief actuary at the Medicare trust fund dollars out of the lows the promises he made to the Center for Medicare and Medicaid Serv- Medicare trust fund, away from Medi- American people, he will not be able to ices called the ability to sign a bill care recipients, over to start a new pro- sign this bill or anything similar to it. such as this, without raising the def- gram; that any new program started in First of all, talking about trans- icit, ‘‘unrealistic and doubtful.’’ David this bill must be paid for by something parency, he said we are going to have Broder, the dean of the Washington other than Medicare. negotiations around a big table on C– press corps, said: The PRESIDING OFFICER. The time SPAN so people can see who is making While the CBO said that both the House- of the Senator has expired. arguments on behalf of their constitu- passed bill and the one Reid has drafted meet Mr. GREGG. Mr. President, I ask ents and who is making arguments on Obama’s test for being budget neutral, every unanimous consent for an additional behalf of the drug companies or the in- expert I have talked to says that the public minute. surance companies. has it right. These bills, as they stand, are The PRESIDING OFFICER. Without The reality is, this bill was merged budget busters. objection, it is so ordered. between the Finance bill and the HELP Then there is the promise of choice. Mr. GREGG. So this shoots with real Committee bill—merged behind closed The President said the American peo- bullets. It says, essentially, if you vote doors, with only three Senators present ple ought to have choice when it comes for this amendment, you are voting to and presumably their staffs. to health care, their choice of their keep the Medicare dollars with Medi- Another promise the President made doctors and health plans. The fact is, care, not to take those dollars that are was this: this bill would consign 60 million being cut out of senior citizen pro- The plan I am announcing tonight— Americans to a health care ‘‘gulag’’ grams and move them to create a This was during the joint session of called Medicaid. I say that because, al- brandnew set of programs at the Fed- Congress, I believe, we attended. though Medicaid provides what some people would say is coverage, it cer- eral level. —will slow the growth of health care costs This will be the vote that I believe for our families, our businesses, and our gov- tainly doesn’t provide access. In the determines whether we raid the Medi- ernment. metroplex of Texas, the Dallas-Fort care funds for the purpose of creating a This is a pledge the President made Worth area, 38 percent of doctors will new Federal program or whether we to the American people. That was his not see a new Medicaid patient because maintain the integrity of the Medicare stated goal for this bill. We see some- of Medicaid’s low rates. system. This is a serious amendment, thing very different in this 2,074-page Then there is this claim that it will and it is a real amendment. There is no bill, a different reality. We see that not raise taxes. Well, the Joint Com- sense of the Senate about this. This is premiums for those in the individual mittee on Taxation indicates that 38 enforceable language. Anybody voting market—families—will be increased by percent of the people earning less than against this amendment is formally 10 percent by 2016, according to the $200,000 a year will see a tax increase voting, unquestionably and unequivo- CBO. You don’t have to take my word under this bill. In other words, this is 1 cally, to take $ ⁄2 trillion of Medicare for it. It is not some insurance com- another promise the President made funds, in the first 10 years, and move pany talking. This is the Congressional that will be violated if this bill is them over to fund a new program; to Budget Office. Businesses that fail to passed into law because taxes will go take $1 trillion from the Medicare comply with the job-killing mandates up for 38 percent of the people. As a funds, when fully implemented, and in the bill will face additional taxes of matter of fact, out of that 38 percent, move them to fund a new program; to $28 billion—yes, during a recession 24 percent of them will experience a take $2.5 trillion, over the next 20 when unemployment is at 10 percent. tax increase, even after taking into ac- years, of Medicare benefits that should That is according to the CBO. They count the premium tax credit that is be going to seniors—because they are also say taxpayers will see Federal out- being paid under this bill. Another Medicare funds and should be bene- lays for health care coverage increase promise made, another promise that fiting the solvency of the Medicare by $160 billion over 10 years. cannot be kept if this bill becomes law. funds—and moves them to create new This is from the dean of Harvard Then there is this one. The President programs. Anybody who votes against Medical School. He said: said: So don’t pay attention to those scary sto- this amendment is accomplishing that; In discussions with dozens of health care ries about how your benefits will be cut. they are cutting Medicare for the pur- leaders and economists, I find near una- That will never happen on my watch. I will pose of creating a new program. If you nimity of opinion that, whatever its shape, protect Medicare. vote for the amendment, to the extent the final legislation that will emerge from Medicare savings occur, they would not Congress will markedly accelerate national Dr. Elmendorf, the head of the CBO, be used to fund new programs. It is a health care spending. said Medicare’s managed care plans real, enforceable amendment. So much for bending the proverbial would see reduced benefits—I am sorry, The PRESIDING OFFICER (Mr. cost curve. Then there is this prom- that is according to CBS News. The KYL). The Senator from Texas is recog- ise—another solemn promise. The chief actuary said: nized. President said: Providers might end their participation in Mr. CORNYN. Mr. President, the I have made a solemn pledge that I will the program, possibly jeopardizing access to President of the United States is re- sign a universal health care bill into law by care for beneficiaries. portedly traveling to Capitol Hill to the end of my first term as President that Dr. Elmendorf said you would see ad- meet with Senate Democrats in a few will cover every American— ditional benefits that seniors get under moments. Unfortunately, Republicans This bill obviously does not. Medicare Advantage cut by about half. are not invited, which follows an estab- —and cut the cost of a typical family’s pre- Another promise, another promise bro- lished pattern, where notwithstanding mium by up to $2,500 a year. ken if this bill becomes law.

VerDate Nov 24 2008 01:08 Dec 07, 2009 Jkt 089060 PO 00000 Frm 00009 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.011 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12532 CONGRESSIONAL RECORD — SENATE December 6, 2009 There is this, which pertains to the into the discussions and negotiations ting Medicare for our seniors. ‘‘Demo- Ensign amendment pending on the off the floor in the office of the major- crats decided to respond . . . with a floor. The President said: ity leader. meaningless amendment.’’ The New I want to work with the American Medical There seems to have been some York Times editorial today, ‘‘a mean- Association so we can scale back the exces- blowback on that, and somebody said ingless amendment.’’ We knew it was sive defensive medicine that reinforces our maybe that wasn’t appropriate to talk meaningless, and we know they are current system, and shift to a system where about deals that were cut. This morn- cutting Medicare from the seniors who we are providing better care simply—rather ing, on the front page of the Wash- depend on it—Medicare Advantage than simply more treatment. So this is going ington Post, it says: from hospitals, from nursing homes, to be a priority for me. Deals Cut with Health Groups May Be at from hospice, from home health care. If this is a priority for the President Peril. This is robbing the people who need of the United States, it is apparently Perhaps the Washington Post is im- this care, deserve the care. not a priority of those who have au- pugning the reputation of someone or If you said maybe we should take a thored this bill because all that is con- staffers or others. They have certainly look at Medicare, then do it, Mr. Presi- tained in the bill is a nonbinding sense impugned mine from time to time. But dent, to save Medicare, to save Medi- of the Senate. We have heard that med- the fact is, this is a news story. care that we know is going broke. ical liability reform laws, such as those Again, I go back, very briefly, be- I see the Senator from New Hamp- that have been passed and implemented cause we have a lot to talk about, my shire is here. He has been an expert on in Texas—if passed nationwide, this colleagues and I. The fact is, there this topic of the budget and ways we bill could bend the cost curve by $54 have been deals cut, just like is re- can save Medicare. I say to my friend billion over 10 years. Yet all we get is ported in the Washington Post this from New Hampshire, is this not true a watered-down sense of the Senate morning, as has been reported all over that Democrats have proposed a mean- that has no binding effect at all. America about the deals cut with var- ingless amendment but they are cut- If the President was sincere about ious interest groups that don’t nec- ting the guts out of the Medicare Pro- making those promises to the Amer- essarily represent the people they gram on which the seniors of this coun- ican people, then this Congress ought claim to represent. I know the Amer- try are dependent? to be sincere about helping him keep ican Medical Association does not rep- Mr. GREGG. As usual, the Senator that promise. The fact is, time after resent the majority of physicians and time, this bill breaks the promises that from Wyoming is absolutely true. The caregivers. In the State of Arizona, I sense-of-the-Senate amendments we President Obama made to the Amer- know too many of them. I also know ican people. It is not too late to change have had from the other side of the they have a very large lobbying pres- aisle on Medicare are political amend- that. I hope that, today, when he meets ence in our Nation’s Capitol, as do the with Senate Democrats behind closed ments meant to make a political state- other interested groups that have ‘‘cut ment, but they have no substantive ef- doors, to the exclusion of Republicans, deals’’ that may be at peril now, ac- there will be some discussion of how fect. That is why I brought forward my cording to the Washington Post. amendment which hopefully will be can we help you keep those promises to With that, I will mention, again, that the American people because this bill voted on in the next couple of days or the doctor is in. Would the doctor care so which says specifically what the does not. to give us some enlightened informa- The PRESIDING OFFICER. The Sen- Senator from Wyoming has asked for. tion, before we give our various opin- To the extent there are reductions in ator from Wyoming is recognized. ions on this issue? Mr. ENZI. Mr. President, I yield such Medicare spending—and there may Mr. BARRASSO. I agree with the need to be some—that those reductions time as they need to several Senators Senator from Arizona. I looked at an- for the purpose of a colloquy. are reserved for the seniors for the ben- other one of his favorite newspapers, efit of their program and to make Mr. MCCAIN. Mr. President, I suggest the New York Times, today because the absence of a quorum. Medicare more solvent and no new pro- we— grams be created on the backs of sen- The PRESIDING OFFICER. The Mr. MCCAIN. My absolute favorite. iors by cutting Medicare and moving clerk will call the roll. Mr. BARRASSO. On this floor have the money from Medicare over to new The assistant legislative clerk pro- said the Democratic proposal is cutting programs. ceeded to call the roll. the Medicare the seniors of this coun- Mr. GREGG. Mr. President, I ask try depend on for their health care. We My amendment is not a sense of the unanimous consent that the order for pointed out that they have taken $120 Senate. My amendment is a real the quorum call be rescinded. billion away from Medicare Advantage. amendment. It is the one chance people The PRESIDING OFFICER. Without Mr. President, 11 million seniors use are going to have to vote for protecting objection, it is so ordered. Medicare Advantage. One out of four Medicare and not creating new pro- The Senator from Arizona is recog- seniors is on Medicare. The reason they grams with Medicare money. And that nized. signed up for Medicare Advantage is is what it is going to be. Mr. MCCAIN. Mr. President, I am because there is an advantage for the Mr. MCCAIN. To be clear, the amend- pleased to see my friends on the floor seniors—preventive care, coordinated ment of the Senator from New Hamp- again today—very intelligent people, care, things we know are important. shire is exactly the same as the White such as the Senator from New Hamp- Yesterday on this floor, the Demo- House sense-of-the-Senate amendment shire and my friend, Senator ENZI, who crats voted to cut away from home and the Bennet amendment, only it has is an expert on this issue, and the rest health care. This is a lifeline for home- the actual force of law. of us who know that a fight not joined bound patients. It helps keep them out Mr. GREGG. Absolutely. It is not ex- is a fight not enjoyed. I look forward to of the hospital and out of the nursing actly the same in the sense that it is another spirited discussion with my homes. Yet in spite of all the letters we real. Theirs is not real. Mine is real. It colleagues. have read from patients, as well as says you are going to keep the Medi- Maybe if I could, to start with, I will home health care communities in all of care money to benefit Medicare, and take up a point about the debate and our States, they have cut back. you are not going to use the Medicare discussion we had yesterday on the Yet the majority whip came to the money for the purpose of creating new floor with the Senator from Montana, floor at the opening of the session programs which have nothing to do the chairman of the committee, where today and said: Oh, we have handled all with Medicare for people who are not he asked me why did I think that cer- of that. He said: We have handled all of on Medicare. tain groups supported this legislation that with a wonderful resolution of the Mr. ENSIGN. I say to the Senator pending before the Senate. I said I Senate by Senator MICHAEL BENNET. from Arizona, another place in this bill didn’t know what kinds of deals had The New York Times today, about where they have a sense of the Senate been cut. I referred to the deal made that resolution, said: that is not real is medical liability re- with PhRMA and others. I didn’t know Democrats decided to respond to the form. Back in September, when The exactly why because I am not taken Republicans saying: Hey, you are cut- President addressed the Nation, he said

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00010 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.011 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12533 defensive medicine caused by the med- would be reform that would help health are if lawyer fees are capped or if dam- ical liability crisis may be contrib- care. ages are capped. Lawyer fees capped, uting to unnecessary costs; there are Since medical malpractice and tort damages capped—that is off the table. unnecessary tests. reform has been passed in Texas, over So I am thinking to myself—maybe the Let me show you the amount of 7,000 new physicians have flooded into Senator from Nevada could tell me, if money they are going to save with our State—a 7,000 increase. The reason? you don’t curb lawyer fees and you their medical liability reform sense of Tort reform. Since passed just 5, 6 don’t curb the caps, what meaningful the Senate in this bill. That is it. That years ago, physicians in Texas have reform do you think we could get in is how much their sense of the Senate saved $574 million in liability pre- medical malpractice? on medical liability reform is going to miums, and their liability rates have Mr. ENSIGN. No question, those are save—zero. been cut an average of 27.6 percent, al- the two most important types of re- In contrast, the Medical liability re- most a 30-percent cut in premiums. forms for medical liability laws that form several of us have offered is real What has this done? Today in rural have been placed in the States—my medical liability reform. Several of us counties, the number of obstetricians State of Nevada, Texas, California and have been working on that. The sav- has increased by 27 percent. Twelve other States. The caps are what have ings from a real medical liability re- counties did not have one obstetrician shown a reduction in the medical li- form: $100 billion. before this was passed, and now they ability premiums for doctors. They are We at least have said we have an do; 24 counties had no emergency room what have shown a reduction in the amendment we are going to vote on physicians, and now they do; and 58 cost of our health care system. later today. Let’s at least do some- counties, in addition to that, have Mr. President, let me quote because thing to get the ball rolling on medical added one more. the other side is talking about these liability reform with the amendment Rural counties are the ones that have contingency fees; that they need these we are offering today. The President suffered the most, and every State in contingency fees to take on these law- suggested getting the ball rolling on this Union has rural counties—every suits, especially for those who are very medical liability reform. one. They are the ones who are hurt poor. They say it is the only way for Back in 1995, Senator Ted Kennedy the most. Yet the Medicare cuts will this to happen. offered an amendment that would at take $135 billion out of rural hospitals’ I quote: least limit attorney’s fees. These are ability to serve Medicare patients. Since 1960, the effective hourly rates of contingencies fees. Twenty-one Demo- There is no medical malpractice reform tort lawyers— crats who were here back in 1995 who unless, of course, in a huge bipartisan These are the personal injury attor- are here now voted for that limit. They effort and gesture we can adopt the En- neys— are: AKAKA, BAUCUS, BINGAMAN, BOXER, sign amendment which we are offering have increased 1,000 percent to 1,400 percent BYRD, CONRAD, DODD, DORGAN, FEIN- to try to make this a bipartisan bill (in inflation-adjusted dollars). GOLD, FEINSTEIN, HARKIN, INOUYE, that can work. While the overall risk of nonrecovery has KERRY, KOHL, LAUTENBERG, LEAHY, We have seen from Senator ENSIGN’s remained essentially constant though it has LEVIN, MIKULSKI, MURRAY, REID, and charts that Democrats have supported decreased materially for such high end tort SPECTER. All 21 of these Senators voted limits on lawyer fees so that we would categories as products liability and medical for caps on attorney’s fees. That would be able to cut back on the frivolous malpractice. at least do something. That would help lawsuits that have been hampering our The lawyers, basically, have created get the ball rolling on medical liability ability to cut the costs in Medicare. all these laws that make it easier for reform. I appreciate so much that Senator them to sue and their contingency But the same thing they have done ENSIGN is offering this amendment be- rates have gone up 1,000 to 1,400 percent with Medicare, saying they are going cause Texas can show us that this will since 1960, and yet there is no more in- to keep Medicare savings in Medicare, work. It would be meaningful reform. creased risk and even reduced risk of they have not done. It is not real. Sen- It would cut the costs and make health nonrecovery in medical malpractice ator GREGG has a real amendment to care more available and, most impor- cases. It is easier to sue nowadays. fix that. I have a real amendment to fix tant, it will give patients the oppor- This comes down to, are you on the pa- the medical liability reform that hope- tunity to have doctors in their rural tients’ side or the trial lawyers’ side? fully will be voted on later as well. But communities who will not practice Which side are you on? We are on the at least let’s go for a little bit of com- today because their liability premiums side of the patients; the other side promise right now. are so high they cannot afford to stay seems to be on the side of the trial bar. Mrs. HUTCHISON. Will the Senator in medicine and give this care to those Mr. MCCAIN. The Senator from Ala- from Nevada yield? rural patients. That is what we need. bama. Mr. ENSIGN. I will be happy to yield. Mr. MCCAIN. May I say in the im- Mr. SESSIONS. I thank the Senator Mrs. HUTCHISON. Talk about liabil- mortal words of Howard Dean, the from Arizona for driving home this ity, I have real statistics. I hear the former chairman of the Democratic point. The reason that malpractice liti- other side say: Oh, we are going to National Committee—he put it simply: gation reform is not in the bill is sim- lower the cost; that is what health care The reason why tort reform is not in the ple, plain, and known to every Member reform is about, lowering the cost of bill— of this body because it is opposed by health care so more people will have Talking about this bill— the plaintiff trial lawyers who are big access to affordable options. Yet the The reason why tort reform is not in the supporters of Democratic Members of main one that is clearly available is bill is because the people who wrote it did the body and the President. That is medical malpractice reform, tort re- not want to take on the trial lawyers in ad- true. form. dition to everybody else they were taking Let me ask Dr. BARRASSO, can the I know the Senator from Nevada has on, and that is the plain and simple truth. Senator think of any other thing that an amendment, and I am a cosponsor. Now, that’s the truth. we could do in reforming health care Let me give some statistics about how I totally agree with Howard Dean. I that could save $100 billion and not di- we could save money. could not agree with him more. minish the quality of care in America? Mr. MCCAIN. May I ask the Senator Mrs. HUTCHISON. If the Senator will Is there anything else? How do fellow from Texas, is it not true that it is the yield, in addition to that, the House doctors feel about that? State of Texas that is the demonstra- said: We have medical malpractice re- Mr. BARRASSO. When I talk to tion project for medical malpractice form. They put it in their bill. You other doctors, they tell me, across the reform? know what it says? There will be a board they order a number of tests, ex- Mrs. HUTCHISON. Exactly. And let State grant program and States can pensive tests—call it defensive medi- me tell you what it has done in Texas apply if they can show that they have cine—tests that do not necessarily help and something we could do, and I think made a meaningful effort at curbing a patient get better, get well, but just we would have bipartisan, 100 percent frivolous lawsuits. But the only two to make sure they get covered in case support in this body because that reasons a State would not be eligible they are sued. It is not unusual, when

