probably happened many times. is that not -- >> what has happened? >> that what is happening at the state dinner has happened many times because we did know but because they didn't post it on their facebook. spirit i would say absolutely not. i would say this is an aberration. again, you know, we take our protection duties very, very seriously protecting the white house, is our number one priority. and i do not believe, i know that this has not happened many times before or anytime. . . these preevent protocols

that are followed for a reason but i'd love to hear your response to the danger they may or may not have been exposed to without the party crasher having a gun or a knife. >> the sir, the issue you brought up, i would be happy to address it in a classified briefing but those are counter-measures we do take into account. again, i would not want to talk about those in here. make no doubt about it. i'm not trying to minimize the fact regarding the danger here. i don't like what happened. none of us want to see that happen here. but i am confident in our levels of security and our men and women that are protecting the president in close proximity to him in all the situations we put him in, we travel all over the country.

it is very difficult protecting a president in a democracy. and, you know, it's our job to make sure that person is able to get out their agenda and get out their message and have access to people and we deal with these type of situations every day. as it's been said if we had our way we'd put them in a bubble. we know we can't do that. and we want to ensure that we get that person out there no matter who it is and allow them to get out their message and agenda and i will tell you that we do it every day. we have to let people have access to them but we do have people that are prepared to react to any type of threat in the near close proximity. and i'm confident in our people. >> the gentlelady from texas, ms. jackson-lee. >> mr. chairman, thank you very much. mr. sullivan, you are right. you have the responsibility of protecting our president. and you know the letter that i

wrote to the secretary of homeland security which i believe should be more intimately involved in this issue as we go forward, i indicated my appreciation for the brave men and women that serve in the secret service. and i will never step back from that representation. i also acknowledge the fact that you've said there's no margin for error. i want to applaud you for the 1.2 million people that have come in securely. and i want to join you in recognizing that you staff-up, man-up, woman-up when you need to but i want to join my colleagues to say this is the time to understand what happened and what kind of resources going forward. so let me say to you that my perspective is that this is a law enforcement issue. a criminal activity that could have generated into a horrific incident at a state dinner in washington, d.c., in the white house and what has been classified as the most powerful nation in the world.

in the backdrop, of the mumbai incident that occurred a year almost to the day of the visit of the prime minister of the great country of india. so i'd like to just show you how severe i think these circumstances are. we've seen these over and over again. severe, absolutely severe. because the person standing there was not vetted to the report that you've submitted to us was not on any list. severe. when we see a picture that we've seen over and over again on the -- severe. violation and potential threat to the president and vice president of the united states. again, in another location all together in an uninvited circumstance standing with the united states military. i'm sure they could take care of themselves but severe.

the same time the prime minister of the nation that suffered this terrorist act was there. so let me focus on why i believe this is a law enforcement issue. you may not be able to discuss a lot of it but let me quickly go through my point. at 15th and alexander hamilton place was there a secret service personnel there. >> there was. >> and did that secret service personnel inquire of the salahis who i believe came according to your report to that checkpoint -- were they invited guests? >> those people presented themselves as being invited. >> was there a discussion? >> there was as far as i know. >> and in your report it says they insisted they were invited. were allowed to proceed to the second pedestrian checkpoint did they speak to a secret service officer? >> at the first checkpoint they did talk one of our people, yes. >> there was dialog and conversation? >> correct. >> and did they in that dialog and conversation again speak to a federal officer? >> they did.

>> and the actions of the individuals speaking to a federal officer covered by a federal law. >> they are. >> so let me proceed on the idea that in 18 u.s. 101, 1001, it says that anyone who proceeds to falsify, conceal or cover up by any trick, scheme or device is violating a federal law. we can talk about the secret service who you have mentioned that you had more than a faux-pas. the lives of these individuals were threatened. but we cannot get away from the fact that the salahis are playing with the attitudes and the trends and the dangers of what we live in. and so i'd like to offer into the record and ask you a question in particular, there is an email that has the salahis reporting that senator harry reid and his wife and bob stevens and his wife will not be

at the dinner. can you tell me how they would have access to this kind of classified information? is the white house lists where people are not coming -- is there a list printed saying these people are not show up? >> congresswoman, i don't know where they got that information from. >> there is also an additional statute that suggests in 18u.s.c.1036 that says industry by false pretenses to any real property, whoever by any fraud or false pretense enters or attempts to enter were they on the list to your knowledge? >> they were not on the list. >> do you believe if they entered into the premises, discussing this with the secret service who made a mistake, more than what we would like -- did they enter on false pretenses? is >> ma'am, as we said before we're in the middle of a criminal investigation here. u.s. attorneys office -- >> and i understand you may not be able to answer. did they enter with approval in terms of being on a list to your knowledge? >> again, ma'am, they were not

on the list, but it's our mistake because they weren't on the list, we let them through. >> they were and they were not on the list and, therefore, not vetted; is that your understanding? is the white house considered a federal building? >> it is. >> all right. mr. chairman, i'd simply want to submit into the record four or five -- i don't know if we're going to have a second round. four or five of these emails that reflect the knowledge of the salahis that they were not invited. and their misrepresentation in a very, very large and conspicuous way. >> without objection. >> i yield back. >> can i have one more comment to the congresswoman -- i feel i have to defend my boss here. secretary napolitano has been involved with me on this investigation. we've been speaking daily regarding this. we spoke about a half hour before i came up here for this testimony so i would not want to leave, you know, any indication or have you under the impression that she has not been intimately involved with this. we've been talking daily about this issue.

>> thank you, mr. chairman. i look forward to meeting with secretary napolitano. i'm sure she will meet with the committee. thank you very much. >> thank you, mr. chairman. and i know there is an investigation underway and the u.s. attorney's office is looking at that. as a former federal prosecutor i know they will do a thorough and diligent job in this case. mr. sullivan, you brief us on a monthly basis on intelligence briefing, threat briefing. i don't need to emphasize to you the threat here. it's the first state dinner that's been pointed out. the prime minister of india who has also been a target was at this state dinner. india, which has been threatened by pakistan on the eve of the president giving his speech on afghanistan, his policy dealing with afghanistan and pakistan. you have two major targets at the white house. and the idea that a couple could get in there without any --

without their names being on the list, without any sort of investigate, if you will, without their social security numbers being submitted in advance is really astounding. now, you were very candid and saying established procedures were not followed and i think that's very clear in this case but how in the world could this couple get past the secret service without having their names on the list? without having their socials in advance and get right up to the president of the united states? >> sir, i've asked myself that question a thousand times over the last week. what we keep coming back to here is that procedures weren't followed. and again, what we have found when we follow the procedures, when we -- when we go by the protocols we have, these type of situations don't occur. i'd like to think that all these

layers -- and that's one thing we do -- we realize we put a plan together that things might not always go to plan and that they might be imperfect. in this particular case, that is what happened. but i still do believe because of all the counter-measures we have which i'd be more than happy to speak to you about in a closed session, i do believe that their safety was never in jeopardy but again, do i like to see this or any of our people like to see this we're beating ourselves up. we do not like to see this. when we have the prime minister comes in we give him the highest level of security and put the best people on detail, sir, i can tell you -- i understand your concern and i have the same concern. but i do think this is an aberration. >> is there a protocol where the white house officials can wave a guest in even if they're not on the list and the social security numbers and background checks have not been done? >> sir, i'd prefer not to get on procedures on that.

every event is going to be different but again, i'd prefer not to get in that procedure. >> well, you said human error happened. certainly it looks like the secret service there's human error. what i want to know is whether this individual -- was anybody from the white house intervened to allow access to these individuals? >> congressman, this is our fault and our fault alone. there's no other people to blame here. you know, look at me and blame me. this is our fault. >> you're certainly doing the job that secret service is known to be doing. and taking full responsibility. but i think that's an issue we need to look into. you mentioned this planning meeting that took place prior to this event. were you at that meeting? >> i was not. >> okay. but the decision that came out of that meeting, was that the -- the social secretary -- it would not be necessary for her or her staff to be present with secret service? >> sir, as i understand it, the agreement was that they would have people available in a

roving capacity and that we would accept that checkpoint -- we would accept the invitation list. >> but in this case, were they there? >> the white house staff was available, you know, it was just a matter of, you know, our people either getting on the radio or picking up the phone and contacting them and asking them to come out to help resolve the issue. >> but you say when this was a secret service error alone that secret service let these people in without any sort of vetting process and that the white house had no role in waving them in? is that what you're telling us. >> that's what i'm telling you, sir. >> i find that very interesting. i'll be very interested to see what the investigation -- how that unfolds and what information comes out of that. i know looking forward, the white house has admitted error in this memo by the white house deputy chief of staff where he stated that in the future, that somebody from the white house absolutely needs to be there present with the secret service;

is that correct >> yes, sir >> so looking forward and protecting the president of the united states and heads of state across the world, the white house employees officials will be present with secret service as individuals come into the white house. >> that's correct. >> okay. i yield back. >> thank you very much. the gentleman from texas for 5 minutes. >> thank you, mr. chairman. director sullivan, i appreciate the history of the secret service back since 1865 and the mission as it evolved from protective to investigatory and i appreciate all of that. listen to what we've heard today and what we've read, my opinion is you've been a good soldier. you're a good soldier. you're taking full responsibility. in my opinion, this is just my opinion, i think this responsibility should be shared but again, you're being a good soldier and i appreciate the work that you and the men and women that are working for the secret service -- let me ask you

this, we talked about the white house memo that came out that they now will go and have somebody at a checkpoint; is that correct? >> yes, sir. >> let's assume that that particular checkpoint that's been in question -- if somebody from the white house would have been there -- and i understand somebody could have gotten on the phone, somebody dropped the ball by not getting on the phone by calling -- let's assume somebody from the white house would have been there at that time. what would have been the procedure? to be followed by y'all? >> the procedure would have been the same as if our person had called that person -- >> no, i mean -- the persons right next to the secret service. >> they would both have worked through this issue together. >> who would have had the ultimate call on this one. >> that's a difficult call to answer. it's a joint security. when it comes to security we have the ultimate call. >> have you ever turned anybody down if the white house asked somebody to come in? >> sir, i can't categorically --

>> can you remember of one particular time? >> i cannot recall that, no. >> okay. do you have the necessary resources and funds to effectively investigate issues like this? you have the personnel and the resources available to do all this work? >> sir, i believe we do. again, when it comes to doing our protection, that's our number one priority. you know, we work with the department. we work with capitol hill to ensure that we have the necessary funding. i don't think you're going to talk to any agency head in washington, d.c., who's not going to tell you they need more money. you know, but again, we do our best. we prioritize. and working through the department, working with capitol hill we do everything we can to ensure that we have the necessary funding. >> prioritiesed with whatever resources we give you? >> that's correct. >> well, what obstacles currently exist that would have hindered the secret service from

accomplishing their protective services? was there anything in particular that night that hindered you? >> no, sir. >> okay. i'll go back to my question again. if the white house would have had their persons standing there, what would you have done at that time? >> we both would have looked at the list. we both would have determined they weren't on the list and i believe we would have worked through it together to determine if, in fact, that person should have been invited. >> okay. again with all due respect, i think you're a good soldier. i feel the work the men and women do under these circumstances -- i think y'all have done a good job. and you're being a good soldier by taking full responsibility but i still think that if somebody would have been there at that time with you, right next, not picking up the phone, i think we would have had a different result at that time. but again i want to thank you and your men and women that do a great job. thank you. >> thank you, congressman. >> thank you, mr. chairman. >> thank you very much.

the gentleman from pennsylvania for 5 minutes. >> thank you, mr. chairman. thank you, director sullivan, for being here. i truly appreciate your service and the service of those who serve in your agency. and listening to my friends, the congressmen, i'm very impressed by your willingness to take responsibility for this incident. but, you know, i never, ever expected, you know -- we always expect the secret service to take a bullet for the president. we don't expect the secret service to take a bullet for the president's staff. and, you know, i think we have to have a discussion here about that issue. that clearly there are issues of collaboration and coordination that were not up to the high expectations that i know you have for your agency and that we all have. and so it's critical that we hear from the social office on this. but my main question, director sullivan is this, there has been much discussion about the planning meeting and who recommended that no representative from the social office be at the initial

checkpoints. and given your 26 years of experience, would you have made such a recommendation? >> you know, sir, i don't really want to debate whether that was the right decision or the wrong decision. i think the fact is that regardless of -- if it was right or wrong, we agreed to it. and when we agreed to it, we took the responsibility for that list. and we took responsibility for allowing that person into the event. my opinion is to look back and to say, you know, what we should have done and could have done does not take away from the fact that we allowed somebody into the white house who shouldn't have come in. we had a protocol for that particular night based upon our decision that if anybody came who wasn't on the list, that we should have -- that that person should have called for help. and we didn't do it.

so i guess we could debate for hours whether or not i should -- you know, i would have made that decision or if we made the right decision but the bottom line is we made a decision. and we have to live with it. >> i appreciate the candor of your answer. and also i understand too since you would not have made that recommendation i certainly hope that when the white house social office receives recommendations from you about the security of the president of the united states, they would take those recommendations very seriously like they perhaps should have in this particular instance. media has reported that desiree rogers, the white house social secretary, was listed as a guest for the event and hosting her own table. do you know if this was, in fact, the case? >> i don't know anything about that, sir.4)g'm" >> okay. and if the secretw, service had question as to whether or not a very important person was, in fact, authorized to attend the event, would ms. rogers be a logical person to contact in a case like that? >> again, sir, i would not know.

i think that she would have -- i would think that there's several people working within her office and i do know for this particular event we had contacts from within her office that we were dealing with. i'm not sure, in fact, if it was her directly or other people who worked for her. >> okay. and again, throughout your time as director of the secret service, were representatives from the white house staff stationed at checkpoints for these types of events like this -- i think you answered it, beneficial in the future. you said yes. that's your position. a few other things, too that i want to run by you. when reviewing the office of inspector general's secret service inaugural security i found an interesting statement by the i.g. that i'd like to just share with you. in reviewing allegations that individuals without tickets were able to attend the breakfast with vice president-elect biden. the secret service found the allegations were true but did not consider them a breach of security. on page 15 of that report it states, quote, because the

secret service relies on physical screening and monitoring, not invitations, to provide security, there were no security lapses at the biden breakfast. can you explain why the secret service considers a ticket a crowd control mechanism and not a security mechanism? >> i think it all depends on how those tickets -- and again, i'm not sure of the conditions and how those tickets were distributed. many times tickets are mailed out unilaterally to hundreds of people. i'm not exactly sure, sir, how those tickets were distributed. i'd be more than happy to look into that and get into it with you. i guess i'm not familiar with that. >> okay. and you've already stated that essentially a white house security was breached. there was an agent near the president when he was in the receiving line and met the salahis. what one might think of as the president is with the rope line.

