Floor Statements

Before the Senator leaves, I wish to put one fine point on something the Senator said in response to the question from the Senator from Pennsylvania about the use of Medicaid funds in the States.

There are a number of States that do provide programs that have abortion funding, but I think there is a very clear distinction that needs to be made in Medicaid funds which are matching funds, and none of those funds can be used to fund abortions. You said that in response to his question, but I think that point needs to be made very clearly because the Senator from Pennsylvania was implying that somehow, since States have created programs to fund abortions and since Medicaid is a Federal and State program, that somehow those two are being mixed, and that this idea that because they are calling for ``segregation,'' that really doesn't exist in the Medicaid Program.

The Medicaid Program--those are matching funds--is a Federal-State program. The Federal dollars that go into the Medicaid Program--the prohibition that exists on Federal funding of abortions applies to Medicaid dollars that go to the States, to the degree that States have adopted programs that fund abortion. Those are State funds and not Medicaid funds, which are matching funds.

If the Senator will yield----

That is what Stupak and other Members of the House of Representatives saw; that this created

tremendous ambiguity and they sought to tighten it up and reinstate the longstanding policy regarding Federal funds and their use to finance abortions since 1977, the Hyde language. The Stupak amendment to the House bill passed with 240 votes. There was a sizable, decisive majority of Members in the House of Representatives who saw through what the ambiguity was that exists regarding the House bill and now the Senate bill.

This is intentionally ambiguous for the reasons you mentioned. This simply clarifies, once and for all, what has been standard policy at the Federal level going back to 1977. As the Senator stated earlier, I believe it represents the consensus view in America of both Republicans and Democrats who believe this is ground we can all stand on, irrespective of where people come down on this issue; that the idea that somehow Federal taxpayer funds ought to finance abortions is something most Americans disagree with. That is why there has been such broad, bipartisan support for this particular policy, and that is why it should be extended into the future.

As the Senator from Utah said, 61 percent are against funding abortions. But I have seen polls that suggest it is much higher than that. I know it is much higher in my State of South Dakota. I commend the Senator for seeing his way to offer an amendment that clarifies and removes all this ambiguity and what, to me, is clearly an intentional ambiguity regarding this issue and the underlying bill.

Will the Senator yield for a question?

It strikes me that the Senator's amendment is very straightforward, very simple, and very clear; that is, any savings that come out of the Medicare Program cannot be used to fund a new entitlement program.

Correct. And it seems to me, at least, that the amendment gets at what some on the other side have argued, with their amendments, they are trying to accomplish.

Could the Senator from New Hampshire describe how the effect, the legal effect, of his amendment differs from, say, for example, the votes we have had, where it was a 100-to-0 vote the other day on a Bennet amendment, what the impact the amendment of the Senator from New Hampshire would be relative to some of the previous votes we have had, which it appears to me, at least, were completely meaningless, sort of cover votes, to try and give people on the other side the opportunity to say: We voted to protect Medicare, when, in fact, they did not?

How is the amendment of the Senator from New Hampshire distinguished from those that have been voted on previously?

So if a Senator on either side of the aisle, a Republican on this side or a Democrat, was serious about protecting Medicare, ensuring that Medicare's solvency is protected and that these funds are not going to be reallocated to create some new entitlement program or spend money on some new, clearly, $2\1/2\ trillion expansion of government, which we know is going to require enormous amounts of revenue which seems to me has to come from somewhere--what the Senator's amendment would do is simply force the other side to put up or shut up with regard to this argument they have, which is that they are, in fact, supporting Medicare; the Senator's amendment would essentially say, very clearly, in a very straightforward way, that funds that come in out of savings from Medicare have to be retained in the Medicare account.

The Senator from Wyoming is correct. This is where the real rub in this bill comes into play because what we were told and the promises that were made--of course, many promises were made throughout the course of the campaign, many of which will never be realized with this legislation. There was also a promise made that taxes wouldn't go up for people making less than $250,000 a year--not payroll taxes, not income taxes, not any kind of taxes. In fact, we now know that 38 percent of the people who make under $200,000 a year are going to see their taxes go up under this legislation. So promises made during a campaign season tend not to necessarily be adhered to when it comes time to legislate and actually follow through, and I think that is clearly the case here.

With regard to the question of the Senator from Wyoming, the whole purpose of health care reform, at least as I understand it--and I think, for the most part, as the people of South Dakota whom I represent understand it--is to lower cost. Because everybody complains--the thing you hear the most when you go home--and the Senator from Georgia is here. If you go to Georgia, Wyoming, South Dakota, I think the sentiment you hear most frequently from people in our States is: Do something about the cost of health care. We have these year-over-year, double-digit increases or increases that are twice the rate of inflation, and we are dealing with this. Small businesses are dealing with it. More and more people--families are struggling with the high cost of health care. Nobody argues that. We all, basically, accept the premise that health care costs have been going up and health care reform ought to be focused directly on trying to get those costs under control.

The irony in all this is, after cutting $\1/2\ trillion from Medicare in the first 10 years, and if you go into the fully implemented time period it is about $1 trillion, and $\1/2\ trillion in tax increases, what happens with premiums? Well, according to the Congressional Budget Office, 90 percent of Americans would be the same or worse off. In other words, 90 percent of Americans would see no improvement in their health insurance premiums. In fact, if you buy in a small group market, if you buy in a large group market, your premiums go up by about 6 percent a year, year over year. In fact, a family of four--let's put it in a perspective that an American family can understand. If you are a family of four--this is according to the Congressional Budget Office-- that is paying $13,900 for insurance this year and you are getting your insurance in a large group market because you work for a large employer, in 2016, your insurance cost is going to be over $20,000 a year. In other words, your insurance is going to go up about--a little under $14,000 to over $20,000 a year in that time period.

So what American in their right mind is going to say that is reform? I think most Americans are going to say: What are you doing? You are spending $2.5 trillion, you are raising my taxes, and cutting my parents' or my grandparents' Medicare benefits, for what? So my premiums can stay the same or go up? If you buy your insurance in the individual marketplace, your insurance premiums, according, again, to the Congressional Budget Office, are going to go up anywhere from 10 to 13 percent a year. So you get Medicare cuts, you get tax increases, and for 90 percent of Americans, you stay the same or are worse off. In other words, your insurance premiums are now going to be impacted, you have achieved the status quo or, worse yet, your insurance premiums are going to go up 10 to 13 percent if you are buying in the individual market. That is according to the Congressional Budget Office.

