where's the democrat printed bill? i'm sure it's somewhere. now usually when we debate any bill on this floor, we have the bill printed and put on the desk. now maybe it's been printed, but it isn't on our desk, and i think there's a good reason for it. it's 2,074 pages long. it's enough to make you barf. when you stop and think about it why do we need 2,074 pages when 85% of americans basically like the health insurance that they have? the other 15% -- if you rulely break it down -- if you really break it down, you have 17 million people who really need our help by the time you knock off those who basically work for a company that provides health insurance but they don't choose to take it because they'd rather have the money, or you take the

approximately 11 million people who qualify for chip, the children's health insurance program, or medicaid that aren't enrolled because they don't know about it. or you take those who earn over $75,000 a year but just won't buy it but can afford it, or you take those who are undocumented workers or others who are legal aliens who for some reason or another don't get it, you get down to about 15 million people at most. we could subsidize those people and we wouldn't have to throw our whole system out into the trash can, a system that 85% of the american people basically think is working relatively well for them. it seems crazy to me. but why are we doing that? you know, 15% of the people in this country basically don't pay federal income taxes as we sit

here. only the you were 50p. pay 97% of all income taxes. the bottom 50% pay 3% or 4% ve t the very most. think about that. where are we going to go? 60% so one side can keep the numbers here so they can remain in majority control? or are we going to get people to be more responsible for their own health care? and on top of it all, they want a government lab -- unquote. why do they want that? medicare is a government plan. for all intents and purposes, it is very well-intentioned, but it's $38 trillion nun funded liability, as we said here, mainly because the government is runninrunning it. the federal government. if the state governments ran it and we had 50 state laboratories, i doubt seriously that we'd be in this terrible

fix that we're saddling our children, grandchildren, and great-grandchildren with. so what's their answer? we're going to take $500 billion -- $464 billion, i guess it's closer to -- but almost $500 billion out of medicare and we're going to put it into making sure that we -- that our plan is deficit-neutral. well, they've used every accounting, every budgetary gimmick they can to get this plan below $1 trillion because they charge taxes from this day on -- the day -- from the day on once it's passed, but they don't implement the man for four years -- complement the plan for four years, until 2014. that way they can kind of indicate to the american people that they're living under $1 trillion. well, even $1 trillion is pretty dog gone much when you are you

think that we're already spending $2.4 trillion on health carement, two-thirds of which is run by the federal government. and by then there are estimates of hdz 1.2 of that $2.4 trillion is wasted money. and yet we're going to add another $2.5 trillion, which is what this bill really is, if you extrapolate it out over a full ten years and not just from 2014 to 2020, if you extrapolate it out, we're going to spend another $2.5 trillion. well, no wonder the american people are so up in arms. they ought to be up in arms. we're going to have ads 5 trillion health care bill in this country if my friends on the other side are successful in what they're doing. now, they know we have 40 votes over here at the most. i've been here a pretty long

time here now. senator lugar and i are the most senior republicans on the floor of the united states senate. we came at the same time. i have to say that having been here all these years, we have never really had a fiscal conservative majority in the united states senate. except through great presidential leadership -- reagan, bush i, even president clinton on occasion, and bush ii, because we've always had enough liberals on our side to go with the almost all liberal democrats that we've never really will a fiscally conservative majority. i appreciate the comments of my good friend from illinois about medicare advantage, but he's just plain wrong. medicare advantage has made a tremendous difference in the lives of almost 11 million

people -- beneficiaries, if you really call them what they should. what he failed to mention is that the program has given choice to every medicare beneficiary across the country regardless of where they live. regardless of where they live. medicare advantage saves beneficiaries dollars. seniors have lower co-payments, cost-sharing, and deductibles through medicare advantage programs. that's why many lower-income seniors participate in the medicare advantage program. up to 25% of all seniors participate. why? because it works for them. i was on the medicare modernization committee -- conference committee, and we came up with it because rural america primarily was not well-served. if my friends will take the time to listen to my statement on medicare advantage, i believe that they will find it i insightful and that it will rebut most everything they're

saying. mr. president, the motion i just sent to the desk to commit the reid health care bill to the finance committee in order to eliminate the medicare advantage cuts -- $120 billion contained in this legislation. i know that i've mentioned this point on the floor over and over again, but i believe it does bear repeating. throughout the health care debate we've heard the president not to -- quote -- "mess" -- unquote -- with medicare. unfortunately, that's not the case with the reid bill that we are currently considering. to be clear, the reid bill cuts medicare by $465 billion to fund a new government program. unfortunately, our seniors and the disabled will be the ones who suffer the consequences as a result of these reductions. now, throughout my senate service i have fought to strengthen, preserve, and protect medicare. i think most republicans have.