>> not as loaf as they were in the rope line. if you watch our men and women on these type of photo lines, people have to pass by an agent on one end. there's other agents on the other end. and we are monitoring these people. we're watching these people.n@ you'll never see our people watching those we protect but we're watching the people that are approaching the people we protect. >> thank you for your service and i yield back. >> the gentleman's time has expired. the gentleman from pennsylvania for 5 minutes. >> thank you, mr. chairman. mr. sullivan, you understand this is a hearing that should never have had to take place. and i commend you for your courage to stand in the breach here today. i am just at a loss to understand why the white house didn't send somebody to discuss this as well, to give us a better sense. certainly, not a profile in courage.

certainly for a white house that touts transparency we would expect somebody to be here. you know, in a very bizarre way, we owe some sort of a thanks to this pathologically egomaniacal couple that has tried to not just at the white house but in many other places and try and do this sort of thing. we owe this weird thanks for exposing some of these issues. what is going on? what has happened with the guards who let this happen at the checkpoints, the initial checkpoints? are they on administrative leave? are they -- can you tell me what's going on there? >> yes, sir. they're on administrative leave with pay. >> how often does the secret service exercise, practice, go through their routines for these sorts of things? >> for every event we do that. >> for every event.

but do it as a matter of course or for your regular training? >> for training. i would say that our level of training for these type of events isn't probably where it should be. over the past year we have done, i think, a tremendous job of improving our training. we do -- we do training out at our raleigh training center in front maryland. we look at these types of issues. we put scenarios together for these type of scenarios. we're not where we need to be, but i see us improving every day as far as getting more people out to training. you know, uniformed division, you know, there's -- we've been authorized at 1419 for uniformed decision going to 2003. we've never been able to get to that number. right now we're at about 1350. we are creeping in on that number. i'm hoping with more people that

we'll achieve the 1419 which will allow us to do more training. right now we are working with congress to get a bill passed which i believe will help with retention and help with recruitment. it's the uniformed division modernization act. it's already been passed through the senate and it's going through the house right now but i believe that'll be a big help. but we do put training procedures together for these type of issues. but i'm not going to tell you we're getting it done as much as i'd like to but i do think as we grow the uniform division that we are going to see more training. but i would also tell you for this one thing that we learned from this particular event, you know, managerial oversight is very important. i believe we had the appropriate managerial oversight for that night but at these type of nights we'll have more man engineerial oversight. we'll have a help desk that will be staffed by somebody a

commanding officer from our uniformed division as well as a senior level person from the white house staff. we've had something comparable to that before but it was more of a mobile-type thing where this will be stationary. everybody is going to know where it is. but again, i go back to the fact that i'm not sure that the any level of training, any level of funding, any number of people could have prevented what happened the other night. this was just an error. -- an error in judgment. it was a mistake. >> how much discretion does a uniformed card or -- >> yes. you know, we he give all -- we give them a lot of discretion and a lot go into our hiring and when they initially come on they go about through seven months of training and i'm confident in our people and we do give them discretion. you know, there are a lot of things that happen out there that they have to make an on the spot decision, you know, things don't -- you know, they don't have the luxury of being able to

pick up the phone and ask somebody for advice. and we do give them a lot of discretion. in this particular case we did have time to make the right decision and we just didn't do it. >> okay. i am very concerned by the revelation that ms. jackson-lee presented with this email of knowing who was and who was not going to be at this event. i think the revelation of that email requires us to do a very thorough investigation into who knew what, when and why and how they got that information. i mean, that was extremely frightening to me. that apparently mr. salahi sent this email. and how he was able to come up with the guest list and not who was going to be there but who was not going to be there and apparently why that is exceptionally troubling. and that is a clear security breach that really needs to be understood. and it may not be secret

service's -- in this case it was probably not secret service's fault. i don't think it is. but there is a security breach that people need to understand the protocol of security here. when we err in this country we have to err for national security. >> that information has been entered into the record. and it's our expectation that director sullivan will get back with us once he's had an opportunity to investigate the email and the source and what have you. we have four votes on the floor. the expectations is to recess and reconvene around 12:15. the committee is recessed.

>> the senate is about to gavel in for day 5 of work on the healthcare bill. senators have proposed at least 72 amendments, a number will be considered today with more to be debated saturday and sunday. senators have agreed that there will be no votes until after 11:30 eastern today. now live coverage of the u.s. senate on c-span2.

the presiding officer: the senate will come to order. the chaplain, dr. barry black, will lead the senate in prayer. the chaplain: let us pray. our father. we bow in your sacred presence to acknowlege our need of you. we can do without many things, but without you we can't live. meet the needs of the members of this legislative body. when sorrow and shadows fall on their path, fill them with your joy and light. when they feel perplexed, provide them with your bountiful wisdom.

when their health fails, be for them the great physician. lord, we also ask you to protect their loved ones with the shield of your favor. give our lawmakers courage for hard times and strength for difficult places. we pray in your loving name. amen. the presiding officer: please join me in reciting the pledge of allegiance to the flag. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible,

with liberty and justice for all. the presiding officer: the clerk will read a communication to the senate. the clerk: washington d.c., december 4, 2009. to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable mark warner, a senator from the commonwealth of virginia, to perform the duties of the chair. signed: robert c. byrd, presidet pro tempore. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: following leader remarks the senate will resume consideration of the health care bill. the time until 11:30 is equally divided and controlled between the leaders or their designees. the majority will control the first half, republicans the second half. we have a number of votes that we're going to try to arrange this afternoon. we'll let all senators know as

soon as we have this worked out. but there will be some votes today and tomorrow. mr. president, the amendment process continues to crawl forward. with this historic health foreman bill continues to evolve and improve. this is a good bill. it saves lives, saves money and saves medicare. it makes health insurance more affordable. it makes health insurance companies more accountable. it makes our economy stronger. the democrats know we can make it even better. this is happening because of the dedicated hard work throughout the democratic caucus from veteran senators and newer senators, by the hands of men and women from the diverse parts of the country and good public servants from all points of the political spectrum. senator mikulski of maryland who for decades has been a champion for women's health made it better by making sure women can get the mammograms, checkups and preventive care they need to stay healthy and get them at no

cost. senator bennet of colorado who served skillfully h in this body for less than a year made it better by reaffirming our commitment to medicare, made it better by ensuring that seniors get the care they need and the quality of life they deserve. that positive trend will continue today. senator whitehouse of rhode island who came to congress with a class of senators elected with a strong mandate to change the way washington works has proposed an amendment based on common sense and accountability. it says that the money dedicated to the health care of american seniors and people with disabilities can be used only for those precise purposes. unfortunately, some republicans are less interested in solving problems than they are in creating them. the day before this floor -- the day before this floor debate began, mr. president, the assistant republican leader, the junior senator from arizona, said -- and i quote -- "there's no way to fix this bill." of course he's absolutely

totally wrong. all senators know there is a very reliable way to improve legislation, to improve this bill. it's been in use for 220 years. it's called the legislative process. it's called doing our jobs. as this bill continues to improve, i once again remind my colleagues not to lose sight of the bigger picture. as we delve into the details and debate the fine print, let's not forget why we're here. our goal remains the same as it was the day we began this debate many months ago. it remains the same as it was a year and a half ago when senate finance chair max baucus first held a series of hearings that led to the legislation that is now before us. our goal remains the same as it was last november when the american people called in a loud and clear voice for change. it remains the same as it did 31 years ago when senator ted kennedy called it shameful that -- and i quote -- "in our unbelievably rich land, the quality of health care available to many of our people is

unbelievably poor and the cost is unbelievably high." it remains the same as it did the day president truman sounded a call to ensure that american families are protected in what he called the economic effects of sickness. that was more than 64 years ago. and more than half of today's united states senators weren't even born by then. that constant goal has been and remains this: we must make it possible for every american, each and every american to afford to live a healthy life. each moment in this fight is historic. no bill to put health care decision in the hands of people has ever come this far. but the most historic days of the journey lie ahead. we can only seize that opportunity if this debate is about facts, not about fear. i remind my colleagues that if we're truly to help the american people and the american economy, we're to sincerely do the work our neighbors sent us here to do. we're to leave our children and

grandchildren a better inheritance. if we're to do any of these things, we must work together and not against each other. let's work as partners, not as partisans. this is not the first time i've asked my republican friends to think of the real families across this nation who face real problems, families with real diseases, real sicknesses, real medical bills, and real fears. it is not the first time i've warned that america has no place for those who hope for failure. this is not the first time i've extended my hand across the aisle and asked my republican friends to abandon their shortsighted strategy to bring the senate to a screeching halt, for example, issuing an info medicational guide -- infomational guide on how to stop and slow things. mr. president, that doesn't work. we need a strategy that says we

can win with because that will mean -- we can win because that will mean the american people will not lose. so i hope that for the first time we'll have people of goodwill on the republican side of this chamber walk over and say "let's work together to get some of these things done." i've had a couple of good conversations in the last few days with some of my colleagues on the other side of the aisle. i hope we can move forward. this is a bill that doesn't look at a person being sick or hurt or afraid being a democrat or a republican or independent. they're americans. they're from virginia, they're from montana, they're from nevada. they're from all over america. they're people who are calling upon us to do the right thing.

the presiding officer: under the previous order, leadership time is reserved, under the previous order, the senate will resume consideration of h.r. 3590 which the clerk will report. the clerk: calendar number 175, h.r. 3590, an act to amend the internal revenue code of 1986 to modify the first-time home buyers credit in the case of members of the armed forces and certain other federal employees, and for other purposes. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, we are beginning our fifth day of consideration of the health reform bill. we'll be in a period for debate only until about 11:30.

pending now is the amendment by the senator from rhode island, senator whitehouse, on fiscal responsibility. also pending is a motion to commit by the senator from utah on medicare advantage. it would be my hope that the senate would vote on these matters today. mr. president, i ask consent that the following staff be allowed on the senate floor for the duration of the debate on the health care bill: cynthia alan, ryan naulty. the presiding officer: without objection. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

the presiding officer: the senator from montana. mr. baucus: i suggest further proceedings under the quorum call be dispensed with. the presiding officer: without objection. under the previous order, the time until 11:30 a.m. will be for debate only with the time equally divided and controlled between the two leaders or their designees, with the majority controlling the first portion of time. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, experts and economists of every political stripe agree that preserving america's long-term economic security means reforming the way we provide and pay for health care. health care spending makes up one-sixth of the u.s. economy

today. in future generations -- and future generations can expect insurmountable debt if we fail to act. fiscal challenges we may face in years to come pale in comparison to the threat of uncontrolled federal health care spending. the chart behind me essentially shows that. the chart shows that the percentage of annual growth rates beginning in 2004 -- the red is the economy. the blue is health care costs. and, clearly, over time, especially as the economy dipped during this great recession, the gap between economic growth and health care spending has widened, and the projections are in future years they'll start to widen more and more and more, as you can see out to the year 2018, the total economy is projected in the year 2018 to be

