Mr. President, I thank the chairman of the Senate Finance Committee for his courtesy. I appreciate the opportunity to be here. I understand, Mr. President, I have a certain allotment of time. If I can be notified when I have 2 minutes…
Mr. President, I thank the chairman of the Senate Finance Committee for his courtesy. I appreciate the opportunity to be here.
I understand, Mr. President, I have a certain allotment of time. If I can be notified when I have 2 minutes remaining, I would appreciate that.
OK. If I can be notified when I have spoken for 20 minutes.
Mr. President, I rise today to talk about this health care bill. I have spoken about it before. I feel obligated on behalf of my State of Florida to explain why I, unfortunately, will not be able to support this bill on final passage. I think, in doing so, it is important to talk about why we are here and how we got here.
I am sure the American people think that in this process of debating health care over the past weeks and months, this has been a process where both sides, Republicans and Democrats, have worked together, sat in an open room and gave ideas back and forth; that there has been give-and-take and compromise so that we could come to the plan that is before us today. I am sure the American people believe that amendments were offered, that each Senator could come to the floor and offer amendments and that his and her colleagues were allowed to hear about those amendments and vote them up or down. I also believe the American people think we do not just come to this Chamber and give monologs. They probably think this room is not empty and that there are just two of my distinguished colleagues here but that we all sit here and listen to each others' arguments and decide what is best for the American people.
Unfortunately, that is not the case with this bill. This bill was designed and crafted by the Democratic leadership, without the input of the colleagues from this side of the aisle. There was no give-and-take. There was no back-and-forth in a conference room with C-SPAN in the room, as the President told us he would ensure when he ran for the Office of the Presidency. And we did not have the opportunity to offer amendments to make this bill better.
I know that seems hard to believe, that we would not have the ability to offer amendments to make this bill better, but I can prove it to you.
I have an amendment at the desk. It is amendment No. 3225. What this amendment does is it takes a piece of legislation I filed shortly after coming to the Senate in September of this year--the legislation is called the Prevent Health Care Fraud Act of 2009. This legislation has 11 cosponsors. It has bipartisan support.
What the bill does is basically three things:
First, it creates the chief health care fraud prevention officer of the United States. It would be the No. 2 person at Health and Human Services. Their only job would be to ferret out health care fraud.
Second, it would use and take a page from the private sector to go after fraud. There is an industry out there right now that does an excellent job of stopping fraud. That industry is about the same size as the health care industry. It is the credit card business. It is about a $2 trillion business. Health care is about a $2 trillion business. In health care and in Medicare alone, estimates are that $1 out of every $7 in Medicare is fraud. In the credit card business, it is pennies on the hundreds of dollars.
How does the credit card business do it? We have all had this experience. You go to purchase something in a store, and when you leave, you get an e-mail or a phone call and your credit card company says to you: Did you really mean to purchase that good or service? Guess what. If you say no, they don't pay. The way we do things in Medicare and Medicaid is we do pay-and-chase. We pay, and then when we think there is fraud, we try to go after it.
This model stops the fraud before it starts. A group here in Washington, DC, has evaluated this legislation and says that it might save as much as $20 billion a year in Medicare alone. We think there is $60 billion in fraud in Medicare--$1 out of every $7.
This proposal that we put forward also would require background checks for every health care provider in America to make sure they are not a criminal. Florida, my State, unfortunately is ground zero for health care fraud. We have the worst health care fraud in America. Just this past weekend, and I sent this letter around to my colleagues--a $61 million Medicare fraud scheme out of Florida and some other States.
My bill, this proposal which has bipartisan support, could save $20 billion a year. We have fashioned this bill into an amendment to this health care bill.
Mr. President, I ask unanimous consent that the pending amendment be set aside to call up my amendment. It is amendment No. 3225.
Mr. President, I thank the distinguished chairman of the Finance Committee. Sure, there are things in this bill that he pointed out to go after fraud. But I would like to inform the Senate of a report that came out evaluating this new bill, the managers' amendment.
I have a table which evaluates how much will be saved from the waste, fraud, and abuse provisions which are in this bill. It is $.9 billion. The proposal that I have, one group--and, again, it is not the CBO--one group has said it might save $20 billion a year.
Putting aside our differences, I sure wish we could talk about my amendment today, I say to my colleague. I hope we can revisit it after this is over because we should be able to agree, and it does have bipartisan support. I wish we could amend the bill today. I hear the objection, and I will move on. I hope we can talk about this.
I thank the chairman. I wish we could do it before we had to rush to judgment on this bill. I wish we had more time. I wish we did not have to be backed up against a wall before Christmas. I understand colleagues on the other side have a desire to get this bill done. But it is my concern with this measure and with the other measures in the bill that we could have worked together.
