this health care plan layers another unaffordable entitlement on top of medicare and medicaid and social security and the other entitlements that we have. on a system that's already -- already crumbling. it seems to me that this bill is what the american people do not need and i think that that's why most americans are reporting that this bill is something that they don't want at this time or ever. i think it's common sense. now, reading through the legislation, one is struck by a myriad of ways this bill raises taxes on american citizens. from job-creating small businesses to middle-class families, i count about a dozen of them adding up to about about $500 billion in tax increases over the next few years. half a trillion dollars in new taxes. so everyone should get ready to pay higher taxes, higher health care bills and higher tax bill should this measure become law.

and some might be inclined to say but president obama promised we wouldn't raise taxes. that was indeed a campaign promise, and the administration that no one making under under $250,000 per year would see their taxes go up. let me go ahead and quote that. this is what president obama said during the campaign, and i'm quoting -- "i can make a firm pledge. no family making less than than $250,000 will see their taxes increase. not your income taxes, not your payroll taxes, not your capital gains taxes, not any taxes." so we started analyzing this bill, and guess what we found out. when the bill is fully enacted, the nonpartisan joint committee on taxation -- now, keep in mind, mr. president, i'm voting sources here that are credible sources and nonpartisan sources. the joint committee on taxation found that the average individual making $50,000 and

families making $75,000 would see their taxes go up. let me repeat that. families making $50,000 as an individual or $75,000 as a family would have their taxes go up under this bill. and indeed, according to the joint committee on taxation, 42 million middle-class families and individuals, those making less than $200,000 on average, will pay higher taxes in this bill. president obama's health care reform bill currently under consideration in the senate raises revenues to a large extent on the backs of middle-class americans, despite the candidate obama's pledge not to do that. so let's look at some of these ininstances where we get taxed. beginning this again. this is from the joint tax committee and from the c.b.o. if you have health insurance, if you have insurance, if you get taxed, according to the

nonpartisan congressional budget office, new excise taxes applied to health insurance providers will end up taxing the beneficiaries. this tax also has the effect of increasing premiums as well, so you're double taxed on this deal. now, that's if you do have health insurance. what if you don't have health insurance? you still get taxed. under this bill, you get taxed if you don't carry health insurance as a penalty. and how does this -- where does this burden fall? you guessed it, in middle-class america. c.b.o. has said that half of the americans affected by this provision make between $22,000 and $68,000 for a family of four. that's $22,000 to $68,000 for a family of four. that's in middle-class america, mr. president. if you take prescription drugs, you get taxed, another area. according to the joint -- the j.c.t. and the c.b.o., new taxes in this bill applied to the provisions of prescription drugs will end up raising the costs of those drugs. so you're taxed again.

if you happen to need a medical device. this is something i'm really sensitive to because -- and i vice president heard much discussion of this on the floor so far, because it's a difficult thing. people -- i was talking to senator enzi. he said people don't really know what medical devices are. the stents, the -- these are things that you can -- that are available here in america. you can't find in many of the other countries. so if you need a medical device, you get taxed. if you have high out-of-pocket medical bills, you get taxed. my senate law, brad -- my son-in-law, brad swan, installs pacemakers and defibrillators. i can never say that right. at 1:00 this morning -- i was talking to him this morning when he told me what happened last night. he said at 1:00 they got a call to go out to the emergency room in st. francis hospital in my city of tulsa, oklahoma. they had an-year-old boy with no

heartbeat. he was born with congenital heart disease, and he put in a pacemaker at that time and he was perfectly healthy in the morning. that's something i think most doctors would agree that that child would not have lived. my older sister marilyn faced a similar situation nine years ago and she is alive today and she is healthy today, and she would not be alive today. that's how serious this is. i talked to him this morning about the significance of the -- the medical devices, and i'm going to quote his answer. i quote it down. he said the decision of who needs a pacemaker could be complicated, particularly the decision to put in a pacemaker on someone we might consider quite elderly, but it's false economy to deny putting one in because of their risk of falling, breaking a hip or shoulder in the case where they fall the costs would become much higher. the costs of a pacemaker pales

in comparison with the cost of a stroke or multiple fractures. the pacemaker, by the way, mr. president, costs about about $5,000 and lasts about a year. that's $500 a year, not a bad deal. so i think, mr. president, this is a quality of life issue that we could lose with one of the -- with the democrats' government-run health care schemes. so those are the -- just some examples of what we can do to pay higher taxes under this bill. if you have health insurance, you pay higher taxes. if you don't have it, you pay higher taxes. if you purchase a medical device, you have higher taxes. if you pay your own medical bills out of your pocket, you have higher taxes. if you take prescription drugs, you have higher taxes. all these activities are taxed under this legislation. i want now to turn to examine one tax provision in particular that i find strikingly dishonest, damaging and expensive to the taxpayer. an additional medicare payroll tax that's in this legislation. it's a perfect example of how