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00011 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.013 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12534 CONGRESSIONAL RECORD — SENATE December 6, 2009 you look at the numbers, that we are so. The unions don’t allow them to cap today, but we are here and ready to sit talking $100 billion a year in tests that the exclusion, which many of us have down with the President and ready to are done that do not necessarily help talked about. The unions keep them discuss with the American people this somebody get better, but they are from doing appropriate health care re- issue. doing it because of the legal atmos- form, and so instead, what happens, in You know, it was said at the begin- phere in this country. order to make this work? Again, they ning of the debate, if they wanted to Here we are on the Senate floor on a are so twisted up. Remember that come up with a bill that would pass Sunday afternoon. The President is Peter Orszag, the major guru within with 80 votes, the way to do that is not less than 100 yards away, a former this administration regarding health to craft a bill that no Republican can Member of this body. He ought to be care, has said the thing that will bend support and end up in the position they involving all Senators. He is meeting the cost curve down would be these ex- are in now, trying to get every single behind closed doors, possibly cutting clusions. I am so glad Senator GREGG, Democrat in line so they can pass this deals, trying to come to arrangements, who has the integrity and the long- bill, even though they know the Amer- twisting arms, asking people to march, standing knowledge to deal with this, ican people are overwhelmingly op- follow his marching orders right off a is offering an amendment. posed to it. All the surveys indicate the cliff that I think is going to be coming Yesterday I was challenged on this American people do not want us to pass for health care in America. I think he by Senators on the other side of the this bill. They would like for us to ought to be involving all Americans. aisle, but there is no doubt this bill stop, start over, and get it right, with We are talking to the Americans in throws seniors under the bus. We have some of the suggestions that have been this country. We are not hiding behind an insolvent program that money is made here on the floor today and other closed doors. People who aren’t part of being taken from to create a whole new days during this debate. those discussions are completely cut entitlement it is leveraging. If that is Mr. MCCAIN. And we could do that, out. not throwing seniors under the bus, I perhaps in the most effective fashion, I know my colleague from Tennessee don’t know what is. So we have a pro- if we sat down with the President and has been outstanding and outspoken on gram that is throwing seniors under made some of the very points he made these very issues, but we are here, and the bus because the unions cannot be in his State of the Union Message. we want to visit with people because offended, the trial lawyers cannot be I want to turn to the Senator from we do have solutions that work; that offended, so many other groups—AARP South Dakota, but I want to mention will not increase the cost of care, cannot be offended—and then we also something first on this issue of tort re- which is what we are seeing now; that lock 15 of the 31 million Americans who form I have never quite gotten over. are not going to cut Medicare, which is are receiving health care into a pro- One of the most famous cases of the what the Democrats are proposing; gram none of us would be a part of— 1970s, and I think it spilled over into that are not going to increase taxes, Medicaid. And they do that because of the 1980s, was agent orange, the defo- which the Democrats are proposing; their unwillingness to address the free liant that was used during the Vietnam and they are not going to drive up the market issues that would make health war and which caused so many physical premiums. care work in this country: medical problems for our Vietnam veterans who The whole idea behind this was to get malpractice issues, addressing defen- were exposed to it. It was a big class the costs under control. Senator EN- sive medicine, capping exclusions, and action suit the trial lawyers won. The SIGN’s amendment does that by taking those kinds of things we Republicans trial lawyers got paid off first, and a look at the lawsuit abuse that we have put forth from day one. Vietnam veterans died before the look at in this country. But I want to So I think the Senator from Arizona money was distributed to them. I will turn to my colleague from Tennessee, is doing an outstanding job pointing never get over that. who I know has some more points he out the conflicts of interest that exist Mr. THUNE. I think the reason we wants to make. in this bill. We have a group on the are here today is that the Ensign and Mr. CORKER. I know all of us benefit other side of the aisle that won’t ad- Gregg amendments strike at the very from the Senator’s background as a dress health care in the appropriate crux and the very core and the very physician and knowledge in the indus- way, and I believe are in another room heart of what this is all about. The try. I also thank the Senator from Ari- twisted up in knots with themselves Democratic majority was unwilling to zona for spending a lifetime focusing trying to figure out a way to get out of take on the trial lawyers, unwilling to on how special interests affect this this box they have put themselves into, do things that actually bend the cost body. and a President who is basically giving curve down, such as capping contin- I was thinking about this meeting them a pep talk to keep them from get- gency fees, and so now we are faced taking place here in the Capitol not far ting out of the box. with voting on the Ensign amendment, from us from 2 to 3 p.m. with the Presi- I thank the Senator so much. which would do that, but we are also dent and 60 of our colleagues on the Mr. MCCAIN. Our Republican leader voting on the Gregg amendment be- left, and I have this image of them is here on the floor of the Senate, and cause they weren’t willing to put ac- being twisted up like pretzels because he can speak for himself, but I am sure tual measures in this bill that would of the fact there are so many interest he would appreciate the opportunity if bend the cost curve down. What they groups they have to sort of kowtow to. the President would come and sit down have had to resort to is cutting Medi- I have this image of a bunch of them up and meet with us. I think we are all care to pay for it. A $2.5 trillion expan- in a room with a yoga instructor, kind ready to have a meeting with him. Per- sion of the Federal Government has to of loosening up, because they are so haps we would be able to give our input be financed somehow, because there twisted in knots trying to basically and recommendations as to what we aren’t any real cost-saving measures in undo all the pledges they have made to need to do to get this bill unstuck. here. so many groups. That was, as I recall, the campaign. I point out to my colleagues that in I think about, for instance, Senator And I am getting tired of going down spite of all that, this is where we are. ENSIGN’s amendment to deal with med- memory lane here, but that was going The Congressional Budget Office says ical malpractice, but, no, the trial law- to be the ‘‘change.’’ That was going to that even with the all of the Medicare yers keep them from doing that. I be the change in Washington. We are cuts and all the tax increases that are think about the kinds of things Sen- going to change the climate. We are all in here, we actually still increase ator MCCAIN ran on during his Presi- going to sit down together, Repub- spending in this country on health dential election campaign, and others licans and Democrats. Well, I think on care. The cost curve goes up. The blue of us have looked at, as has Senator this Sunday afternoon, we are all avail- line on this chart represents the exist- GREGG, so that people in this country able, are we not, I would ask the Sen- ing cost curve if nothing is done. If we have choice; that we create a market ator from Kentucky? did nothing today, that is what would system that allows people to have Mr. MCCONNELL. I would say to my happen. That is the blue line. The red choice. But they cannot do that be- friend from Arizona, normally we line represents what happens under cause the unions don’t want them to do would be watching the Redskins game this bill. We actually raise the cost

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00012 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.014 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12535 curve even more. Costs for health care I am glad the Senator from Nevada the Gregg amendment is going to be so in this country under this legislation has offered this amendment. I am anx- important. go up $160 billion. ious to see how the other side votes on I know the Senator from Kansas How does that affect the individual the amendment the Senator from New wants to jump in, so we welcome you family? I want to show you exactly Hampshire has offered which would to the conversation. what this means in terms that I think guarantee these Medicare savings Mr. BROWNBACK. I appreciate that. most Americans can understand. This would go back into Medicare and not I also note the Ensign amendment, in- is the example of a family of four who be used to pay for a new government stead of cutting, creates. today is paying $13,000, a little over entitlement program at a cost of $2.5 A Robert Woods study in 2006 said $13,000 for their health insurance. trillion to the American taxpayer. caps on things such as this hold down Under this bill, their life doesn’t get Mr. MCCAIN. I will recognize the awards in cases 20 to 30 percent and in- any better. In the year 2016, they are Senator from Texas, who will be pre- creases the supply of physicians, which going to be paying over $20,000 a year siding next, and wish to add one more is something else we need. in health insurance. So what happens comment. I wish to give a better live example is they have locked in the status quo. Mrs. HUTCHISON. I so appreciate the that we have in my State of Kansas. In And that status quo is year over year opportunity to talk about these dif- the early 1980s, mid-1980s the piston en- increases, double the rate of inflation, ferent areas of cuts and then the in- gine industry of aircraft was just about all because they were unwilling to put crease in spending overall, because ev- dead. It had been sued—the aircraft in- measures in this bill that actually do eryone in America today is concerned dustry, general aviation had been sued control costs. about the spending and the debt and so much they were stopping making If we did something along the lines of the ceiling we are about to reach. piston engine aircraft. Congress, fi- the Ensign amendment, that actually I wanted to bring up one more point nally, because the industry was dead, would get these contingency fees under on hospitals, because this affects every said we are going to put a 17-year stat- control. We all have seen the statistics. State in America. In Texas, 29 percent ute of limitations on it so after 17 The CBO has said that would bend the of our hospitals are in rural areas. The years you cannot sue the manufacturer cost curve down. anymore after that period of time. We have all talked to physicians in cuts in this bill will especially affect hospitals in rural areas. In fact, out of It brought the industry back. They our own States. I talked last week to a are now being made. There is a new physician from my State who, unsolic- the $135 billion in Medicare cuts to hos- pitals, $20 billion is cuts in Medicare plant in Independence, KS. There is an- ited, said that 50 percent of the tests he other one that is making this aircraft does are to avoid being sued. Fifty per- payments for treating low-income sen- because there was a limitation put, a cent of the tests he conducts are due to iors and another $23 billion in Medicaid reasonable limitation on manufac- defensive medicine. That drives the payments to hospitals for treating low- income patients. turing reform. cost of health care up for everybody. If we do this, this will create—this That is why the Ensign amendment is I want to read an excerpt of a letter will help our medical industry, it will so important. I received this week from the Texas Or- hold down costs, it will increase the Unfortunately, why we have to vote ganization of Rural and Community on the Gregg amendment is because Hospitals, which represents 150 rural number of physicians. These sorts of the Gregg amendment forces the Demo- hospitals in the State. They write: changes have worked. There is no rea- crats to put their money where their We also fear the Medicare cuts as proposed son at all not to do this in this bill. Mr. ENSIGN. I thank the Senator mouth is and to see if they mean what could disproportionately hurt rural hos- they say—that they want all these sav- pitals, which are the health care safety net from Kansas for his excellent remarks. ings in Medicare to go into Medicare. for more than 2 million rural Texans. Be- I know the Senator from Florida, the cause of lower financial margins and higher newest Member, one of the newest We all know that is not true. To pay percentage of Medicare patients, rural hos- for a $2.5 trillion expansion of the Fed- Members of the body, would like to pitals will be impacted more than urban hos- join in. eral Government and create an entirely pitals by any reductions in reimbursement. Mr. LEMIEUX. I thank the Senator new entitlement, you have to take the These proposed Medicare cuts could have a cuts from Medicare and put them into devastating effect on many of the hospitals, from Nevada. this new entitlement program. which could lead to curtailing of certain I don’t know that there is a State So we are voting on a couple of services. And, the closure of some of these that is going to be more impacted by amendments today that will ensure Texas hospitals is a real possibility. It has cuts in health care for seniors than my seniors in this country are not going to happened every time previously when Con- State of Florida, with 3 million Florid- be faced with cuts to their benefits— gress imposed so-called large-scale, cost-sav- ians on Medicare, almost 1 million on ing measures. home health care, nursing homes, hos- Medicare Advantage. I think it is pitals, all those that receive cuts in Well, this is the granddaddy of large- worth repeating what these cuts are this bill—and actually try to sub- scale cost cuts—$500 billion, or $1⁄2 tril- going to mean: $137.5 billion from hos- stitute something in there that would lion—taken out of the hide of the hos- pitals that treat seniors. I talked to get costs under control, and would—ac- pitals that are treating low-income pa- the director of a hospital district down cording to the CBO—drive the cost tients and seniors. where I am from, down in south Flor- curve down; would do something about I ask the Senator from Nevada if he ida. He said these cuts will be dev- this year over year double the rate of is experiencing that same thing, and if astating: $120 billion from Medicare inflation that the average American he feels that hospitals all over our Advantage, $14.6 billion from nursing family is seeing. country are going to be hurt by this homes that treat seniors, $42 billion This is what the CBO said would hap- bill? from health care for seniors—from pen to the average American family of Mr. ENSIGN. Mr. President, I thank home health care, and $7.7 billion from four if this bill passes. Today they are the Senator from Texas for her com- hospice care. paying $13,000 a year—a family of ments, and I note that even the Con- Yesterday, our friends on the other four—and in the year 2016, they will be gressional Budget Office has said when side were trying to convince us and the paying $20,000 a year. Tell me, how is you cut, for instance, reimbursement American people that there are not that reform? How can anybody go to an rates, those are going to come out of going to be any cuts to benefits. It is average American family with a somebody’s hide. And basically, the not going to affect health care for sen- straight face and say they are reform- hide it is going to come out of is the iors because they are going to pay less, ing health care when all they are doing seniors. but that will just get rid of the waste is locking in permanently year-over- As the Senator from Tennessee said, and the fraud and the abuse. year increases that are double the rate we are throwing seniors under the bus. Everyone is against waste fraud and of inflation, and in some cases even When you cut $465 billion out of Medi- abuse. We have a measure on this side going up beyond that if you have to care, it is going to come out of services of the aisle that actually, I think, buy your insurance in the individual for seniors—if these cuts are real. And would do something about it. We have market? in this bill they are real. That is why gone through the Reid bill to find all

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00013 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.015 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12536 CONGRESSIONAL RECORD — SENATE December 6, 2009 the provisions. My staff and I have into the Medicare trust fund, which is try 20, 30, 40, 50 cases a year—so for been going through it, line by line, to an insurance program, in part. each case, if the average award is $4.3 find all the provisions that go after As a practical matter, it will take million, I am only going to keep $1.1 waste, fraud, and abuse—and there are scarce resources out of the Medicare million. Is that fair; that the trial law- some, to their credit. But the Congres- trust fund, which should be used to yer should only get $1.1 million for sional Budget Office has said, in their make the Medicare trust fund more every one of these cases? Of course, the report that came out on November 18, solvent, and move them over to expand clients I am recovering the money for the provisions that go toward waste, the Government in another place. don’t get that money. That money goes fraud, and abuse would cut $1.5 billion It will mean that we as a government into my pocket. and create that efficiency. But the cuts have basically used up some of the re- Mr. ENSIGN. Remember, if I would are $464 billion. So if they are going to sources which we might want to use to ask a practicing attorney, they also save $1.5 billion and there is going to make Medicare more solvent because it don’t just get that percentage, they be $464 billion in cuts, where are the has $35 trillion of unfunded liability also get court costs and various other rest of the cuts going to come from? out there, and we will use up those re- research they have to do. It is not that It is, as my friend, the Senator from sources to create a new Federal pro- the person who was injured gets three- Tennessee, said, seniors are going to gram which will not help us address quarters; they actually get less than get thrown under the bus. But you are this outyear insolvency of Medicare. the three-quarters that even this not going to be able to cut $464 billion, It doubles the problem. First, it does amendment would limit them to. only get $1.5 billion in savings, and not not address the Medicare problems in Mr. KYL. Exactly so. Under the cut benefits. So seniors who want to go the future and, second, it creates a amendment of my colleague, at least to the hospital are going to have their brandnew entitlement which will have the plaintiff, on whose behalf the law- benefits cut; seniors who have home to be supported forever by Medicare suit was brought, would get a fair health care, their benefits are going to funds, it appears. amount of recovery, unlike today, get cut and all the way down the line. Mr. ENSIGN. I see the Republican when there are no caps, and we fre- Everyone needs to understand that at whip is on the floor and wants to join quently find the person who was in- its base, this is a bill that hurts sen- in the fun we are having on a Sunday jured gets a very small percentage iors. afternoon. Please join us. after the lawyer gets his chunk, the ex- Perhaps no State is going to be im- (Mrs. HUTCHISON assumed the pert witnesses, other court costs, and pacted more than Florida, where we chair.) so on. have this huge population of seniors. I Mr. KYL. I thank my colleague from Maybe I should not defend my lawyer know my friend from Nevada has a Nevada. I had the opportunity, which friends. Maybe the Senator is right. huge population of seniors in his State. we don’t have very much anymore, to This is a way to attack costs. It is cer- We have the highest per capita number preside for a half hour, watching over a tainly not unfair to the trial lawyers of seniors. We like to say all the rest of dozen of my Republican colleagues en- and actually would benefit the people the seniors in the country are eventu- gaging in a very informative debate for who do deserve to get some recovery in ally going to move to Florida anyway. the American people. these cases where, in fact, they have We are going to have the greatest gen- It occurred to me, as my colleague been injured. eration—we have them there now—we from Nevada was talking about his Mr. ENSIGN. We do have a couple at- are going to have more of them living amendment, which would actually re- torneys on the floor, including the in Florida, and their health care is duce the cost of medicine, would re- ranking member of the Judiciary Com- going to get cut. duce the defensive medicine practiced mittee, and maybe one of the two of This bill cuts from health care for by physicians and, therefore, have a you could also talk about the true vic- seniors, it raises taxes, and it doesn’t tendency to reduce health care costs, tims who actually have had medical decrease the cost of health care for the that he was doing that by actually at- malpractice against them. How long 170 million Americans who have health tacking another problem we have been does it take to get through the court insurance now. For some, it raises it. talking about; that is, these runaway today because of all of these frivolous For me, a new Member to this body, lawsuits or these junk lawsuits that lawsuits that clog the courts? it does not make any sense. But what have been talked about. Mr. SESSIONS. I think the Senator does make sense is what my esteemed As a person who used to practice law, raises a very important point. It seems colleague from New Hampshire has as I was listening to the Senator, it oc- to me that there should be mechanisms done with this amendment. If you are curred to me that maybe I should take created to settle cases much quicker, for health care for seniors and you do the microphone and defend the trial without the huge payouts going to law- not want it to be cut and if you are lawyers. So I wish to make sure I have yer fees and litigation. Don’t forget, true to your word that we have to put the math right. the insurance company that the doctor the savings back into Medicare, then Under the amendment of my col- hires and that is defending the doctor this bill, which says as its purpose ‘‘to league, there would be a cap on the charges too. That is all money going to prevent Medicare from being raided for amount of attorney’s fees these law- increase the cost of health care. new entitlements and to use Medicare yers could get, depending upon how I have with me, today, working for savings to save Medicare’’—I cannot much money they recovered for their me, Dr. Conrad Pierce. On a normal imagine that anyone could vote plaintiff client; is that correct? day in Alabama, he would be my Sun- against that amendment, because if Mr. ENSIGN. That is correct. day school teacher today. Today he is you vote against that amendment, you Mr. KYL. First of all, you would get working. are voting against senior health care. one-third of all the money you col- He just retired. He delivered 7,000 ba- I ask my colleague from New Hamp- lected up to $150,000. That is $50,000. bies. He told me, some years ago, that shire, who has so much experience on Then you would get one-fourth of ev- an average OB’s insurance for a year is these budget issues, if this amendment erything beyond that; is that correct? $60,000. I don’t know whether it is still is not agreed to, what is going to hap- Mr. ENSIGN. My colleague is correct. that way. That was several years ago. pen to the Medicare program? Mr. KYL. Is my colleague aware that Some smaller town physicians may not Mr. GREGG. To begin with, it is the average malpractice award in this deliver more than 60 babies a year. going to be reduced by $460 billion in country today is $4.3 million? Does That is $1,000 per delivery in insurance the first 10 years. In the second 10 that sound about right? premiums. It is driven by this litiga- years, it will be reduced by $1 trillion. Mr. ENSIGN. It depends on the State, tion rush we are having, and the pur- In the full 20-year time, it will be re- but that sounds about right. suit of these big verdicts that some- duced by $3 trillion. All those funds, all Mr. KYL. In fact, over half of all the times occur and make lawyers those reductions, will go to create a awards are over $1 million. As a poor wealthy—and, to be fair, sometimes se- new entitlement for people who are not trial lawyer, for every one of these rious injuries occur and serious mal- seniors and who probably have not paid cases—we are not talking about cases practice occurs. But I absolutely be- into the HI trust fund, not having paid per year and this is per case, you can lieve this country can, consistent with