So I would say to my friend from Wyoming, the point he made is exactly right. In doing all this, the exercise ought to be about reducing costs. Clearly, that is not the case with this legislation.

If the Senator will yield, the Senator, of course, is one of only two physicians in the Senate and has great experience and great depth on this issue and knows what it is like to serve and provide health care services to people in rural areas, such Wyoming and South Dakota and some areas of Georgia.

I think it is interesting too--and the Senator from Georgia was here, as was I; I don't think the Senator from Wyoming was here at the time. But in 2005, we had a debate about Medicare, and the Senator from New Hampshire proposed cutting $10 billion in Medicare, taking $10 billion over a 5-year period or about $2 billion a year, and paid for it by income testing the Part D benefit that people got. In other words, the premiums that are paid, those who are in the higher income categories would have to pay a higher premium for their Part B drug benefit than would those in lower income categories. You would have thought that the apocalyptic pronouncements and predictions around here about what that was going to do for Medicare: $2 billion a year or $10 billion over 5 and you heard the other side describe it as immoral, it was cruel, it was a disaster of monumental proportions. That was some of the terminology that was used around here at the time. That was for $10 billion over 5 years, and that basically was to say to people who have higher incomes, the Warren Buffetts of the world ought to pay a little bit more for their prescription drug benefit under Medicare than those in lower income categories, and people on the other side went nuts about that.

Now here we are talking about cutting $465 billion over a 10-year period, $1 trillion over 10 years, when it is fully implemented, and it seems to me, I would say to my colleagues, the other side is going to have a lot of explaining to do to the American people about why $10 billion in reductions was immoral, cruel, and a disaster of monumental proportions, but cutting $\1/2\ trillion out of home health care and nursing homes and hospitals and everything else to pay for an entirely new entitlement program, a $2.5 trillion expansion, somehow makes sense.

I think the reason we are here today is that the Ensign and Gregg amendments strike at the very crux and the very core and the very heart of what this is all about. The Democratic majority was unwilling to take on the trial lawyers, unwilling to do things that actually bend the cost curve down, such as capping contingency fees, and so now we are faced with voting on the Ensign amendment, which would do that, but we are also voting on the Gregg amendment because they weren't willing to put actual measures in this bill that would bend the cost curve down. What they have had to resort to is cutting Medicare to pay for it. A $2.5 trillion expansion of the Federal Government has to be financed somehow, because there aren't any real cost-saving measures in here.

I point out to my colleagues that in spite of all that, this is where we are. The Congressional Budget Office says that even with the all of the Medicare cuts and all the tax increases that are in here, we actually still increase spending in this country on health care. The cost curve goes up. The blue line on this chart represents the existing cost curve if nothing is done. If we did nothing today, that is what would happen. That is the blue line. The red line represents what happens under this bill. We actually raise the cost

curve even more. Costs for health care in this country under this legislation go up $160 billion.

How does that affect the individual family? I want to show you exactly what this means in terms that I think most Americans can understand. This is the example of a family of four who today is paying $13,000, a little over $13,000 for their health insurance. Under this bill, their life doesn't get any better. In the year 2016, they are going to be paying over $20,000 a year in health insurance. So what happens is they have locked in the status quo. And that status quo is year over year increases, double the rate of inflation, all because they were unwilling to put measures in this bill that actually do control costs.

If we did something along the lines of the Ensign amendment, that actually would get these contingency fees under control. We all have seen the statistics. The CBO has said that would bend the cost curve down.

We have all talked to physicians in our own States. I talked last week to a physician from my State who, unsolicited, said that 50 percent of the tests he does are to avoid being sued. Fifty percent of the tests he conducts are due to defensive medicine. That drives the cost of health care up for everybody. That is why the Ensign amendment is so important.

Unfortunately, why we have to vote on the Gregg amendment is because the Gregg amendment forces the Democrats to put their money where their mouth is and to see if they mean what they say--that they want all these savings in Medicare to go into Medicare. We all know that is not true. To pay for a $2.5 trillion expansion of the Federal Government and create an entirely new entitlement, you have to take the cuts from Medicare and put them into this new entitlement program.

So we are voting on a couple of amendments today that will ensure seniors in this country are not going to be faced with cuts to their benefits--home health care, nursing homes, hospitals, all those that receive cuts in this bill--and actually try to substitute something in there that would get costs under control, and would--according to the CBO--drive the cost curve down; would do something about this year over year double the rate of inflation that the average American family is seeing.

This is what the CBO said would happen to the average American family of four if this bill passes. Today they are paying $13,000 a year--a family of four--and in the year 2016, they will be paying $20,000 a year. Tell me, how is that reform? How can anybody go to an average American family with a straight face and say they are reforming health care when all they are doing is locking in permanently year-over-year increases that are double the rate of inflation, and in some cases even going up beyond that if you have to buy your insurance in the individual market?

I am glad the Senator from Nevada has offered this amendment. I am anxious to see how the other side votes on the amendment the Senator from New Hampshire has offered which would guarantee these Medicare savings would go back into Medicare and not be used to pay for a new government entitlement program at a cost of $2.5 trillion to the American taxpayer.

Will the Senator yield?

Madam President, this is a great discussion. I have to say the fundamental point in this discussion should not be lost on anybody in this Chamber or on the American people; that is, whatever was said during the course of the campaign last year was said in the context of protecting and preserving and prolonging the lifespan of Medicare.

Senator McCain is very accurate in the way he describes his position. But the American people need to understand what the other side is proposing: a $2.5 trillion expansion of the Federal Government, financed with $\1/2\ trillion in Medicare cuts in the first 10 years and, as the Senator from New Hampshire said, $3 trillion in the first two decades of this program--which does nothing to extend the lifespan of Medicare by 1 day, nothing. What it does is it creates an entirely new entitlement program that is going to be paid for by future generations of Americans.

So Medicare, which is destined to be bankrupt by 2017--is sitting out there floundering with this huge unfunded liability. It is going bankrupt. What we are talking about doing is piling a $2.5 trillion new entitlement program on top of that. That is what this debate is about.

