Mr. President, I ask the leader, the ranking member, that I be recognized after that. About 25 minutes. Mr. President, I echo a lot of the same concerns just voiced by the Senator from Illinois. We have all been here a few years, and we…
Mr. President, I ask the leader, the ranking member, that I be recognized after that.
About 25 minutes.
Mr. President, I echo a lot of the same concerns just voiced by the Senator from Illinois. We have all been here a few years, and we see some things that are questionable. But the actions taken by the majority in this session of this Congress are beyond questionable. In many cases, I think they are outrageous, and I am very glad the Senator from Illinois brought the Senate's attention to them.
Mr. President, I am here to speak on the pending legislation, and that is the budget reconciliation bill that is before us. I oppose this budget reconciliation bill, and I do so for a couple of very basic reasons.
First of all, this bill would cause many of America's poorest citizens to go without needed medical treatment. Just think of that: some of the poorest citizens in our country to go without needed medical treatment. It would make it harder for many of America's neediest citizens to move off of welfare and on to work. It would make it harder, not easier, to get off of welfare and on to work. It would also deprive many single parents help in getting child support from their deadbeat spouses. It makes it harder to get child support from deadbeat spouses. That is what this bill does, and I will explain later why that is the case. And this bill would undercut American lumber workers in their dispute with Canadian lumber.
There is a better way. The better way is something much more similar to what the Senate passed here, although I opposed it because I thought it was so draconian, and I opposed it because I felt it would lay the seeds for just what is happening here today, and that is a conference report that is much, much worse than the Senate-passed bill.
I think the Senate should vote down this bill. We do not have to pass it this year. This is not an appropriations bill. This is not a tax bill. It does not have to be passed this year. It should be voted down so we can get to work next year and cut the budget in a more fair and more moderate way, rather than this draconian way contained in this bill.
There is a right way and a wrong way, for example, to control health care spending. We all know health care costs are high, but let's just reflect a little bit and try to figure out what is the right way to cut health care costs to address that situation and do that rather than the wrong way.
Well, I might say, we in this body included some of the right way in the Senate-passed reconciliation bill. What is that? We included provisions to put us on the road to paying for performance and quality in health care. That is the right way to control health care costs; that is, to reimburse providers--doctors and hospitals--a little bit more when they show their outcomes are a little better, they are doing a better job. That means health care costs will come down because the quality will increase and we will not be providing, in many cases, health care that is irrespective of quality. We have to start addressing quality in health care. The Senate-passed bill started to address that. The conference report hardly even touches that. I will explain that a little bit later, too.
What does this bill do? Instead, this bill merely cuts holes in the safety net. It cuts holes in the safety net. It does not shore it up and try to figure out ways to address the problems; it cuts holes and makes things worse. How? Well, it raises Medicaid copayments for those least able to pay. It raises costs for people on Medicaid. It also allows States to cut Medicaid benefits below existing minimum benefits. That is the wrong way to control health care costs. The better way is to address paid performance and quality. The wrong way is to just willy-nilly cutting expenditures for the poorest of our Americans; that is, for the Medicaid Program.
We have also seen how the wrong way works, not in theory but in practice. Increasing costs for poor people forces them not to seek health care when they need it. It has that effect. When the poor people in our country have to pay that much more for health care, what do they do? They don't get the health care. What happens? They live a little bit more with the illness they have. What is the consequence of that? They come back to the emergency room later when their condition gets worse. The system ends up spending more on health care rather than less. The burden of uncompensated care grows. You and I and all the rest of us who pay for health care end up paying still more for health care because of the increased uncompensated care because the poorer people will not be seeking the health care they need but put it off and, therefore, go to emergency rooms, and we end up paying more. That is the way the wrong way works. That is the way provided for in this bill.
Furthermore, this bill is not a moderate package. Far from it. The Senate-passed bill was more moderate. Instead, the bill before us hews largely to the House-passed bill which is not moderate. It is extreme. It is draconian. The bill before us, which hews mostly to the House side, would impose nearly $2 billion in increased cost sharing on Medicaid beneficiaries or about 80 percent of the cost-sharing increases in the House bill. What else? The bill would also allow State Medicaid Programs to offer Medicaid beneficiaries an ``actuarially equivalent'' benefit package. What does that mean? I will tell you what it means. It means reduced benefits. It is a fancy euphemism for reduced benefits for Medicaid beneficiaries. States will also be able to impose new premiums for coverage and to drop individuals from Medicaid if they can't pay.
Last week I offered a motion to instruct participants of this conference not to harm Medicaid beneficiaries by passing a budget reconciliation bill that resembles the House-passed bill. The Senate overwhelmingly supported that motion. The vote was 75 to 16. I was heartened. I felt good about that action. The Senate was speaking clearly and strongly not to let the conferees impose draconian cuts. Senators who supported that motion should stick to their guns. They should remain consistent in their support of Medicaid. They should vote against this reconciliation conference report in view of what the Congress has done juxtaposed to that 75-to-16 vote.