7%, closer to 8% -- excuse me, the economy is going to be about 4% and the health care i spendig is going to be about 7% or 8%. doing nothing means intielt spending more than doubles in the year -- means entitlement spend more than doubles in the year 2015. but it's not simply the federal budget on the line. it's the family budget, too. incredibly, in total, we spend 80 times as much on health care today as we did five decades ago -- 80 times. 80 times more in health care today, 80, than we did five decades ago. and now family budgets are breaking under the strain -- already. and that's going to get worse if we do nothing. the cost to the average family

health care plan will reach $24,000 in the year 2016. that's not too many years away from now. this represents an 84% increase over 2008 premium levels. that means if we do nothing, in fewer than ten years, most families would have to dedicate half of their household blught -- household budget to health care. every day we hear from folks back home that simply cannot afford the care that they need. we have an opportunity to act. we have an obligation to act. and now we have an opportunity to act. the country's leading economists and federal budget experts have laid out strategies and options for getting costs under control. we've all taken their recommendations to heart. there really is a lot of agreement among those who study

these issues as to what we must do, and now we have a bill that does what they suggest, and it also passes the test of fiscal responsibility. we have many reasons to vote for this bill. it protects and even increases medicare benefits for seniors. it achieves near-universal coverage in less than ten years. that means it achieves the goal of virtually everybody having health insurance in that period of time. it slows the growth of federal health care spending. it stops insurance industry discrimination. and based on independent nonpartisan analysis, it makes a serious dent in our federal deficit. mr. president, i'd like to cease my statement and pick it up at a later tievment i see the minority leader is on the floor and in deference to hirnlings -n

deference to hirnlings i think it is only appropriate that -- and in deference to him, i think it is only appropriate that he be recognized. mr. mcconnell: mr. president, i thank the senator for yielding for my comments. i would ask that my comments appear at the appropriate place in the record, not to interrupt senator baucus's comments. we've now had a very, very clarifying vote on the senate floor about the direction of our friends on the other side with regard to our health care system. yesterday all but two of them voted to preserve nearly half a million dollars in cuts to medicare, the health program for our seniors. in the run-up to that vote, they said these cuts weren't really cuts appeared that medicare advantage in particular isn't really a part of medicare, arguments plainly contradicted by the text of the bill itself, by the department of health and

human services, by the independent congressional budget office, and by the experience of seniors themselves. seniors do not want senators fooling with medicare. let me say that again. seniors do not want senators fooling with medicare. they want us to fix it, to strengthen it, to preserve it for future generations, not raid it like a giant piggy bank in order to create some entirely new government program. yesterday's vote was particularly distressing for the millions of seniors on medicare advantage. so today members will have an opportunity to undo the damage they voted to do to this program. with yesterday's vote -- with yesterday's vote, proponents of this measure authorized $120 billion in cuts to medicare advantage, and in the process, they expressly voted to violate

the president's pledge that seniors who like the plans they have can keep them. the president has said seniors who like the plans they have can keep them. because you can't cut $120 billion from a benefits program, obviously, without cutting benefits. the congressional budget office has been crystal clear on this matter. when asked about the effect these cuts would have on medicare advantage, the director of c.b.o. was unequivocal, unequivocal. he said that approximately half -- approximately half -- of medicare advantage benefits will be cut for nearly 11 million seniors enrolled in this program under this bill. now, this is the director of the congressional budget office being unequivocal. he said that approximately half of medicare advantage benefits

will be cut for nearly 11 million seniors enrolled in this program under this bill. that's what our friends on the other side voted for yesterday, and they know it. one democrat last night was explicit. he admitted that after yesterday's votes, democrats won't be able to say that -- quote -- "if you like what you have, you can keep it." this is one of our democrat colleagues yesterday saying, "if you like what you have, you can keep it" can to longer be said. and he went on to say -- quote -- "that basic commitment that a lot of us around here have made will be called into question." i think that's highly likely. so our friends have a couple of choices here today. they can reaffirm their plan to cut benefits for nearly one-fourth of all seniors enrolled in medicare, they can admit that the president's pledge about ceemg the plan you

like -- about keeping the plan you like no longer applies, or they can reverse part of yesterday's vote later today by voting with republicans to restore those cuts to medicare advantage. mr. president, i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: [iinaudible] i have some remarks here for the record. the presiding officer: without objection. mr. baucus: again, mr. president, that means if we do nothing in fewer than ten years most families would have to dedicate half of their household budgets to health insurance. for years we have heard the warnings from federal budget experts and every day we hear from folks back home that they simply cannot afford the health care that they need. now we have the opportunity to

act. as i mentioned, the nation's leading economists and federal budget experts laid out strategies and options for getting costs under control and we took those recommendations in this bill to heart, and now we have a tbhail passes the test -- and now we have a bill that passes the test also of fiscal responsibility. doing nothing means health care spending continues growing faster than our economy. doing nothing means entitlement spending more than doubles by the year 2050, tacking one-fifth of our g.d.p. -- taking one-fifth of our g.d.p. but it is not simply the federal budget on the line. it is the family budget, too. as i mentioned a few moments ago, in total, we today spend 0 times as much on health care as we did five decades ago -- 80 times. and now family budgets are breaking under the strain. the cost to th of the average fy health care plan will reach $24,000 in the year 2016.

that represents an 84% increase over 2008 premium levels. it's dangerous stopping in the middle of a speech. you have to figure out where you were. we have many reasons to vote for this bill. it protects and even increases medicare benefits for seniors. it achieves near-universal coverage in less than ten years. it slows the growth of federal health care spending. it stops insurance industry discrimination and based on independent nonpartisan analysis, it makes a serious dent in our federal deficit. this chart behind me represents that. two weeks ago the congressional budget office and the joint committee on taxation confirmed in no uncertain terms that deficits go down under this plan

and the official cost estimate reads as follows: the congressional budget office and the joint committee on tax estimate that, on balance, the direct spending and revenue effects of enacting this legislation would yield a net reduction in federal deficits of $130 billion over the years 2010 to 2019. that's represented by the green bar there on the left. it is a net $130 billion reduction during the first ten years of this bill. in addition, -- in addition to reducing the federal deficit, the c.b.o. also confirms this bill is fully paid for. it does not add one dime to the federal deficit. in fact, it reduces, as i mentioned, our deficit by $130 billion over the next ten years. but it also stands the test of time. the second decade, the deficit decreases by another amount,

this time by a much greater amount -- by $650 billion. and by the end of the third decade, our children would benefit from a reduction equal to -- close to 2% of gross domestic product. that's much more than the second decade, which is a quarter -- .25 -- of gross domestic product. so you can see in each of the decades -- the first decade, $130 billion, the second decade, the reduction of the d.v.d. $650 billion, and in the -- and the third senior senator much more than that. i can't do the correct math. but roughly it would be -- roughly it would be hundreds of billions of dollars greater than the reduction in the second decade. this is serious deficit reduction. in today's dollars, that would mean that there would be more than -- that would be more than

we spend on the entire medicaid program this year. according to c.b.o. this bill also slows the growth in medicare costs, which has been a principal goal in our health care debate from day one. medicare spend wooing grow 6% annually instead of 8% annually. in other words, medicare would continue to grow but unlike today it would grow at a sustainable rate. of course, no projections, even from the congressional budget office, can be certain. we can safely say this bill will puts on the right track. i can safely say this bill is better than doing nothing. no honest assessment challenges the case for enacting it gna gno slow the growth -- it now to slow the growth of spending. and no honest assessment of this bill challenges the c.b.o. analysis. i have not heard an honest challenge to this -- to the

c.b.o. analysis, nor have i heard of an honest case for not acting now to slow the growth of spending. which means we have many reasons to pass health care reform, not the least of which is the long-term cost of restoring the hetion of our nation. forced into bankruptcy by medical tragedy, this is about stopping insurance industry discrimination. this is about saving medicare for our seniors and reducing the deficit for our grandchildren. mr. president, i don't know what other senators we have. i guess senator bingaman would like to seek recognition during the time we have.

let me check on how much time we have and how many speakers we have. the presiding officer: 40 minutes. mr. baucus: 40 minutes. how many speakers? okay, 15. go for it. mr. bingaman: mr. president? the presiding officer: the senator from new mexico. mr. bingaman: let me first thank senator baucus for his leadership on this issue. i mentioned to him many times and strongly believe that without his leadership, we would not be where we are today in our effort to reform health care in this country. so i congratulate him on the superb effort he's made. i want to spend a few minutes talking about health care reform both as it affects the country, but also as it affects my home state of new mexico. first i'd like to discuss the context for this health reform

bill, and that is the very serious problem that we face as a country with growing costs of health care if the congress fails to act. now we have a chart that i'll put up, since everyone's got chart. this is a chart that shows what's happening to all health care costs and has been happening since 1960. and you can see that as a percent of the gross domestic product, back in 1960 we were spending right at 5% of our gross domestic product on all health care in this country. today we are spending much more like 16% of the gross domestic product on health care. and the projections for the future if we do not act to reform the health care system, the projections for the future are very serious indeed.

let me allude to an article that was in the morning "new york times." this is by our, by award-winning, the noble award-winning economist paug -- paul krugman at princeton university. he talks about this issue of fiscal responsibility and the impact of health care reform on the deficit and talks about how some senators seem to believe that they have concerns about going ahead with this health care reform bill because of what it might cost. he makes the point, he says "if they are really concerned with fiscal responsibility, they should not be worried about what would happen if health reform passes. they should instead be worried about what would happen if it does not pass. for america can't get control of its budget without controlling health care costs. and this is our last best chance to deal with these costs in a

rational way." mr. president, i'd ask that his full column from "the new york times" this morning be included in the record following my remarks. the presiding officer: without objection. mr. bingaman: as as this chart demonstrates, the one here on my left, according to the congressional budget office, if we don't act -- if we don't act to deal with the growth in health care costs, federal spending on medicare and medicaid combined will grow from 5% of g.d.p. today to almost 10% by 2035. by 2080, the government would be spending almost as much as a share of the economy on just its two major health care programs as it has spent on all of its programs and services in recent years. let me put up another chart that demonstrates that most of this

increase in cost is not the result of our aging population. we do have an aging population, and that does add to the cost of health care, because as people get older they tend to need more health care. but what this chart shows is the dark blue here shows the increase that is expected in health care costs by virtue of aging. but the lighter blue talks about the effect of excess cost growth. and that is not related to aging. that is just that the growth that health care costs are out of control in our current system. such spending is unsustainable. it has led the congressional budget office to say that slowing the growth rate of outlays for medicare and medicaid is the central long-term challenge for fiscal policy. moreover, across the country premiums continue to increase. they're becoming more and more unaffordable for individuals and

for businesses. i hear on a regular basis as i go around new mexico -- and i'm sure all my colleagues hear from their constituents as they travel in their states -- that people cannot continue to pay more and more each year for their health care coverage. according to an august report by the commonwealth fund, nationally family premiums for employer-sponsored health insurance increased 119% between 1999 and 2008. and if cost growth continues on its current course, those premiums could increase another 94% to an average of $23-rbgz 84 -- $23,842 per family by 2020. i'm not sure what the circumstance is in many states but i know in the state of new

mexico, there are many families that cannot afford to be paying $23-rbgz -- $23,800 in health care premiums. nowhere is the growth felt more acutely than in my state. without health reform in my state, these are the projections. we are expected to experience the greatest increase in health insurance premiums of any state in the union. for example, the average employer-sponsored insurance premium for a family in new mexico was about $6,000 in the year 2000. by 2006, this rate had almost doubled, or the cost had almost doubled to $11,000. by 2016, the amount is expected to rise to an astonishing $28,000. in addition, health insurance premiums in new mexico make up a larger percentage of new

mexico's income, the income of the average new mexico family than almost all other states. we are paying 31.18%, over 31% of the average income of a family in income income is going to pay -- family in new mexico is going to pay for health care. this is expected to grow to 66% if we do not reform our health care system. it's important to highlight that the higher spending on health care in the united states does not necessarily prolong lives. i hear a lot of speeches around here about how we have the greatest health care system in the world. we're the envy of the world, and people will just love to have access to our health care system. this chart illustrates that in 2000, the united states spent more on health care than any other country in the world, an

average of $4,500 per person. that was in 2000. switzerland was the second highest at $3,300, substantially less. essentially pay, in switzerland the cost per person was 71% of what it was in the united states during that year. nevertheless, the average u.s. life expectancy comes out at 27th in the world. our life expectancy average is 77 years. many countries -- 26 to be exact -- achieve higher life expectancy rates with significantly lower spending on health care. data from the mackenzie global institute clearly indicates that there is a considerable level of waste in our current system. mackenzie estimates that the united states spends nearly $500 billion annual in excess of other similarly situated nations. of this, about $224 billion in

excess costs are found in hospital care. about $178 billion are found in outpatient care. together these account for more than 80% of u.s. spending above the levels of other nations. here's one other chart. this is one that i've used before here on the senate floor. not surprisingly, as costs and inefficiencies continue to build, access to health care is becoming more and more difficult for middle- and lower-income americans. this chart indicates the rate of uninsurance throughout the country. first, on the left-hand side, this is in the year 2000. on the right-hand side, the year is 2008. you can see the dark color, the dark blue states are states where 23% or more of the population age 18 to 64 are

uninsured. back in the year 2000, new mexico and texas were the only two states where the rate of uninsurance exceeded 23%. now you can see that the rate of uninsurance exceeds 23% for many of the states, particularly across the southern part of our country. so, we have a very serious problem that needs addressing. it's clear that the u.s. health care system is failing many americans, and the situation is becoming more and more urgent. according to a study published by the harvard medical school in august, medical costs have led to almost two-thirds of the bankruptcies in this country. more than 62% of the bankruptcies are attributable to health care problems. the study found that most medical debtors were well educated, owned their own homes,

had middle-class occupations, and shockingly three-quarters had health insurance. so these were people who had coverage, but the coverage was not adequate to meet the needs. unfortunately for many individuals, the very high cost of medical care leaves them to delay or to avoid receiving medical care altogether. the urban institute reports that 137,000 people in this country died between 2000 and 2006 because they lacked health insurance. that includes 22,000 people in the year 2006. so clearly, the need for health, national health reform has never been so great. the patient protection and affordable care act, which is the legislation we are debating here on the floor, which was introduced by senator reid and others a few weeks ago and includes the key reforms that we have come up with and that the