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00014 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.017 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12537 our heritage of allowing individuals to businesses, which are the engines that Mr. CORKER. I know Senator ENZI sue for wrongs done to them, create a drive the economy of this country—and wants the floor. much better system for medical mal- profoundly. Mr. GRASSLEY. Madam President, practice. One of the steps is the one the We heard the Senator from South Da- there are a number of issues that this Senator has mentioned in his amend- kota show the premiums families are amendment raises. Some are health ment. going to have to pay for insurance are care-related, most are not. Mr. ENSIGN. I appreciate that. going to climb faster if this bill be- First, this amendment amends sec- Maybe we can have Dr. BARRASSO jump comes law than if nothing were passed. tion 162(m) of the Tax Code—a tax law in. I have a good friend who practices Even though the President promised intended to curb excessive executive obstetrics and gynecology in Las that families in this country on aver- compensation. Vegas, and he is a specialist in high- age would see a $2,500-per-year decline Unfortunately, section 162(m) has risk pregnancies. Because of the in premiums, the President’s own num- been a disaster. It has encouraged com- messed up medical liability situation, bers people say: Sorry, it is going to go panies to cook up complex design pack- his insurance company limited the up $2,100. That is a $4,600 shift for every ages so as to avoid the limitations number—the same as Senator SESSIONS family who tries to buy their own under the law. was talking about—limited the number health insurance. That is what we are Actually, excessive executive com- of high-risk deliveries he could partici- seeing in Wyoming. pensation exploded as a direct result of pate in. So if you are one of the unfor- I ask my colleague from Tennessee if section 162(m)—which was enacted tunate ones who got cut off—in other he is seeing the same things at home. back in 1993. Mr. CORKER. Madam President, I words, he had reached his cap of the I have consistently made it clear have just finished my second tour of all number he could actually deliver, and that the outrageous pay practices of 95 counties in our State. In 91 of the 95 you are a woman who has a high-risk many companies must stop. True pay- counties in our State, women do not pregnancy—there may not be one of for-performance must be the corner- have access to the types of medical the specialists around. Now you have stone of any compensation package. services they should have. The reason to deal with just the normal OB who And the boards of directors, compensa- is that this whole issue of malpractice may not have the expertise. tion committees, and shareholders is especially prevalent in the issue of What does that do to not only the must all be partners in practicing good OB. That is the area of babies being practice of obstetrics but, as an ortho- corporate governance. We should look born. Obviously, a physician cannot de- pedic surgeon, I am sure this kind of to reform section 162(m) of the Tax termine if there is going to be a genetic example plays out in many other areas Code, not add to it. And we should look deficiency of some kind or something in medicine? at whether Congress needs to reform else. But trial lawyers are out there Mr. BARRASSO. Standing on the the way corporate governance is prac- waiting to ensure that no matter what Senate floor, looking at so many col- ticed. happens, even if it is by the grace of leagues from States with a lot of rural This amendment adds to section God that something happens that is areas, it is a challenge to have people 162(m). It does not reform it. This not so good, the fact is a trial lawyer is who can provide these excellent serv- amendment does nothing to empower waiting there to take advantage of a ices, who are very well trained, know shareholders to hold the corporation’s physician. So they have just decided to how to do it, how they can provide the leave that particular industry. board accountable. All it does is hurt services in these small communities. We have had a bunch of side-by-side shareholders by taking money out of We have dealt with that in Wheatland, votes here. The American people under- the company and giving it to the gov- WY, and New Castle, WY, where the ex- stand the trickery that takes place. ernment. pense for the malpractice insurance for Fortunately, Senator MCCAIN’s favor- That is right. By limiting a corpora- those physicians was so high that even ite publication, the New York Times, tion’s deduction, shareholders are the though they didn’t deliver that many pointed out what absurdity it was yes- ones who are disadvantaged, not the babies in these small communities, terday that we passed 100 to zip the corporation. they could not afford and the hospital Bennett amendment which everybody My friends on the other side of the could not afford to allow them to con- knows is toothless. aisle forget that seniors are often tinue to deliver any babies. The Today, we have the opportunity to shareholders who rely on dividends and amount of money they would receive actually have a values vote. The Amer- capital gains for income to live on day from delivering babies was not enough ican people can determine the values of in and day out. So actually, my Demo- to cover the insurance. In New Castle, each Senator. Senator ENSIGN has an cratic friends are enacting policies WY, there were three physicians quali- amendment to cap the amount trial that will hurt seniors. All in an effort fied to deliver, but the number of deliv- lawyers are paid. Senator LINCOLN has to show the country that they have it eries was such they ended up with no one to cap the amount that people who in for the big, bad insurance compa- one delivering because they wanted to are actually delivering health insur- nies. take one night and the next and the ance are paid. This is a values vote. We I also find it interesting to hear my next. So you have communities all have a nonprofit in our State that friends say that it is unfair for insur- across our country that are losing pours every bit of its money back into ance companies to get a taxpayer fund- highly qualified medical practi- providing health insurance. Senator ed ‘‘subsidy’’ in the form of a tax de- tioners—whether it is cardiologists, LINCOLN’s amendment would cap the duction. surgeons, trauma surgeons, whether it amount that person is paid. Senator First, all corporations are allowed to is obstetricians, gynecologist. We are ENSIGN would cap the amount a trial deduct compensation as a business ex- seeing this all over our communities. lawyer is paid who is pursuing a physi- pense. Big, small, private, and public The Senator from Tennessee is here. cian and causing them to pay more. corporations get this same tax deduc- There are a lot of small communities This is the first of a real values vote. tion. where they are going to lose those. We Mr. ENSIGN. One clarification: We Are these companies getting a tax are seeing it in the cuts yesterday for don’t cap the total dollar they can be subsidy? If so, why not take the sub- home health. Those people are not paid; we just cap the percentage. So sidy away from them? going to be available to deliver small even though they will cap at $400,000 Now, my friends on the other side community care, lifeline, homebound, what somebody can be paid for an in- may argue that these restrictions are keeping them out of nursing homes, surance company, trial lawyers could just like those Congress passed in keeping them out of hospitals. still, because they can get up to 25 per- T-A-R-P. And the way the legislation There are real consequences of this cent of the verdict—if the verdict is on works, they would be correct. bill, not just with the junk lawsuits— average, as we learned from Senator But, the executive compensation re- that is a big part of it—but also with KYL, $4 million, they can still make $1 strictions in T-A-R-P were conditions the Medicare cuts, also with the in- million on that one case, and they can for receiving taxpayer dollars. My con- creased taxes we are seeing in this bill have however many of those cases they stituents in Iowa would call them bail- and how that is going to affect small want per year. outs.

VerDate Nov 24 2008 01:08 Dec 07, 2009 Jkt 089060 PO 00000 Frm 00015 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.018 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12538 CONGRESSIONAL RECORD — SENATE December 6, 2009 Now my friends may argue that Senator from Nevada, which I have ability reform would reduce health health insurance companies are bene- also cosponsored, that calls for real re- care costs because the practice of de- fiting from their reforms and they form of the medical liability system. fensive medicine adds billions of dol- should pay their ‘‘fair share.’’ They A key component to health care re- lars to the yearly cost of health care. may also say that they are receiving form in our Nation is medical liability Oklahoma physicians pay anywhere the government-subsidized tax credits reform. However, the Democrats are from $20,000 to $90,000 a year, depending for health insurance, which is taxpayer not actually interested in making on their specialty, for malpractice in- dollars. changes to the current system as evi- surance, and their yearly costs have The main reason why the govern- denced by the inclusion in this bill of risen astronomically since 1999 to the ment is subsidizing health insurance ‘‘the sense of the Senate that health point that some specialties, like OB– for low-income individuals is because care reform presents an opportunity to GYNs, have had to change careers or the Reid bill forces people to buy address issues related to medical mal- move to other States where State mal- health insurance. practice and medical liability insur- practice reform is already in place. If you force people to buy insurance, ance.’’ Well that opportunity has come Since 1999, Oklahoma OB–GYNs have you have to make sure it is affordable now, with a vote on this amendment seen their yearly malpractice costs rise for them to buy. This has forced the that will limit the amount of contin- from $15,000 to $63,000. government to spend close to $400 bil- gency fees available to trial lawyers Meaningful malpractice reform must lion on these tax credits, which is one who bring medical liability actions. be a part of any comprehensive health of most expensive parts of the Reid The threat of massive lawsuits and care reform. This is not a partisan bill. And the cost of these tax credits the costs of insuring against them have issue. As my colleagues mentioned yes- are paid with higher taxes, fees, and driven doctors out of the practice of terday, this amendment was actually penalties on the majority of Ameri- medicine, influenced doctors and proposed by Senator Kennedy in 1995, cans. Paid by many of those who earn nurses to avoid certain specialties, and with the support of many current Sen- less than $250,000 a year. in part led to the steady increase of ators on the other side of the aisle. It Data from the Joint Committee on health care premiums. With the threat will be very interesting to see just how Taxation tells us that 38 percent of tax of lawsuits hanging over their heads, serious the Democrats are about health returns making under $200,000 in 2019 doctors are forced to take extra pre- care reform. The bill has a ‘‘sense of will see a tax increase under the Reid cautions when diagnosing and treating the Senate’’ recognizing medical mal- bill. Yet only 8 percent of tax returns patients through the ordering of addi- practice costs are a problem. We will in 2019 will be benefiting from the tax tional tests and procedures. The Jour- see if they think it is important to credit. That doesn’t seem balanced. nal of the American Medical Associa- Finally, this amendment directs the really do anything about it. tion found that 93 percent of doctors revenue generated from it to the Medi- The PRESIDING OFFICER (Mr. admit practicing this type of self-pro- care trust fund. I commend my Demo- BROWNBACK). The Senator from Wyo- tective medicine. cratic friends for crafting policies that ming. A recent study by the Pacific Re- would help shore up Medicare. What is Mr. ENZI. Mr. President, the time for search Institute estimates the cost of interesting is that this bill cuts Medi- the colloquy has, unfortunately, ex- defensive medicine is at least $191 bil- care. To the tune of $400 billion—that pired. The balance of the time goes to lion per year, while other reports put is billion with a B. the Senator from Iowa. I thank every- And the money raised from cutting costs over $200 billion annually. Ac- body for their participation. Medicare is not being directed to help cording to the Congressional Budget The PRESIDING OFFICER. The Sen- shore up Medicare. Rather, the money Office, if Congress adopted only a few ator from Iowa is recognized. is being spent on expanding and cre- of the malpractice reforms we have Mr. GRASSLEY. Mr. President, I rise ating new entitlement programs. The seen various States enact, such as to speak in favor of the amendment of Joint Committee on Taxation scored Texas and Alabama, the deficit would the Senator from New Hampshire. this amendment as raising $651 million decrease by $54 billion over 10 years. Because as I have been saying, the over 10 years—that is million with an At the heart of this issue, beyond the people who wrote the excesses of the M. costs and savings, is the damage the Reid bill appear willfully ignorant of So what we have here is $400 billion current liability system does to the re- what is going on in the rest of the in cuts in Medicare that is being used lationship patients have with their economy outside of health care. for other spending, in exchange for $600 doctors. When physicians are afraid We are a nation facing very chal- million which would be directed Medi- they could be sued, not only do they lenging economic times with industries care trust fund. Doesn’t seem like a run unnecessary tests and procedures, in financial crisis and Federal debt in- fair trade. but the quality of care patients receive creasing to all-time highs. Do my friends on the other side feel is compromised. A 2003 GAO report So we should be considering a bill guilty for using Medicare money for concluded that defensive medicine has that would create jobs and prevent this non-Medicare purposes? And to make also contributed to access issues, espe- country from being burdened with a up for this guilt, they decided to direct cially in rural areas. Physicians tend bigger and more unsustainable Federal non-Medicare-related money to the to move to States and areas with lower budget instead of this health bill. Medicare trust fund? liability rates, and hospitals are able But instead, we are now considering I will close by saying that my Demo- to expand available services. a bill that cuts half a trillion dollars cratic friends will take to the floor and It is estimated that attorneys’ fees from the Medicare Program to fund yet say that anyone who votes against this and administrative costs amount to 54 another unsustainable health care enti- amendment is ‘‘in the pockets of the percent of the compensation paid to tlement program. insurance companies.’’ I will first tell plaintiffs. Less than 15 cents of every You have heard from Members on my friends that they should look in the dollar awarded actually goes towards this side of the aisle about how flawed mirror. Then I will say opposing irra- compensation for the individual. This this approach is and how these drastic tional policies that add complexity to amendment is not about preventing Medicare cuts will threaten beneficiary our tax laws is not protecting insur- compensation to injured individuals; it access to care. ance companies. is about increasing access to doctors Medicare’s chief actuary at the U.S. Let’s get on to reforming our health and lowering costs. In fact, this meas- Department of Health and Human care system, instead of voting on ure allows injured plaintiffs to keep Services has warned Congress in his re- amendments so my Democratic friends more of the reward. The simple truth is port that these cuts could jeopardize can (1) look like they are taking it to that lowering the cost of doing busi- access to health care for beneficiaries. the insurance companies, and so they ness allows doctors to serve more peo- In fact, a number of Members on the can look like (2) they are helping Medi- ple at lower costs. other side of the aisle have made clear care solvency. On November 6, I received a letter that they share our concerns when Mr. INHOFE. Madam President, I from the Oklahoma State Medical As- they joined us to vote in favor of mo- support the amendment offered by the sociation, confirming that medical li- tions to eliminate these cuts.

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00016 Fmt 0637 Sfmt 0634 E:\CR\FM\A06DE6.002 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12539 Most of the Members on the other lars from the Medicare Program to That is why I support the Gregg side of the aisle, however, claim that fund yet another unsustainable health amendment. And I urge my colleagues this bill does no such thing. care entitlement program. to do the same. They claim that Medicare money is By diverting Medicare resources else- Vote to protect Medicare. not being used to start up yet another where, this bill ignores other major Vote to keep Medicare from being unsustainable entitlement program problems in the Medicare Program, used to fund a separate new program. that we clearly can’t afford. like fixing the physician payment flaw Vote to keep Medicare funds from They claim that the Reid bill doesn’t with the sustainable growth rate for- being siphoned off. technically change the law on guaran- mula, or SGR as it is known. Vote to put in place a real guarantee teed benefits for beneficiaries. So the few years of extended life this that Medicare funds won’t be used. They are ignoring the fact that while bill would give to the Medicare hos- Vote to back up those promises with those benefits may be technically guar- pital insurance trust fund is a Pyrrhic real action. anteed, if the cuts put health care pro- victory. I yield the floor. viders out of business, then those guar- Because the drastic and permanent The PRESIDING OFFICER (Mr. antees will be nothing more than use- Medicare cuts in this bill will worsen FRANKEN). The Senator from Wyoming. less words in the Medicare Act. health care access and quality. Mr. ENZI. What is the status of the Guaranteed benefits are not worth And the Reid bill leaves problems time? much without health care providers that have long been vexing Congress The PRESIDING OFFICER. The mi- who can treat patients, provide home like the fatally flawed physician pay- nority has 50 seconds remaining, and health services, run the hospitals and ment formula unsolved. the majority has 16 minutes 48 seconds. hospice agencies. The Reid bill will leave Congress Mr. ENZI. I will reserve the remain- These claims are not good enough to with few options for fixing these prob- der of my time. assure seniors who have paid into the lems. The PRESIDING OFFICER. The Sen- Medicare Program all these years. It is So the Gregg amendment is essential ator from Illinois. not good enough for protecting access for protecting the Medicare Program. Mr. DURBIN. I ask unanimous con- to the health care services and benefits It is essential for making those guaran- sent to be recognized for 5 minutes they were promised. tees real. under the majority time. So the Gregg amendment would back The way the Gregg amendment The PRESIDING OFFICER. Without up those claims with a real enforceable works to enforce those guarantees is objection, it is so ordered. mechanism to ensure that Medicare quite simple. Mr. DURBIN. Mr. President, one of The Gregg amendment would make savings aren’t being used to fund a new the amendments we are about to con- sure that the Medicare Program is not program. sider is offered by the Senator from Ne- used as a piggy bank to spend for other The Gregg amendment is needed to vada. purposes. It would make sure that the protect the Medicare Program. We know medical malpractice is an After all, if you knew that the Medi- Medicare Program is not being raided issue in this country. The Institute of care Program already had $37 trillion to fund this new program as the other Medicine tells us that 98,000 Americans in unfunded obligations, would you be side claims. die each year from medical mal- Under this important amendment, assured without an enforcement mech- practice. Many more are injured. In the the director of the White House Office anism to back up those promises? United States of America each year, of Management and Budget and Medi- No guarantee is worth the paper it is there are about 11,000 medical mal- care’s chief actuary would both be re- written on without an enforcement practice claims paid. quired to add up non-Medicare savings mechanism to back it up. Otherwise, it There is a concern about the impact in the bill and compare that total to is just a meaningless guarantee. It is of medical malpractice on the practice the total of new spending and revenues not real without an enforcement mech- of medicine. That is why President in the bill. Obama and this legislation were look- anism. If non-Medicare savings don’t offset ing together for ways to reduce med- The Gregg amendment provides that all the new costs, then the Treasury ical malpractice, negligence, and er- enforcement mechanism. It makes the Secretary and the HHS Secretary rors. We are looking for ways to reduce guarantee real. would be prohibited from imple- any number of lawsuits that may not Opposition to the Gregg amendment menting the new spending or revenue be necessary. That is a good and posi- will shine a light on the issue. If the provisions in the bill. Gregg amendment is not approved, it By doing so, the Gregg amendment tive thing for us to do. should be clear to everyone watching would ensure that the non-Medicare Unfortunately, the amendment of- that all the guarantees they are mak- savings are paying for the new spend- fered by the Senator from Nevada is ing that Medicare is protected in the ing in this bill. And it would ensure not a good amendment to achieve that Reid bill are, in fact, worthless. As a that Medicare itself is not being used goal because what the Senator from result, I hope that everyone will be to pay for the new spending in the bill. Nevada does is puts together a formula watching carefully how the other side It is that simple. for compensating the lawyers who rep- votes on the Gregg amendment. The amendment therefore would pre- resent the victims of medical mal- Now supporters of the Reid bill trum- vent massive government expansions practice and reduces the amount of pet the fact that their drastic and per- at the expense of Medicare bene- money that is available. I want every manent Medicare cuts extend the life ficiaries. single dollar we can bring to the vic- of the program. As you can see, this amendment has tims of medical malpractice, but the I agree that we can’t ignore the pend- teeth. This amendment is real. fact is, in our country today, most vic- ing insolvency of the Medicare Pro- As opposed to a mere nonbinding tims are not wealthy, and the only way gram. sense of the Senate resolution that the they can bring a lawsuit is if the law- The Medicare hospital insurance other side has offered to pretend to yer says it is a contingency fee. If you, trust fund started going broke last protect Medicare, the Gregg amend- the victim, win, then I will be paid. If year. In 2008, the Medicare Program ment requires action to protect the you lose, I am not paid. It is the only began spending more out of this trust Medicare Program. way many people of modest means can fund than it is taking in. The Gregg amendment is the enforce- get into a courthouse. The Medicare trustees have been ment mechanism for the guarantees The Senator from Nevada wants to warning all of us for years that the the other side says they are making to limit the amount of money that can be trust fund is going broke. They now protect Medicare benefits. paid to the attorneys, limit the oppor- predict that it will go broke right Slashing Medicare payments to start tunity for victims to be represented. If around the corner in 2017. up another new unsustainable govern- his goal is to reduce the money paid to But rather than work to bridge Medi- ment entitlement program is not the lawyers, you would think the amend- care’s $37 trillion in unfunded liabil- way to address a big and unsustainable ment would also reduce the money paid ities, this bill cuts half a trillion dol- budget. to defense lawyers, those insurance