They can say these Medicare cuts are not real. But we have 11 million people in this country who get Medicare Advantage benefits, and if there is going

to be $118 billion cut, somebody is going to feel some pain. Surely, you jest when you say these cuts are not going to hurt anybody. Hospitals, home health agencies--$15 billion out of nursing homes.

In the State of South Dakota, home health care agencies, like they do in Montana, provide services to people in rural areas. Some home care specialists have to travel 50 or 60 miles to serve a patient in their home. What we are talking about doing is cutting, in my State, $35 million out of home health care. These cuts are $\1/2\ trillion. Of course, somebody gets hurt by that.

But what is probably most troubling of all, I guess, about the whole proposal the other side has made is, after all that--cutting Medicare, raising taxes--at the end of the day 90 percent of the people in this country either have their health insurance premiums stay the same or go up--over 6 percent if you are in the small-employer market, 5 percent if you are in the large- employer market--double the rate of inflation. That does not change anything.

If you are a family today, and you are paying $13,000 for health care insurance--this is according to the Congressional Budget Office--in 2016 you will be paying over $20,000 a year for health insurance. That is a $7,000 increase. Now, tell me how that reforms or helps anybody in this country?

I want to show you how far we have come because the President said, in 2007, when he was campaigning: When I become President, we will have a health care reform bill that reduces premiums for people in this country by $2,500 per family and covers everybody. We all know this bill leaves 24 million people uncovered, according to the Congressional Budget Office. It raises premiums by 10 to 13 percent for everybody who buys in the individual marketplace. It keeps them the same--and when I say ``the same,'' there will be yearly increases of 5 to 6 percent year over year for this foreseeable future--for everybody else.

The best you can hope for, America--90 percent of America--is the status quo. That is the best you can hope for under this bill. How does that change the status quo? How is that reform? You can call this an overhaul. You can call this a takeover. You can call it lots of things. But it is not reform because when the American people think about reform, they are thinking about something that drives their health care costs down not up.

The Congressional Budget Office has said that under this bill, health care costs in this country will go up by $160 billion over the first 10 years, not down. If you are 90 percent of Americans, you stay the same or your premiums--at worst--go up by 10 to 13 percent. That is according to the Congressional Budget Office.

So I want to point out how far this debate has evolved from what the goals were in the first place. I have some comments some of my colleagues have made. Senator Stabenow said:

High health care costs are causing cuts in benefits and

increases in premiums, adding to the ranks of the uninsured

at alarming rates. But the impact of this problem goes beyond

individual families. Skyrocketing health care costs make our

businesses less competitive in the global marketplace and

cost us good-paying jobs.

This is about jobs, and this proposal does nothing to help small businesses create jobs. It kills jobs. That is why the National Federation of Independent Business, the Chamber of Commerce, the National Association of Wholesalers and Distributors--all the major business organizations--are opposed to this legislation. They know the impact it will have on jobs.

I want to read one final quote. This does not come from a business organization. This comes from the dean of the Harvard Medical School. This was in an op-ed just recently in the Wall Street Journal:

Speeches and news reports can lead you to believe that

proposed congressional legislation would tackle the problems

of cost, access and quality. But that's not true. . . . So

the overall effort will fail to qualify as reform.

In discussions with dozens of health-care leaders and

economists, I find near unanimity of opinion that, whatever

its shape, the final legislation that will emerge from

Congress will markedly accelerate national health-care

spending rather than restrain it.

That is from the dean of the Harvard Medical School. He goes on to say:

This will make an eventual solution even more difficult.

So these Medicare cuts are real. They are $\1/2\ trillion in the first 10 years. As the Senator from New Hampshire has said, $3 trillion over the first two decades. It cuts Medicare Advantage. There are 11 million seniors in this country who get Medicare Advantage. So do not say they are not going to get hurt. Their benefits are going to go down. Of course they are going to get hurt.

Home health agencies, nursing homes, hospices--as I said, in my State of South Dakota, home health care delivery will feel an impact of $35 million in an area of the country where we have vast distances in geography and where we already have home health agencies closing up shop because the reimbursements do not keep up with the costs, particularly when you have to travel the distances we have to in our States. If you have to put them in the hospital, the costs go up by multiples. It is so much more efficient to have somebody served in a home health setting rather than have them stay overnight in a hospital or staying successive nights in a hospital.

So this is not reform. This actually keeps costs the same or drives them up for 90 percent of Americans. It does nothing to preserve the lifespan----

I yield the floor.

Mr. President, I would like to call up amendment No. 2901 and ask for its immediate consideration.

Mr. President, I want to speak to the amendment that we just filed at the desk. This amendment is very straightforward and very simple. It does what a number of my colleagues on the other side have asked to do, and that is to strike the CLASS Act from the underlying health care reform bill that is being debated on the floor of the Senate right now.

I want to read some excerpts from a letter that seven Democratic Senators, including the chairman of the Senate Budget Committee, Senator Conrad, put together asking that this CLASS Act not be included as part of this legislation.

Mr. President, I ask unanimous consent to have printed in the Record the letter from which I will be quoting.

Mr. President, the letter said:

We urge you not to include these provisions in the Senate's

merged bill, nor to use the savings as an offset for other

health items in the merger. While the goals of the CLASS Act

are laudable--finding a way to provide long term care

insurance to individuals--the effect of including this

legislation in the merged Senate bill would not be fiscally

responsible for several reasons.

The letter goes on to say:

[N]early all the savings result from the fact that the

initial payout of benefits wouldn't begin until 2016 even

though the program begins collecting premiums in 2011. It is

also clear that the legislation increases the deficit in

decades following the first 10 years.

They go on to say in this letter, Mr. President:

We have grave concerns that the real effect of the

provisions would be to create a new Federal entitlement

program with large, long-term spending increases that far

exceed revenues. This is especially the case if savings from

the first decade of the program are spent on other health

reform priorities.

That, Mr. President, is a letter that was signed by the chairman of the Senate Budget Committee, Senator Conrad of North Dakota, Senator Lieberman, Senator Landrieu, Senator Lincoln, Senator Warner, Senator Nelson, and Senator Bayh. Seven Democratic Senators have gone on the record saying the CLASS Act shouldn't be included in this legislation because it is not fiscally responsible.