in spite of what my colleagues say on the other side. unless we're blowing money down the drain, they don't think we're doing anything. medicare is already in trouble today. the program faces challenges in the very future. the medicare trust fund will be insolvent in the year 2017 and the program vs over th 37 million in unfunded liability. the reid bill will make this situation much worse. look at the cuts to medicare. hospitals -- $134.7 billion. in this bill! where are they going to get that money? how are we going to keep our hospitals going? hospices -- $7.7 billion. nursing homes -- $14.6 billion. my gosh, i've been to all kind of nursing homes all across this cufnlt and i've golt to tell you, they have a rough time keeping -- we're going to take $14.6 billion out of them. and they're critical to our seniosenior citizens by and lar. and others. medicare advantage -- $120

billion is coming out here. home health agencies -- $42 toy 1 billion. that's just mention ago few things. so the ride bill is going to cut $135 billion from hospitals, almost $15 billion from nursing homes, more than $40 billion from home health care agencies and close to $8 billion from hospice providers. these cuts will threaten beneficiary access to care as medicare providers find it more and more challenging to provide health services to medicare patients. and what's the argument on the other snide oh, it is the awful insurance companies who are causing all those problems. no, it is the awful federal government that's causing all these problems -- all this trouble. it is the awful bureaucracy that's causing all these troubles. it is the awful central government that dominates all of our lives and if this bill passes, katie bar the door. our lives are going to be completely controlled by the federal government on one-sixth of the american economy. today i want to focus my comments on the medicare

advantage program. it's been totally distorted in my opinion, by my colleagues. i'm sure not intentionally. they would never do that. again, i -- well, by the way, here is -- it's not the printed version, but this is the -- this is this bill. no small bill. one of the largest i've seen in my whole time here. mr. president, i'm strongly opposed to the deep cuts -- $120 billion over ten years -- that the reid bill would impose on the benefits of over almost is 11 medicare beneficiaries. medicare beneficiaries who currently are enrolled in the medicare advantage program. while they knock medicare advantage, they're pushing people towards the aarp insurance program. aarp, that makes hundreds of millions and billions of dollars off senior citizens.

it's small wonder that aarp supports this monstrosity of a bill. it's in their best financial interest. buddies are always taken care of around here, i guess. and they certainly are buddies to the other side of the floor. as we consider the serious threat these cuts pose to seniors, i want to point out during the senate finance committee markup -- i wanted to point out this fall, we saw senator bill nelson and other democrats work to parptionly mitigate senator nelson from florida and other democrats worked to partially mitigate the impact of the bill's medicare advantage funding cuts. this effort, while taking only very small steps, clearly demonstrated that a number of our democratic colleagues recognized the value offered by medicare advantage plans and the danger of enacting the deep cuts proposed by the pending bill. unfortunately, only a limited number of states would benefit

from the nelson amendment, so most medicare advantage beneficiaries are not protected from the cut. bethey recognized how important -- but they recognized how important these programs are -- or this program s i also recall that six years ago when enacted the medicare modernization act, we intentionally provided new funding to stablize the medicare health plan program. this was one of the few issues on which there was strong bipartisan agreement during the 2003 medicare debate. i was here. i was on the conference committee. i have helped to bring about that -- i helped to bring about that medicare modernization act. in june 2003, several our colleagues, including senators schumer and kerry, schumer from new york, kerry from n.a.s. mass -- great democrats -- offered a bipartisan amendment on the senate floor to provide additional fundin funding for bs your honor the medicare advantage program. why would they do at that if it's such a lousy program? now all of a sudden it is lousy

because they want the money to be used for a massive, new government program that's going to be run by them. back then they wanted it for medicare advantage, recognizing how important that program was. later that year in june of 2003, as the medicare conference committee was completing its deliberations -- later than june -- a bipartisan group of 18 senators signed a letter -- this is a bipartisan group -- signed a letter urging the conferees to provide a meaningful increase in medicare advantage funding. this letter was signed by a diverse group of our colleagues, including democratic senators, such as dianne feinstein from california, christopher dodd from connecticut, ron wyden from oregon, frank lautenberg from new jersey, patty murray from washington -- the state of washington, arlen specter from pennsylvania, mary can't well

and mary landrieu from louisiana. they recognized how important this was. they recognized we were trying to solve major problems for people, especially in rural amplest i think it would be worthwhile to reflect back on the 2003 debate and remember the reasons this issue inspired such strong bipartisan consensus. you don't hear it at all from that side now. after the program has proven its efficacy and has proven that it works. we supported the medicare advantage program six years ago because we knew it was the right thing to do for beneficiaries and the same logic holds true today. we owe it to beneficiaries to provide a strong, adequately funded program that provides them with high-quality health care choices. during the finance committee's consideration of -- and by the way, every medicare beneficiary can go into medicare advantage if they desire under current circumstances. during the finance committee's consideration of the baucus health bill, i offered an amendment to protect extra benefits currently enjoyed by medicare advantage