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00017 Fmt 0637 Sfmt 0634 E:\CR\FM\A06DE6.009 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12540 CONGRESSIONAL RECORD — SENATE December 6, 2009 company lawyers who are at the other is very simple. When health insurance termine what the compensation is table in the courtroom. Studies show reform becomes law, health insurance going to be. In these cases, the parties that 50 percent more is paid to them companies will receive millions of new sign a contract where the attorney than paid to the victims’ lawyers. But customers purchasing their product for may agree to work on a case with no the Senator from Nevada does not re- the first time. compensation at all unless the victim strict their payment in any way. In My amendment is intended to en- ultimately receives compensation from other words, if you are going to try to courage those insurance companies to the doctor or hospital responsible for defeat a victim of medical malpractice put the additional premium dollars the injury. This is called a contingency in a courtroom, you can spend an un- they will be bringing in with the vol- fee. In other words, a judge and a jury limited amount of money, according to ume of new customers back toward have to agree that person was injured the Senator from Nevada. However, if lowering their rates and making more and deserves this compensation. The you are going to represent that victim, affordable coverage for consumers, not parties do not do that. This allows all he would limit the amount of money putting it in their own pocketbooks. Americans, not just the wealthy, to that counsel, that attorney can be Where health insurers spent more have their day in court. paid. It will mean fewer victims will than 90 cents of every dollar on patient It should also be noted that if a judge have lawyers, and maybe some of the care in the early 1990s, that number has believes a compensation agreement is lawyers they have will not be the best decreased dramatically to just over 80 unfair to the victim, or if they believe because of the amendment offered by cents for every dollar in 2007, and even it is disproportionate, the judge has the Senator from Nevada. That is bad more so in recent years. the power to reduce the fee. I believe policy. It is not fair to the victims be- According to testimony delivered in this is the same in virtually every cause many of these victims are inno- the Senate Commerce Committee ear- State in this country. States have reg- cent victims. lier this year, this trend has translated ulated the area of attorney compensa- I recall a woman in Chicago who into a difference of several billion dol- tion extensively, striving for reason- went to one of our more famous hos- lars in favor of insurance company ableness. States have done this. pitals for the simple removal of a mole shareholders and executives at the ex- Doesn’t that make the most sense that from her face. She was administered a pense of health care providers and their the States decide? general anesthesia, and during the patients. Let’s not forget that lawyers only are course of the general anesthesia, the I think it is so important we under- compensated if the client’s case is suc- oxygen, which she was receiving, ex- stand what it is. This amendment does cessful and if a jury finds that a wrong ploded, caught fire, and burned off her not dictate what insurance companies was committed and if that jury finds facial features. She went through re- can pay their executives. They have they should be compensated. This is peated reconstructive surgery, scar- the complete ability to pay what they not some kind of windfall. It is the re- ring, disfigurement, pain and suffering. choose. It is not a salary cap. But it sult of an attorney’s very hard work to She was an innocent victim. She did does limit the American taxpayers’ redress a wrong. nothing wrong. She wanted to make subsidization of outrageous pay and, The pending amendment would over- sure her medical bills were paid, her instead, devotes those resources to pro- ride all of these traditional consider- lost wages were paid, there was com- tecting Medicare. ations. It would impose a flat cap on pensation for her pain and suffering. A vote for this amendment is a vote all attorney fees for significant inju- She was not a wealthy person. She in support of strengthening the Medi- ries. But the amendment would not cap went to an attorney, who said: I will care trust fund. A vote against this the attorney fees of those representing take the case, but it is a contingency. amendment is a vote in support of hav- a negligent hospital or doctor. That If you win, I am paid. If you lose, I am ing the IRS write a check of $650 mil- hospital, those doctors—their insur- not paid. lion to the health insurance companies ance companies could pay any amount What the Senator from Nevada does to subsidize the multimillion-dollar of money they wanted, for example, in with his amendment is limit the oppor- salaries they are paying their execu- the case—and there have been cases tunity for innocent victims, just like tives. like this—where the wrong leg was am- her, to go into a courtroom, into our So I urge my colleagues to support putated by mistake or a person was court of justice, and see justice at the this effort on behalf of the American given the wrong medicine and they end end of the day. That is not a just re- taxpayer and our seniors and to vote in up paralyzed. sult. We need to stick with this bill, favor of our amendment. But this amendment says, if that per- which moves us forward, with innova- Mr. BAUCUS. Mr. President, how son who was paralyzed wants to sue, we tive ways to reduce medical errors, re- much time is remaining on our side? are going to cap the amount of com- duce medical malpractice, and find The PRESIDING OFFICER. There is pensation that could be possibly paid ways to resolve the differences between 9 minutes 39 seconds remaining. to their attorney. But for the person medical providers and the patients in Mr. BAUCUS. Mr. President, I yield 9 who wants to escape liability for giving the fairest possible way. That is what minutes 39 seconds to my esteemed the wrong medicine that paralyzed a this bill does. That is what we should friend from Vermont. patient—their insurance companies, do. The PRESIDING OFFICER. The Sen- their hospitals—they can pay all how- The amendment that has been offered ator from Vermont. ever much they want for attorneys. by the Senator from Nevada fails to Mr. LEAHY. Mr. President, I thank They can pay their own counsel 10 reach that goal and is fundamentally the senior Senator from Montana. times what a plaintiff’s attorney might unfair and unjust to victims who are AMENDMENT NO. 2927 get in their effort to prevent a hospital just asking for a day in court and for Mr. President, let me wear my hat as or doctor from being held liable for the compensation which they deserve chairman of the Senate Judiciary Com- that horrible mistake. for their injury. mittee and talk about the amendment Trust me, this gives a defendant Mr. President, I reserve the remain- we are going to vote on to cap attorney every incentive to prolong litigation. der of my time. fees. It is a one-sided amendment. It Why should they settle? Why should The PRESIDING OFFICER. The Sen- does not hurt attorneys. It hurts in- they admit wrongdoing? They have the ator from Montana. jured Americans who seek to recover deep pockets. Yet through this amend- Mr. BAUCUS. Mr. President, I yield 2 damages in our court system. It may ment, a plaintiff would be limited by minutes to the Senator from Arkansas. not be obvious to the nonlawyers lis- the actions of the Senate—made up of The PRESIDING OFFICER. The Sen- tening to this debate that many ordi- 100 people who can afford a lawyer, un- ator from Arkansas. nary Americans who suffer an injury like many of the people who are in- AMENDMENT NO. 2905 through another’s negligence cannot jured? And so are we going to say that Mrs. LINCOLN. Mr. President, I afford to pay for the legal representa- the Senate has capped what a plain- think it is so important we look at the tion they need to go to court. tiff’s lawyer can get? By the way— choice we will be making when we vote Our legal system allows for a plain- wink, wink, nudge, nudge—if you are on this amendment in a few minutes. It tiff and an attorney to negotiate to de- the hospital, the insurance company

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00018 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.022 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12541 for a doctor or somebody who has done have already been injured by making it Kennedy. Twenty-one Members of the a grievous wrong, just keep this thing more difficult for them to gain access current Democratic majority who were rolling long enough because you have to our court system. also Members of the Senate in 1995 who the money and you can just beat it I yield the floor. voted for that amendment. Let’s see down. Mr. BAUCUS. Mr. President, how how that vote comes out today. It is When a patient receives more than much time remains on this side? the right amendment. Let’s be on the $150,000 in medical expenses or compen- The PRESIDING OFFICER. A minute side of the patient instead of the side of satory or other damages, it is because and a half. the personal injury attorneys. the injury is severe and ongoing or be- Mr. BAUCUS. A minute and a half. I The PRESIDING OFFICER. All time cause it resulted in death. Those pa- yield 1 minute to my friend from Cali- has expired. tients are going to have a tougher time fornia. The question is on agreeing to the finding someone to hold the person who The PRESIDING OFFICER. The Sen- Lincoln amendment. harmed them accountable. Adding this ator from California. Mr. BAUCUS. Mr. President, I ask for insult to injury does not further the Mrs. BOXER. Mr. President, I thank the yeas and nays. laudable goals of the pending health the Senator. The PRESIDING OFFICER. Is there a care bill. We should be increasing pa- I have been listening to this debate. sufficient second? tient safety and health, not punishing It has been very interesting. It is very There appears to be. those who have already been injured by clear what this amendment does. It The clerk will call the roll. wrongdoing. hurts the victims who, through no The assistant legislative clerk called I understand that yesterday the jun- fault of their own, get hurt in a med- the roll. ior Senator from Nevada identified sev- ical malpractice case by essentially Mr. DURBIN. I announce that the eral prominent Democrats as having making it very difficult for them to get Senator from West Virginia (Mr. BYRD) supported a similar amendment offered the best attorneys. Some of these cases is necessarily absent. by Senator Kennedy a decade ago in a cry out for the best attorneys. Mr. KYL. The following Senator is Republican-controlled Senate. I am not But let me tell you, I have been in necessarily absent: the Senator from surprised by this tactic, given the dis- Congress since the 1980s. When a House Kentucky (Mr. BUNNING). appointing tenor of the debate. Of Member or a Senator gets into trouble, Further, if present and voting, the course, upon a review of the actual do you know the first person they call? Senator from Kentucky (Mr. BUNNING) vote, anyone would see that several An attorney—the best attorney—and would have voted ‘‘nay.’’ The PRESIDING OFFICER. Are there Senators in this Chamber, including they do not come on this floor and say: any other Senators in the Chamber de- this one, opposed a motion to table Oh, let’s make sure those attorneys do siring to vote? Senator Kennedy’s amendment. That is not earn enough money. They are will- The result was announced—yeas 56, hardly the same as advocating a cap on ing to pay whatever it takes with their nays 42, as follows: fees. campaign accounts. By the way, that is It is also worth noting that in 1995, all legal. [Rollcall Vote No. 365 Leg.] the Senate was considering a draconian But I find it amazing that Senators— YEAS—56 products liability bill, not a health who the first person they call when Akaka Harkin Nelson (FL) care bill. At that time, the then-Repub- they are in trouble through their work Baucus Inouye Pryor Bayh Johnson Reed lican majority was attempting to go is an attorney—would wind up going Begich Kaufman Reid further than any other Congress in his- after victims the way they do. When Bennet Kerry Rockefeller tory to prevent injured Americans they are a victim of a problem, as they Boxer Kirk Sanders Brown Klobuchar from recovering damages from the cor- see it, they get the best attorneys and Schumer Burris Kohl Shaheen they pay the high price. It is just not Cantwell Landrieu porations that hurt them or their chil- Snowe Cardin Lautenberg dren. right. Specter Casey Leahy I am relieved that legislation in 1995 The PRESIDING OFFICER. Thirty Stabenow Dodd Levin never became law. I can see why some seconds remain. Dorgan Lincoln Tester might have wished it had. Maybe they Mrs. BOXER. I hope we will defeat Durbin McCaskill Udall (CO) knew what was going to come because the Ensign amendment. Feingold Menendez Udall (NM) Feinstein Merkley Warner after that, what came to light were The PRESIDING OFFICER. The Sen- Franken Mikulski Webb many recent incidents of harmful prod- ator from Montana. Gillibrand Murray Whitehouse ucts that had been introduced into Mr. BAUCUS. Mr. President, let me, Hagan Nelson (NE) Wyden commerce—many of them toys for lit- in closing, remind Senators that the NAYS—42 tle children—and nothing could have Senate is about to conduct two back- Alexander Cornyn LeMieux been done about it had that bill become to-back votes. The first vote will be on Barrasso Crapo Lieberman law. If that bill had become law, I fear the Lincoln amendment on executive Bennett DeMint Lugar compensation. The second vote will be Bingaman Ensign McCain we would have seen many more deaths Bond Enzi McConnell or serious injuries among children as a on the Ensign amendment on attor- Brownback Graham Murkowski result of faulty products. ney’s fees. Burr Grassley Risch I find it ironic, given the often-pro- Mr. President, I yield back the re- Carper Gregg Roberts Chambliss Hatch Sessions fessed loyalty to the sovereignty of the maining time. Coburn Hutchison Shelby States and the sanctity of private con- The PRESIDING OFFICER. Fifteen Cochran Inhofe Thune tracts, many on the other side of the seconds remains on the minority side. Collins Isakson Vitter aisle now seem to have no concerns The Senator from Nevada is recog- Conrad Johanns Voinovich Corker Kyl Wicker about the vast Federal intrusion into nized. these areas of traditional State control Mr. ENSIGN. Mr. President, the En- NOT VOTING—2 that this and other medical mal- sign amendment is going to come down Bunning Byrd practice reform proposals represent. to a choice: Are you on the side of the The PRESIDING OFFICER. On this Basically they are saying: Oh, we are patients or are you on the side of the vote, the yeas are 56, the nays are 42. all for States rights and sovereignty of trial bar, personal injury attorneys. Under the previous order, requiring 60 the States except when it may cost That is what it comes down to. Per- votes for the adoption of amendment some of the big insurance companies sonal injury attorneys will be able to, No. 2905, the amendment is withdrawn. some money. We are all in favor of the on their contingency fees—the first Mr. REID. Mr. President, I move to sanctity of private contracts—except $150,000 they will be able to collect reconsider the vote, and I move to lay when it may cost some of the big insur- 331⁄3 percent. Anything above that, we that motion on the table. ance companies some money. are going to cap them at collecting 25 The motion to lay on the table was So I am going to oppose the amend- percent. agreed to. ment offered by Senator ENSIGN. It is This was from an amendment that Mr. REID. Mr. President, I have had unfair. It will only hurt Americans who was offered in 1995 by Senator Edward a brief conversation this afternoon