The fact is, the chairman of the Senate Budget Committee, Senator Conrad, has described this as a Ponzi scheme of the first order-- something that Bernie Madoff would be proud of.

Now, I have heard my colleagues get up and talk about how solvent this is and what a great program this is. Well, there are programs out there that are available for people to buy long-term care insurance. The problem with this one is that it takes all the money that comes in in the early years and spends it on other government programs--in this case health care reform--but who knows what other government programs are going to be created that will use the revenues that come in from this plan that supposedly a lot of people are going to sign up for, and CBO says it is going to be fewer than 4 percent that will sign up.

In fact, no senior today is going to benefit from it because you have to work for 5 years. If you are a senior who is retired, you will not see any benefit. This doesn't impact seniors, contrary to the assertion of some of my colleagues on the other side. It will impact future generations of Americans who are going to be stuck with the deficits and the debt that gets piled on them because of the outyears when this liability is incurred as people start getting paid out, from having paid in, and there is no money there. It is the classic definition of a Ponzi scheme: The money comes in today, it gets spent on other things, and then someday, when the liability comes in and people start saying: I paid into this program, and I should get some benefit, there will be no money there. So we will borrow for it or tax for it or something else.

They say, well, it is actuarially solvent over 75 years. Well, maybe, because you are running surpluses in the early years. But in the later years, you are running huge deficits. In the early years the surpluses are being spent. They are not being put into paying benefits for this program, when those benefits start being demanded by the people who have participated in the program.

Just look at what others have said about this program, Mr. President. I have quoted for you what the chairman of the Budget Committee, Senator Conrad, said with regard to this program; that it is a Ponzi scheme of the first order, and that is being echoed by others. But this is what the administration's chief health actuary said about the CLASS Act. He said it would result ``in a net Federal cost in the longer term.'' The chief actuary also determined the program faces ``a significant risk of failure'' because the high cost will attract sicker people and lead to low participation.

The Congressional Budget Office agreed, saying:

The CLASS program included in the bill would generate net

receipts for the program in the initial years when total

premiums would exceed total benefit payments, but it would

eventually lead to net outlays when benefits exceed premiums.

. . . In the decade following 2029, the CLASS program would

begin to increase budget deficits.

This particular quote could come as a bit of a surprise because this comes not from the CBO or the CMS actuary, but it comes from the Washington Post. The Washington Post called the CLASS Act a ``gimmick'' ``designed to pretend that health care is fully paid for.'' The Post goes on to say:

[T]he money that flows in during the 10 year budget window

will flow back out again. These are not ``savings'' that can

honestly be counted on the balance sheet of reform.

Even the Washington Post recognizes this for what it is. It is a sham. This is a budget gimmick, Mr. President, that is designed to obscure the cost of this program by generating surpluses in the early years. It is supposed to generate $72 billion in the first 10-year window, so that counts on the balance sheet of health care reform to make it look better. But this program is going to run deficits-- deficits as far the eye can see--once the chickens come home to roost. Who will pay the bill for that? Future generations of Americans.

Mr. President, this is not good policy. Certainly, if you look at programs we already have on the books, Medicare is destined to be bankrupt in the year 2017. We have big problems down the road--unfunded liabilities in Social Security. This would create a huge new liability down the road that would be unfunded because all the money that comes in during the early years is going to be spent. This is more of the same old business as usual in Washington, DC, that the American people are fed up with. We can make people happy today by saying we are creating this new program that makes the majority's health care reform bill look better because it obscures the real cost of this bill by rolling in these revenues in the early years. But there is a long-term impact, according to the CBO, according to the actuary at Health and Human Services, and according to a lot of our colleagues on the other side--the seven Democrats who signed the letter, including the chairman of the Budget Committee, who, as I said, has called this program a Ponzi scheme of the first order; something that would make Bernie Madoff proud.

I don't know how my colleagues on the other side, with a straight face, can come to the Senate floor and say this is a great program, that it is actuarially sound. Sure, it may be a benefit to a few people, but I have to tell you, somewhere down the road, when the chickens come home to roost, there is going to be a huge liability that is going to be facing future taxpayers, future generations of Americans, as we start to pile up more deficits and more debt as a result of this Ponzi scheme.

This is a sham, Mr. President. I hope my colleagues will support this amendment. It would strike the CLASS Act from the underlying bill, not allow those revenues to be assumed in paying for or understating the cost of this bill, and not pile mountains of debt onto future generations.

Mr. President, I reserve the remainder of my time.

Mr. President, the CLASS Act is the same old Washington, same old smoke and mirrors, same old games. I wish to read what the Congressional Budget Office and the chief actuary for the administration have said:

The program would add to future Federal budget deficits in

large and growing fashion.

If we don't take this out of this legislation, if we allow this to become law, we are locking in future generations to deficits and debt as far as the eye can see. This is, as has been described by the other side, a Ponzi scheme of the highest order. We need to take it out of this bill.

I urge my colleagues to adopt this amendment.

Mr. President, I ask for the yeas and nays.

Madam President, I appreciate the opportunity to speak on this important piece of legislation.

Again, I point out to my colleagues, and to anybody else who may be observing, the volume of this bill. This is 2,100 pages and 21 pounds, which means it is about a pound per 100 pages. It is $1.2 billion dollars per page, $6.8 million per word, and it creates 70 new government programs. It gives the Secretary of Health and Human Services--in 1,600 or 1,700 instances in this bill--the opportunity to create, define, and determine things in the bill.

This is a big government bill, a massive expansion of the Federal Government--$2.5 trillion, when it is fully implemented. Of course, the paid-fors in the bill--all the things in this bill, not only those intended things but also the unintended consequences of the bill--you have some revenue to pay for these things. Where do we get the revenue?

In the Reid bill, they decided they are going to raise taxes on small businesses, individuals and families and they are going to cut Medicare by about $\1/2\ trillion.

What is ironic about that is, a few years ago, the Republicans, back when we were in the leadership in the Senate, tried to do a budget bill that actually achieved some savings in Medicare and Medicaid, to the tune of $27 billion combined. But the Medicare savings in that bill was $10 billion. That was over a 5-year period, at $2 billion per year. I wish to remind some of my colleagues on the other side about some of the comments they made about that.