you get the bill -- you have to go into it to find these things. there are clan clandestine taxes in the bill that will hit you when you basically don't expect it. the bill says that people making making $200,000 a year are going to pay an additional payroll tax called a hospital insurance payroll tax. that raises over $53 billion. now, keep in mind, this is above the taxes that we're already paying. we're getting these people $200,000. you might think that's a lot of money, but there's a catch to this and they didn't index it. if you don't index the $200,000, then the period of time goes by, it's far greater than the amount that -- that it would sound like today. in fact, i would say that in ten years from now, that $200,000 would pretty much fit a lot of the middle-class people in america. so there is this increase of additional medicare and payroll tax. this bill that raises $50 billion is not indexed, and we know what -- how

that's going to extend to other people now. i remember candidate obama making a firm pledge not to raise taxes on middle-class americans. however, this health care reform bill before us breaks that pledge on numerous occasions. but it's not unlike the new taxes which will be imposed on other measures the democrat congress and president obama would like to enact. i just mentioned the the $500 billion in new taxes on the health bill it raises. there's another tax and another program going on i've talked about on this floor many times, and that is the captain. that's still on the floor. that could come up at any time. of course, that's not something that would be $500 billion over a ten-year period. that would tax the american people in excess of $300 billion every year. and i quote as my sources there, the wharton school of economics, the m.i.t., c.r.a. and others have done evaluations. so it's not just this bill, even

though this is what we're talking about today. we still have the problem of other lgz that are being promoted -- other legislation that are being promoted by the president and by the democrats in here, and the -- president obama's administration's own treasury department estimated that a captain legislation would cost each family in america america $1,761 a year. now, that's really much more than that in heartland america. in oklahoma, it would be closer to $3,300 a year. so we're talking about some very, very large tax increases, but again, back to the -- the health bill. i noted earlier that the governor -- the government-run health care system as proposed by the president and by the democrats is expected to cost cost $2.5 trillion on top of the already exploding record deficits. this bill will increase payments. we make on our country's

ever-exploding federal debt. the democrat congress agenda clearly includes more taxes on america. they may be hidden but they are there. it's disingenuous, it's costly, and it's another reason this bill should not be passed by the u.s. senate. i say another. the other reason and the main reason is that a government-run health system doesn't work. i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i understand that we're now under the order where the half-hour is allocated to the majority side, is that correct? the presiding officer: that's correct. we have 30 minutes, senator. mr. baucus: mr. president, i reserve myself ten minutes. the presiding officer: without objection, so ordered. mr. baucus: mr. president, i just want to just help people understand this legislation. i'm sure many do, but i'm sure there are some who don't with

respect to the choices that people will have. we have a uniquely american system of health care in america. it's roughly half public, half private. and the goal of this legislation is to retain what we have. it is basically that same balance of public and private. it's worked pretty well for america, it's uniquely american. we're not canada. we're not great britain. we're not switzerland. we're the united states of america. i think it's just good to build on our current system, make our current system work better. i'm prompted to explain the choices in part by the statement by the senior senator from arizona who said that medicare advantage plans enable people to get eyeglasses and dental care, and that's true. he went on to say that, gee, shouldn't members of congress like all that and want to keep all that because members of congress get free dental and free eyeglasses. well, that's really not true.

members of congress don't get that. but it is true that members of congress participate -- all federal employees, all federal employees, members of congress, people of the forest service, all around the country, all the federal employees participate in the same system. it's called fehbp, federal employees health benefits plan, where federal employees and members of congress, all together, the same, can choose among many different private health insurance plans. there is an open rollment season. in fact, we're in the middle of it right now where members of congress and all federal employees can look to see whether they want to choose a different insurance company or not. now, some of those companies do provide dental and vision coverage. some don't. so if a federal employee wants to choose a plan that covers dental and vision, he or she can do so. just pay the premium and you're

covered with dental and vision. and we're setting up under this legislation an exchange very similar, almost identical to the fehbp where people who don't have health insurance can go look on the exchange, choose among private companies, which one makes the most sense to them. some may have dental, some may have eyeglass coverage, some may not. that's just a choice people could make. and if they -- in addition to that, there is even more choice because currently a federal employee does not have to join fehbp. a federal employee can choose not to get health insurance if he wants to or maybe through his or her spouse someplace else. the same would be true with the exchange set newspaper this legislation. the person could buy among different competing private plans that offer health insurance on the exchange, or a person could go outside the

exchange because he or she thinks he can get a better deal if that's what that person wants. so i just want to make it clear here that we're encouraging choice, we're encouraging competition, and i might say that under the legislation, democrats of congress fully participate in this -- and be co-equal with others. if there is a private option, members of congress can contribute -- can participate in that as well. in fact, we are requiring senators and their staffs -- they don't have to participate in the exchange, but it's certainly available to them and they can opt out if they want to. now, let me just say a little bit about medicare advantage, and what does medpac say about medicare advantage? several years ago, congress established an advisory board, it's now called medpac, to advise on how medicare should