VerDate Nov 24 2008 01:08 Dec 07, 2009 Jkt 089060 PO 00000 Frm 00019 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.024 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12542 CONGRESSIONAL RECORD — SENATE December 6, 2009 with the Republican leader. We origi- AMENDMENT NO. 2927 members I ran into Howard Dean. He nally were not going to offer a side-by- The PRESIDING OFFICER. There is hopes we will pass the bill that is on side to the Gregg amendment. We have now 2 minutes of debate prior to a vote the floor. one more vote. We would like Senators in relation to amendment No. 2927 of- Second, the motion he talks about GREGG and PRYOR to lay down their fered by Senator ENSIGN. and those who voted, including this amendments after that. Because we The Senator from Nevada is recog- Senator, was a procedural motion on a have told everybody we wouldn’t be nized. question of tabling Senator Kennedy’s voting late tonight, we need to com- Mr. ENSIGN. Mr. President, the 2,074- amendment. We thought he should be plete work on these matters in the page health care bill before us has a allowed to have a vote. It was not a morning. So we will debate this tomor- provision on medical liability reform. vote in favor of caps. row. Here are the savings: zero. Lastly, if you look at what he has It is my understanding that tomor- Back in 1995, Senator Edward Ken- done with this amendment, he is say- row there will be a bipartisan amend- nedy offered an amendment on liability ing that the insurance companies and ment on abortion. We can debate the reform to cap attorney’s fees. Twenty- the hospitals or somebody who may Pryor and Gregg thing in the morning, one current Democratic Senators, who have cut the wrong leg off or paralyzed and then we will debate abortion, and were Members at that time, voted for you by giving you the wrong medica- we will be able to dispose of the Gregg that amendment. This chart lists the tion, they can spend all the money and Pryor matters no earlier than 3:15 Members who were in the Senate then. they want to stop you from getting any tomorrow. So we are going to be debat- The Members from the other side of relief. You, however, will be limited ing these two things tomorrow. the aisle have made arguments that and the Federal government will over- I say this off the subject: We have plaintiffs need these contingency fees ride the laws of your State and tell you been grinding things out here for some to be that high. Let me quote an ab- what you can contract for on fees with time on a very partisan basis. I was stract of a study written in the Wash- your attorney. confronted yesterday with an issue. We ington University Law Quarterly: In other words, the people who are here working on a Sunday. We had Since 1960, the effective hourly rates of caused the damage can spend any the President come here to talk to the tort lawyers have increased 1,000 to 1,400 per- amount of money they want to escape caucus. The Republican leader said: I cent (in inflation-adjusted dollars), while the liability from the damage. The poor in- don’t really think that is fair. Why overall risk of nonrecovery has . . . de- dividual who has been damaged would should we be out of session? It is your creased materially for such high-end tort not have an equal chance at rec- caucus. So I said: You keep talking; categories as . . . medical malpractice. ompense. Come on. Is the Senate actu- you can preside. I had no concern about Mr. President, the complete study any untoward action taken. In a situa- ally going to vote for something like that I just quoted an abstract of, is en- that? I would hope not. tion such as that, I had no problem. I titled, Effective Hourly Rates of Con- trust implicitly Senator MCCONNELL Mr. ENSIGN. I ask for the yeas and tingency Fee Lawyers: Competing Data nays. and Senator KYL. and Non-Competitive Fees. I would The PRESIDING OFFICER. Is there a I hope that is kind of a breakthrough urge all of my fellow Members to re- sufficient second? here. We have to start trusting each view that study. There is a sufficient second. other. It is rarely done. I have never Let me also quote from Howard The question is on agreeing to seen that happen before. I think it is Dean, who said: the right thing to do. I am dis- amendment No. 2927. The reason why tort reform is not in the The clerk will call the roll. appointed that there weren’t more bill is because the people—— Democrats listening to what they had The legislative clerk called the roll. The PRESIDING OFFICER. The Sen- to say. From a procedural perspective, Mr. DURBIN. I announce that the ator’s time has expired. I never doubted that everything would Senator from West Virginia (Mr. BYRD) Mr. ENSIGN. Mr. President, I ask go fine. is necessarily absent. We are going to have one more vote. unanimous consent for 30 more sec- Mr. KYL. The following Senator is We will not be in session much longer onds. necessarily absent: the Senator from The PRESIDING OFFICER. Without today. Kentucky (Mr. BUNNING). objection, it is so ordered. The PRESIDING OFFICER. The mi- Further, if present and voting, the Mr. LEAHY. Reserving the right to nority leader is recognized. Senator from Kentucky (Mr. BUNNING) object. If the Senator receives an extra Mr. MCCONNELL. Mr. President, I would have voted ‘‘yea.’’ minute, then we will have an extra thank the majority leader. I did sug- The PRESIDING OFFICER. Are there minute on this side. gest yesterday that, since the Presi- any other Senators in the Chamber de- The PRESIDING OFFICER. Without dent was not meeting with us, we had siring to vote? objection, it is so ordered. nothing constructive to do during that The result was announced—yeas 32, Mr. ENSIGN. Howard Dean said: hour. I suggested that we be allowed to nays 66, as follows: speak. We worked that out in our first The reason why tort reform is not in the [Rollcall Vote No. 366 Leg.] bipartisan moment on this bill, as he bill is because the people who wrote it did indicated. not want to take on the trial lawyers in ad- YEAS—32 With regard to the agenda tomorrow, dition to everybody else they were taking Alexander Grassley McCain on, and that is the plain and simple truth. as the majority leader indicated, we Barrasso Gregg McConnell Now that’s the truth. Bond Hagan Murkowski have the Gregg amendment, the Pryor That is a quote from Howard Dean. Brownback Hutchison Roberts amendment, and the abortion amend- Burr Inhofe Sessions We have a choice. We can be on the ment. We will have an additional Coburn Isakson Snowe Corker Kohl amendment on this side as well. That side of personal injury attorneys or we Thune can be on the side of the patients. I Cornyn Kyl Vitter DeMint Lieberman is up to four. Voinovich think we should be on the side of the Ensign Lincoln Mr. REID. A counter to the abortion Warner amendment or something like that? patients and vote for the Ensign Enzi Lugar Mr. MCCONNELL. No. amendment. NAYS—66 The PRESIDING OFFICER. The Sen- Mr. REID. Just an additional amend- Akaka Carper Franken ment. ator from Vermont. Baucus Casey Gillibrand Mr. MCCONNELL. Yes. Mr. LEAHY. Mr. President, it is hard Bayh Chambliss Graham Mr. REID. Mr. President, I don’t real- to respond to all the inaccuracies in Begich Cochran Harkin Bennet Collins Hatch ly know who is going to offer the the statement of the junior Senator Bennett Conrad Inouye amendment tomorrow for sure, but it from Nevada. Bingaman Crapo Johanns is an issue I want to get out of the way. One, incidentally, he may be inter- Boxer Dodd Johnson I think we all do. So it is OK. It will be ested in knowing, as I was leaving Bur- Brown Dorgan Kaufman Burris Durbin Kerry our slot, no matter who will be the lington, VT, this morning after saying Cantwell Feingold Kirk first person on the amendment. goodbye to a number of our Guard Cardin Feinstein Klobuchar

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00020 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.026 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12543 Landrieu Nelson (NE) Shelby with health care in America are immense. to geographic area, smoking and age and Lautenberg Nelson (FL) Specter These complex problems require solutions would limit age bands to a 3:1 ratio. The age Leahy Pryor Stabenow grounded in fact and sound deliberation. band restriction will shift the cost of the LeMieux Reed Tester Large numbers of uninsured Oklahomans older individual to the younger individual. Levin Reid Udall (CO) McCaskill Risch Udall (NM) generate more than $954 million dollars in Blue Cross estimates that this factor alone Menendez Rockefeller Webb uncompensated medical care each and every will increase the base cost for a healthy 25- Merkley Sanders Whitehouse year in our state alone. This cost is shifted year-old by 44 percent in Oklahoma. This Mikulski Schumer Wicker to those with insurance. Recent estimates higher cost burden on the young will further Murray Shaheen Wyden indicate that this adds an additional $2,911 discourage coverage take-up and drive up NOT VOTING—2 annually to health insurance premiums for costs to the remaining insured’s. an Oklahoma family of four. (4) Employer Penalties: Bunning Byrd As Oklahoma Insurance Commissioner, I The Senate Leadership bill would impose a The PRESIDING OFFICER. On this strongly support efforts to provide our citi- penalty on employers who do not offer cov- vote, the yeas are 32, the nays are 66. zens with high quality health care and af- erage equal to $750 for any employee who fordable health insurance. Many features of purchases coverage through a state ex- Under the previous order requiring 60 change. This penalty is inadequate to induce votes for the adoption of this amend- the Senate Bill attempt to accomplish this, at least in part, when taken together. How- an employer to establish a plan. Most em- ment, the amendment is withdrawn. ever, in the absence of a strong inducement ployers who do not offer coverage have fewer Mr. DURBIN. Mr. President, I move to purchase coverage, the consequences of than 50 employees (only 37 percent of Okla- to reconsider the vote and to lay that adverse selection can cause market disrup- homa small businesses offer coverage com- motion on the table. tion, higher costs and lower than desired pared to 48 percent nationally) and most un- The motion to lay on the table was take-up rates. insured Oklahomans work for small busi- nesses. This nominal penalty creates a po- agreed to. IMPACT TO OKLAHOMA tential incentive for certain small employers The PRESIDING OFFICER. The Sen- (1) Individual Mandate: who currently offer coverage to employees to ator from Oklahoma. The Oklahoma Health Care Authority has drop their plan and simply incur the penalty Mr. COBURN. Mr. President, I am estimated that there are nearly 600,000 unin- at less expense than the cost of a plan—par- going to ask to have printed in the sured working Oklahomans—nearly half be- ticularly once the small employer tax cred- RECORD a letter dated December 1, 2009, tween the ages of 19 and 32. There is no indi- its sunset. from the insurance commissioner of cation that most of those uninsured would (5) State-Based Health Insurance Ex- voluntarily enroll in any health benefit plan. changes: the State of Oklahoma—she happens to Our popular Insure Oklahoma individual The Senate Leadership bill would require be of your party, the majority’s party— plan offers comprehensive, guaranteed issue the formation of state-based exchanges from outlining the significant problems that coverage to individuals earning less than which individual coverage would be solely she sees for our State if this bill be- 200% of federal poverty level for less than $40 available and small group insurance may be comes law. This is not a partisan docu- per month, yet we have only 6,000 covered by purchased. While we support the state-based ment. This is a document that relates that plan and most are over age 30. A exchange concept and are currently in the to what is going to happen to Okla- healthy 25-year-old male in Oklahoma can planning stages for a similar concept here in Oklahoma, the infrastructure costs have homa. purchase a comprehensive individual health insurance policy from a major Oklahoma been estimated in the millions of dollars. In If I might summarize, very shortly: medical insurer for just $1,634 annually. In the absence of a financial grant, current It will increase premium costs and in- Oklahoma, affordability is not the issue for state budget limitations will preclude Okla- crease the number of uninsured people this age cohort. Therefore, we support an in- homa from making the necessary investment in Oklahoma. That is according to our dividual mandate to purchase health insur- to create the exchange. State insurance commissioner, who is ance that includes a strong inducement to (6) Public Health Insurance Option: take up health coverage to avoid the likeli- The Senate Leadership bill would allow for of your party. It will decrease the a federal ‘‘Public Health Insurance Option’’ amount of availability of insurance to hood of adverse selection when only the older and healthier are motivated to enroll. from which states may opt-out. Oklahoma people who do not have insurance The Senate Leadership bill includes a would likely resist participation as long as today. minor penalty for non-enrollment scheduled the private insurance market remains robust The letter states it will not rein in to be phased in over a three year period be- and competitive. Although the bill provides that the federal government would ‘‘nego- the cost. In fact, it will increase costs ginning in 2014. The penalty is $95 the first tiate’’ provider rates, experience with Medi- for everybody else in the State of Okla- year, increasing to $750 in year three. This care and Medicaid suggests that reimburse- penalty is inadequate to induce a large-scale homa. It will drive up costs and in- ment rates for a federal public option would take up of health coverage among Okla- crease the number of uninsured. It will result in low reimbursement rates. increase the costs for the private plans, homa’s uninsured. Even with generous pre- Currently, our medical provider commu- mium credits, the absence of a strong non- negatively impacting medical pro- nity relies on private pay to make up the dif- compliance penalty will not encourage the ference in cost of services over government viders and the health delivery system desired and necessary take-up among the in Oklahoma, and it will encourage reimbursement rates resulting in higher pri- young and healthy to offset the greater risk vate insurance rates—more cost-shift. In ad- fewer businesses in Oklahoma to offer and cost of the older and unhealthier. dition, we have concerns over the potential benefits. (2) Guarantee Issue: for government to assert an unfair advan- That is a fairly strong indictment The Senate Leadership bill would require tage that would adversely affect our insur- from somebody who cares about the insurers to offer individual plans on a guar- ance markets and further stress our health people of Oklahoma and what is going anteed issue basis without pre-existing con- care delivery system. dition limitations. We support guaranteed to happen in health care. (7) Health Insurance Cooperatives (Co-Ops): coverage when accompanied by a mandate to The Senate Leadership bill would provide Mr. President, I ask unanimous con- purchase coverage that is strongly enforced. funding to establish non-profit health insur- sent to have printed in the RECORD this The absence of a meaningful penalty for non- ance ‘‘co-ops,’’ We question the likelihood letter from the State insurance com- enrollment will likely result in those with that this notion will produce a lower cost op- missioner of Oklahoma. chronic or serious health issues purchasing tion while meeting all requirements stipu- There being no objection, the mate- coverage while younger healthier individuals lated in the bill (specifically, benefit and sol- rial was ordered to be printed in the simply choose to pay the nominal penalty. vency requirements). Some of the principles The result will be higher insurance rates due RECORD, as follows: embodied in this idea already exist. For ex- to a higher percentage of insured being high- ample, Oklahoma’s largest health insurer, OKLAHOMA INSURANCE DEPARTMENT, er risk/expense individuals. with nearly 30% of the Oklahoma health in- STATE OF OKLAHOMA, (3) Qualified Health Benefit Plans (QHBP): surance marketplace, is a mutual company Oklahoma City, OK, December 1, 2009. The Senate Leadership bill would establish owned by policyholders for the benefit of pol- Re Senate Leadership Bill Patient Protec- ‘‘Qualified Health Benefit Plans’’ and require icyholders. tion and Affordable Care Act. all individual/family plans to conform to (8) Premium Credits: Senator TOM COBURN, QHBP standards by 2014. While the minimum The Senate Leadership bill would provide Russell Senate Office Building, coverage requirements are suitable for some, ‘‘Premium Credits’’ for individuals with in- Washington, DC. they restrict individual choice and limit the comes up to 400% of FPL. The majority (ap- DEAR SENATOR, I appreciate the oppor- ability of healthy and/or wealthier individ- proximately 65%) of Oklahoma’s uninsured tunity to give you an Oklahoma perspective uals from self-insuring part of their risk. population have incomes less than 250% of on the latest health care reform measure (4) Rating Standards: FPL. Currently, 74% of Oklahoma’s total being considered by the US Senate. As you The Senate Leadership bill would restrict population has incomes of 400% of FPL or are well aware, the challenges associated the use of risk factors in determining rates less.

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00021 Fmt 0637 Sfmt 0634 E:\CR\FM\A06DE6.003 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12544 CONGRESSIONAL RECORD — SENATE December 6, 2009 (9) Medicaid Eligibility Expansion: Mr. GREGG. I will reserve. spending increases or revenue reductions can The Senate Leadership bill would increase The PRESIDING OFFICER. The Sen- occur. eligibility requirements for Medicaid. Re- ator from Arkansas. (2) IN GENERAL.—Notwithstanding any cently, the Oklahoma State Coverage Initia- other provision of this Act, the Secretary of AMENDMENT NO. 2939 TO AMENDMENT NO. 2786 tive (SCI) process reached consensus and rec- the Treasury and the Secretary of Health ommended that Medicaid be extended to Mr. PRYOR. Mr. President, I call up and Human Services are prohibited from im- adults with incomes up to 100% of FPL. The amendment No. 2939. plementing the provisions of, and amend- Senate Leadership bill would expand eligi- The PRESIDING OFFICER. The ments made by, sections 1401, 1402, 2001, and bility to all non-elderly persons with in- clerk will report the amendment. 2101, or any other spending increase or rev- comes up to 133% of FPL. This would in- The legislative clerk read as follows: enue reduction provision in this Act until crease Medicaid rolls by an estimated 285,000 both the Director of the Office of Manage- The Senator from Arkansas [Mr. PRYOR] adults and the state’s annual cost share by proposes an amendment numbered 2939 to ment and Budget (referred to in this section $116 million. This rough estimate is based on amendment No. 2786. as ‘‘OMB’’) and the Chief Actuary of the Cen- current Medicaid experience and does not in- ters for Medicare and Medicaid Services Of- clude working-aged individuals who have not Mr. PRYOR. I ask unanimous con- fice of the Actuary (referred to in this sec- accessed reasonable and timely medical care sent that further reading of the amend- tion as ‘‘ CMS OACT’’) each certify that they due to an inability to pay. Our concern is ment be dispensed with. project that all of the projected Federal that the cost of this expansion for the state The PRESIDING OFFICER. Without spending increases and revenue reductions is severely underestimated. objection, it is so ordered. resulting from this Act will be offset by pro- (10) Long-Term Care: The amendment is as follows: jected savings from this Act. The Senate Leadership bill would provide (3) CALCULATIONS.—For purposes of this (Purpose: To require the Secretary to pro- for a federal, voluntary long-term care insur- section, projected savings shall exclude any vide information regarding enrollee satis- ance plan. This plan appears to directly com- projected savings or other offsets directly re- faction with qualified health plans offered pete with the private insurance market sulting from changes to Medicare and Social through an Exchange through the Internet based on reasons other than need. Security made by this Act. portal) (11) Anti-Trust Exemption: (b) LIMIT ON FUTURE SPENDING.—On Sep- The Senate Leadership bill would leave in On page 134, between lines 10 and 11, insert tember 1 of each year (beginning with 2013), place the anti-trust exemption established the following: the CMS OACT and the OMB shall each issue by the McCarren-Ferguson Act. We support (4) ENROLLEE SATISFACTION SYSTEM.—The an annual report that— such a decision. This exemption has long Secretary shall develop an enrollee satisfac- (1) certifies whether all of the projected provided for a more competitive insurance tion survey system that would evaluate the Federal spending increases and revenue re- marketplace and has facilitated solvency level of enrollee satisfaction with qualified ductions resulting from this Act, starting among carriers. health plans offered through an Exchange, with the next fiscal year and for the fol- (12) Controlling Cost: for each such qualified health plan that had lowing 9 fiscal years, are fully offset by pro- As mentioned in the opening of this letter, more than 500 enrollees in the previous year. jected savings resulting from this Act (as coverage is essential to increasing access to The Exchange shall include enrollee satisfac- calculated under subsection (a)); and affordable health care. However, this bill tion information in the information provided (2) provides detailed estimates of such does very little to address rapidly increasing to individuals and employers through the spending increases, revenue reductions, and health care costs. Data shows that the num- Internet portal established under paragraph savings, year by year, program by program ber one driver in health insurance premium (5) in a manner that allows individuals to and provision by provision. costs are increased medical costs and utiliza- easily compare enrollee satisfaction levels tion. As you know, on average, between $0.80 between comparable plans. Mr. PRYOR. Mr. President, I ask unanimous consent that no further and $0.90 of every premium dollar for a com- Mr. GREGG. Mr. President, I ask prehensive health plan is spent directly on amendments or motions be in order unanimous consent that the amend- benefits to policyholders. today. In Oklahoma, we are studying the issue of ment of the Senator from Arkansas be The PRESIDING OFFICER. Without rising costs as it relates specifically to our set aside so I may call up my amend- objection, it is so ordered. non-profit self-insured state plan. Medical ment. The Senator from North Dakota. costs for the Oklahoma State Employee and The PRESIDING OFFICER. Without Mr. DORGAN. Mr. President, this Education Group Insurance plan have in- objection, it is so ordered. creased an average of 10% annually in recent issue of health care and health care re- AMENDMENT NO. 2942 TO AMENDMENT NO. 2786 years. form has been an issue that has caused Of concern to us are reports from the CBO Mr. GREGG. Mr. President, I call up a great deal of advertising and claims and others that the Senate reform plan will amendment No. 2942. on television from both sides, back and reduce premium costs. In actuality, we be- The PRESIDING OFFICER. The forth. A substantial amount of the ad- lieve premium costs will rise substantially if clerk will report the amendment. vertising we have seen has been totally adverse selection is allowed to occur and if The legislative clerk read as follows: and completely without foundation— the cost of medical care is not addressed. The Senator from New Hampshire [Mr. completely inaccurate. But, nonethe- While the generous premium subsidies con- GREGG], for himself, and Mr. CORKER, Mr. templated by the bill will indeed reduce an less, political dialogue in this country THUNE, Mr. COBURN, Mr. ENSIGN, Mr. individual’s expense in financing their allows one to say whatever one wishes, ISAKSON, Mr. BURR, Mr. ENZI, Mr. ALEX- health care needs (a strategy we agree is nec- so the very aggressive discussion about ANDER, Mr. BARRASSO, Mr. CORNYN, Mr. essary to ensure affordability), health insur- MCCAIN, and Mr. LEMIEUX, proposes an this issue of health care has taken on ance premiums will not be lower. amendment numbered 2942 to Amendment interesting tones—claims by some that Again, I thank you for the opportunity to No. 2786. Congress is working to undermine the provide this perspective and I hope that you Mr. GREGG. I ask unanimous con- Medicare Program. have found it helpful. If you wish to further The fact is, those of us on this side of discuss this matter, please do not hesitate to sent that the reading of the amend- contact me at anytime. ment be dispensed with. the aisle are the ones who created the Sincerely, The PRESIDING OFFICER. Without Medicare Program, at a time when KIM HOLLAND, objection, it is so ordered. most senior citizens had no health in- Commissioner. The amendment is as follows: surance at all. There were no insurance Mr. COBURN. Mr. President, I yield (Purpose: To prevent Medicare from being companies in this country tracking the floor. raided for new entitlements and to use down senior citizens and saying: Do The PRESIDING OFFICER. The Sen- Medicare savings to save Medicare) you mind if we sell you a policy for ator from New Hampshire. At the appropriate place, insert the fol- health care? At a time when people’s Mr. GREGG. Mr. President, I ask lowing: lives were going to need an increasing unanimous consent to call up my SEC. lll. PREVENTING THE IMPLEMENTATION claim on health care benefits, were in- amendment No. 2942. OF NEW ENTITLEMENTS THAT surance companies tracking them down I see the Senator from Arkansas is WOULD RAID MEDICARE. and saying: Can I do business with you? standing. I thought I was supposed to (a) BAN ON NEW SPENDING TAKING EF- Of course they weren’t. Over half the FECT.— offer my amendment first. Is the Sen- American people had no access to (1) PURPOSE.—The purpose of this section ator from Arkansas supposed to go is to require that savings resulting from this health insurance. Folks reaching the first? Act must fully offset the increase in Federal end of their lives, retired, would lay Mr. PRYOR. I believe the sequence spending and reductions in revenues result- their head down on their pillow at was that I would go first. ing from this Act before any such Federal night and wonder if tomorrow would be