experts have come up with that are aimed at addressing she thee very serious problems while protecting the aspects of our system that are working today. first, this bill includes long over due reforms to increase the quality of the health care system while reducing overall costs. the legislation includes payment reforms that i've championed to shift from a fee-for-service payment system to a bundle payment system. this will reshape our health care reimbursement system to reward better care and not simply more care as it does today. second, it includes a broad new framework to ensure that all americans have access to quality and affordable health care. this includes the creation of a new health insurance exchange in each state which will provide americans a centralized source of meaningful private insurance as well refundable tax credits

to ensure that coverage is affordable. and finally, these new health insurance exchanges will help improve choices by allowing families and businesses to compare insurance plans on the basis of price and peformance. this puts families rather than the insurance companies or the government bureaucrats in charge of health care. it helps people to decide which quality, affordable insurance option is right for them. the congressional budget office, which is cited here -- and i think it's healthy, quite frankly, i notice that the congressional budget office is cited by both the democrats and the republicans in this debate. that is a credit to the congressional budget office. they are seen as nonpartisan. they are nonpartisan, and i congratulate doug elmendorf for the good work that the c.b.o. has been doing in support of our efforts to come to the right answer on health care reform. but the c.b.o. forecasts that this legislation would not add

to the deficit, as the chart that senator baucus had up here just a few minutes ago clearly indicates, the deficit would be reduced in the first ten years by $130 billion. it would be reduced in the second ten years, going up to 2029, by something over $600 billion. let me just also point out the contrast here. we're talking here about a bill which the congressional budget office says will reduce the size of the deficit in future decades. i can remember a couple of congresses ago when we had debate here on adding subpart-d to medicare, part-d to medicare. and there were many on the floor here who are concerned about costs today -- at least they say so in their speeches -- who were very anxious to add that legislation to medicare, adding

another $500 billion -- that was estimated by the c.b.o. at that time -- another $500 billion over a ten-year period to the cost that medicare was married. the efforts to bring the costs down in medicare is essential if we're going to keep medicare solvent in the future and part of the solvency problem medicare has in the future frankly is related to what we did in subpart-d. mr. president, i see my time is up. and there are other waiting to speak. let me just conclude and ask unanimous consent that the balance of my statement be included in the record. the presiding officer: without objection. the senator from montana. but how much time remains undere

time of the majority? the presiding officer: 24 minutes. mr. baucus: i yield ten minutes to the senator from massachusetts. a senator: thank you. mr. baucus: we might be able to find extra time. right now that's all we have in this first block. but sometimes we can work things out if you want to talk a little longer. but right now it is ten. mr. kirk: thank you, mr. president. today approximately 2 million of -- 200 million of our citizens are elderly. they are family members and loved once -- valuable, challenged and often forgotten but they were not forgotten by their friend and advocate, senator ted kennedy. he understood that a fair and civilized society should be judged on how it treats its most

vulnerable citizens. sadly, millions of seniors and persons living with disabilities struggle to obtain the services and supports they need to live fulfilling lives and to remain in their communities, among their friends and families, in what they hoped would be their productive, goaden years. senator kennedy understood it is morally wrong for so many men and women who need assistance to be forced to face the heartbreaking decisions -- do i give up my american dream in order to qualify for med cairksd the only government program that can provide me with the support i need? or do i forego my independence and resign myself to living the rest of my life confined to a facility? senator kennedy also understood that it is morally wrong when that infirmed or elderly

individual's friends or loved ones must also face heartbreaking choices. do i give up my job and commit my time to care for my infirmed parent at the expense of my own family and children, or do i resign myself to confining my ailing mother or father to a facility? families across this country understand this harsh crisis all too well. a recent poll found that nearly 60% of those surveyed had a personal experience with long-term care. and as this chart demonstrates, nearly 80% will be more likely to support health care reform if -- if -- it included a long-term care program. these families know that the current long-term care dry is not meeting their current needs and that change must come. as always, senator kennedy cared how our society would be judged.

he didn't just sit by. he acted. he drafted the community living assistance service and supports act, known as the class act, which we are debating this morning. this program was at the heart of his effort to help people with functional limitations and their families to obtain the services and supports they need. it gives them the chance to maintain their independence and remain active, productive members of their communities. under the class act, a worker in massachusetts or any other state can choose to pay a premium into this voluntary insurance program through affordable payroll deductions. after contributing for five years, they become eligible for a cash benefit of at least $50 a day if they become disabled. that cash benefit can make the difference in allowing a disabled person to live with independence, self-respect, and

dignity. for example, it can pay for having a ramp installed to their home or to pay for needed transportation or to purchase a computer to work from home and remain self-sufficient. it can also pay for a care giver to come to their home, help them bathe, get dressed, and cook meals, services that otherwise often fall to family and friends who are forced to work reduced hours on their own jobs or quit those jobs altogether to provide that needed care. currently, long-term care as we know it is paid for through a fragmented combination of sources including family budgets, medicaid, medicare, and private insurance. without a prior and voluntary insurance investment, which the class act offers, paying for long-term care can be the financially -- can be financially catastrophic since nursing homes and home care can

cost thousands of dollars a year. only one in five individuals can afford private long-term care insurance and many are excluded because of preexisting conditions. medicare's role in providing long-term services is extremely limited covering only short-term, skilled nursing care, and home health. this lack of option forces many people to turn to medicaid, which is our nation's primary payer and sole safety net program providing comprehensive long-term services and supports. but who is eligible for medicaid? people only qualify for medicaid if they are or become poor. this criterion forces many families to impoverish themselves to obtain the medicaid support they need. we have all heard the stories. a family member works hard all his or her life and then, due to an accident, they cannot afford to pay for needed services and supports out of their pocket.

so they now must give up their savings to become eligible, to turn to the government and to medicaid to provide the proper care they need to survive. no one wins, not the disabled or elderly parent, not the family caregiver, not the government, and not medicaid. i have a letter from a woman who lives on cape cod in massachusetts. she knows first ifirsthand how l the class act can be for families. she is caring for a family member that is legally blind and incontinent. smee writes, "caying for my sisser at home has saved the state thousands and thousands of dollars every year and we have done this for 38 years. we are holding down full-time jobs which also supplement my sister's care. this is wrong. instead of encourage families who want to keep their loved

ones at home," she writes, "and save the state money, they work against us. so i believe we will give up and just place them in a nursing home, which in turn costs the state money. is this not crazy," she asks. she is asking the right question. the class act will help turn this serious no-win situation into an everyone-wins result. it gives individuals with disabilities and their families the funds they need to obtain some of the services they need. without having to return or retort to medicaid. the current reliance on medicaid is not only a strain on our families; it is also a strain on our already overburdened medicaid system. today medicaid spends nearly $50 billion a year on long-term services and supports. estimates indicate that by 2045, that spending could exceed $200

billion. obviously, this is unsustainable. in addition, the private insurance industry is not doing enough to meet the growing demand for such care. aging baby boomers and a longer life span will increase the demand fo for long-term care. yet 95% of people over 45 do not have long-term care insurance and fewer and fewer people are able to buy such coverage. make no mistake, as it stands today, if someone without adequate long-term care becomes disabled, they will have to turn to the medicaid system to get the help they need. the class act is designed specifically to remedy this looming crisis by giving people an affordable option other than medicaid, the act will save the system over $1.6 billion over the first four years that people start receiving benefits.

now some opponents of the class act argue that the program will not be sustainable over time and that it will become insolvent and end up costing taxpayers large amounts. that argument could not be further from the truth. and let's give proper credit where it's due. with the help of our friends on the other side of the aisle, we have taken real steps to ensure that the program remains solvent for years to come. the act ste establishes a strong work requirement to make sure that funds continue to come into the program from the payroll tax deduction or from an individual's voluntarily paid premium. it requires the secretary of h.h.s. to review and set the premiums annually, to ensure that the program will remain soflts for the next -- will remain solvent for the next 75 years t directs the secretary, in addition to review the cost projections 25 years in the future and it mangeds that no taxpayer funds will be used to

pay benefits. let me repeat that final point since i have often heard it misrepresented. no taxpayer funds will be used to pay benefits. benefits will be paid through self-funded and voluntary premiums. during the parkup in the "help" committee this summer, senator dodd led a discussion about this program. with the help of the republicans on the committee, especially senator gregg of new hampshire, additional safeguards were included to ensure that the act will stand on strong financial footing for years to come. after the committee adopted senator gregg's 75-year solvency amendment, the program won strong words of support from both parties. we credit senator gregg for that constructive contribution. this class act will do all the things it should do: provide financial and health security to elderly and infirmed

americans. it'll strengthen medicare. and it'll make health reform the exact thing that the american people needed. and with that, i yield the floor and thank you, mr. president. the presiding officer: the senator from montana. mr. baucus: mr. president, i yield to the senator from wisconsin, the chairman of the special committee on age. mr. kohl: thank you very much, senator baucus. the presiding officer: the senator from wisconsin. mr. kohl: i come to the floor today to talk about the many ways in which this bill will have a positive impact for seniors. over the past year we've seen confusion about what health care reform will mean for americans, and particularly for seniors. i had hoped that once the senate voted to move forward with debate on one merged bill we could answer why health reform will help them. unfortunately, here we are on the floor continuing to send mixed pledge messages about somy

concrete provisions. i want to help set the record state for older americans. this health reform bill is not going to cut medicare benefits. independent groups such as the aarp and the national committee to preserve social security and medicare have said that this bill will strengthen medicare and not harm it. aarp believes that this bill will transition medicare to a more efficient system where quality health care outcomes are rewarded and waste which accounts for up to 30% of medicare spend something reduced. in terms of the cuts to medicare advantage, this bill will only cut back on overpayments to these private medicare plans, benefits will not be affected. aarp also supports these cuts because they understand that most of the overpayments are going to insurance company profits, not to seniors' benefits and that this overspending is putting medicare

on a faster path to insolvency. experts say that health reform will extend the solvency of medicare trust fund for five years without making one cut to guaranteed benefits. i understand that people complain that this bill is too long. but any bill that seeks to offer choice and meet the needs of so many americans is, by necessity, complex. we cannot gloss over these vital issues, so i'd like to take a moment to share with you some of the issues that have not received as much attention but are nevertheless crucial to improving america's health care system. there is a lot in this bill for older americans, retirees and those planning ahead for a healthy and happy long life. the aging committee has worked closely with the leadership of the "help" and finance committees to include several of our provisions, most of which have bipartisan support. i'd like particularly to thank

senator baucus, senator dodd, senator harkin, and majority leader reid for being so willing to work with us on these important issues. we have enlisted help from seniors' groups of every stripe to ensure that health reform makes commonsense improvements that in some cases are desperately needed. this bill will significantly improve the standard of care in nursing homes nationwide for the first time in 22 years, and i thank my khraoerbgs senator grassley -- my colleague, senator grassley, for working together to make sure this important issue was not overlooked as part of health reform. in and of itself, this is a huge undertaking but it's just one piece of the puzzle to comprehensively reform our health care system. this bill will also train and expand the health care workforce so they are prepared to care for the growing elderly population. by implementing recommendations from the institute of medicine, we will begin to address the

severe shortage we face of direct care workers. this bill will protect vulnerable patients by creating a nationwide system of background checks for longterm care workers. this policy is more than just a good idea in theory. we have implemented it in seven states and seen its results. comprehensive background checks are routine for those who work with young children and we should be protecting vulnerable seniors and disabled americans in the same way. this bill will make it easier for seniors to get the care they need in their own homes because when it comes to longterm care, one side does not fit all. the goal of long-term care should be to allow older or disabled americans to live as independently as possible. this bill will help update our current long-term care system in order to offer choices tailored to an individual's needs. it will also help to alleviate the huge financial and emotional burden on married couples who

need long-term care. i worked with my colleague, senator cantwell, to ensure that married couples who receive care in their home and community are not required to spend the vast majority of their assets to receive assistance. the committee has also helped to include a provision that will benefit all americans regardless of age by helping to lower the cost of prescription drugs and medical devices. our policy aims to make transparent the influence of industry gifts and payments to doctors. these are only a few of the aging committee's priorities. this bill makes many other improvements in our current health care system for older americans. of the senate bill will reduce the cost for preventive services and add a new focus on paying doctors to keep patients well and not just paying them for when their patients get sick. today's seniors pay 20% of the cost of many preventive services while eliminating the co-payment and deductibles in medicare for

important services such as immunizations, cholesterol screening, bone calcium level screening and colonoscopies, we will help save lives as well as lower health care costs. the bill will also provide for the first time an annual wellness visit at no cost to the medicare beneficiary. patients will be able to receive a personalized health risk assessment for chronic disease, have a complete review of their personal and family medical history, and receive a plan for their care. this bill will remove the ability of insurance companies to deny access to consumers based on preexisting condition. we know that having health care is essential throughout one's life from beginning to end. but many older americans count the days until they become eligible for medicare because they're not able to find insurance coverage at any cost due to a health condition in their past. i could go on about the many other improvements small and large that will benefit our

nation's seniors, but i'll stop here and simply urge my colleagues to work to educate seniors and not scare them about the important changes this bill will make to provide them with better health care at lower cost. thank you, mr. president. i yield the floor. the presiding officer: the senator from montana. mr. baucus: how much time is left for the majority? the presiding officer: five minutes. mr. baucus: mr. president, i ask consent there be an additional five minutes under the control of the majority at this time and there be an additional six minutes -- five for each side. the presiding officer: without objection. mr. baucus: mr. president, i now yield to the senator from oregon the remaining time, which will be ten minutes. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: i want to spend a few minutes this morning talking about medicare advantage and particularly to highlight the fact that i think it is important to support the