Senator Reid, at the time--bear in mind this was to reduce Medicare by $2 billion per year, $10 billion over 5 years. The now-majority leader said:

Unfortunately, the Republican budget is an immoral

document.

The Senator from West Virginia said this:

This proposed budget would be a moral disaster of

monumental proportions.

A couple other colleagues in the Senate commented. The Senator from Michigan said:

People who rely on Medicare and Medicaid are going to be

hurt by this bill.

The Senator from Wisconsin said:

I urge my colleagues to reject this bill, and the

irresponsible and cruel budget of which it is part.

The former Senator from New York, Mrs. Clinton, said this:

This bill slashes $6.4 billion from Medicare over the next

5 years.

It was actually $10 billion. My point is simply this: It was $10 billion over 5 years, $2 billion per year. Those were the statements-- overstatements--about the impact that a $2 billion reduction per year in Medicare was going to have on people in this country. Now we are talking about $\1/2\ trillion in Medicare cuts.

Where do their cuts come from? They will come from $118 billion from Medicare Advantage, which now we have about 11 million Americans impacted by Medicare Advantage. Every State has seniors who have subscribed to that program whose benefits will be cut if this bill is enacted. You get it out of hospitals because there are $135 billion in reductions and reimbursements to hospitals; $15 billion in reductions to nursing homes and reimbursements; $40 billion in reductions to home health agencies; and $8 billion in reductions to hospices.

Those are all the ways this $2.5 trillion expansion of the Federal Government is to be paid for. I didn't even get into the tax cuts, which will be a debate for another day.

The Medicare cuts in this bill are unlike anything we have seen in the past.

Clearly, when you compare it to 3, 4 years ago, when we were trying to achieve $10 billion in savings over 5 years, you thought the sky was falling. Now here they are trying to pay for a $2.5 trillion expansion of the Federal Government by cutting $500 billion out of Medicare.

The point I also wish to make, because it has been made by the other side--by the most recent speaker--is that somehow this recent CBO analysis should be hailed as good news. The corks are popping in the celebration, and people are crowing about the new CBO report because it has such good news for this bill and the impact it will have on people who buy health insurance in this country.

What is it they are celebrating? CBO, in its report, essentially said this: 90 percent of Americans are going to see their premiums increase or see virtually the same increases as they do today year after year.

That is preserving the status quo, not decreasing costs, as promised. President Obama, when he was running for office in 2007, said when he got a chance to do health care reform, he was going to reduce costs by $2,500 for every family in this country and cover everybody.

This bill, after spending $2.5 trillion and creating 70 new government programs, doesn't cover everybody. There are still 24 million Americans who don't get covered under this bill, according to the CBO. Furthermore, nobody--I shouldn't say nobody--90 percent of Americans, those who don't get subsidies, don't come out any better. They will still see the year-over-year increases in premiums they have been seeing for the past several years, and the cost of health care is growing at twice the rate of inflation. If you assume a year-over-year increase similar to the past several years, in the small group market, you are looking at annual increases of over 6 percent for the cost of health care--to the point where a family that, today, is paying $13,000 a year for health insurance, in 2016, will pay over $20,000 a year for health insurance. So nobody gets any better out of this, except a handful of people who will get subsidies. If you are in the individual marketplace, your premiums go up. According to the CBO, there will be a 10- to 13-percent increase in premiums in the individual market. If you are in the large group market, you will see an almost 6-percent increase a year. If you are in the small group market, premiums will go up over 6 percent a year.

We are talking about spending $2.5 trillion, cutting reimbursements to nursing homes, to hospitals, to home health agencies and hospices, and raising taxes on health care providers, medical device manufacturers, prescription drugs, raising the Medicare payroll tax which, incidentally, doesn't go to preserve or extend the lifespan of Medicare or put it on a path toward sustainability but creates a whole new government entitlement.

We are going to do all that for what? At best, to keep the status quo for people today; at worst, to increase their premiums by 10 to 13 percent. That is the bottom line. That is what this says. That is the new CBO report. That is the CBO report about which the other side is saying this is great news. They are celebrating. It is great news that premiums are going to continue to go up at twice the rate of inflation, just like in the past, protecting and preserving the status quo as we know it in America today.

This bill does nothing about the fundamental issue of cost. It doesn't matter what market you are in--small group market, large group market--it stays the same, at best, and in the individual marketplace, your premiums will go up 10 to 13 percent. That is the news being hailed by the other side as validating the argument for why we need to pass a 2,100-page, $2.5 trillion monstrosity of a bill with 70 new government programs in it.

We will vote on the Medicare amendment later. Senator McCain has a motion to commit the bill to essentially take the Medicare cuts out of it. I hope my colleagues vote for it. They are arguing it doesn't cut Medicare. How can you say that with a straight face? How can you say you are going to find $500 billion to pay for this bill out of Medicare and then say it doesn't cut Medicare? Of course it cuts Medicare. Of course it raises taxes. You can't finance $2.5 trillion of new spending unless you find a way to finance it.

The way they have chosen to finance this is to hit seniors squarely between the eyes and cut reimbursements to the providers all across this country that are dealing with the serious health needs our senior citizens are experiencing. In South Dakota, we have a lot of people who are employed in the health care industry. I think that is true of every State. Even in small towns in South Dakota, in nursing home employment you are talking about almost 6,000 employees. You are going to take $15 billion out of nursing homes, $40 billion out of home health agencies, $135 billion out of hospitals, and what we are talking about are huge reductions in Medicare, unlike anything we have seen.

As I said, to put it into perspective, a few short years ago, when we were in the majority, in a budget trying to reduce Medicare by $10 billion over a 5-year period, it was referred to as ``immoral,'' as a ``monumental disaster,'' as ``cruel''--$10 billion over 5 years. This has $\1/2\ trillion in Medicare cuts--cuts to Medicare Advantage and providers.

I hope my colleagues will support the McCain motion.

I yield the floor.

Will the Senator yield for a question?