beneficiaries. unfortunately, my amendment was defeated. in other words, the president's pledge assuring americans that they would not lose benefits was not met by either the finance committee bill or the reid bill currently being considered by the senate. and here is how supporters of the finance bill justified the medicare advantage reductions: they argued the extra benefits that would be cut, such as vision care, dental care for these poor people, reduced hospital deductibles, lower co-payments and premiums, were not statutory benefits, they claim. they claim they were not statutory benefits offered in the medicare fee-for-service program. therefore, those extra benefits did not com count, although a quarter of the medicare beneficiaries were getting them

from medicare. but try telling that to -- that they didn't count to a medicare ÷dvantage enrollee. who's been receiving these additional benefits. i want to talk about the differences between fee-for-service medicare and medicare advantage. because of the gaps in traditional medicare, it is incumbent for most beneficiaries to buy a medigap policy which wraps around the medicare benefit. guess who provides these medicare policies? among others, but really in a big way? why, the aarp. on average, these policies cost a couple of hundred dollars a month. in compare sorng th comparison,e monthly premium in a medicare advantage plan was $54 in 2009. these plans also -- and i've heard this $0 -- $90 baloney. it's $54 is what that costs compared to $200 a month.

now, these plans also fill in the coverage gaps of medicare. moreover, almost half of all beneficiaries are in medicare advantage plans that charge no monthly premium. let me say that again. if you have to buy medigap policy for traditional fee service, medicare, you will have to buy a policy that costs a few hundred dollars a month, compared to medicare advantage plans which cost beneficiaries on average $54 per month in 2009. and this is why several studies have shown that medicare advantage is one of the most popular choices for the low-income elderly, because they do not have to buy a medigap policy from the aarp or some others who provide it as well. they don't have to do that. this week we had members on the other side of the aisle claim that medicare advantage is not part of medicare. that's how far they've gone to

distort the record. now, again, i hope that nobody was doing that intentionally and that it's just a lack of knowledge about what's really going on in health care. keep in mind, we had members on the other side of the aisle claim that medicare advantage is not part of medicare. it is absolutely unbelievable. i would invite every member making this claim to turn to page 50 of the 2010 medicare and you handbook. it expressly says -- quote -- "a medicare advantage is another health coverage choice you may have as part of medicare." that argument has been want only fallaciou --not only fallaciousd never have been made. the bottom line is simple, if you are cutting medicare advantage benefits, you are cutting medicare.

now, i raised this point yesterday but i want to raise it again. yesterday, the distinguished senator from connecticut, my friend, senator dodd, mentioned that the bureaucrat-controlled medicare commission will not cut benefits in part-a and part-b. well, once again, my friends on the other side are only telling you half the story. so much for transparency. on page 1,005 of this itty-bitty bill that i can hardly lift, it states in plain english -- quote -- "include recommendations to reduce medicare payments under c and d." now, let me translate that into english for everybody here. that means that the commission can cut medicare advantage, which is medicare part-c, and the medicare prescription drug benefit, which is medicare part-d. making sure that we take enough time to discuss a 2,074-page

bill that will affect every american life and every american business is the sacred duty of every senator in this chamber. we will take as long as it takes to fully discuss this bill, and it's going to take some time, as you can imagine with that big pile of paper. i've heard several members from the other side of the aisle characterize the medicare advantage program as a giveaway to the insurance industry. now, let me say a few words for a minute about the creation of medicare advantage. i served, as i said, as a member of the house-senate conference committee which wrote the medicare modernization act of 2003. so did the distinguished senator from montana, senator baucus. among other things, this law created the medicare advantage program. when conference committee members were negotiating the conference report, several of us insisted that the medicare advantage program was necessary in order to provide health care coverage choices to medicare

beneficiaries. at that time, there were many parts of the country where medicare beneficiaries did not have adequate choices in coverage. in fact, the only choice offered to them was traditional fee-for-service medicare, a one-size-fits-all government-run health program. by creating -- i might add, which didn't really work. by creating the medicare advantage program, we provided beneficiaries with choice in coverage and then empowered them to make their own health care decisions as opposed to the federal government. we gave them the empowerment to make their own decisions. that's unique around here. there won't be any empowerment if go with this bill. in fact, there's almost 2,000 decisions that the secretary of health and human services has the authority to make. well, they might like the current health -- health and human resources secretary today, but what if a really good conservative gets in that position. of course, it's very difficult