I am disappointed with many of the provisions included in this budget reconciliation bill. I am also disappointed with provisions that were not included in this bill. The conference report does not include meaningful pay-for-performance and quality provisions. We live in a country that spends twice as much as any other country on health care per capita. Yet our country ranks
37th in the world on quality. Think of that. We spend twice as much per capita as any other country in the world and yet we rank 37th in the world on quality. Our country leaves almost 16 percent of our population with no health care coverage at all.
We are not getting good value for our health care dollar. The value that each health care dollar buys varies widely from patient to patient. Consider recent research from Dartmouth that looked at large hospitals in California.
That research found that per-person Medicare spending on health care in the last 2 years of life ranged from $20,000 to almost $90,000. The more expensive patients were not sicker. That is the point. They did not receive higher quality care. That is also the point. But they cost the Medicare Program over four times more.
I was proud to work with the chairman of the Finance Committee, Mr. Grassley, to write legislation bringing quality improvement and accountability to Medicare. We worked hard on that. We got a bill passed out of committee. Under our Medicare Value Purchasing Act, Medicare providers would be held accountable for the care they provide. And the best providers would be rewarded accordingly.
Doesn't that make sense, that we reward quality? Shouldn't we do that in the health care system? We don't today in America. Most every other industry is rewarded for quality, but our health care service by and large is not. The Senate included our pay-for-performance legislation in the budget reconciliation bill that passed this Chamber last month. I did not support the larger bill, but I was pleased that our Medicare quality legislation was included in the package. But our quality bill has mostly been stripped in the conference report.
The conference report expands existing quality reporting requirements for hospitals. It sets up minimal reporting requirements for some home health. The report includes a study on pay for performance in hospitals and some minimal payment changes to discourage a couple of hospital- acquired infections. These provisions are only for hospitals and are mostly at the discretion of the Secretary.
Moreover, these provisions are delayed until years after the independent Medicare Payment Advisory Commission recommended that Medicare providers would be ready to be paid for quality. I am disappointed to see Congress setting the bar so low because we have so little time in which to address the increasing costs of health care and all the problems that creates. I oppose this conference report because it doesn't begin to address what could and should be done. I remain fully committed to seeing Medicare pay-for-performance become law.
I also supported a motion to instruct conferees related to TANF, the Nation's welfare program. Offered by Senator Carper, this motion instructed conferees not to reauthorize TANF through the budget reconciliation process. That was the motion offered by the Senator from Delaware. That passed by a large vote.
What happened? First, let's remember that Congress enacted the TANF Program back in 1996. It was enacted to help welfare recipients get work skills and to help low-income families become economically self- sufficient. I supported it in 1996. Many Democrats did not, but I thought it was a good way to get people off of welfare and a fair way to get people back to work. What has happened? Welfare reform has mostly succeeded. That 1996 bill was a good bill. States have adopted creative policies to support low-income families making the transition from welfare to work, and millions have moved to self-sufficiency. It is not great, but it is a lot better than what it was prior to 1996.
The TANF law expired in 2002. Senator Grassley, chairman of the committee, and I worked diligently on the TANF reauthorization bill this year. It was a compromise that enjoyed near unanimous support in the committee. We could not get that bill up in the full Senate. There were a few willful Senators who opposed it, even though it had the near unanimous support of the Finance Committee. It was a moderate reauthorization of TANF.
Let's also remember policy changes to TANF--and they are quite pervasive and significant--do not belong in the fast-track budget reconciliation process. It does not belong there. The Presiding Officer knows that, as does everybody in this body. That process was designed to reduce the deficit, not to reauthorize important safety net programs such as TANF or other major policy issues. That is particularly true given the nature of the TANF provisions in this bill. This conference report contains strict new work requirements in TANF. Not only is it a reauthorization, it has provisions that make the program not work, make it worse. It is not moderate. It makes it worse. It is in this conference report.
This report undermines the State flexibility necessary to meet the standards of their most vulnerable citizens. This conference report provides only $1 billion in childcare funds, even though we need $12.4 billion in childcare funding to keep up with inflation. How miserly is that? Only $1 billion in childcare, when we really need 12 billion. Let's compromise, maybe 6, $7 billion; that is a compromise. That is midway between what this bill provides and what inflation calls for. But no, there is only $1 billion in this bill.
The report also foists a set of unfunded mandates on States, mandates that would harm low-income families. Let's not forget these families are playing by the rules right now. They are trying to do what is right. They are trying to work their way off of welfare and trying to get into sustainable employment. But this conference report eliminates the State flexibility that has made the TANF Program a resounding success.