language put together by the chairman of the finance committee on medicare advantage and to reject the amendment offered by our friend from utah, senator hatch. and i want to begin my comments with respect to medicare advantage by pointing out that it is clear that not all medicare advantage is created equal. some medicare advantage is a model of efficiency and some of it is pretty much a rip-off of both taxpayers and seniors. and i'd refer, as it relates to the abusive plans, to the very important hearings chaired by senator baucus in the finance committee. i recall on one occasion sitting next to our friend from arkansas, senator lincoln, we had witnesses describe how medicare advantage was being sold door to door in her part of the country by individuals

dressed up in scrubs as physicians and health care providers. and in the discussion of how to handle it, we looked at various kinds of reforms to rein in abusive practices. i came to the conclusion, when you do something like that, the c.e.o.'s ought to be put in skwraeufplt that is what is documented on the record in relation to the committees held in the senate finance committee and why i come to the floor. i think it is important tpo distinguish between the good-quality medicare advantage plans and those that have been living high on the hog through some of the overpayments that we have documented on this floor. mr. president, my state has the highest percentage of older people in medicare advantage in the country. and i had an opportunity to work closely with chairman baucus in terms of addressing medicare advantage, and i think with the

chairman's leadership it's been possible to show that you can find savings in the medicare program without harming older people, without reducing their guaranteed benefits, their essential benefits, as we have learned with medicare advantage. the way chairman baucus goes about doing that is by forcing the inefficient medicare advantage plans to follow the model of the efficient ones. and the way we have been able to do that is essentially through a two-part strategy. first, encourage competitive bidding. quality, which is done through the bonus payment provisions that are in the legislation. so, first, on competitive bidding, you have plan bids -- you use the plan bids to set

medicare advantage benchmarks which would encourage the plans to compete more directly on the basis of price and quality rather than on the level of extra benefits offered to those who are enrolling. with competitive bidding, plans compete to be the most efficient and hold down costs. i want to commend chairman baucus for making this a central part of the way medicare advantage would be handled, and certainly our part of the country has shown this is a path to get more value for the medicare advantage dollar in the days ahead. in addition, in the finance committee, i offered an amendment with several kaoegz that -- several colleagues that would boost the payment to those plans that according to the government -- and the government uses a system of stars in effect to reward quality. our amendment would boost the payments to those medicare

advantage plans with four- and five-star quality rated. so in effect with our legislation, there are both carrots and sticks. competitive bidding plus bonus payments offers both, so that the plans compete to provide the best value for seniors by encouraging the plans to be more efficient, it's possible to achieve significant savings for older people, help shore up the solvency of the medicare trust fund and meet the cost-saving goals of the legislation. one final point that has been discussed by colleagues on the floor of the senate, and that is this matter of individuals being able to keep what they have. and i have heard that that is not the case with medicare advantage plans. that somehow under the legislation that has been offered by the finance committee, older people would not be able to keep what they

have, according to some on the floor. that is simply inaccurate. seniors who have medicare advantage plans under the baucus legislation will be able to keep those plans. they'll be able to stay with what they have, keep their guaranteed essential benefits, and through the language that has been authored now in the legislation before us, there will be lower costs for taxpayers. last point, mr. chairman, i've heard a lot of talk about grandma on the floor of the united states senate. i spent the bulk of my professional life in effect working with grandma. i was the cofinder of the oregon gray panthers, ran the legal aid program for older people in our home state for a number of years, and i want it understood that i think with the baucus

legislation on medicare advantage that proves that it is possible to make savings in the medicare program without cutting essential benefits, using commonsense principles of competitive bidding, number one, and incentives for quality, i think grandma's going to be just fine under our language for medicare advantage. mr. president w-rbgs that, i yield the floor. -- mr. president, with that, i yield the floor. mr. baucus: how much time remains on our side? the presiding officer: three minutes. mr. baucus: on the minority side? the presiding officer: 55 minutes. mr. baucus: i reserve the balance of the majority time. the presiding officer: the senator from tennessee. mr. alexander: mr. president, during the next 55 minutes, we'll have several republican senators come to the floor.

and i ask unanimous consent that during that time senator mccain be allowed to be the manager of a colloquy among the republican senators. thank you, mr. president. the presiding officer: without objection. mr. alexander: before senator mccain begins, i'd like to, if i may, take a moment just to establish where we are today, what happened yesterday, and as a lead-in to what he's about to discuss. yesterday senator mccain offered an amendment on the floor of the senate that would do two things. it would send back to the finance committee this, the democratic health care bill, which is the 2,000-page bill right here. and it would say to them, one, take out the cuts in medicare. and, two, any savings in medicare must go to make medicare more solvent. that was the mccain amendment. that was defeated. 58 democrats said yes to the cuts in medicare. they said no to using -- they

said yes to using the money that comes from these cuts to create a new entitlement program. 40 republicans said no, we don't want to do that, and two democrats joined in that as well. so yesterday we made it clear that the central core of this bill includes nearly $500 billion in cuts in medicare. there's no question about that. everyone concedes that. the president has said that when he addressed us. the congressional budget office says that. the question is whether it's a good idea or bad idea. and yesterday by 58 votes the democrats said yes to these cuts in medicare. today what we want to do is talk about one of those cuts and to try to do it in a careful, accurate way so that 11 million seniors who have medicare advantage understand exactly what the risk is to their medicare advantage policies. you can see that under the cuts approved, again, yesterday in

this bill are $120 billion over the next ten years in cuts to medicare advantage. what is medicare advantage? medicare advantage is a option that seniors have. medicare, if you choose that option, pays a fixed amount for your care every year for companies that might come to you and offer a medicare advantage plan which you can choose instead of the original medicare plan. many seniors choose these plans. 11 million seniors, nearly one out of four seniors in america, who is part of medicare, chooses the medicare advantage plan n my home state of tennessee, the number is about 230,000 tennesseans. why do they choose it? well, it includes some benefits that they may not have in the original medicare plan. these are dental care, vision care, hearing coverage, reduced hospital deductibles, includes lower co-payments, lower premiums, coordinated chronic care management, and physical

fitness programs. now, the distinguished senator from oregon was on the floor. he mentioned grandma. i've mentioned grandma a few times. no disrespect to grandpa. he is in the same boat. and he said that grandma didn't need to worry about her medicare advantage plan because none of the benefits would be cut. but, mr. president, that's not what the director of the congressional budget office, who's often sited b cited by tht of the committee. he said that nearly half of the benefits currently provided to seniors would disappear under the finance committee plan which is much like the plan we're considering. these would include those i was mentioning. so today, mr. president, with senator mccain leading the discussion, we'd like to talk about the medicare advantage plan and why it's such a

essential part of this bill. this is a $2.5 trillion bill. that's what it would cost over ten years. and about half it is paid for by these medicaid cuts and the -- medicare cuts and the ones we're talking about today is the medicare advantage plan. i understand there will be an amendment by senator hatch, who i'm sure will talk about his own amendment. he of course was present on the finance committee, a leading member, when medicare advantage was created -- that there will be an amendment today to say send back to the finance committee and say don't cut medicare advantage. mr. mccain: i listened to senator hatch's very important statement last night, which he will add to today. he was able to take us down a trip on memory lane. in june 2003 when the medicare modernization act was before the senate, several our colleagues, including senator schumer and kerry, offered a bipartisan

amendment on the floor to provide additional funding for benefits under the medicare advantage program. but amnesia is not confined to one side of the aisle around here. but i would like to ask my friend from tennessee, exactly -- you know, this discussion about medicare advantage. we have to better understand, what is this program and why is it so popular? is it because it offers seniors a chance to get additional benefits? maybe you could just give me a short definition of that because i think the american people may not be totally clear of what we're discussin discussing here1 million men's -- 300,000 citizens in my own state -- have chosen medicare advantage and has prompted, according to bloomberg, senator casey of pennsylvania to say, quote,

"we're not going to be able to say, if you like what you have, you can deep," said senator bob casey, a pennsylvania democrat. that basic commitment that a lot of us around here have made will be called into question. the question is "deem senator says medicare advantage cuts break a president's pledge." so maybe if the senator from tennessee would just give me a brief outline of what seniors get under medicare advantage and why it is so popular for 330,000 senior citizens in my state and 11 million all over the country. mr. alexander: i can do that. the senator from arizona is exactly correct. if senator casey said that, he's merely repeating what the director of the congressional budget office, when he said that fully half the benefits of medicare advantage would be lost. but in answer to your question, the medicare advantage is an option that 11 million of the 40

million seniors who are on medicare have chosen. and the reason they choose it is because the plans that are offered by private companies a often in rural communities, lower-income americans choose these. they often choose them because the plans generally offer these benefits: dental care, vision care, hearing coverage, reduced hospital deductibles, lower co-payments, lower premiums, coordinated chronic care management, and physical fitness programs. so those are some of the benefits that these plans generally offer seniors. mr. mccain: well, i thank my friend. and the reason i ask is you mentioned that medicare advantage allows seniors to have dental care, vision care, hearing care, physical -- physical fitness -- physical

fitness. you know, fascinating. this allows our senior citizens to have dental, vision, hearing care, physical fitness. you know, that's a little strange because, as was pointed out to me, that's exactly what we have here in the united states senate. about 100 paces from here, if i need some doctor care immediately, if i need some vision care, if i need some dental care, necks t next to mye in the senate russell office building -- and i don't know at what cost -- i'd like to get entered into the record how many tens of millions of dollars it is -- guess what they're doing? they're renovating the gym! so -- so, my colleagues yesterday voted against keeping

the medicare advantage program when we've got right here the best medicare advantage program that i've ever heard of in the world: free hearing, free vision, free dental, free -- and expanding a gymnasium in a many month-long project and i will get the cost, although it may be hard to do. so let me get this straight. again, the american people should understand, we just voted to cut drastically a program that seniors have taken advantage of which gives them additional hearing, vision, dental, and physical fitness care while we practice it here every single day -- every single day there is a physician on duty -- or more than one -- not very far from where i speak who is ready to give us instant care. if hospitalization is needed,

instant transportation to the bethesda naval hospital where we will get free care. and, incredibly -- incredibly -- the senate, on largely partisan lines, yesterday voted against senior citizens in this country, most of whom have made a lot more into the program than we have. we're going to deprive them of what we have every single day we are members of the united states senate. that, my friends, is an exercise in hypocrisy. the senator from pennsylvania has it right. he says because the president time after time said to the american people, if you like the insurance policy you have today, you can keep it. how many hundreds of times have we seen him say that at town hall mettings and his administration -- at town hall meetings and his administration mouth speoses say the same thing. senator co-payscy is right when he says we're not going to be

able to say, if you like what you have, you can keep it, said senator bob casey, a pennsylvania democrat. that commitment a lot of us made will be called into question. i'd like to say a couple of words. i will be talking a little bit more about it later. every time the senator from montana is on the floor and others, they talk about the fact that aarp now supports this blatant transfer of funding from the medicare program, which the seniors have earned, into a brand-new entitlement -- $2.5 trillion entitlement program. that's what this bill is all about. so just for your information, aarp has received $18 million in stimulus money. now, there's a job creator for you. there's a job creator for you. aarp, which has given its full support to democratic health care legislation, even though

seniors remain largely opposed, received an $18 million grant in the economic stimulus package for a job-training program that has not created any jobs, according to the obama administration's recovery.gov web site. that is astonishing to me because everything i've ever seen, they've created millions of jobs, including in the ninth congressional district of arizona where they said they create some thousands of jobs, which unfortunately for me we only have eight congressional districts. but that's okay. but that's ofnlgt so in february the "politico" reported that aarp was putting pressure on republican members of congress to support the stimulus package. since then, aarp has moved on to lobbying for passage of health care legislation, even though democrat proposals have called for several hundred billion thrars idollars in cuts to media program that they oppose when

republicans propose it. aarp is on route to benefit financially because seniors losing cuts to medicare advantage will be forced to buy medigap policies, which is the main source of aarp revenue. barry rand, the chief executive of aarp, was a big donor to the obama campaign and has retained cozy relationship with the administration. that's shocking news. shocking news. so, my friends, i also might add that in 2006 -- in 200 6, the aarp received $18 million from the federal government and we are researching additional federal moneys that they get. but the most important thing is that, let's make it clear. aarp will receive direct

benefits because seniors who have their cuts in medicare advantage and other medicare programs can buy, guess what? -- a medigap insurance policy -- in other words, to cover the things that are being cut back under this legislation -- and it costs $175 a month. medicare advantage premiums, for most seniors, are zero or $35 a month. so if the medicare advantage plans go away, people would have to buy medigap plans sold by? -- you got it, the aarp. and some low-income seniors couldn't afford $175 month. that's why what the senator from tennessee has stated -- if we drive people out of medicare advantage, we are harming low-income seniors all over this country. we are harming them. we are doing them a great

disservice. and if you think with 17% real unemployment in my state that seniors who are unemployed and down on their luck are going to be able to afford the aarp medigap program -- policy for $175 a month, then come and visit my state, and i'll tell you they can't. they can't. so it's interesting the conversation about how we're -- about how high-income seniors and how we're going to tax people with cadillac plans and all of those things, when we really what we're doing -- what we're really doing is harming the lowest -- the low-income seniors in rural areas of america. mr. kyl: my colleague was talking earlier making the point that you can't take $120 billion out of the program without hurting folks. those on the other side of the aisle said, well, we can do that. we can cut by $120 billion and