because a good conservative would be filibustered. today, every medicare beneficiary may choose from several health plans because of what we did. we should have learned our lessons from legislative changes made in the balanced budget act of 1997 when we cut is payments for medicare -- when we cut payments for medicare h.m.o.'s. these plans collapsed, especially in rural areas, because washington, our wonderful people here in washington, decided to set artificially low payment rates. in fact, in utah, all medicare h.m.o.'s eventually ceased operations because they were operating in the red. and i fear history could repeat itself if we are not careful here. during the medicare modernization act conference, we mixed the problem. we increased reimbursement rates so that all medicare beneficiaries, regardless of where they live, be it in fillmore, utah, or new york city, had choice in coverage. again, we did not want beneficiaries stuck with a

one-size-fits-all government plan, which, by the way, this monstrosity is. today, medicare advantage works. every medicare beneficiary has access to a medicare advantage plan if they so choose. one-quarter of them have so chosen and it has worked amazingly well. and close to 95% of medicare beneficiaries participating in the program are satisfied with their health coverage. but that could all change should this health care reform legislation currently being considered become law. choice in coverage has made a difference in the lives of more than 10 million americans nationwide. beneficiaries in every state have benefited from medicare advantage. let me just show you some things here, and since it's very difficult to read on television, i'm sure, let me go through all these states. these charts show the estimated impact of current medicare advantage payment reform -- the payment reform proposal we have

here. i'm going to list the state and then how much medicare advantage enrollment each state has and now it will be gone, for the most part. alabama has 181,304 people on medicare advantage. alaska, 462. arizona, 329,157. arkansas, 70,137. california, 1,606,193. colorado, 1898,521. connecticut, 94,181. delaware, 6,661. the district of columbia even has 7,976. how about florida? 946,836. almost a million people on medicare advantage. good reason -- it works. georgia, 176,090. hawaii, 79,386. idaho, 60,676. illinois, 176,395.

indiana, 148,174. iowa, 63,902. people enrolled in medicare advantage. let's proceed further. kansas, 43,867 people enrolled in medicare advantage. kentucky, 110,814. louisiana, 151,954. maine, 26,984. maryland, 56,812. massachusetts, 199,727. michigan, 406,124. minnesota, 284,101. mississippi, 44,772. missouri, 195,036. montana, 27,592. nebraska, 30,571. nevada, 104,043. new hampshire, 13,200.

new jersey, 156,607. new mexico, 73,567. look at new york, 853,387. north carolina, 251,738. people enrolled in medicare advantage, who love the program. north dakota, 7,633. ohio, 499,819. goo geewhiz, that's a lot of people who are satisfied with medicare advantage. oklahoma, 84,980. oregon, one of the most liberal states in the union, 249,993. pennsylvania, 864,040. puerto rico even, 400,991. rhode island, 65,108. south carolina, 110,949.

these are senior citizens. south dakota, 8,973. tennessee, 233,024. texas, 532,242. my own state of utah, 85,588. vermont, only 3,966, but 3,000 people -- 4,000 people in vermont. virginia, 151,942. washington, 225,918. west virginia, 88,027. wisconsin, 243,443, and wyoming, 3,942. these are people who benefit from medicare advantage that would not like to get off of it. well, this choice in coverage has made a difference in the lives of more than almost 11 million people. 11 million individuals nationwide, families that benefit from this. the extra benefits that i had mentioned earlier are being

portrayed as gym memberships as opposed to lower premiums, copayments and deductibles. let me read you some letters from my constituents. these are real lives being affected by the cuts contemplated in this bill. i'm going to have to get my reading glasses on. and you should see some of the beautiful handwriting. some of it is very shaky but beautiful, to me, anyway. from cedar city, utah. "senator hatch: i'm writing to you to request your help in preserving our medicare advantage plans from being cut. my medicare advantage plan provides me with benefits and servings that traditional medicare did not provide. i like my plan very much. it allows me my choice of doctors, hospitals, and various specialists, if needed. i do not want to see a single national health care plan. i do not want cuts in medicare

advantage programs. senator hatch, when you go to washington, d.c., please do not cut our medicare advantage programs. vote to maintain our present systems, and thank you for your service. sincerely. p.s., i speak for my husband, too." [laughter] i'll bet. okay. "honorable senator hatch: please do not vote for any bill which would compromise my medicare advantage plan. i'm 92 years old and of necessity worked until i was 87 and have taken pride in being self-supporting. hi to retire 6 1/2 years ago because of pancreatic cancer. amazingly, i recovered and live an active, useful life. my medicare advantage plan makes the difference between living with self-respect and having to depend on others. once again, i beg of you, don't deprive me of my self-respect. let me keep my medicare advantage plan