Mr. President, I say to the chairman, I am new to the Chamber. But this is not the way businesses work. It is not the way American families work. It is not the way even State legislators work, which I have experience with in Florida.
I wish we could have talked about that amendment and offered it. I wish my colleagues were here to debate it up or down. Let's talk about where we are instead. Let's talk about what this bill does and why I cannot, unfortunately, support it as a Senator from Florida.
We know this bill cuts Medicare by nearly $\1/2\ trillion. We know this bill raises taxes by nearly $\1/2\ trillion. And we know it does not accomplish the fundamental goal the President put forward when we embarked on this debate about health care reform.
The American people are beginning to realize and if they have not realized yet will be shocked to hear that this bill is not going to cut the cost of health care for people who have insurance already. That is the very reason this debate was embarked upon, not just access for people who do not have health care insurance but to bring the costs down. Health care has gone up 130 percent in the past 10 years. This bill will not address that. In fact, estimates show that for some folks, the cost of health care will go up.
There are basically five reasons why I cannot support this measure as a Senator from Florida.
I am concerned, first of all, about access and quality of care for our seniors. When you take $\1/2\ trillion out of Medicare, my fear is that it is going to diminish the quality of care for seniors in Florida.
It is said on the other side that we are not going to take away benefits, that we are just going to take money away from providers. It was said on the other side that the new insurance will take care of uncompensated care, so that the cuts to hospitals and to other providers will not really hurt seniors in the end. I think that is a tremendously risky experiment.
I cannot believe, at the end of the day, when we pay providers less, it is not going to affect benefits. Right now, studies show that 24 percent of seniors on Medicare trying to find primary care physicians cannot find one. I get letters from seniors in Florida who say they cannot find a doctor who will take their Medicare. We know in Medicaid it is worse. We know in Medicaid that if you are just going into the program and trying to find a physician, almost 40 percent of the physicians will not take you. In metropolitan areas for specialists, it is up to 50 percent who will not take Medicaid.
I fear that if we take nearly $\1/2\ trillion out of a program that is already in financial trouble, a program that in the next 7 years is going to be in serious financial trouble and not be able to
meet its obligations, that it is going to hurt seniors.
I have heard this discussion about how we are prolonging the life of Medicare. The distinguished chairman just spoke about it. But when you look at what the Actuary at HHS has said about that assumption, the assumption is that we are not going to restore the 21-percent decrease in physician payments which, of course, as soon as we get back in the new year, we are going to have before us.
You cannot take money out of Medicare and pay for a new program and shore up Medicare. You do not need an actuary or an evaluation or an analyst to tell you that. It is common sense. You cannot get blood from a stone. If the doctor is not in, it is not health care reform.
I have received a letter, as many of my colleagues have, from an organization called 60 Plus which represents 5.5 million seniors. James Martin, the president of 60 Plus, writes:
Cutting half a trillion dollars from Medicare while adding
31 million more to the health care rolls is an outrage.
60 Plus strongly supports health care reform but first we
should do no harm to a system serving so many so well. . . .
Make incremental changes that do not bankrupt a system
already teetering on insolvency.
I want to talk a minute about Medicare Advantage. There are more Floridians in Medicare Advantage than any other State. A lot has been said about this program. We have had amendments to try to stop the cuts. Mr. President, 950,000 Floridians--Medicare Advantage is a great program, and people in Florida enjoy it. Seniors enjoy it because they get more than regular care; they get eye care, hearing care, wellness, diabetic supplies, and other things that add to the quality of life of seniors and help their entire health care. These Medicare Advantage providers are actually working hard to make sure their senior customers are happy, not a concept you hear a lot about when the government is in charge.
There is a fix for Florida, as has been talked about, but I wish to talk about what that fix is, as I understand it. It is an off-ramp. For the rest of the country, it is going to be somewhat of an exit. For Florida, it is an off-ramp.
First of all, we don't know what will happen in conference. The Senate cuts $120 billion; the House cuts $170 billion. I don't know if the Florida fix will still be there. But in talking to experts and reading the bill myself--specifically around page 895 through about 901 of the original Reid bill--there is this grandfathering in for folks in Florida, and other areas, but part of Florida is covered. Of the 950,000 people, the experts think 150,000 to maybe as many as 250,000 will not get this grandfathering in. They are going to get the cuts to Medicare Advantage. So this is not good for them. Then, for the others, say, 700,000 people or so, every year, starting in 2013, their benefits--or the payments to the providers for benefits--are going to decline 5 percent a year. That is on pages 895 through 897. So it is an off-ramp. Every year, less payments. Every year, less benefits.