still won't hurt anybody. my colleague asked the senator from tennessee exactly what some of the benefits were and repeated those. so i went back to get the actual statistical number here of how much it will actually reduce benefits in terms of actuarial value, and according to the congressional budget ostles in the year 2019 when this is fully implemented, here's the statistic: the actual actuarial value of the reduction in benefits under medicare advantage is 64%. in dollar numbers, it goes from $135 a month down to $49 a month. in other words, the very things my colleague is talking about -- the vision care, the dental care, all of those things, as well -- mr. mccain: things that we routinely use, that we here in the united states senate. i would hope that those who voted to harm the seniors in this country and not allow them to have dental, vision, other health care, would unilaterally

disavow the use of the physician care and vision care and hearing care that's available to all of 2us 4 hours a day right here -- 24 hours a day right here in the united states senate. mr. kyl: just a last point. i'd like to say that i hear my colleague loud and clear and i hope that the american people do, too. because you can't call a $120 billion cut something that doesn't hurt people and especially when the congressional budget office itself says, yes, that reduces these very benefits from a value of $135 a month down to $49 a month. that is -- that is a huge cut in the value of the services that they receive under medicare advantage. and that's what we are trying to prevent by this amendment. mr. mccain: could i just mention one other thing? i'm not going to spend that much more time on aarp. but the reason why i do is because every time the senator from montana stands up, he talks about that aarp has endorsed

this rip-off of the american people. so, let me just quote again from a bloomberg article entitled "aarp's stealth fees often sting seniors with costlier insurance." and i coat from the bloomberg article -- and i quote from the bloomberg article. arthur lapos joined aarp because he thought the nonprofit senior citizen advocacy group would make his retirement years easier. he signed up for an auto insurance policy endorsed by aarp believing the advertising that said he would save money. he didn't. when lopas, 71, compared his car insurance rate with a dozen other companies he found out he was paying twice the average. why? one reason he learned was because aarp was taking a cut out of his premium before sending the money to hartford financial services group, the provider of the coverage. aarp uses the royalties and fees to fund about half the expenses

that pay for activities such as publishing brochures about health care and consumer fraud as well as paying down the $200 million bond debt that funded the association's marble and brass-studded washington headquarters. in addition, aarp holds clients' insurance premiums for as long as a month and invests the money which added $40.4 million to its revenue in 2007. during the past decade, royalties and fees have made up an increasing percentage of aarp's income, rising to 43% of its $1.17 billion in revenue in 2007 from 11% in 1999, according to aarp data." this is a bloomberg article. this isn't from the republican policy committee. so the point is who gains? who gains from this legislation?

who's going to make hundreds of millions dollars more because they provide the medigap policies that people will be deprived of when we kill off medicare advantage? aarp. mr. kyl: -- mr. alexander: i see the senator from texas, the senator from idaho and the senator from wyoming have come to the floor in addition to the sponsor of the amendment, senator hatch. i'm sure they are prepared to reflect on who's hurt by these cuts. the only thing i would emphasize with what you have said is that disproportionately low-income americans in texas and in idaho and in tennessee and in wyoming and in utah are hurt. only a third of eligible white seniors who don't have medicaid or employer-based insurance are enrolled in medicare advantage. but the number increases to 40% for african-americans and 53% for hispanics. mr. mccain: could i ask the senator again, he described the

benefits provided under the medicare advantage program that seniors can have if they want; right? are those same ability -- dental, vision, hearing and fitness care -- that available under regular medicare today? mr. alexander: my understanding is the answer is no to that. that's the reason 11 million americans choose medicare advantage is because these benefits are not available under the original medicare. mr. mccain: in montana, there are 27,000 enrollees who will see a 24% decrease. in connecticut, there's 94,000 enrollees who will see a 14% decrease. by the way, some special deals have been cut for three states, i understand: oregon, new york, and florida. we're going to try to fix that. there's no reason why one state should be shielded anymore than another from these draconian measures. we're going to try to fix that.

but the reason why i bring up this issue, present-day medicare beneficiaries don't have vision. they don't have dental care. they don't have fitness. yet, we here in the united states senate enjoy it every single day. so yesterday what we did was we voted to deprive seniors from the ability to have the same privileges that we enjoy every single day in the united states senate. i would argue that's an exercise in hypocrisy. mrs. hutchison: mr. president? mr. alexander: i might say, we're operating under a colloquy managed by senator mccain, and so the republican senators are free to engage in a discussion. mrs. hutchison: i very much appreciate what the senators have been talking about, because what you're saying, senator mccain, is that these seniors who are low-income have an affordable option, and it's less expensive than the aarp option

that would give them this extra care: the eye care, the dental care, the hearing aids. it's an affordable extra option. in texas, we have over 500,000 seniors enrolled in medicare advantage, and one of the great things about medicare advantage is that it is available in rural areas and it gives them choices that they might not be able to afford with other programs that are medigap. this one is affordable. and that's why we're fighting so hard to restore the cuts to medicare advantage. medicare advantage costs about 14% more than traditional medicare because it provides a wide range of these extra benefits that we have discussed dental, eye care, hearing aids, and in many cases it pays providers more. republicans, of course, are open to discussing how to improve the medicare advantage payment

formula. we want to be more efficient with taxpayer dollars. but do we want to do that in the context of creating a massive new entitlement program and ask medicare to pay for it? or to cut lifesaving benefits for seniors? is that what we want to do? senator crapo? mr. crapo: thank you. mr. president, that's absolutely the case. i'd like to point out when we had the finance committee markup, i asked the c.b.o. director elmendorf directly whether the provisions in the bill, which are still in the bill, would reduce the benefits that medicare recipients receive. and his response was for those who would be enrolled otherwise under the current law, yes. there's been a lot of talk here, well, we're not cutting medicare benefits or we are, or it's this or that. the bottom line is the c.b.o. director said it directly, yes, we're cutting benefits. i'd like to ask the sponsor of this amendment a question,

because i know there are some who are saying the reason we're cutting medicare advantage is that it's so expensive, and we should be cutting medicare and controlling its costs, and it's like 14% more expensive than fee-for-service medicare. some people say, if you're defending medicare advantage, you're defending overpayments in health care plans. would the senator from utah like to respond to that criticism that some are making? mr. hatch: i'd be delighted to do that. to be clear, the so-called overpayments to medicare advantage plans do not go to the plans. as a matter of fact, they go to the seniors in the form of extra benefits. that's a pretty important thing that a lot of people miss. 75% of the additional payments to medicare advantage plans are used to provide seniors with extra benefits, including chronic care management. you would think you'd want to do that.

hearing aids, eyeglasses. the other 25% of any extra payments are returned to the federal government. i mean, i can't imagine why anybody wouldn't want to do that. mrs. hutchison: mr. president, i would ask the distinguished senator from utah: let me ask you to also respond to the arguments that claim that the government really can't afford now to continue overpaying these private plans and that the medicare trust fund is going broke. of course we're trying -- we tried actually several years ago to shore up the medicare program, trying to do it in a responsible way, not cutting out the medicare benefits that these seniors can receive as an affordable option. but what do you say to that? mr. hatch: you pointed out the medicare trust fund is going broke. yet, what do we have from the other side? take almost $500 billion out of medicare. now, to trust me, i'm deeply

concerned about the solvency of the medicare trust fund. mr. mccain: it's my understanding that dr. barrasso has actually seen medicare advantage patients, he and dr. coburn are probably the only two. and maybe we could give him the benefit -- give us the benefit of his experience and also not only benefit of his experience, but i'm sure he's going to tell us what's the impact going to be on these -- on the low-income seniors from his state. mr. barrasso: i agree with the senator from arizona that people choose to be on medicare advantage. 11 million people have chosen to be on medicare advantage because it's a wise choice to make, because they get better benefits. they get dental care. they get the vision care. they get the hearing. they get the fitness thing. mr. mccain: as we do. mr. barrasso: just as we do. it works on preventive care and

coordinated care. mr. mccain: i don't think they have as nice a gymnasium as we're going to get. mr. barrasso: it's also no surprise that when people read about it and learn about it that they would want to be on medicare advantage. what the senator from utah has said and the sponsor of this amendment, the money that goes into this program is for the benefit of the seniors. it's for services for the seniors on medicare. this is -- to me, this whole bill basically guts medicare, raids medicare to start a whole new program. today, as the senator from arizona has mentioned, in these article, today's associated press and "usa today" "senate democrats closed ranks thursday behind $460 billion in politically risky medicare cuts at the heart of health care legislation." it goes on to say "approval would have stripped out money to pay for expanding coverage to tens of millions of uninsured

americans." they're going to take $460 billion, this says, away from our seniors who depend upon it for their medicare and start a whole new government program. it says -- "washington times," front-page story, headlines, "democrats win cuts of $400 billion to medicare." mccain pushed for another way to pay. so i look at this and say this is not fair to our seniors, not fair to the patients that i have taken care of for 25 years in wyoming, taken care of families, taken care of folks when grandma breaks her hip and what we need to do for our patients. these are choices that people have made. 11 million americans have closen medicare advantage because there is an advantage to them for the health care they get. the additional services, the coordinated care, the preventive care. anyone who looks at this and studies it says i want to sign up for this. it's been wonderful in rural areas, wonderful in big cities. this has helped a lot of people in the country. so it's not surprising that one

out of four people in the country on medicare have chosen medicare advantage. but yet what we're seeing here is the democrats want to get rid of medicare advantage. mr. mccain: so let me get this straight. so basically by removing the choices that seniors have as a part of medicare advantage -- dental, vision, hearing, fitness, et cetera -- we are taking away from them what we ourselves enjoy every single day here in the united states senate? mr. barrasso: we are taking it away from seniors, and we're using all of that money to start a new government program when we know that medicare itself is going to go broke by the year -- mr. hatch: i think we ought to be listening to one of the only two doctors in the united states senate who really knows, who's been on the ground, who's met with the people, who understands what this means to senior citizens. a quarter of whom are on medicare advantage. and in the end, i believe we actually not only help the seniors to be more healthy, but we save a lot of money in the end. trust me, i'm deeply concerned

about the solvency of the medicare trust fund. as you know, we've been sounding that alarm for years, for years. that's why it's so shocking that we are debating a $2.5 trillion health reform bill that does almost nothing to make sure that medicare is sound. in fact, does a lot of things to make it unsound, or almost nothing to make sure that medicare is around for future generations. instead we're just creating another federal entitlement program that we cannot afford while medicare's $38 trillion in unfunded liabilities. a senator: a lot of people trying to defend these cuts are saying these expert costs in the medicare advantage programs are going to make insurance companies profits bigger and to help large c.e.o. salaries and so forth. mr. crapo: but nothing could be further from the truth. the reality is, as the senator from utah has indicated, that 75% of this 14% extra payment goes to -- in these plans go to

provide the seniors with the extra benefits that we are talking about here. and then 25% is returned to the federal government. not to insurance companies. not to c.e.o.'s. and i have a chart here. we're going to make this into a bigger one. but when those who support this program say that we are not cutting medicare benefits, this chart -- i apologize, it's a little bit small -- but this is a chart of the united states and it shows you what's happening to the benefits of medicare advantage beneficiaries. the dark red is more than 350% reduction of the people in -- more than 50% reduction of the people in knows dark red states. the medium colors is a 25% reduction. the only states without a reduction are the white ones. three or four states that are not seeing deep cuts in medicare advantage benefits. and those who say, like the president said was one of his goals, that if you like what you have, you can keep it, not if you live in one of the states that's not in white on this

chart. because your benefits will be cut. mr. alexander: i wonder if i might ask the senator from idaho to go back over a point he made just a moment ago because he went over it quickly but it is such an important point and it is the one reflected by the chart behind him and by what he just said. repeatedly we're told that seniors won't lose benefits to be cut nearly a half trillion in medicaid. so if you could take a moment -- i believe you were in the finance committee markup where the bill was being written that was offered by the distinguished finance committee chairman. and i believe you were talking to the head of the congressional budget office, who is often cited by our friends on the other side as the nonpartisan authority for exactly what the bill does. and i believe you asked him whether benefits of medicare advantage sift recipients would be cut. would you describe that in a little more detail so people understand exactly the scenario?