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00022 Fmt 0637 Sfmt 0634 E:\CR\FM\A06DE6.013 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12545 the day they would get sick and have I walked into a restaurant about 2 bate these things, there is so much no health insurance coverage; and won- weeks ago, and I saw what several of misinformation, so much bad informa- der if they would get sick, who would my colleagues have seen: advertise- tion that is alleged about legislation to treat them or how they would find the ments on the wall. This particular res- try to deal with health care. money to provide for themselves. So taurant, as you walk through the door, It is interesting to me, I do not know the fact is, this Congress created some- has a plate glass window up to the ceil- of an attempt of a government take- thing called Medicare at a time when it ing, and it had a couple of advertise- over of the health care system. I have was decided that maybe we should put ments on it. Both of them were adver- heard it 1,000 times on this floor. I am together a program to give senior citi- tisements for people who needed to not familiar with any legislation that zens an opportunity to be covered with raise money to try to pay for their has been discussed that represents a health care. health care costs—spaghetti dinners, government takeover of health care. I It was decried as socialism—unbe- bake sales, various things to ask people am just not familiar with it. Maybe it lievable—when we tried to put together to come and chip in some money for exists in some cubbyhole someplace, this government program to provide their health care needs. but I have not seen it. But I know why Medicare for senior citizens. Some old Let me read a few of them. I will not the allegation comes to the floor every guy in a little town in North Dakota read the name, but this one is a benefit day—because it works. Scare the devil one night, at a town meeting, got up, for Chris’s family: A spaghetti feed and out of people. Somebody is trying to and he was so angry with the govern- silent auction is going to be held from have a complete government takeover ment. He shook his hand as he spoke. 5 to 7:30 p.m. to benefit Chris. He is a of the health care system. I wouldn’t He was a thin, older guy, and his neck sheriff’s deputy who was shot in the support a government takeover of the was coursing out and bulging so that I head and the abdomen while on duty health care system. I wouldn’t support thought he was going to have a heart and is still recovering at a rehabilita- it. I do support Medicare. By the way, attack right there, shouting about the tion hospital outside of Denver, CO. that is a government-created system to government. At the end of the meeting, They will have a spaghetti feed and si- make sure all citizens have access to an elderly woman took me aside and lent auction to try to raise the funds to health care because the private indus- said: You know what, I hope you are benefit that family for their needs. try is not going to get there. They not upset with Ernie because he’s been Here is a spaghetti supper, silent auc- didn’t prior to Medicare, and they pretty emotional about a lot of things. tion, bake sale, free-will offering for wouldn’t now if we didn’t have Medi- He just had open heart surgery and he supper or donations to be made to the care. gets kind of emotional about things. Duane fund at the Community Na- The very people who come and talk So I saw the gentleman as he was tional Bank. He has stomach cancer about government health care, it is in- leaving, and I sidled up to him and I that has spread to other areas and is teresting they do not come to the floor said: I understand you just had open undergoing various treatments and of the Senate offering an amendment heart surgery, and he said: Yeah. So I needs help with medical and living ex- that would abolish Medicare. I don’t asked him if his surgery was covered penses. understand—if, in fact, they really do This is what you see on the side of by Medicare, and he said it was. I said: not like this at all, they should be of- the wall in cafes, posted to a bulletin Well, there is at least one government fering an amendment that abolishes board downtown: A burger supper and program that works. He said: Medicare the Medicare Program, saying it is just free-will offering to be held for Amy. In ‘‘ain’t’’ government. It just ‘‘ain’t’’ not worthy, to have a system in which July, Amy was diagnosed with uterine the government tries to guarantee government. cancer, which has metastasized to the Well, of course, it is government. The health care for America’s seniors. The lymph nodes. She has had surgery and reason he had health insurance cov- is now undergoing chemotherapy radi- reason I think they do not is they erage was because we—that is we the ation and needs to raise funds for agree with Medicare. They believe government, the Congress, the Amer- health care costs. Medicare should exist, and as a result, ican people—decided we weren’t going Here is a pancake breakfast to be they support a form of government to let people come to the end of their held for Sean in the school cafeteria. health care, at least for senior citizens. years and not have health insurance Scrambled eggs, pancakes, and sausage What I want to do briefly—I will talk coverage. will be served, and there will be a free- more about that later. I am going to Some might say: Well, yes, you put will offering. Sean’s infant daughter offer an amendment. I expect it will be together Social Security and Medicare was born with a heart defect and needs tomorrow night or Tuesday. RASSLEY is on the and now you have trouble financing it. corrective surgery and a lengthy stay I see Senator G That is true. That is true. We have in the hospital. The staff is hosting the floor. He has been a cosponsor of this trouble financing it because of success. event to defray the expenses so they legislation, Senator SNOWE, Senator We can handle success. Our country can provide the funds to try to afford MCCAIN and others—many on my side— can handle success. People are living this very expensive medical treatment. Senator STABENOW. There are a lot of longer and better lives these days— Joyce is the mother of Brandy. Brand folks who have worked on this, the longer and better lives—and they claim is a 16-year-old who was involved in a issue of prescription drug importation. more health care during those extra 5, car accident weeks after her parents I want to make a couple of comments 10 or 20 years they are living. decided to give up their health care about that. I have not been on the floor I have often told my colleagues that coverage so they could afford mortgage speaking about the health care much I have an 89-year-old uncle who runs in payments. The family had a meatball until now, and I will be offering this the Senior Olympics. He runs the 50 and mashed potato dinner benefit last amendment; I guess it will either be to- meter, the 100 meter, and the 200 month to help pay for Brandy’s health morrow evening or I expect it to be on meter. He runs the 100 meter in under care needs. Tuesday. But I want to make a couple 19 seconds at age 89. Would that have I have a long list. The list goes on, of comments about it because I think happened 30 years ago? Not likely. But and one wonders whether we should be it is very important. people are living longer and healthier oblivious to that, that we walk into I don’t think you can leave the issue lives and it causes some strain on So- the business places in the downtowns of health care, having tried to do cial Security and Medicare, but we can and the Main Streets of our commu- things about the escalating costs— deal with success. Surely, we can deal nities and see that there are many peo- some people talk about bending the with success. ple who have to have a spaghetti sup- cost curve, whatever that means. All I Now we are talking about a system of per or burger feed to see if they can know is, putting the brakes on increas- health care that doesn’t work for ev- raise enough money just to get to the ing costs at the time they are sky- erybody or it doesn’t work very well hospital, just for transportation, let rocketing is important for businesses, for many people and it works very well alone the surgery, let alone the med- for families, for individuals. The ques- for some others. But should we do ical treatment. tion is, What about prescription drugs? nothing or should we decide to try to I think it is the worst, not the best of How can we possibly leave that subject tackle this question? our political system that when we de- behind?

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00023 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.031 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12546 CONGRESSIONAL RECORD — SENATE December 6, 2009 There are a whole lot of people in ple, in some cases quadruple what passed? We have tried for a long time. this country who are taking prescrip- other people are paying for exactly the We have been rebuffed here and there tion drugs to manage their diseases same prescription drug. for various reasons. and keep them out of an acute-care bed On this chart, this represents infla- There is a supposed ‘‘deal’’ that has in a hospital. Cholesterol-lowering tion—the yellow line. This represents been struck with the pharmaceutical medicine, blood pressure-lowering med- the increased prices for prescription industry, for $80 billion. I think the icine—a whole lot of people take both drugs—the red line—which I think pharmaceutical industry has some- every day of their lives and do so to demonstrates clearly why something thing like $220 billion a year in reve- manage health care problems. Yet ought to be done. nues, so that is $2.2 trillion over 10 what they see with brand-name pre- A group of us have put together a years. A very small fraction of that scription drugs is a dramatic increase piece of legislation that is simple, and, $220 billion was agreed to by the White in prices. I want to just give some ex- in my judgment, very effective in ad- House, I guess, and somebody here in amples. dressing this problem that the Amer- Congress. This year alone, the average price of ican people are charged the highest One of my colleagues who served here brand-name prescription drugs has prices in the world for brand-name pre- years ago said, ‘‘I am not for any deal gone up 9.2 percent, well over quad- scription drugs. I am not a part of.’’ Most Members of ruple the rate of inflation. Justifica- An example of that, I sat on a straw the Senate were not part of any deal. tion for that? I see none. Should we do bale out on a farm once about a year or So my expectation is, the time and something about it? Should we try to so ago with some people at a town place and reason to offer this is right put the brakes on some of this? I think meeting. One of the old guys out now. We can’t do health care and leave we should. Let’s look at some exam- there—he was about 80 years old—he behind this question of the cost, the ples. Enbrel, for arthritis, up 12 percent said: My wife and I have driven to Can- price of prescription drugs. in 2009; Nexium, for ulcers, up 7 percent ada every 3 months so she could buy I think the drug industry is a fine in- in 2009; Lipitor, up 5 percent; Singulair, Tamoxifen to treat her breast cancer. dustry. I want them to succeed. I want I said: Why did you do that? for asthma, up 12 percent; Plavix, up 8 them to be profitable. I want them to He said: Because we can’t afford to be successful. I want them to produce percent; Boniva, for osteoporosis, up 18 buy Tamoxifen in the United States. I the new miracle lifesaving drugs, and percent this year. bought it for one-fifth of the price in All of us understand—you watch tele- by the way, much of that comes from Canada of what it would cost us. My public investments we make in the Na- vision in the morning and brush your wife has been fighting breast cancer— tional Institutes of Health. But I just teeth, you have a television set there in her late seventies now—for 3 years, want them to change their pricing someplace, and they are saying to you: and the only way we could afford the strategy. Why should the American Do you know what you should be drug was to drive into Canada. doing? You should be going to talk to Most people cannot drive into Can- people be paying the highest prices in your doctor. You should talk to your ada. There is an informal opportunity the world? Europe has had a strategy—it is doctor and see whether the purple pill for people to bring back a 3-month sup- is right for you. ply on their person if they go to Can- called parallel trading—that they have I don’t know what the purple pill is, ada. Most Americans cannot possibly had in place over 20 years. If you are in but the television commercial is pretty do that. But the same drug is sold all England and want to buy a drug from seductive. You almost feel like: I ought over the world by the major France, no problem. If you are in Spain to find a doctor someplace; maybe I am drugmakers, and the difference is they and want to buy a drug from Italy, no missing something; maybe the purple charge the highest prices to the Amer- problem. They have done it for 20 years pill is right for me. ican people. successfully. Somehow, people are sug- The list go goes on and on. Flomax, The question is this: Why shouldn’t gesting that we can’t do what the Eu- Lipitor—you name it, they are adver- the American people have some free- ropeans do? That is nonsense. tising it relentlessly. Go ask your doc- dom—the freedom to shop for that We are going to offer this legislation: tor whether these pills are right for same FDA-approved drug wherever it is myself, Senator MCCAIN, I mentioned you. sold if it is sold at a fraction of the Senator STABENOW, Senator GRASS- The problem is, the American people, price? The answer is, they should have LEY—there are so many Members of the with respect to the price of prescrip- that freedom. Our legislation gives Democratic and Republican side on tion drugs, are charged the highest them that freedom. this. We will offer this legislation, and prices in the world. Not even close— I assume there will be people coming I hope we will have the 60 votes nec- brand-name prescription drugs cost here and saying: If you pass this legis- essary to pass it. I hope finally, at much more here than anywhere else in lation, that allows the American peo- last—at long, long last—we will have the world. ple to access, through pharmacists or enough people standing on the floor of I have in my desk something I would through registered wholesalers, these Senate who will say: You know what, I like, by consent, to show. These are identical FDA-approved drugs for a am on the side of the American people two bottles of Lipitor. This is, by the fraction of the price. If you do that here. I am not interested in having the way, the most popular cholesterol-low- somehow, we are worried we will have American people pay the highest prices ering drug in America. These bottles, an unsafe drug supply, we are worried in the world for prescription drugs. as you can see, are the same shape. about counterfeit drugs. How about some fair pricing for a These pills are made in the same place. In this legislation I put together with change, fair pricing for the American They are made in Ireland and then my colleagues, Senator SNOWE, Senator people? And how about some freedom, shipped around the world. This bottle STABENOW, and Senator GRASSLEY—a freedom for the American people to ac- was shipped to the United States. This wide range, bipartisan group of Sen- cess those identical drugs where they bottle, with 20-milligram tablets of ators—that is pretty unusual. This is a are sold at a fraction of the price? Why Lipitor, was shipped to the United bipartisan amendment, by the way. restrict the freedom of the American States. You get to buy them as a U.S. But in our legislation, we have the sig- people? Everybody talks about this consumer for $4.48 per tablet. This bot- nificant changes that are necessary to being a global economy. Well, that is tle—one is red, one is blue, same size, ensure safe drug supply, not just those so when it benefits everybody else, but same pills, same company—this bottle you would ship in but those you buy what about a global economy that ben- went to Canada, same 20-milligram here. We talk in our legislation about efits the consumer when they want to tablets. No, it was not $4.48, which the batch lots and pedigree and a whole se- access an FDA-approved drug when it American consumer paid, it was $1.83. ries of things. So you track every drug is sold elsewhere for a half, quarter, or It does not matter whether it is Can- right back through the chain of cus- eighth of the price? ada, Italy, Spain, Germany, France—I tody, right to its manufacturer, and Let’s give people a little freedom. I would cite exactly the same numbers that is something we do not do today. hear people talk about freedom on the in terms of the American people being When we offer this, the question is, floor of the Senate. This will be a bill told they should be paying double, tri- Do we have the votes to get this in which we decide whether we want to

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00024 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.032 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12547 give the American people the freedom and I will cut them in half and see if I takeover of health care. I take the po- to access those low-cost prescription can make that work somehow. The sition that it is definitely a first step drugs. next time they show up at the counter, in that direction. If you spend a little I am going to have a lot to talk it is 9 percent more. bit of time watching any of the cable about when we offer this amendment. I say knock off a little of that adver- news stations, you will hear someone Just this year, again, just this year tising. There are different reports, but talking about how the current health the price of prescription drugs has in- there are some reports that say they reform proposals represent a govern- creased 9.2 percent. spend more money on marketing pro- ment takeover of our health care sys- I showed the chart. There is no rea- motion and advertising than they do tem. The phrase ‘‘government take- son that brand-named prescription on research. How about knocking off a over’’ has become a common talking drugs should be on a stepladder like little of that advertising if that is point for people opposed to this pend- that. What about the people who strug- causing some of the relentless price in- ing bill. Unfortunately, these oppo- gle, trying to figure out how to buy creases. nents rarely explain why this bill war- those drugs? Does anybody care about I want to begin the discussion be- rants such a claim, that it is a step to- them? cause we will have a full discussion on ward government takeover of the en- They say the deal that was made this when it comes to the floor. It will tire health care system or the nation- with the pharmaceutical industry af- be either tomorrow afternoon or Tues- alization of health care. Supporters of fects what is called the doughnut hole, day morning. Senator MCCAIN will be these bills don’t do much better as and 50 percent of the doughnut hole is joining me on the floor and many of well. These supporters dispute the being filled if they buy brand-named— my colleagues on both sides of the aisle claim but at the same time they seem I don’t care about that. That is a recipe to see if we can’t finally lift this piece unaware of all the new roles and re- for a stew I was not part of making. of legislation and get it over the finish sponsibilities the Federal Government What I do care about is a whole lot of line. It is important for the American is taking on in this 2,074-page health folks going to the grocery store where people. care reform bill. I want to explain why the pharmacy is in the back of the I yield the floor. I see the pending bills as a government store and they are trying to figure out, The PRESIDING OFFICER. The Sen- takeover of our health care system. what do these drugs cost me this time ator from Iowa. I don’t come to the floor to scare peo- when I fill them so I know how much Mr. GRASSLEY. Mr. President, I had ple or misinform them. I am more than money I have left to buy food. Over and a chance to hear the Senator from willing to listen to different points of over in this country, people are making North Dakota. I am not rising to speak view. But if I am going to use the those choices. There is no excuse for a on that issue right now, but I support phrase ‘‘government takeover,’’ I want 9-percent increase in these brand-name him in that effort. I thank him for to make sure other Senators—and par- prescription drugs this year, in antici- working with my staff over a period of ticularly my constituents in Iowa— pation of health care reform. years to develop a bill that does not know what I am talking about. I wish The fact is, health care reform ought violate any of our trade agreements. to start with the simplest example of to contain the kinds of things that That is an important aspect of the government takeover, the government- begin to put brakes on this. work of the Senate Finance Committee run plan. It is sometimes referred to as I am not saying you put the brakes on which I serve. I look forward to that the public option. This one seems to be on it by imposing government pricing. debate coming up. pretty straightforward. In other words, I am saying you put the brakes on it by Mr. DORGAN. Will the Senator yield the government-run plan is a pretty giving the American people the free- for a question? straightforward example that people dom to access those drugs where they Mr. GRASSLEY. I yield. can understand the government getting are sold at a fraction of the price they Mr. DORGAN. I wanted to say it is so more involved. are sold here. And you give the Amer- rare for us to have a bipartisan amend- If you wonder maybe sometimes why ican people that freedom, I guarantee ment. Those of us who have worked on the public at the grassroots is a little you, they will shop where they get the this, including Senator GRASSLEY and bit concerned about the takeover of best price on identical drugs, FDA ap- Senator MCCAIN and many on my side, health care by the Federal Govern- proved. It will force the pharma- will be faced once again with the ment, remember that it was only a few ceutical industry to reprice drugs in charge that this would undermine safe- months ago the Federal Government the United States. ty and so on. I wanted to make the nationalized General Motors, as an ex- A couple quick points in conclusion. point that Senator GRASSLEY was one ample, and has partially nationalized President Barack Obama was a cospon- of those who especially worked with individual banks and financial institu- sor of this legislation last year when he us—and Senator MCCAIN—to make sure tions—in a sense, taking a big step to- was a Senator. The Chief of Staff at the we had safety in this legislation, pedi- ward nationalizing the whole financial White House, Rahm Emanuel, was one grees, batch lots, safety that does not system with the Federal Reserve sys- of the leaders in the House on this leg- exist now even in domestic supply, let tem’s intimate involvement and the islation last year when he served in the alone imported drugs. Secretary of the Treasury’s intimate House. It tells you a little something I appreciate the Senator from Iowa involvement in a lot of decision mak- about the breadth of support that ex- working with us on this legislation. ing there or decisions that affect the ists or existed for this. Somebody told This is a good piece of legislation. I entire financial system. me at the door as I came in: We are not look forward to seeing the Senator We are here with the prospect of sure the White House is supporting from Iowa on the floor when we get it building upon other things that have this. I fully expect the White House to to the floor to have that debate. happened this year, having the Federal support an amendment they supported Mr. GRASSLEY. I thank Senator Government take over health care. The last year in the Senate. DORGAN. He gave a very good descrip- public option is one step in that direc- There are big issues and small issues. tion just now of how careful this piece tion. I see a government-run plan, This issue is an important issue. A lot of legislation—of which I am a cospon- whether it is an opt out, an opt in, a of us have worked for a long time to sor—would go not only to make price trigger or a straight government plan get it right. We have been thwarted by transparency and price competitive- paying Medicare rates, as this coun- a very powerful industry that has a lot ness much better for the American con- try’s first step toward a single-payer of friends in this town. I am hoping the sumer but to guarantee the same safe- system. A single-payer system is a gov- consumers have a lot of friends as well. ty we would for drugs imported as we ernment-run system, one system for A lot of people are out there struggling do for drugs produced here. the entire country, as in Canada, with- to try to figure out how to afford the I rise to speak in a generic way about out options or choices that people prescription drugs they need to take. A this 2,074-page bill that is before us, to have. I don’t want you to take my word whole lot of folks are deciding, I guess speak about people who have raised for it. what I will do is get the prescription questions about whether this bill is or Let’s look at a quote from Represent- drugs the doctor says I should have, is not a first step toward a government ative JAN SCHAKOWSKY of Illinois:

VerDate Nov 24 2008 23:32 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00025 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.033 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12548 CONGRESSIONAL RECORD — SENATE December 6, 2009 A public option will put the private insur- This is within the principle of the Fed- ness research in and of itself is not ance industry out of business and lead to sin- eral Government’s constitutional something I oppose because I think gle payer. power to regulate interstate commerce, when it is used as a way of informing I have another quote by Representa- going way back to 1944 or 1945. The Su- patients and providers about best prac- tive BARNEY FRANK of Massachusetts: preme Court ruled that. Then Congress tices, it is a good thing to have. But I If we could get a good public option it passed the McCarran-Ferguson Act and am also worried this research could be could lead to single payer, and that’s the gave it right back to the States to do, used as a tool for government to ration best way to reach single payer. where it has been basically regulated. care. Especially the reason for my con- Judging by these quotes, I would say But this bill brings a lot of that regula- cern is the recently passed House bill both of these prominent Members of tion back to the Federal Government. I failed to include a prohibition on ra- the Democratic party agree that the do support some stronger rules and reg- tioning that was in their original dis- so-called public option is a first step ulations. Congress should make sure cussion draft. That discussion draft of toward government taking over our that people are not discriminated the House bill, H.R. 3200, stated that health care system. But we don’t need against because of preexisting condi- the committee should ‘‘[e]nsure that to rely only upon sound bites. Let me tions, and people should not have to essential benefits coverage does not explain why I see the government-run stay up at night worrying about wheth- lead to rationing of health care.’’ plan leading to a single-payer system. er their insurance will be there when But, unfortunately, that line was not The government-run plan may start they get sick and need it most, just as included in the final bill. out with some rules to keep it from you wouldn’t want your fire insurance Now, that makes you wonder: When having an unfair advantage over pri- on your house canceled at the same everybody says comparative effective- vate insurers. Supporters might say it time the fire starts in the house. ness research is not going to be used to is on a level playing field with private Those are the kinds of reforms I say ration care, then why would you object insurers. They may say it would have are good in this bill and could get to a statement saying: ‘‘Ensure that to pay the same rates, form networks, strong bipartisan support. But the essential benefits coverage does not and be independently solvent. But I re- pending bills go much further than cre- lead to rationing of health care.’’ Why mind people, when they hear those ating stronger rules and regulations. wouldn’t that be in the bill if that is promises today, why something the First, let’s keep in mind that under what you believe? government is doing can be competi- current law, health insurance is pri- So under these pending bills, you tive and not unfair competition with marily regulated under McCarran-Fer- have the Federal Government telling the private sector. guson at the State level. State insur- private plans how much they can Those same kinds of promises were ance commissioners and legislatures charge and deciding what benefits they made during the Medicare debate way set most of the rules. The health re- have to cover. Then the Federal Gov- back in 1965. Supporters of the bill in form proposals being debated in the ernment is going to tell them—again, a 1965 promised the new government Senate and over in the House would Federal intervention in health care and health insurance program would not have the Federal Government take a step toward more nationalization— interfere with the practice of medicine over these responsibilities. Under the they are not only going to tell them and would pay fair reimbursement present bills, the Federal Government, what benefits they have to cover, but rates. But over time, as the costs of the either through the Secretary of Health then the Federal Government is going program exceeded projections, the gov- and Human Services, or a newly cre- to tell you that you have to buy it. ernment broke promises it made. The ated office of health choices commis- Understand, as far as I know, in the pending bills represent a government sioner, or an unelected Federal health 225-year history of our great country, takeover of our health care system, be- board is going to decide what health in- the Federal Government has never said cause I believe the same thing that surance has to look like. What every you had to buy anything—buy or not happened in 1965 with Medicare, the health plan has to cover is what the buy anything. They do not tell you. government breaking its promises, will Federal Government is going to decide. Somebody is going to say: Well, the also happen with the so-called public It is not just a case of ending dis- States make you buy car insurance. option. crimination. It is a case of the Federal Well, under the 10th amendment, the In fact, I want to quote from a recent Government saying what that health States can do anything they want to Wall Street Journal article: insurance plan needs to look like. If that is not prohibited by the Federal Any policy guardrails built this year can your current coverage does not meet Government. But the Federal Govern- be dismantled once the basic public option one of the bronze, silver, gold, or plat- ment is a government of limited power. architecture is in place . . . That is what has inum categories set up by the Federal So you have the Federal Government always happened with government health Government—despite the President’s saying you have to buy health insur- programs. promise—you may not be able to keep ance. But the government takeover Isn’t that what Representative what you have. does not stop there. The proposed bills SCHAKOWSKY and Representative FRANK The Federal Government is also also include the biggest expansion of were saying? Start in a very simple going to set a national standard for the Medicaid Program since it was cre- way, saying to people the private sec- how much insurers can vary prices be- ated in 1965. The bills force 14 million tor needs competition. Government tween younger and older beneficiaries. more Americans into Medicaid, even will give that competition. But start These reforms will result in drastic though many doctors will not see Med- with a government-run plan so you can price increases, particularly for young- icaid patients. Under current law, the end up with a single-payer system, re- er and healthier beneficiaries. This government already pays for about 50 gardless of how innocent it sounded means millions of people who are ex- percent of health care. But with the when you first started out. Slowly but pecting lower costs as a result of re- new subsidies and massive Medicaid ex- surely, the government plan would form will end up paying higher pre- pansion, the Federal Government will take over the market. This is just one miums. eclipse the private market when it example of why I see the pending bills So the Federal Government will de- comes to paying for health care serv- as a government takeover of our health cide how much plans can charge and ices. care system. But there are others. what benefits can be covered. To help I am sure some of my colleagues saw I wish to take a look at some health make these decisions, the Federal Gov- recently released data from the inspec- insurance reforms that are within this ernment will have a newly created tor general showing that about 12 per- bill. All of these insurance reforms comparative effectiveness research pro- cent of Medicare payments were pay- aren’t bad as separate items. But cou- gram. This program would be similar ment errors that could be the result of pled with all the bad things in the bill, to the ones in Great Britain and other fraud, waste, and abuse. It is no wonder it makes it difficult to sort out the foreign governments that decide which then that Medicare is scheduled to be good things. treatments you can and cannot have. insolvent within the next 10 years. For instance, I support stronger rules I want everyone to understand that Clearly, the government cannot af- and regulations for private insurers. the principle of comparative effective- ford or even manage the programs it

VerDate Nov 24 2008 01:08 Dec 07, 2009 Jkt 089060 PO 00000 Frm 00026 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.034 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12549 has now. But here we are debating the able to support this legislation are not times the number that their supporters single largest expansion of government able to support it. It is why I am not claim. health care in history embodied in this able to support it. How can this happen? Well, Senator 2,074-page bill. Supporters of this legislation prom- REID and whomever he selected met So I would like to review why I see ise that it will do a number of things. down the hall in secret, and they the current bill as a government take- We are being told we should support it talked about the numbers, and they over of our health care system. and vote for it. But it does not do those were worried about how to meet the First, there is a government-run plan things that are advertised of it. I wish president’s claim that their bill would that will drive private health plans out it did. I wish we could create some- not cost more than $900 billion. They of business. In fact, some Democratic thing for nothing. I wish we could were trying to promise it would be only legislators have said publicly they see make these numbers balance, but they $848 billion, but the numbers were not it as a first step toward a single-payer do not. adding up. system. Earlier today, one of our colleagues So what did they do? They delayed Second, States will no longer be in on the other side of the aisle said: We the implementation of the expendi- charge of their own insurance markets. would not do anything about hurting tures the bill promises for 5 years. So The Federal Government is going to Medicare. We Democrats, 45 years ago, they delay the expenditures, the bene- take over the responsibility of setting created the program, and we would not fits they promised, for 5 years, but the premiums and defining benefits. So re- do anything to hurt it. taxes start now. That way, you can gardless of whether you are getting Well, then, we are going to have a take the first 10 years of the bill, and your health insurance through an em- vote. We are going to have a serious it looks pretty good because you only ployer or on your own, when you go to vote coming up, probably tomorrow, on have expenditures—the big expendi- buy a new policy, the Federal Govern- the Gregg amendment. Senator Judd tures—for 5 years, and you have rev- ment is going to tell you what you can Gregg is one of the most knowledgeable enue for 10. Well, this is flimflammery. and cannot buy. If you do not buy the persons in the Senate on Medicare. He It is not honest. The numbers do not add up. coverage the government has chosen has worked hard on it for a number of If you examine the bill’s costs when for you, you could end up paying a new years. He chaired the Budget Com- it is fully implemented for 10 years, it mittee when Republicans were in the tax or even end up in jail under this is $2.5 trillion, $2,500 billion. new intrusive health insurance man- majority, and now he is the ranking So I would say, first of all, that is a date that is going to be enforced by the Republican. Everybody respects him. fiction. The fact is that these numbers Internal Revenue Service. He has offered an amendment that are not accurate. They did not do what Interestingly, an analysis of similar would make sure we do not raid Medi- they said they were going to do. The health reform legislation said the IRS care—and that is exactly what this bill bill does not do what it promises. would have to grow by 25 percent in would do. If this bill does not raid No. 2, the President told us in a joint order to manage all the new taxes, fees, Medicare, then why wouldn’t every- session of Congress that he will not and mandates. body vote for the Gregg amendment? sign a bill that adds one dime to the By the way, I have written a letter to We are entering a time in which we deficit. Well, that is pretty good. In the Secretary of the Treasury trying to will have a defining moment. Some of fact, they produced this $848 billion get exactly some estimate of how much my colleagues will say they voted for bill, they say, that it is going to only money it is going to take for the IRS the Bennet amendment. As we said cost $848 billion. They say, boy, give us to administer this program, and we do then, the amendment meant nothing. a pat on the back. Not only is it going not have an answer yet. It did not do what they said it would do to be deficit neutral and not add to the Finally, we have the single largest because it did not prohibit the raiding debt, it is going to increase revenues expansion of Medicaid since its incep- of the Medicare trust fund. But my col- by $130 billion, and we will pay down tion. Current proposals plan to add 14 leagues wanted to adopt it. This is why the debt. Have you heard that? We are million people to the Medicaid Pro- people are angry with Congress—it was going to pay down the debt. gram—a program that States already a cover amendment. But they had a number of problems. cannot afford. For a day or two it seemed as if the One of them was they promised to pay All of this begs the question then: At cover may have worked; that by voting the doctors a reasonable fee. Under the more than 2,000 pages, and about $2.5 for this amendment, my colleagues existing law, the way it was passed in trillion in spending when fully imple- who are supporting this legislation one of the budget balancing acts, doc- mented, how can anyone say the pend- could say they voted to not hurt Medi- tors are set to take a 23-percent reduc- ing bills do not represent a government care. They could go back home and tion in their payments in 2011 for doing takeover of health care? From the gov- say: I voted for the Bennet amendment. Medicare work—23 percent—which we ernment-run plan, to a Federal take- Well, the New York Times—along know we cannot allow to occur. Doc- over of private health insurance, to a with anybody who takes the time to tors will quit doing Medicare. Many of massive expansion of Medicaid, I find it look at the amendment—said it was them are having difficulty continuing hard to call the pending bills anything meaningless. And the New York Times to see Medicare patients now. We can- else. supports the legislation. It is meaning- not cut them 23 percent. So what did The American people want lower less. It was absolutely meaningless. the writers of this bill do? They in- costs, higher quality, and better ac- The amendment does not do anything, creased the doctors’ reimbursement for cess. That is clear. I share these goals, and will not protect the Medicare pro- 1 year. Next year, they give them a but I cannot support any bill that I be- gram. one-half-percent increase. But in the lieve hands our private system of medi- We are going to have an opportunity next 9 years, their budget assumptions cine over to a bunch of Washington bu- to deal with that tomorrow. The num- assume the doctors will take a 23-per- reaucrats. That is not what my con- bers in this bill are not adding up. The cent cut. That is absolutely bogus. We stituents want, and it is not what this way this bill is being financed in part are not going to cut the doctors 23 per- country needs. is by a $465 billion raid on Medicare. cent. We cannot do so and maintain I yield the floor. Well, I am going to raise a number of health care in America for our seniors. The PRESIDING OFFICER. The Sen- issues, but I will not do them all today, And yet, that is one of the major prob- ator from Alabama. so you can rest with some relaxation. lems with Medicare today: we are not Mr. SESSIONS. Mr. President, I As to some of the things that are on a sound financial basis. This bill as- thank Senator GRASSLEY for his leader- critical to whether a person can sup- sumes that Medicare expenditures for ship on this issue. port this kind of reform, the fiction physicians is going to drop 23 percent I am going to share some facts and that has been stated is that the bill’s in 2011 and remain at that rate—and fictions that are relevant to this bill. I net total cost is $848 billion. Well, in that amounts to a $250 billion shortfall think it will explain to anybody who truth, when the bill is fully imple- from 2011 through 2019. looks at it carefully why Senator mented, the first 10 years of full imple- So, they ask: how can we figure out GRASSLEY and others who hoped to be mentation costs $2.5 trillion, three how to do this, how to make this bill

VerDate Nov 24 2008 01:08 Dec 07, 2009 Jkt 089060 PO 00000 Frm 00027 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.036 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12550 CONGRESSIONAL RECORD — SENATE December 6, 2009 deficit-neutral and less than $900 bil- money for economic growth and jobs in 2017. We should use that money, lion? We don’t want to admit that our and other important items. those savings to help the seniors. bill is not a $130 billion surplus over 10 Well, does the bill do that? No, it Remember, Medicare is funded and years if we have to pay the doctors, doesn’t. As Senator THUNE has pointed has been funded by people such as Bill which we are going to pay one way or out, and others have, health care cur- Eberle from Huntsville, AL, who wrote the other. If we pay the doctors, it will rently is about 17 percent of our gross me about it. He said he paid into the actually be a $120 billion deficit on that domestic product. Of the total wealth fund for 40 years and now he is ready to issue alone. So what can they do? They of America, its productivity, 17 percent draw down benefits. He didn’t get any came up with a budgetary gimmick. goes to providing health care. If this benefit from his years of Medicare They just took physician pay out of bill is passed, it will increase to 21 per- taxes until he hit 65. But now he is the health care reform package, and cent, and that is a faster rate of in- ready to draw, and we are considering decided to try to pass it on the floor of crease than if we didn’t pass this bill at taking his money and spending it on the Senate, with every penny of it, $250 all. That is a big deal. I thought we had somebody else. He doesn’t like that. He billion, going to the deficit—not a a promise and a commitment that the doesn’t think that is right, and he is penny of it paid for. bill would reduce the percentage of correct. So if you bring the physician pay growth there. Indeed, it will not. That is why I am not able to support issue back up, and add it to the health There are a number of other issues the legislation. It doesn’t do what it care reform bill that we are supposed that I will be talking about, including promised. It is going to make our to be passing, you end up at the begin- how the actual premiums for average health care situation worse. It is going ning of the whole thing with a $120 bil- families for insurance will be going up to create greater debt at a time when lion deficit. So, to avoid that, sup- instead of going down as has been our spending is already out of control. porters of this bill moved physician promised by the President and how this I thank the Chair and my colleagues. pay out of the bill and tried to pass it. bill will increase the deficit and not re- I hope as this debate goes forward that A lot of the Democratic colleagues duce it; how it will increase the per- we can make some improvements, al- wouldn’t vote for that. It failed be- centage of GDP to health care and not though I am not confident of the direc- cause, out in the open before the whole decrease it; how it will increase taxes tion that we are headed right now. It world, people did not want to vote, and how it will raid Medicare, but not seems as though any significant at- after all of this deficit that we are im- shore up the program. I am just going tempt to make real progress with the posing on our children and grand- to repeat this again, because it is im- bill is failing. But Senator GREGG’s children, for another $250 billion hit to portant: This bill is a raid on Medicare. amendment is important. I hope my the debt. How can we continue to do It cannot be disputed, in my view. The colleagues will study up on it and vote that? So it was voted down, thank idea that we could take $465 billion out to preserve Medicare and to keep the goodness. But the problem is still of Medicare and put it into an entirely savings that can be obtained in Medi- there. You have to raise $494 billion in new program without having any ad- care in the program, and not create a taxes to make this bill deficit-neutral. verse effect on Medicare is something I new entitlement. Instead of using that money to fund I thank the Chair. don’t think anybody can imagine to be Mr. ENZI. Mr. President, I rise in new entitlement programs, maybe we true. support of Senator JUDD GREGG’S ought to use that tax revenue to pay How did they do that, you might ask. amendment, which would prevent the for the program we have: Medicare, the Well, Senator SESSIONS, surely they Medicare cuts in the Reid bill from one that is slipping into serious de- thought this through. How can they being used to pay to create a new enti- fault, one in which we are not paying say that? This is the gimmick. This is tlement program to cover the unin- the doctors what we should be paying how they do it: We are not denying any them for the work they do. If we are sured. ‘‘guaranteed’’ benefits under Medicare, I do not oppose covering the unin- going to raise taxes, maybe that is they say. Don’t worry, seniors. All sured. Nor do I oppose reforming the what we ought to do with the money— your guaranteed benefits are going to Medicare Program. We should do those and not create a new entitlement ben- be provided. Where does the $465 billion things. efit that is going to grow and far ex- come from? Well, we are just going to What I oppose is the Reid bill. This is ceed costs projections in the years to cut the providers, not your benefits. the wrong approach to solve these come and further jeopardize our spend- We are going to cut hospitals. We are problems. ing. As I think most of my colleagues going to cut hospice. We are going to The amendment offered by my friend are pretty well informed, under the cut home health care. We are going to from New Hampshire highlights the present spending program we will dou- cut nursing homes. We are going to cut main problems with the Reid bill and ble the entire debt of the United States disproportionate share hospitals that suggests a better approach. of America in 5 years. Then, in 10 treat the poor, all of these things. We His amendment would protect the years, we will triple it. It will go from are going to cut all of these institu- savings from the Medicare Program, $5.7 trillion to over $17 trillion in 10 tions and groups that provide health and prevent them from being used to years. We cannot keep doing this. It is care, but don’t worry. You will still get create a new entitlement. unsustainable and the American people all of the benefits you had before. This would mean that this new pro- know it. Study after study indicates that the gram would not have to rely on cuts to So, the cost promises of the bill are health care providers are already oper- Medicare to fund its operation. It not being met. There are a lot of other ating on the margin. Health care will would also reserve all of the money points too. I would just first mention be savaged under this bill. taken from Medicare so that it could the fact that it was contended at the Second, if, indeed, we could save be used to fix the problems in the Medi- beginning that this reform bill ought money in Medicare—and I think there care Program. to be able to keep us from spending so are some savings there, and we need to Some Democrats have argued that we much of our gross domestic product on work at it and see what we can do are not creating a new entitlement pro- health care. It is a serious matter. We without breaching the promise we gram. They are simply wrong. Just like definitely need to wrestle with the cost made to our seniors—if we could save Social Security, Medicare and Med- of health care. It is not an easy thing money there, let me ask my colleagues: icaid, this bill will commit the Federal to deal with. But what does this bill What would you do with the money Treasury to paying for these new sub- do? It promised it was going to do that is saved? Would you use it to try sidies for the uninsured forever. something about that. It was going to to keep Medicare healthy, or would you That means that, as Federal spending bend the cost curve. Our cost curve on create a new entitlement program with continues to grow, this new program health care is currently going up, and it and raid the seniors’ money? will continue to grow. It will crowd out this bill was going to bend it down- Well, that is what has happened. The other federal spending priorities, like ward, contain the growth of health savings that are from Medicare need to education and national defense. care as a percentage of the gross do- be kept in Medicare so that we can Any future attempts to modify or re- mestic product in America, and free up keep the program from going insolvent strain its growth will be met by cries