My understanding is as to the CLASS Act, to make the deficit situation with the enactment of this bill look better, they argue they are actually going to reduce the deficit as a result of this bill because of the revenues that come in early from the CLASS Act. I think the Senator from New Hampshire has accurately described this. You get a short-term infusion of revenues and another long-term liability which is why the Senator from North Dakota described it as a Ponzi scheme of the highest order, something of which Bernie Madoff would be proud. I guess my question to the Senator would be, how does this impact deficits in the long run and the debt in the long run? There was a lot of discussion around here, probably more rhetoric than action, about doing something to reduce the deficit and deal with the debt that continues to pile up and accumulate and at some point will be handed off to future generations. This Ponzi scheme, as it has been described by the Senator from North Dakota on

the other side, in the form of the CLASS Act does seem in the short term to understate the fiscal impact of the cost of this health bill which, as the Senator from New Hampshire has described, is $2.5 trillion. But could the Senator elaborate on what happens in the outyears? You talked about the impact down the road when all the bills come due. You get all the revenue in the short term, and then some time down the road that revenue gets spent and you are stuck with all these liabilities. How is this going to affect deficits and debt in those years in the future when our children and grandchildren will have to pay for it?

I say to my colleague from New Hampshire, it is the classic definition of a Ponzi scheme, which, as I said, is how it has been described not just by the chairman of the Budget Committee from North Dakota but also by others who have looked at this. Editorial pages in newspapers across this country have looked at this CLASS Act and said it does not add up, and it does not add up. I think Ponzi scheme is a good description.

The Senator from New Hampshire has correctly outlined the impact this will have on future generations, on deficits and debt, and spending and the growth of government. That is why it is such a bad idea to include this. The sense of the Senate resolution is simply that. It has no legal binding effect on spending. It simply is sort of a political statement that makes everybody feel better, but in the end it is going to be our kids who pay.

Madam President, today I mourn the loss of Royal J. ``Bud'' Wood, of Warner SD. Bud passed away on November 19, 2009, at the age of 87.

Born and raised in Warner, Bud will be remembered as a man who committed his life to his family and community. Bud celebrated his life with his wife Dorothy, his 4 children, 12 grandchildren, and 6 great- grandchildren. His passion for his faith, family, and friends was unwavering as he spent much of his time at church and family activities.

Although Bud was extremely dedicated to his family, he will also be remembered for his service to the State of South Dakota. I got to know Bud when his wife Dorothy managed Senator James Abdnor's office in Aberdeen. Elected to the South Dakota House of Representatives in 1966, Bud was one of the longest serving representatives, working for the people of South Dakota for 26 years. While a member of the State legislature, he served in many different capacities including: assistant majority leader, speaker pro tempore, speaker of the house, along with vicechairman of the Legislative Research Council and chairman of the Local Government Study Commission and Local Government Standing Committee. Bud also served on the Presidential Task Force for both President Ronald Reagan and President George H.W. Bush.

Beyond his political career, Bud was a talented auctioneer at Hub City Livestock Auction for 25 years. He was on the board of directors for the South Dakota Wheat Growers, the Warner Elevator Board, and at one time a church council member at St. John's Lutheran Church in Warner.

Bud was a man who was always willing and determined to help out his neighbor. A mentor, confidant, and friend, he selflessly impacted his community in a positive way.

Today I wish to celebrate the life of an extraordinary public servant and leader. As we mourn the loss of this great South Dakotan, I extend my thoughts, prayers and best wishes to Bud's family, friends, and loved ones.

Madam President, today I recognize Thomas Kurt Jaros, an intern in my Washington, DC, office, for all of the hard work he has done for me, my staff, and the State of South Dakota over the past several months.

Kurt is a graduate of Downers Grove South High School in Downers Grove, IL. Currently he is attending the Biola University, where he is majoring in philosophy and political science. He is a hard worker who has been dedicated to getting the most out of his internship experience.

I would like to extend my sincere thanks and appreciation to Kurt for all of the fine work he has done and wish him continued success in the years to come.

Madam President, today I recognize Dennis D'Aquila, an intern in my Washington, DC, office, for all of the hard work he has done for me, my staff, and the State of South Dakota over the past several months.

Dennis is a graduate of Wantagh High School in Wantagh, NY. Currently he is attending the Catholic University of America, where he is majoring in politics. He is a hard worker who has been dedicated to getting the most out of his internship experience.

I would like to extend my sincere thanks and appreciation to Dennis for all of the fine work he has done and wish him continued success in the years to come.

Madam President, today I recognize Dylan Thomas Kessler, an intern in my Washington, DC, office, for all of the hard work he has done for me, my staff, and the State of South Dakota over the past several months.

Dylan is a graduate of Roncalli High School in Aberdeen, SD. Currently he is attending the Hillsdale College, where he is majoring in English. He is a hard worker who has been dedicated to getting the most out of his internship experience.

I would like to extend my sincere thanks and appreciation to Dylan for all of the fine work he has done and wish him continued success in the years to come.

Madam President, today I recognize Brittni Jo Palke, an intern in my Washington, DC, office, for all of the hard work she has done for me, my staff, and the State of South Dakota over the past several months.

Brittni is a graduate of MACCRAY in Clara City, MN. Currently she is attending the Southeastern University, where she is majoring in journalism. She is a hard worker who has been dedicated to getting the most out of his internship experience.

I would like to extend my sincere thanks and appreciation to Brittni for all of the fine work she has done and wish her continued success in the years to come.

Madam President, today I recognize Aleli Marie Pardo, an intern in my Washington, DC, office, for all of the hard work she has done for me, my staff, and the State of South Dakota over the past several months.

Aleli is a graduate of Carrollton School of the Sacred Heart in Miami,

FL. Currently she is attending the George Washington University, where she is majoring in political science. She is a hard worker who has been dedicated to getting the most out of her internship experience.

I would like to extend my sincere thanks and appreciation to Aleli for all of the fine work she has done and wish her continued success in the years to come.

Madam President, I appreciate the great job done by my colleagues from Missouri, Alabama, and New Hampshire in pointing out many of the concerns we have with regard to this bill and why we think this is a bad direction to go.

You have heard my colleagues talk about a massive expansion of government, tax increases, premium increases; obviously, the very serious problem we have with our national

debt and the deficits we are racking up every single year, to the tune of about $1 trillion or north of there, $1.4 trillion last year, on a pathway to hit that target this year.