mr. crapo: yes, i would. this chart shows the last two sentences of our colloquy when we were in the finance committee. but it went went on for sometime. i was asking the director of c.b.o. whether the cuts to medicare advantage that are in the bill would reduce benefits to senior citizens. and he said, yes. and the reason he had this phrase that said "for those who would be enrolled otherwise under current law" -- the reason he prefaced it that way is the rest of what he said was that for future seniors, it's not going to be a viable option. so they in the future, those who are not on it now, won't have a really significant, viable option to get on it because it's going to be gutted. so what he was saying for those 75% -- by the way, medicare advantage is the most popular part of medicare in america today. the fastest of-growing part of medicare because it is so popular, because it provides these additional biforts that seniors have to pay so significantly for to get in

supplemental insurance that aarp is going to provide. and what the c.b.o. director said was that for the future, those who aren't already on it don't get it. mr. mccain: could the senator from texas and i go back a second to one of the things i mentioned earlier, because in texas, i ask how much are under medicare care? hutch 500,000 of my constituents. mr. mccain: 500,000 senior citizens in your state. there is no -- quote -- "shieldinshielding." according to this bloomberg article, it says "senators's senators charles schumer, bill nelson of florida and ron wyden of or oregon are among those who secured special provisions shielding constituents from cuts." casey -- that's senator casey says he wants -- quote -- "very comparable protections for his state." surprisingly enough. "where more than one-third of medicare beneficiaries

participate in medicare advantage." quote -- "it is the kind of thing that will likely be addressed on the floor, he said. "i eagerly look forward to working on the other side of the aisle with all the members from those states with the exception of new york, florida, and oregon who have earned special shielding from these cuts. i look forward to working with them and let's fix it for all of us. right, senator? mr. hatch: that's right. go ahead. mrs. hutchison: i would just say to the senator from arizona, i was wondering if every state could have the same treatment? why not have every state get this shielding for their medicare advantage? that is 11 million people in this country who would be then helped by a fair assessment all over the country of this. but meet me just point out one -- but let me just point out one other thing. the way they have been shielded is grandfathering. cane inand it is what shielding

-- and may i ask, was that shielding done on the floor of the senate in open debate and discussion of the issue? mr. hatch: oh, no. mrs. hutchison: oh, no. now amissionly -- mr. mccain: ity it was done in an office here where we still await the white smoke. mrs. hutchison: the white smoke. that's correct. but then the question arises, well what about future meme say, that's what i can afford, it is what i want to have. oh, but grandfathering doesn't include anyone that might want to join in the future. it's only the people who are already in the system, and foreever how long they last and live, that's great. but what about the future? so this is a great program. it is affordable for the lower-income people. it's only for three states now. but i'd like to see us have all the same capabilities for our constituents. but what about our future constituents? mr. gregg: would the senator yield on that point? i think the senator from arizona has raised an extraordinary point.

because if this is such a grued program for these four states, why isn't it such a good program for everybody? the senator is the expert around here on earmarks. is this not a classic earmark? and didn't we hear from the other side of the aisle how we were going to have an open government, how we were not going to have this type of exercise occur within major bills, that bills weren't going to be loaded up with special interest earmarks, assisting one member or another? as the expert on the issue of earmarks -- mr. mccain: i'd say this is probably the classic hometown protectionism that we see in the earmarking and benefits that we see in the earmarking process. but also i would remind the senator from new hampshire, as we've all discussed several times, in october of last year -- a year ago last october, the then-candidate for president said, it's going to be on c spafnlonc-span. the c-span cameras are still

waiting to film these negotiations. so all americans can see who is on the side of the pharmaceutical companies and who's on the side of the american people. c-span, keep waiting. we're going to try get you in. mr. gregg: if i could ask one more question. i came over because i wanted to participate a little bit because i think it's been such an excellent and informative debate. but i've been looking at the numbers here. and i know the numbers are big, big, in this first ten-year period, almost $500 billion in reductions in medicare spending. but i think the point we need to make is that it doesn't end there. it doesn't end there. those medicare spending reductions, they go on into the next decade, too. and over the first two decades of this bill, medicare spending reductions will account for $3 trillion -- $3 trillion. mr. mccain: and isn't -- mr. gregg: how can anybody argue against what the senator from idaho said, which is that this translates into real

reductions in medicare spending? mr. mccain: isn't the vitally important point here in this discussion is this massive money that's taken out of medicare is not being used to save medicare? it is creating a huge, new entitlement program. so here we are with medicare going broke in seven years. we're taking money out of it in order to create new program. that's -- that's what the crime is being committed here. mr. gregg: the senator is absolutely right. the new program by the way will not be solved either. so we're compounding the insolvency of the future that we're passing on to our children. mr. hatch: we're taking a-billion out of a program that's going to be insolved before -- mr. gregg: $3 trillion -- mr. hatch: before the end of this program. and we're giving to another program that's already insolvent. mr. gregg: taxpayer be insolvent. mr. hatch: it is almost insane what they're doing. and then they wonder why the american people are having such

a difficult time, why we have 10%, you know, unemployed, have the underemployment is 17% in this country. those are people who try to get part-time jobs because they can't get full-time jobs. that's what the real percentage is. and they -- and they -- and yet -- you know, this whole program is about helping low-income people and minorities. when you stop and think about it, that's what medicare advantage is about. they can't afford these -- as the distinguished senator from arizona has said, they can't afford these supplemental policies that aarp is going to make a lot of money off if they can -- if they can -- if they can kill this program. there are a lot of gaps in traditional medicare benefits, including high cost-sharing and no out-of-pocket limits. that's about 89% of seniors have some form of supplemental coverage on top of medicare. for many low-income americans

and minorities, medicare advantage is the only way that they can afford the supplemental coverage. i want to compliment al all of y colleagues here on the floor -- the distinguished senator from arizona, the distinguished senator from idaho, the distinguished senator from texas, our own doctor and one of only two in the senate, senator barrasso from wyoming, of course our leader in the senate both on the budget committee, senator gregg, and of course senator alexandria. you guys have really summed this up. mr. mccain: we've had spirited debate and discussion on the floor. it is clear that the majority of the american people do not support the proposal that is before us. so -- and they don't support meetings in private, mostly in secret, closed negotiations. again, i renew our offer to the democrats and to the administration: let's get together in a room

with the c-span cameras and any other outlet and let's sit down and do some serious negotiations on the areas we can agree on, which there are many, and let's save medicare, and let's fix the system in the way the american people want us to do in a bipartisan fashion, not behind closed doors but so that the american people can see us work together for a change. and i thank all of my colleagues for their many contributions. we're ready to talk. we're ready to talk. but we won't be driven. mrs. hutchison: mr. president, i would just like to return to a point that was made earlier about the president promising , it being understood by everyone that if you like what you have, you can keep it. but on medicare advantage, once again the c.m.s. has estimated -- and i would ask the distinguished senator from utah to verify -- that enrollment in medicare advantage will decrease

by 64% under this bill. mr. hatch: a lot of seniors are going to be very badly hurt by this. mrs. hutchison: 8.5 million seniors. mr. hatch: a lot are minorities, by the way, as well. this is amazing to me how we got through all kinds of demagoguing about low-income people and minorities and yet they're going to take one of the most important benefits away from them, and that benefit is mentioned in the medicare handbook for 2010. and they act like it's not part of medicare. i can't believe some of the arguments that have come from the other side. mr. mccain: can i ask the senator from new hampshire, what happens -- what happens -- the senior member on the budget committee, a person that is well-phone for his knowledge of the comirks of the budgetary situation in america -- what happens, what happens, i ask the senator from new hampshire, if we pass this massive bill? what happens to america's economy? mr. gregg: well, my view is

this: first off we know a couple of facts. that we grow the government by $2.5 trillion over a ten-year period when this bill is fully implemented. we also know that the tax increases during that period will be approximately $1.2 trillion, tax tax increases and fees. and they aren't going to fall on the wlty. they are going to fall on the small business person trying to create the extra job. we also know that there will be an entire seed change in the way people get their health care. the government will be stepping in between you and your doctor and basically making a decision as to what your doctor can tell you what you can have for health care, what the provider group can tell you you can have for health care. something else hasn't been discussed much, which is the innovation in health care which has done so much to make america the best place to get health care in the world, which has put us on the cutting edge of drugs, which who is improved the lives of not only those in the united states but across the world. it will be significantly chilled

bus there will not be an interest in investing capital in a market that is so controlled by the government. in the end, it's fairly obvious that anybody who's been around this place, there aren't going to be $3 trillion of reductions in medicare spending over the next 20 years. and there aren't going to be $500 billion in the next ten years. and so all of that spending is going to fall on the backs of our children in the form of debt. and we already have a nation that is on an unsustainable path under the present budget scenario without this health care bill. our deficits are $1 trillion a year, on average, for the next ten years, that's without this bill. our public debt goes from 35% of the gross national product to 85% of the gross national product. we become insolved at the end of this decade. not this decade but the decade starting today, ten years from

today. mr. hatch: senator, would you yield on that? mr. gregg: and that's all aggravated dramatically by exploding the size of the government under this bill rather than taking the step-by-step approach that has been approached by our side to reform health care and make it more effective and make it deliver more services to more people at a better cost the. there is nothing in this bill -- i have heard people on the other side of the aisle a number of times get up and say, the c.b.o. says this bill reduces the health care spending of the federal government. just the opposite. just -- the c.b.o. letter specifically said that the cost to the federal government of health care go up, go up, under this bill. in the ten-year period. and so this bill does not turn down the cost of health care. it does explode the size of government. it does put the government into the business of managing your health care. and, as a result, i think it's going to reduce the quality of life of our children. hatch will the senator yield on

that point? mr. gregg: i don't have the floor. mr. mccain: go ahead. mr. hatch: okay. well, the senator has pointed out that you really don't believe they can afford all these programs. you do you're not suggesting this is a game, are you? mr. gregg: i -- i am suggesting that it is very difficult under any scenario to believe that this congress is going to do anything other than spend the money that is put in this bill. it's certainly not going to end up making the reductions in medicare that it proposes in this bill. if it does make those reductions, though, i think the senator from utah has been absolutely right in saying those reductions should go to making the medicare system solvent. they shouldn't go to creating a brand-new entitlement. mr. mccain mccain: on that poini think senator crapo would like exactly to emphasize senator gregg's point. mr. crapo: yeah, i'd like to engage -- make a comment or two and then engage again with the

chairman -- or the ranking member of the budget committee. often people talk about driving the cost curve down, and, frankly, when you talk to americans about what they want in health care reform, the vast majority of them say the reason we need health care reform is because of the skyrocketing costs of health care and health care insurance. and those who are promoting this bill say that they are bending that cost curve down. my question is: this cost curve are they talking about? is it the size of government? are they bending the size of government growth down? no, as the senator from new hampshire said, they're growing government by $2.5 trillion for the first true ten-year period of the bill. are they driving personal health care costs down? no. the c.b.o. report that we recently got said that 30% of americans will see their health insurance go up. and the other 70% will, at best, see it stay just about what it is today, rising at the same level as it is today. are they talking about the federal deficit? well, the chairman of the budget committee has just indicated to us that we're going to see

skyrocketing deficits, and those who claim that this bill's going to reduce the deficit can say so only if they take into account all of their budget gimmicks, like not counting the first four years of the spending, or the hundreds of billions of dollars in taxes that are going to be imposed on the american people, are or the medicare cuts that we've been talking. you can take any one of those three out of this bill and it drives the deficit up in the skyrocketing fashion. is that not correct, senator? mr. mccain: and as the senator from -- has the senator from new hampshire ever heard of legislation where you pay in the first four years before a single benefit comes about? you know, nowadays, i see these advertisements that you can buy a car and you don't have to make a payment for a year and then you start making payments. on this deal, it's the reverse. you make payments and then perhaps you get the benefits after some years. and the senator from tennessee i think would like to comment too. mr. alexander alexander: i wouly comment to the senator from new hampshire too. the president of the united

states said something a few weeks ago that i thought was profound and that i agreed with, which -- he said that this debate is not just about health care, it's about the role of the federal government in the everyday lives of the american people. and i believe he's exactly right about that, which is why so many americans are turning against this bill. would the senator from new hampshire agree that -- that the president was correct, that this debate is about, in my words n now, washington takeovers, more taxes, more spending, more debt, taking over car companies? this -- it's not just about health care. the enormous interest across the country in these votes comes from a much larger picture than just this health care bill. mr. gregg: well, i think the senator from tennessee is once again -- has once again hit the nail on the head. and i -- and i ready the president's forthrightness, because the president has said very simply, he believes that prosperity comes from growing the government. and when this bill passes, we will see the largest growth in

government in the history of our country. this is going to be 16% of our economy basically managed by the federal government. and you're going to see the government explode in size. does that lead to prosperity? i don't happen to think it does. it certainly doesn't lead to prosperity if along with that massive expansion in the size of government, you're going to see your debt go up significantly, you're going to see the deficits go up significantly. or you're going to see your tax burden go up significantly, which reduces productivity. or if you're going to take a large segment of our society -- our seniors, 35 million a day, 70 million by the year 2019 -- and say to them, they're not going to have the ability to have a solvent medicare system because the way that system might have been made more solvent is now be used to create a brand-new entitlement, a massive new entitlement for a whole group of people who never paid into the insurance policy and never paid into the medicare insurance fund. so i -- i think the senator's has touched the base. you know, we've seen automobiles, we've seen financial institutions, we've seen the student loans and now we're seeing health care all taken over by the government.