VerDate Nov 24 2008 23:52 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00028 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.038 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 6, 2009 CONGRESSIONAL RECORD — SENATE S12551 of indignation, arguing that cuts would cuts to health care providers, including The Gregg amendment says that sav- devastate access to health care. If any- hospitals, nursing homes, home health ings from any Medicare cuts should be one has any doubts, they should look agencies and hospice providers. The reserved for the Medicare Program. at the transcripts from our debate on Reid bill also includes an additional That way, if the Washington experts the Deficit Reduction Act. $120 billion in cuts to Medicare Advan- again got it wrong, we will not have al- In 2005, Congress tried to reduce tage plans. ready spent all the savings on another Medicare spending by about $20 billion Those are not reforms. Instead they program. and enact modest reforms to the Med- represent the best efforts of folks in Mr. INHOFE. Mr. President, yester- icaid Program. These programs would Washington to guess how much it actu- day the U.S. Senate voted on two have strengthened the long-term sol- ally costs real doctors and nurses to measures, one by the Senator from vency of these programs and helped re- provide health care services to Medi- Massachusetts and one by the Senator duce the Federal deficit. care beneficiaries. from Nebraska relating to home health In response, Senator REID called that These cuts are an excellent example benefits. I was unable to attend yester- bill an ‘‘immoral document.’’ The jun- of how government price controls day’s session of the Senate but had I ior Senator from California said she work. voted, I would have voted for both strongly opposed the cuts in the bill, Medicare does not negotiate payment measures. because they would ‘‘cut Medicare and rates with providers, like private insur- Home health and hospice benefits are Medicaid by $27 billion.’’ ers. Medicare uses price controls to set very important to Oklahomans. In fact, Yet today, these same Members and payment rates. Experts in Washington the National Association for Home the rest of my Democratic colleagues then look at various reported costs, Care and Hospice reported that Oklaho- want to create a new entitlement pro- revenues and profits of health care pro- mans alone may receive a cut of over $1 gram that will spend hundreds of bil- viders and then decide how much we billion in home health and hospice ben- lions of dollars. And they would pay for should pay health care providers. efits under this bill. I understand the it by cutting $464 billion from the I have often said that everyone value of home health and hospice very Medicare Program. thinks they know everything about a well. In March 2007, I introduced legis- I believe these facts highlight why we business, until they actually have to lation with Senators THAD COCHRAN, need to adopt the Gregg amendment. I run it. As a former small business ROGER WICKER, PETE DOMENICI, and don’t believe we should create a new owner, I want to assure them, it is ac- RICHARD SHELBY, the Preserving Access entitlement program, which will per- tually a lot harder than it looks. to Hospice Act, to ensure America’s manently obligate our children and The Medicare cuts in this bill are terminally ill seniors have access to grandchildren to pay its costs. If my based on the efforts of folks in Wash- hospice care, by providing immediate colleagues insist on doing it, however, ington to decide how much it costs to relief for hospices impacted by the at a minimum we need to guarantee run a nursing home in Cheyenne or a Medicare hospice cap and authorizing a that any new program has a stable and home health agency in Gillette. Based MedPAC study on the cap issue. Iden- reliable source of funding. on their past track record, I don’t have tical legislation was introduced in the The Medicare cuts in this bill are nei- much confidence in their abilities. House led by Congressman JOHN SUL- ther stable nor reliable. In 1997, Congress passed the Balanced LIVAN with many cosponsors. I intro- My Democratic colleagues have spo- Budget Act. It contained over $434 bil- duced this legislation because of a ken at length about how the Medicare lion in Medicare payment cuts. Lots of flawed provision in Federal law which provisions in this bill will bend the really smart folks in Washington made required hospices to repay the Centers growth of heath care spending. That is arguments similar to those we are for Medicare and Medicaid Services, unfortunately far from accurate. hearing today about how these cuts CMS, for serving eligible patients in If you don’t believe me, listen to would not harm providers or bene- prior years. Many small, family, and what other nationally recognized ex- ficiaries. community-owned hospices faced clo- perts have to say. What happened after these cuts went sure, and patients faced losing access According to the New York Times, into effect? Within two years, these to hospice care. In Oklahoma espe- the CEO of the world renowned Mayo cuts had driven four of the largest cially, hospice care companies of all Clinic dismissed the reforms in the bill. nursing home chains in the Nation into sizes service a large number of Oklaho- Dennis Cortese said the Reid bill only bankruptcy. mans. However, in 2005, 41 percent of took baby steps towards revamping the Vencor, Sun Healthcare, Integrated the hospices providing care in Okla- current fee-for-service system. Health Services and Mariner Post- homa received letters from CMS de- The dean of the Harvard Medical Acute Network all filed for bank- manding repayment. Since then, I have School, Jeffery Flier, said that the ruptcy. Between them, they operated been working to help small, commu- bills being considered in Congress 1,400 nursing homes that provided care nity hospices in Oklahoma as they face would accelerate national health care for hundreds of thousands of Medicare repayment letters from CMS for mil- spending. beneficiaries. lions of dollars. Without help, hospices I wish there were more actual re- Similarly, the bill also included cuts face closure and the discharge of sig- forms in this bill. I applaud some of the in payments to Medicare + Choice nificant numbers of terminally ill pa- efforts that Senator BAUCUS included plans. After these cuts went into effect, tients, possibly into more expensive that will create incentives for coordi- one out of every four plans pulled out care. In fact, during last summer’s con- nated care and rewarding providers of the Medicare Program. Millions of tentious debate on physician Medicare who provide higher quality. I believe beneficiaries then lost the extra bene- reimbursements, I argued at the very those are exactly the types of things fits that these plans had provided. least for a MedPAC study on payment that we should be doing to improve the Given this track record, I have grave methodology for hospice care to evalu- Medicare Program. concerns about what the Medicare cuts ate if there is a problem with payments Unfortunately, the savings from in the Reid bill would do to Medicare and whether cap amount revisions are these actual reforms are a few pennies beneficiaries and the doctors, hospitals needed. compared to the dollars of arbitrary and other providers who treat them. I understand and greatly appreciate payment cuts included in this bill. I have even greater concerns about the value of good home health care and According to the Congressional Budg- using any estimated savings from these hospice benefits. et Office, all of the savings from the cuts to fund this new entitlement pro- Admittedly, one of the measures con- various policies to link Medicare pay- gram for the uninsured. sidered yesterday would have been bet- ments to quality and encourage better That is why we should pass the Gregg ter than the other. The amendment coordination of care in the Reid bill amendment. Rather than relying on from the Senator from Massachusetts provide less than $20 billion in total cuts that could devastate the Medicare simply said that nothing in the bill savings. Program, let’s find a stable and reli- should result in the reduction of guar- In contrast, the Reid bill includes able funding source that we could use anteed home health benefits. The prob- over $220 billion in arbitrary payment to pay for health care reform. lem is that access to home health is

VerDate Nov 24 2008 23:52 Dec 06, 2009 Jkt 089060 PO 00000 Frm 00029 Fmt 0637 Sfmt 0634 E:\CR\FM\G06DE6.039 S06DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S12552 CONGRESSIONAL RECORD — SENATE December 6, 2009 not a ‘‘guaranteed’’ Medicare benefit. AMENDMENT NO. 2927 SA 2948. Ms. SNOWE submitted an amend- So even though the amendment from At the request of Mrs. HUTCHISON, her ment intended to be proposed to amendment the Senator from Massachusetts passed name was added as a cosponsor of SA 2786 proposed by Mr. REID (for himself, 96 to 0, will it have a real impact on amendment No. 2927 proposed to H.R. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to 3590, a bill to amend the Internal Rev- the bill H.R. 3590, supra; which was ordered protecting seniors from the loss of ac- to lie on the table. cess to home health care? No. The bet- enue Code of 1986 to modify the first- SA 2949. Mr. ROCKEFELLER (for himself ter approach was offered by the Sen- time homebuyers credit in the case of and Mr. BROWN) submitted an amendment in- ator from Nebraska. Unfortunately, members of the Armed Forces and cer- tended to be proposed to amendment SA 2786 the better approaches are failing by tain other Federal employees, and for proposed by Mr. REID (for himself, Mr. BAU- party line votes. However, I com- other purposes. CUS, Mr. DODD, and Mr. HARKIN) to the bill pliment the Senator from Virginia, Mr. AMENDMENT NO. 2939 H.R. 3590, supra; which was ordered to lie on the table. At the request of Mr. PRYOR, the WEBB, for his support of the motion by SA 2950. Mr. ROCKEFELLER submitted an the Senator from Nebraska. This mo- names of the Senator from Iowa (Mr. amendment intended to be proposed to tion would have recommitted this en- HARKIN) and the Senator from Massa- amendment SA 2786 proposed by Mr. REID tire legislation to the appropriate Sen- chusetts (Mr. KERRY) were added as co- (for himself, Mr. BAUCUS, Mr. DODD, and Mr. ate committee to remove the cuts to sponsors of amendment No. 2939 pro- HARKIN) to the bill H.R. 3590, supra; which home health benefits. I think that is posed to H.R. 3590, a bill to amend the was ordered to lie on the table. the best and most direct approach. I Internal Revenue Code of 1986 to mod- SA 2951. Mr. ROCKEFELLER submitted an amendment intended to be proposed to think that is the most honest ap- ify the first-time homebuyers credit in the case of members of the Armed amendment SA 2786 proposed by Mr. REID proach. Simply remove the cuts. For (for himself, Mr. BAUCUS, Mr. DODD, and Mr. the past several days we have been dis- Forces and certain other Federal em- HARKIN) to the bill H.R. 3590, supra; which cussing the cuts to Medicare and espe- ployees, and for other purposes. was ordered to lie on the table. cially the cuts to Medicare Advantage. f SA 2952. Mr. ROCKEFELLER submitted an In each case, the Republicans have of- amendment intended to be proposed to AMENDMENTS SUBMITTED AND amendment SA 2786 proposed by Mr. REID fered motions and amendments to re- PROPOSED commit this massive 2,000-page health (for himself, Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to the bill H.R. 3590, supra; which bill back to committee to improve it, SA 2940. Mr. SPECTER (for himself, Mr. MERKLEY, Mr. WYDEN, Mr. CASEY, Ms. was ordered to lie on the table. namely, to remove the cuts to pro- STABENOW, Mr. LEVIN, and Mr. BROWN) sub- f grams seniors and the disabled use. I mitted an amendment intended to be pro- was disappointed to see this most re- posed to amendment SA 2786 proposed by Mr. TEXT OF AMENDMENTS cent attempt to send this massive bill REID (for himself, Mr. BAUCUS, Mr. DODD, and SA 2940. Mr. SPECTER (for himself, back to committee to improve it fail 41 Mr. HARKIN) to the bill H.R. 3590, to amend Mr. MERKLEY, Mr. WYDEN, Mr. CASEY, to 53. the Internal Revenue Code of 1986 to modify Ms. STABENOW, Mr. LEVIN, and Mr. the first-time homebuyers credit in the case I look forward to today’s debate. One BROWN) submitted an amendment in- scheduled for a vote is on medical mal- of members of the Armed Forces and certain other Federal employees, and for other pur- tended to be proposed to amendment practice reform. It will be very inter- poses; which was ordered to lie on the table. SA 2786 proposed by Mr. REID (for him- esting to see just how serious the SA 2941. Mr. SPECTER (for himself, Mr. self, Mr. BAUCUS, Mr. DODD, and Mr. Democrats are about health care re- WYDEN, and Mr. CASEY) submitted an amend- HARKIN) to the bill H.R. 3590, to amend form. Currently, the bill only has a ment intended to be proposed to amendment the Internal Revenue Code of 1986 to ‘‘sense of the Senate’’ recognizing med- SA 2786 proposed by Mr. REID (for himself, modify the first-time homebuyers cred- ical malpractice costs are a problem. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to it in the case of members of the Armed We’ll see if they think it is important the bill H.R. 3590, supra; which was ordered Forces and certain other Federal em- to lie on the table. to really do anything about it. SA 2942. Mr. GREGG (for himself, Mr. ployees, and for other purposes; which f CORKER, Mr. THUNE, Mr. COBURN, Mr. ENSIGN, was ordered to lie on the table; as fol- Mr. ISAKSON, Mr. BURR, Mr. ENZI, Mr. ALEX- lows: MORNING BUSINESS ANDER, Mr. BARRASSO, Mr. CORNYN, Mr. On page 466, between lines 5 and 6, insert Mr. BEGICH. Mr. President, I ask MCCAIN, and Mr. LEMIEUX) submitted an the following: unanimous consent that the Senate amendment intended to be proposed to SEC. 2305. EXTENSION OF DELAY IN APPLICA- proceed to a period of morning busi- amendment SA 2786 proposed by Mr. REID TION OF MEDICAID PROVIDER TAX (for himself, Mr. BAUCUS, Mr. DODD, and Mr. PROVISIONS TO CERTAIN MANAGED ness, with Senators permitted to speak HARKIN) to the bill H.R. 3590, supra. CARE ORGANIZATIONS. therein for up to 10 minutes each. SA 2943. Mr. CARPER (for himself and Mr. Effective as if included in the enactment of The PRESIDING OFFICER. Without CONRAD) submitted an amendment intended the Deficit Reduction Act of 2005 (Public objection, it is so ordered. to be proposed to amendment SA 2786 pro- Law 109–171), section 6051(b)(2)(A) of that Act posed by Mr. REID (for himself, Mr. BAUCUS, of 2005 42 U.S.C. 1396b note) is amended by f Mr. DODD, and Mr. HARKIN) to the bill H.R. striking ‘‘2009’’ and inserting ‘‘2011’’. ADDITIONAL COSPONSORS 3590, supra; which was ordered to lie on the table. SA 2941. Mr. SPECTER (for himself, S. 1389 SA 2944. Mrs. BOXER submitted an amend- Mr. WYDEN, and Mr. CASEY) submitted At the request of Mr. NELSON of Ne- ment intended to be proposed to amendment an amendment intended to be proposed braska, the name of the Senator from SA 2786 proposed by Mr. REID (for himself, to amendment SA 2786 proposed by Mr. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to Arkansas (Mr. PRYOR) was added as a REID (for himself, Mr. BAUCUS, Mr. cosponsor of S. 1389, a bill to clarify the bill H.R. 3590, supra; which was ordered to lie on the table. DODD, and Mr. HARKIN) to the bill H.R. the exemption for certain annuity con- SA 2945. Mrs. BOXER submitted an amend- 3590, to amend the Internal Revenue tracts and insurance policies from Fed- ment intended to be proposed to amendment Code of 1986 to modify the first-time eral regulation under the Securities SA 2786 proposed by Mr. REID (for himself, homebuyers credit in the case of mem- Act of 1933. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to bers of the Armed Forces and certain AMENDMENT NO. 2884 the bill H.R. 3590, supra; which was ordered other Federal employees, and for other to lie on the table. At the request of Ms. STABENOW, the SA 2946. Mr. CASEY submitted an amend- purposes; which was ordered to lie on name of the Senator from Minnesota ment intended to be proposed to amendment the table; as follows: (Mr. FRANKEN) was added as a cospon- SA 2786 proposed by Mr. REID (for himself, On page 857, strike lines 5 through 25 and sor of amendment No. 2884 intended to Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to insert the following: be proposed to H.R. 3590, a bill to the bill H.R. 3590, supra; which was ordered (a) IN GENERAL.—Section 1834(a)(7)(A)(iii) amend the Internal Revenue Code of to lie on the table. of the Social Security Act (42 U.S.C. 1986 to modify the first-time home- SA 2947. Ms. KLOBUCHAR submitted an 1395m(a)(7)(A)(iii)) is amended— amendment intended to be proposed to (1) by inserting ‘‘complex rehabilitative buyers credit in the case of members of amendment SA 2786 proposed by Mr. REID power-driven wheelchair and any other’’ the Armed Forces and certain other (for himself, Mr. BAUCUS, Mr. DODD, and Mr. after ‘‘in the case of a’’ and Federal employees, and for other pur- HARKIN) to the bill H.R. 3590, supra; which (2) by adding at the end the following: ‘‘In poses. was ordered to lie on the table. the case of a power-driven wheelchair that is

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