We should reauthorize TANF. We should improve the program to focus on reducing poverty as well as welfare caseloads. And we should ensure that more people can leave welfare for sustainable work.
This conference report does just the opposite. More families will lose assistance. And our State partners will lose the flexibility that they need to support families in their time of need.
Speaking of families, what about the child support enforcement provisions in this bill? This conference report includes a $5 billion cut in Federal funding for child support enforcement efforts. That's right, a $5 billion cut.
States use these funds to track down absent parents, to establish legally enforceable child support orders, and to collect and distribute child support owed to families. These cuts will take billions of dollars out of the pockets of mothers and children who are owed child support. This cut is simply indefensible.
This bill also fails to adequately address the health needs of Katrina victims. It has been nearly 4 months since Katrina hit, resulting in over a thousand deaths, the displacement of over a million people, and a reconstruction bill that may exceed a couple hundred billion dollars. The Katrina disaster was unprecedented. It required an unprecedented response by Congress. That's why I worked with Chairman Grassley in the days following the hurricane to write S. 1716, the Emergency Health Care Relief Act.
That bill would have provided 5 months of temporary Medicaid coverage for Katrina evacuees in poverty.
That bill would have shored up State Medicaid programs overwhelmed by Katrina evacuees. That bill would have reimbursed providers for uncompensated care provided to Katrina evacuees. And that bill would have helped States with the unprecedented burden on Gulf State welfare programs.
But the Senate did not pass that bill. The Senate could not even take it up.
We tried to take it up many times. We stood on the floor many times and asked unanimous consent to bring up the bill, but we were opposed by a band of two or three or four Senators, but we cannot understand why. I think, basically, they are doing it at the behest of the White House, the President. The President didn't want to help people down there with their health care needs, and the congressional leadership did his bidding.
I appreciate Chairman Grassley's efforts to help Katrina victims. He fought to pass S. 1716 legislation against the wishes of the White House and his congressional leadership. I want him to know that I appreciate his efforts.
When the Senate eventually passed this budget reconciliation measure, it included some Katrina relief. It was an
insufficient amount. And I could not support it. It was so paltry, it was an insult. As for this conference report before us today, it is still insufficient. Moreover, its Katrina funding comes in the form of a block grant.
So States affected by Katrina, as well as States treating Katrina evacuees, are given $2 billion for their Katrina health-care needs, whether that is a sufficient amount or not. Both the House and Senate bills had provided for 100 percent federal financing over the short term for all States with Katrina-related Medicaid costs.
Finally, I want to briefly mention an important trade issue. This bill repeals the Continued Dumping and Subsidy Offset Act, also known as the Byrd amendment. This repeal could not come at a worse time for the American lumber industry. The industry has recently suffered a series of setbacks in its long-running dispute with Canada on imports of Canadian softwood lumber.
The Byrd amendment is one of the few tools the industry still has to encourage Canada to settle the lumber dispute once and for all. Repealing the Byrd amendment now pulls the rug right out from under the industry. I won't do that. And I urge my colleagues who are friends of the lumber industry to join me in supporting the industry by voting against this bill.
We don't have to pass this bill this year, Mr. President. There is no need. None. So let's not pass it and do what is right in a subsequent reconciliation bill.
Mr. President, there is a great deal to be disappointed about in this spending reconciliation legislation. It does not meet the health and welfare needs of Katrina victims. It makes health care for the poorest among us more expensive and lets well-heeled people off the hook.
It puts forth an unreasonably austere welfare program in a vehicle where it doesn't belong. It fails to advance the Medicare quality agenda that many of us have worked so hard to make reality. And it undermines the U.S. lumber industry at the worst possible moment.
In short, Mr. President, the Senate should reject this bill. The Senate can do better. I urge my colleagues to do better by the American people by voting ``no.''
Mr. President, I ask unanimous consent to have printed in the Record a lengthy list of all of the groups that oppose this bill.
This is a lengthy list. I don't have time to read them all.
The groups that start with A, such as AARP, for example, are at the head of the list. This is seven pages. Let me guess how many groups per page. It is about 30 groups per page at least, in groups of seven. So 30 times 7 is a couple hundred groups that are opposed to this bill-- for good reason. This is not something they willy-nilly just came up with; they have looked at this bill. They have concluded, as I have, that we should not pass this bill. We don't have to pass it now. We can do it next year. We should go home for Christmas.
This is some Christmas present. This bill cuts Medicaid to people, pulls the rug out from under the lumber industry, and it hurts low- income people trying to get to work and off of welfare. Some Christmas present. We should go home for Christmas and not pass this legislation and then come back next year and do the right thing.
I yield the floor.