or partially taken over by the government. and, clearly, the goal is, as the president said, expand the size of the government, you create prosperity. use the european model. i don't happen to be attracted to the european model. i think the american model works betterment where you have a government that you can afford and you give entrepreneurs a chance to go out and take exprisks create jobs. -- risks and create jobs. mr. mccain: senator hutchison concludes. mrs. hutchison: mr. president, we've been talking about medicare advantage and losing this great option for our lower-income seniors is so important. i was reminded that looking at hospitals, we haven't even talked about the $135 billion that would be taken out of hospitals in this amendment -- i mean, thi in this bill, and thas the care providers. so we're talking about taking away their options, and eye care and dental care and hearing aids, sort of basic things that

seniors need, but also undercutting the hospitals that read it them so that the care in the hospitals themselves would also have to be cut back. mr. president, it just does not pass common sense to cut medicare in order to create a new, big entitlement program. we've all that said medicare is on life support anyway, that everyone understands that, so you take half a trillion dollars out of a program that is working for seniors, that gives options to seniors, like medicare advantage, and you take away their care to pay for another entitlement program that is not specifically designed for them. mr. president, i want to thank the senator from arizona, and i would ask him to -- to finish the comment on -- on what's happening to this bill in this country to our seniors and we need to stop it. mr. mccain mccain: i thank my

colleagues. its been a lot of fun. i yield the floor. mr. brown: mr. president? mr. president? mr. president? the presiding officer: the senator from ohio. mr. brown: yeah. mr. president, i ask unanimous consent to -- the presiding officer: the senator from montana. mr. baucus: mr. president, i ask consent that we extend for an additional hour the period for debate only. the presiding officer: without objection. mr. baucus: there's more to it. with no further amendments or motions in order during the hour and that the time be equally divide between the two sides, with the republicans controlling the first 30 minutes, the majority controlling the second 30 minutes. the presiding officer: without objection. mr. baucus: but there are three minutes remaining on the first block on the majority side. the presiding officer: 2 minutes and 20 seconds. mr. baucus: that's close enough.

mr. president, i ask consent that sarah feld of senator harkin's staff be granted floor privileges for the duration of today's session. the presiding officer: without objection. mr. brown: mr. president? the presiding officer: the senator from ohio. mr. brown: mr. president, i ask unanimous consent to be added as a cosponsor to the coburn amendment number 278 requiring all members of congress -- 2789 requiring all members of congress to enroll in the new public insurance option. i wanted to add my name to senator coburn's amendment. 17 years ago when i first ran for congress, i promised i'd pay my own health insurance until congress passed health insurance for everyone. i look forward -- i've paid it out of my pocket since then. i look forward with great eagerness to join the public option come as soon as it's available. thank you, mr. president. the presiding officer: without objection. mr. baucus: mr. president, i think i'll use my three minutes just to say this. mr. president? the presiding officer: the senator from montana.

mr. baucus: 2 minutes and 20 seconds. the presiding officer: 15 seconds. mr. baucus: okay. well... i just want to make a pretty basic point. the senator from arizona talks about, gee, all these medicare advantage plans have dental and vision coverage and -- and he goes on to say, so do members of congress. well, the fact is, that's not automatically true. the fact is that the members of congress choose among various private plans. some plans offer dental and vision. some don't. aetna is a company that members of congress can choose from under fehbp and humana is another one that members of congress can choose from. those companies do provide dental and vision coverage, but there are others, i think bluecross blueshield does not provide dental and vision coverage. and i make that point because

this is exactly what we're trying to set up in these exchanges, that is, people can participate in the exchanges, they can -- where they would buy private coverage and they could choose among various private plans which coverage they want. do they want a plan that covers dental and vision or not. it's exactly what we're trying to do on the exchange. and as is the case for members of congress. and it's -- and medicare advantage plans do provide dental and vision. that's -- i think that's great. i see my time's expired. at the appropriate time, i would like to go into greater detail explain why what we do in this bill i think makes eminent sense. a senator: mr. president? the presiding officer: the senator from iowa. mr. grassley: i would yield myself such time as i might take, and i don't think i'm going to speak more than six or seven minutes, for the benefit of my colleagues that may want

some of this time. i want to tell my colleagues why i'm supporting the hatch amendment. in my home state of iowa, there are 64,000 seniors enrolled in medicare advantage. these are seniors that have come to rely on lower cost and particularly additional benefits that medicare advantage provides as opposed to traditional medicare. yesterday, i came to the floor to point out that my colleagues on the other side of the aisle are playing word games to cover up the fact that they are raiding medicare, cutting benefits by 64% for these 11 million seniors that have chosen voluntarily to go on medicare advantage as opposed to traditional medicare.

so let me repeat, this bill cuts medicare benefits, or let's say raids medicare, by 64% for 11 million medicare beneficiaries. my friends on the other side of the aisle keep saying that they're not cutting, and they use these words -- they're not cutting guaranteed benefits. but this isn't even the case, because we have this new independent medicare advisory board that's set up in this legislation. it's given very specific authority to cut payments to medicare part-d. this will result in higher costs and less guaranteed benefits for medicare beneficiaries enrolled in medicare part-d. but i want to leave that debate for later. i want to visit with my colleagues now just about medicare advantage.

64,000 seniors in iowa and 11 million seniors nationwide don't care about the gobbledygook type words we use here in town, as legal as they are, guaranteed benefits on the one hand and the words "additional benefit" on the other hand. in other words, "guaranteed benefits," or, as the other side wants us to believe, just somehow additional benefits provided under medicare. so i say that's washington nonsense and i want to bring a little bit of midwestern commonsense to this debate. because our constituents just want to know that congress isn't cutting medicare benefits that they have come to rely upon, and that would include under medicare advantage. dental care, eyeglasses, hearing aids and other additional

benefits provided by this program that they voluntarily choose medicare advantage. now, i know that to be the case because i just have -- i have at least a thousand letters that i received last summer -- since last summer on this point. but i just want to read one from miss galardo of iowa city, iowa. "i am writing to urge you to oppose cuts to medicare advantage. this plan was a great help to me when my late husband, who passed away in may, was hospitalized. i was able to afford to pay the hospital without going bankrupt. we seniors who live on fixed income depend on our benefits from medicare advantage. i am retired and i don't --" for a quote -- "i am retired and don't know how i would have managed without medicare advantage." end of quote from a constituent

letter. now, some of my colleagues on the other side of the aisle don't want seniors, even people like my constituent from iowa city, iowa, ms. galado, to know that this 2w06r this 2,074 billg their payments. they're cutting their payments in the medicare advantage plan. that doesn't make a difference to ms. guardo. but that these payments must be spent on additional benefits. not just free money for a company to use or free money that benefits a medicare advantage recipient without any concern about what it costs.

75% of these payments must be spent for additional benefits and then where does the rest of it go? the rest of it comes back to the federal treasury. cuts to these medicare advantage payments are, in fact, cuts in medicare benefits. i'm more than happy to have a debate on how to reform medicare advantage payments. we should always be looking for ways to make payments more efficient. but the solution is not to cut benefits by 64% that seniors have come to rely on to fund an entirely new entitlement program that this country can't afford. at a time when seniors are in the midst of the biggest economic crisis since the great depression, we shouldn't be

debating a bill that spends them to spend more money on health care, but that is exactly what this 2,074-page bill will do. seniors that lose their medicare advantage as a result of this bill may be forced to buy a medi-gap plan to fill all the holes in the traditional medicare plan. that's why more low-income seniors enroll in medicare advantage. the so-called overpayments that my colleagues on the other side of the aisle keep decrying help fill in a significant cost sharing and premiums that exist in traditional medicare. so this bill will force low-income seniors that pay little to nothing under medicare advantage to come up with $175 per month to buy a medi-gap plan.

that doesn't sound like that's a very good way to help seniors. that sounds like this bill is paying for an entirely new entitlement program. and paying for it, quite frankly, on the backs of 11 million medicare beneficiaries. so i support the hatch amendment. let's take the d $120 billion in cuts to medicare back to the finance committee and find a which to improve the program without hurting 11 million seniors. i would like to at this point, mr. president, as i yield the floor to yield five minutes as a manager on this side to senator hutchison. mrs. hutchison: thank you, mr. president. mr. president, i appreciate what the distinguished senator from iowa has just talked about because i specifically like the fact that he's relating this to

where we are today. sometimes it's -- it seems like we're in a vacuum not realizing how stretched people are right now. we are in a time of joblessness. people worried about keeping their jobs or worried about having lost their jobs. where are they going to get health care? you have seniors that are stretched because they're not able to earn anything that will help them very much. we're in a distressed time in this country. there's no doubt about it. and to talk about cutting medicare $500 billion is just astounding. now, i'm concerned about hospitals. because we talked for the last 45 minutes about the cuts to services, the hearing aids, the dental work that seniors need, the eye care that seniors need. we've talked about the cuts to benefits, but what about the

cuts to treatment in a hospital? every hospital in texas treats people who have no insurance and, therefore, get dispropayments that make up for the low reimbursement rates of medicare. and medicare senior services are a major component of these lessened payments to the providers, to doctors, but also to hospitals, to hospices, to nursing homes, medicare advantage, we talked about, that's a cut of $120 billion, and then home health agencies. all of these serve our seniors. -- our seniors in such great ways. and look at the cuts, half a trillion dollars over 10 years. this is not sustainable. you cannot take away from medicare, cut services, cut

reimbursements to providers. because what's going to happen to a hospital -- what's going to happen to a hospital in a rural area that is barely hanging on right now because they're trying to make ends meet in a more expnsive treatment area, -- expensive treatment area, and they lose that added benefit -- it's not a benefit, it's a payment, that would make them whole in the treatment of our seniors, our low-income seniors and our seniors? the texas hospital association estimates that $2 billion will be cut in the payments to hospitals for medicare patients. now, $2 billion out of our economy. 254 counties in texas. more than one-fourth do not have an acute care hospital within their boundaries.

with these kinds of cuts to our rural hospitals, we are talking about losing more hospitals, there's no doubt about it. because they're already struggling. why we pay for health care reform on the backs of our senior citizens? why would we take away the program that they have that is tailored for their needs in order to pay for another big government program that is going to cost $2.5 trillion? $2.5 trillion, most of which is going to be added to the deficit, added to the debt in our country. and we're already hitting the ceiling of the debt a at $12 trillion. we're in a very tough financial time. we are in a time that is hard for people who have lost their jobs, hard for seniors who are stretched to make ends meet.

hard for hospitals that are serving these seniors. and not getting paid the full cost of the treatment and, yet, we're talking about cutting these services. of the $135 billion in cuts in medicare, $20 billion are for the reimbursement rates that will no longer be making hospitals whole. i've talked to -- in fact, i went to the major medical centers in texas, in dalt dallan houston, and then i went out to rural areas, and it is the topic of conversation. anyone who is dealing with a hospital in a rural area, they're all saying: what are you doing? well, of course, we're not doing anything. we're fighting these health care cuts. but they've got to know what is

happening here so we can achieve that result. mr. president, i understand that my time is up, and i think the senator from oklahoma has the rest of the time on our side and i yield to him. the presiding officer: the senator from oklahoma. mr. inhofe: first of all, i thank the senator from texas. i yield myself the remainder of your time, which i understand is until 10 after the hour. mr. president, i want to talk about the tax here today, which is our subject in maybe a little different way than some of the others did. the stated purpose of the democrats' health care proposal is to do two things, lower costs an increase coverage. -- and increase coverage. now, this bill is a miserable failure under both counts. under the plan the premiums are expected to increase as a result of the new taxes, new regulations and restrictions. in general you're going to pay more for your health insurance thanks to the democrats'

2,000-page bill. that is in direct contradiction of the stated goals of the bill itself. i'm going to be specific about that in a moment. the second issue is coverage. again, we find a miserable failure, the moss often cited number of uninsured americans is 47 million americans that would be uninsured. i saw some interesting numbers in "the washington post" opinion piece the other day, which kind of ranks out the uninsured and how they're broken down. this is very significant. of the 47 million, 39% reside in the five states of california, florida, new mexico, arizona, and texas. of course those are border states. indeed, it is estimated that 9.1 million of the 47 million are illegal immigrants, people here in this country illegally. now, secondly, of the

47 million, 9.7 million have incomes above $75,000 and choose not to purchase health insurance. this bill would solve that issue by using a coercive power of the federal government to force these citizens to allocate their resources in a manner that meets the bureaucrats in washington and the politicians. the bill makes it a crime not to have health insurance so -- and if you don't get it, you get taxed. lastly, a total of 14 million of the 47 million are currently eligible for current government programs, medicaid, medicare, schip and so forth and choose not to sign up. now, if you do the math, that reduces that 47 million down -- if you take out the illegals and the others for the reasons i stated to about 14 million. so this by and large is what people are talking about when they mention the 47 million uninsured americans. i think these numbers shed some

interesting light on the compensation of the uninsured americans that gets thrown around. president obama, interestingly, uses a different number. he doesn't use 47 million. he uses 30 billion -- discuss me -- 30 million. because i think he wants to avoid the embracing issue, and i think that's probably wise of him to do that. he doesn't want to be accused of giving rich benefits to those who are here illegally. he's not using 47 million, but 30 million uninsured americans. i noted with great interest the c.b.o.'s estimate of the number of americans who will not have health insurance even if this bill were to be enacted over the wishes of the majority of the american people, 24 million. this bill still leaves 24 million americans uninsured after spending $2.5 trillion to do just that while at the same time making health care more expensive for the rest of us. you know, i like to use -- i hear the other side often

throwing numbers around without any documentation. and i used the c.b.o. and others nonpartisan, credible sources so that we can avoid doing that. president obama wants to spen spend $2.5 trillion in new health care promises at a time when the country can't afford the promises we've already made and we have a record one-year budget deficit of $1.4 trillion. which, by the way, means that 47 cents out of every single dollar that the federal government spends this year is borrowed. in 10 years, 16% or nearly one out of every $5 that the government spends, will be spent solely on interest payments on the debt. obama's budget doubles the federal debt in five years and triples it in 10 years. we talked about this on the floor. i don't think there's disagreement on this. on top of this we face faced $60 billion from the current entitlements o