I have heard my colleagues on the other side talk repeatedly about Republicans not having their own solution. I have to say, maybe the reason they haven't been seeing the Republican solution is because they have been hiding behind this voluminous 2,100-page bill at a cost of $1.2 billion per page. Republicans--hundreds of times, if not thousands--have come to the floor and outlined a step-by-step solution to dealing with the health care crisis and the concerns most Americans have which is the high cost of health care. Unfortunately, many of my colleagues on the other side perhaps have not been able to see that because they can't see around this $2.5 trillion expansion of the Federal Government they seem intent on pushing through the Senate. Republicans have talked about buying insurance across State lines, small business health plans, tort reform, incentives for wellness and chronic disease management. There is a whole range of things that could be done to address the concerns of the American people about the high cost of health care that do not involve a $2.5 trillion expansion of the government, a 2,100-page bill, at a cost of $1.2 billion per page.

The other thing I have heard my colleagues say is we have to do something. People in this country are dealing about the high cost of health care. They are. We all hear it. We hear it from small businesses, from families, and from individuals. Everybody is concerned about the high cost of health care. In fact, a number of my colleagues on the other side have said of all the bankruptcies that occur every year, most occur because of the high cost of health care. Get this, America: Under their proposal, you will go bankrupt sooner. Because they drive the cost of health care up. They don't do anything to bend the cost curve down.

I want to show a chart which points out what happens to the cost curve under the Democratic plan we are talking about. The blue represents the current cost curve. That is the increase in health care costs we would see if nothing is done, year-over-year increases into the future. What we would expect, if we were going to reform health care, is that line starting to bend down a little bit so that health care increases go down over time instead of up.

What happens? Under this proposal--and this is the CBO; this isn't what I am saying or any of my Republican colleagues, this is what the Congressional Budget Office says--the Democratic plan we are talking about increases the cost of health care. It bends the cost curve up; $160 billion more will be spent on health care if their plan gets enacted. All those people who are concerned about the high cost of health care today are not getting any relief under the Democratic plan. In fact, their lives will get much worse--in particular, those who already have health care.

There are some in this proposal who will get some subsidies to buy insurance in a health care exchange. That affects about 19 million Americans. But there are 182 million Americans who currently have health care who, if this bill passes, are going to be faced with higher taxes and higher premiums. That is the way it works. They are ineligible to get any subsidies to buy insurance. In fact, they don't have any more options available to them. What they are facing is higher taxes that they will be faced with under this bill, as well as higher premium costs.

If you are the average person who is worried about cost, which I think most Americans are, and you are watching what is happening here in Washington, you have to be asking yourself: What is the whole purpose of going through a health care reform debate if, in fact, it doesn't do anything to drive down the cost of health care?

My colleagues have pointed out that when you spend $2.5 trillion, when you expand the Federal Government by that amount, when you raise taxes on medical device manufacturers, on prescription drugs, on health plans themselves, and when you cut Medicare providers and, if you believe this, this is something that seems hard to fathom, that any of this would ever take effect, but this $2.5 trillion is paid for in the form of Medicare cuts and tax increases, tax increases when it is fully implemented over a 10-year period, as the Senator from New Hampshire pointed out, about $1.2 trillion, about $1.1 trillion in Medicare cuts--who in this Chamber believes that $1.1 trillion in Medicare cuts is going to occur? There was a discussion between the Senator from New Hampshire and the Senator from Missouri about what happened a few years ago when the Senator from New Hampshire was chairman of the Budget Committee and proposed cutting $10 billion out of Medicare over a 5- year period, which amounts to $2 billion a year. What we are talking about here is $1.1 trillion over 10 when fully implemented or $100 billion a year. When he proposed cutting $2 billion a year over 5 out of Medicare, there wasn't a single Democratic vote in support of that. In fact, the Vice President had to come back from a trip to Pakistan to vote on it to try and reduce Medicare by $10 billion. They are talking about, when it is fully implemented, $1 trillion in Medicare cuts. Do you know who that hits?

Yes, sir.

It is. I assume it is in New Hampshire.

That is where a big share of the savings is going to hit, senior citizens, right squarely between the eyes, if they get benefits under Medicare Advantage. In addition, $135 billion comes from hospitals; $15 billion from nursing homes; $40 billion from home health agencies; $8 billion from hospices. Does anybody believe all that will happen? And if it doesn't happen, guess what, it all goes on the Federal debt.

I thought it was interesting that last week when the President was in Asia, the Chinese raised the issue with him about what happens if health care reform passes. They weren't worried about universal coverage or a public option. They were worried about what impact it is going to have on the deficit.

According to the New York Times and their reporting on his trip:

The Chinese wanted to know in painstaking detail how the

health care plan would affect the deficit, said one

participant.

They are worried about their investment because they are the biggest buyer of American debt. What happens to all these Medicare cuts that are proposed? We couldn't get 51 votes to cut $2 billion a year out of Medicare a few short years ago, and they are talking about cutting, when it is fully implemented, $100 billion a year. Does anybody believe we will cut $15 billion out of nursing homes? I don't think so. Here we are. How do we pay for it?

If it isn't paid for in Medicare cuts or tax increases, it all goes on the Federal debt which is growing at over a trillion dollars a year.

This is a bad deal for the American taxpayer. It is a bad deal for the 182 million Americans who already have insurance. They don't get anything out of this. What do they get? Higher taxes and higher premiums.

Listen to what CBO says: $160 billion in additional health care costs over this time period. It bends the cost curve not down but up. That is what we get. That is why so many business organizations have come out opposed to this, because they know the impact it will have on small businesses. The best way to get health care coverage to more people in America, as long as we continue to have an employer-based health care system, is to get people a job. People who are struggling with the economy right now and losing jobs, the thing we ought to be doing is figuring out how can we provide incentives for small businesses to put people back to work, not how can we kill jobs by raising taxes on small businesses.

That is exactly what we are doing right here. That is why every business organization--the National Federation of Independent Businesses, to the Chamber of Commerce, the National Association of Wholesaler-Distributors, right on down the list--is opposed to this bill. They know the impact it would have on small businesses and their ability to create jobs. The best

way--best way--you can get health insurance today in America is to get a job. This bill kills jobs.

I yield to the Senator from Louisiana.

Mr. President, Wyoming is not a lot unlike the States of South Dakota or Nevada, as the Senator knows, although they have a few larger businesses in Nevada. But the people who get hit hardest under this bill are small businesses.