I talked to one provider down in Miami that many Senators in this Chamber have visited. He runs a very successful Medicare Advantage Program. He said these cuts would be devastating. So while it might not be an exit for Florida right away, it is certainly going to be an off- ramp that one day ends up being an exit.
Let's remember that many of the folks on the other side of the aisle who are proposing these cuts to Medicare Advantage didn't vote for Medicare Advantage to start with. They don't like it. They don't like the private sector being involved. They don't like these extra benefits being provided. It goes against what they philosophically believe. But I know Floridians like it. Because this bill cuts it, I can't be for it. No one can guarantee to me that in the next 10 years Medicare Advantage in Florida will be as robust as it is today.
I am concerned also about the home health care payments. I am concerned about what it is going to do to the small business home health care providers in Florida. I talked to the largest provider of home health care services in Florida, and he said: We will be fine, but the small businesses--the mom and pops who do this--will go out of business. That is disconcerting in a State with 11\1/2\ percent unemployment.
The second reason I can't support this bill is this is going to have a devastating effect on our State budget in Florida. We talked today to the head of the Florida health care system, the Agency for Health Care Administration, and these increases in Medicaid, raising Medicaid from 100 percent of poverty to 133 percent, are going to cost Florida an estimated $3\1/2\ billion over the next 10 years. That is $3\1/2\ billion Florida can't afford to pay.
Our budget has gone from $73 billion to $66 billion in a short period of time with the economic decline. Unlike this Chamber, which spends money it doesn't have, Florida has to balance its budget. So what happens when you have less money? You have to cut programs. But when you have a Federal mandate, you can't cut that. So what do you cut? You cut education and teachers. You cut law enforcement--not good for Florida. This is a burden Florida can't afford to pay. That is why all the Governors in the country--virtually Republican and Democratic alike--including our Governor, Charlie Crist, are against this unfunded mandate.
The third reason I can't support this bill is because it raises taxes--$518 billion. What happens when the drug company that makes your medicine or the medical device company that makes the lifesaving implement for you gets taxed? They are going to pass it along to you. They are going to put it right in the bill. That is the way it is going to work. That is why health care costs aren't going down for the 170 million Americans who have health insurance. In fact, for some, they are going to go up. That is not health care reform.
Fourth, this is a budget-busting bill. It is not deficit neutral. Let me explain why. You will hear reports this is going to cut more than $100 billion from the deficit over the next 10 years. Only in Washington, DC, could you come to this calculation. It is funny math. We have this Congressional Budget Office, which is sort of the arbiter of all things financial here in Washington. You send them a proposal and they give you an answer. But it is not a thinking answer; it is an analytical answer, and it gets gamed. What you send them determines what you get back. They only look at a 10-year period--what it is going to cost in the next 10 years. If you bring in more money than you spend in the next 10 years, then it will cut the budget. It will cut the deficit. That is what they say back to you.
So what was done in this bill in order to get something that would fulfill the President's promise to be a budget cut or at least deficit neutral? We have 10 years of taxes and 6 years of benefits. Most of the benefits don't start until 2014, yet the taxes start in 2 weeks--in January. That is akin to you going to buy a home and saying: I am going to live here for 10 years, and they say: That is great, start paying today and you can move in in 2014.
It is funny math. This is a $2.5 trillion new entitlement program we can't afford. We can't afford the programs we have, let alone the programs the majority in this Chamber want. We have a $12 trillion deficit. We have $30-some trillion in unfunded entitlement deficit. We have hundreds of thousands of dollars of debt for every family in America, and no plan to pay for it. We spend more than we take in. We spent $1.4 trillion--we have a $1.4 trillion deficit this year--just the debt this year. That is more than the past 4 years combined.
The American people are on to this and they are angry about it and they should be.
Fifth and finally, the reason I can't support this bill is it doesn't lower the cost of health insurance for Americans.
The Congressional Budget Office has said the majority of Americans would see the same increases as they currently get under the current system. For some people, individual policies, for example, they will receive a 10- to 13-percent increase.
I am going to conclude by saying this, and this will probably be the final time I will speak before we have final passage on this bill. I long for what could have been. We could have worked together. We could have had an 80-vote bill. We could have had a bill that would say insurance companies can't drop you if you are sick, insurance
companies can't deny you if you have a preexisting condition, insurance companies can compete across State lines, set up an exchange, give a tax credit to the American people, put money in their pocket, let them be consumers who go out and buy health insurance and drive the cost down because the market economy would, once again, work in health care.
This bill doesn't solve the problem. It perpetuates it and makes it worse. At the same time, it cuts health care for seniors and doesn't lower the cost of health insurance for most Americans. For more and more seniors, the doctor will not be in. That is not reform. For those reasons, respectfully, for that lost opportunity, I will not be able to support this bill.
I yield the remainder of my time to my friend and colleague from Alaska.