We heard the Senator from Maine, Ms. Collins, point out the impacts on small businesses. The ironic thing about that is a lot of small businesses, where you would want to encourage them to offer health insurance to their employees, will be discouraged from doing so under this bill. In fact, what most of them are probably going to do is pay the $750 penalty and then push everybody off into the government plan.

The assumption that is being made in here is that the government plan--it will grow over time, obviously. I think 5 million people will lose their private insurance, according to CBO. My guess is that number is going to be much higher because I think what is going to happen is small businesses that are impacted the most by these tax increases are going to find themselves less and less able to provide health insurance coverage to their employees.

The other thing I want to point out, as to what my colleagues from Wyoming and Nevada have said, is that I would be somewhat, I guess, interested in what is being proposed by the other side if it did anything to impact cost. But it does not. The whole purpose of this exercise, at least in the minds of most Americans, is to drive the cost curve down. I heard my colleagues on the other side get up and talk about, well, their plan is going to decrease costs for people in this country.

Well, here is the cost curve, as shown on this chart. The blue represents the cost curve; that is, what would happen if we do nothing. That is the expected increase in health care costs in this country if we do nothing.

What is ironic is, the red represents what happens under this bill. So instead of bending the cost curve down, it actually increases the cost curve. So we are going to spend $160 billion more on health care in this country by enacting this bill, this monstrosity of a bill right here, which, as my colleagues have pointed out, is 2,074 pages. The Senators from Nevada and Wyoming both also have the House version, which is 2,200 pages. But look at this thing. You would think somewhere in here, in all this volume of paper, there would be a way to actually do something to actually bend the cost curve

down. But all that represents more spending.

In fact, if you look at the amount of spending in the bill when it is fully implemented, it is much more than what the CBO estimated it would cost. There was all the publicity when they unveiled this health care plan a couple days ago that it is going to be under $1 trillion. Well, in fact, we all know they have used a lot of accounting gimmicks, a lot of scoring tricks, a lot of ways to obscure the true cost. In fact, even in the first 10 years it understates the cost, which is over $1 trillion. But the 10-year fully implemented cost of this bill is $2.5 trillion--a $2.5 trillion expansion in the size of the Federal Government.

If you look at how that plays out and how it is paid for over the fully implemented phase--we all talked about $\1/2\ trillion in Medicare cuts. For 10 years, fully implemented, it is over $1 trillion they have to cut Medicare to pay for this thing, and then to raise taxes by another $1 trillion. So you are talking about not only cutting Medicare to senior citizens, as the Senators have talked about, but also raising taxes substantially on small businesses. But at the end of the day, after all is said and done, what do you end up with? You end up with an increase in cost above and beyond what we would see if we did nothing. Tell me how you can call that reform.

The other point I will make before I yield back to my colleagues is, if you are someone who already has insurance--and 182 million people in this country have insurance--you are not going to be able to participate in the exchange.

You get no more options out of this. There are 19 million Americans who would, perhaps, benefit from being part of an exchange. But if you are one of the 182 million people in this country who currently have insurance, you cannot get into an exchange and you cannot get any subsidy. What you get are big fat tax increases and increases in your insurance premiums, for all the reasons that have been mentioned. Because when you tax the health insurance companies--as this bill does--when you tax the medical device manufacturers--as this bill does--when you tax the pharmaceutical companies--as this bill does--and create all new kinds of mandates on insurance companies, including changing these age band ratings, going to a 3-to-1 age band rating, you are going to raise premiums for a lot of people in this country, and you are going to raise them the most for people who are age 18 to 34. The people who are age 18 to 34 do not realize what is coming at them today, but it is about a 69-percent increase in their insurance premiums. They are the ones who get stuck the hardest.

But if you are any of these 182 million people, your taxes are going to go up, your insurance premiums are going to go up, and you are not going to see any benefit from being able to participate in any sort of an exchange. These are the cold, hard facts.

I have heard countless Democratic colleagues come down here and talk about bending the cost curve down and reducing premiums for people in this country. As shown on this chart, this is the Congressional Budget Office number. This is not anything the Republicans put together. This is the CBO cost estimate of what it would do to the cost curve. As I said before, the red represents the increase: a $160 billion increase in health care spending over 10 years--all of which is going to be borne by those 182 million Americans in this country who already have insurance.

Well, the Senator is absolutely right. I think what the CBO has pointed out is--and I have the Joint Tax Committee there; the data they produced is very similar to what CBO said--84 percent of the tax burden is going to fall on people making less than $200,000 a year. And half of the families making under $100,000 a year are going to get hit with new taxes under this bill. So it is going to fall on those people in this country. And I think they like to think they are taxing medical device manufacturers and everybody else, but at the end of the day, a lot of this gets passed on. And the taxes in the bill, the premium increases in the bill, are all going to be borne by the people who are probably least able to absorb that and take that, and it is going to be the people in the lower income categories.

So the Senator from Nevada is absolutely right. I again come back to the basic premise of this whole purpose of health care reform, which should be to get health care costs down, not raise them. The Senator from Wyoming has alluded to a number of things we believe would do that, that actually do put downward pressure on health care costs in this country. It is done in a step-by-step way. It is done in a way that does not call for throwing out everything that is good about the health care system in this country, creating this massive new expansion of the Federal Government here in Washington, DC, with $2.5 trillion in costs over a 10-year period when it is fully implemented.

And probably--who knows--if a lot of these things do not happen, if the tax increases, for some reason, do not happen, if the Medicare cuts do not occur, it means borrowing from future generations. They talk about reducing the deficit by $130 billion only because they did not include the physician fee fix in this, only because they added $72 billion in revenue from something called the CLASS Act, which we know is never going to become law--and even if it does, it is a huge money loser in the outyears.

So you have all these things that they did, including delaying the implementation date by 5 years so it understates the true cost of this thing--all these things that have been done to try to make this turkey look like something other than what it is, which is a massive increase in spending, massive tax increases on the American people, and increased premiums for Americans, particularly those 182 million Americans who already have health insurance who are going to get hit the hardest by this.

Mr. President, 69 percent. If you are 18 to 34, that is what you are looking at in the form of premium increases, not to mention the fact that future generations are going to deal with all of the debt we continue to pile on them, which I think bears heavily on this debate right now, when you are looking at trillion-dollar deficits as far as the eye can see. This is not a good deal if you are a young person in America.

Will the Senator from California yield?