pay providers and traditional fee-for-service and private medical insurers and medicare advantage. again, medicare advantage are private companies. they have executives, stockholders. it's a private company. and medpac advises how much congress should provide -- should pay medpac and other medicare providers and traditional fee-for-service. it's an independent agency, it's experts, nonpartisan, highly respected. each reports to congress and examines issues on medicare. here is what medpac had to say about the current state of medicare advantage in its 2009, june, report. i'm going to quote now from this independent advisory panel -- "first we estimate that in 2009, mayor pays about $12 billion more for enrollees in benefit plans than it would in fee-for-service medicare. second, current high payments have resulted in some plans that

bring no innovation but simply mimic fee-for-service medicare at a much higher cost to the program. in other words, they're saying that medicare advantage plans get paid for a lot more but with no innovation than -- than the fee-for-service medicare. and they also say, sme, medpac - "they're not enrolled in medicare advantage which are subsidized." in addition, they say, "these excessive payments often encourage inefficient plans to enter the program, further raising costs to medicare." because there's so many dollars currently given to medicare advantage plans, according to medicationspac, that -- medmac that encourage inefficient plans to enter the program. why not? they're not all this extra money. further quoted from medpac, "the cost of medicare advantage subsidies is borne by taxpayers

who finance the medicare program and by all medicare beneficiaries through part-b premiums." or to say it differently, about 78% of americans who are not in medicare advantage plans are paying, in effect, a $90-per-year tax for which they get no benefit, which goes into the medicare advantage plans. in addition, the part-b premium for all beneficiaries is increased by about $3 a month regardless of whether you receive any of the benefit. that's another quote from medpac. i might say a couple more quotes from medpac. "additional medicare advantage payments hasten the insolvency of the medicare part-a trust fund by 18 months." that's an interesting statement. "the additional m.a. payments hasten the insolvency of medicare part-a trust fund by 18 months." that's the hospital version. going on quotes from medpac, "although many plans are available, only some are of high quality in addition," continuing

their quote, "only about half of the beneficiaries nationwide have access to a plan that c.m.s. rates as above average in overall plan quality." this is what medpac says, that's the nonpartisan experts that help advise congress in what reimbursement levels, what they should be. now, we've heard day after day this this bill is cutting medicare benefits for our seniors. what my colleagues on the other side of the aisle realize that this bill does not cut, reduce, or eliminate a single guaranteed benefit. they turn their argument to medicare advantage. i think they finally recognize that there are no guaranteed benefits cut in this legislation so they turn to medicare advantage and they argue that the efficiencies and savings would be achieved by ending billions of dollars of overpayments to these private plans will either end the program or dramatically cut services to beneficiaries. but let's just look at the numbers. i have a chart behind me.

this chart shows the yearly spending for medicare advantage in billions of dollars. so you can see from the chart that in the year, say, 2009, $110 billion will be spent on medicare advantage plans. and moving to the right ten years later, in the year 2019, it's about $204 billion. excuse me, the -- is spent. so if you total it all up, it's about $1.7 trillion that will be spent on medicare advantage plans over the next ten years. now, you see that little -- what color is that? it's kind of an orange, it's kind of an interesting sort of red, whatever it is, at the top of that chart? that represents the reduction in medicare advantage plans payments under this legislation. it's not very much, as you can

tell by looking at the chart. it averages out i think around 10% reduction in medicare advantage payments. so when you hear the crocodile tears how medicare advantage is being cut, hear all these dramatic statements that so much is going to be taken away from seniors because congress is cutting medicare advantage, the fact is we're reducing the rate of increase in medicare advantage payments by only about 10%, and under this legislation, about $1.7 trillion will be spent on medicare advantage plans. remember, medpac says these are overpayments. medpac says that this 10% is about -- reduction is what they should be paid. and remember, too, that these are private plans. these are private companies. it's not medicare. these are private companies receiving these -- these

payments. and they're insurance companies. it's interesting to me, mr. president, that a lot of members of congress aren't too wild about insurance companies. well, medpac -- excuse me. the medicare advantage companies are insurance companies. they're private companies. that's what they are. they're insurance companies. they've got their private insurance company chief executive. they've got their private insurance company officers. they've got their private insurance company stockholders. they've got their private insurance company administrative costs and marketing expenses. they're private insurance companies. that's what they are. and it's -- it's -- that -- we should not lose sight of all of that. now, i want to also point out that as private insurance companies, these medicare advantage plans are doing pretty well. let me quote from an open hierm

capital analyst about medicare advantage plans. "between 2006 and 2009, we estimate that medicare" he meant medicare advantage -- "medicare advantage counted for nearly 79% of the gross profits in the industry highlighted by an estimated gross profit increase of $1.9 billion in 2009 relative to commercial risk earnings gains." now, commercial risk earnings gains are the ordinary health insurance companies but 75% of the gross profit increase was under medicare advantage plans not traditional health insurance. i might say too -- i don't have the papers here. maybe i can find them. just worth noting. these are private companies. they're not -- it's not, you

know, traditional medicare. oh, here it is. let's look at -- this is interesting. you know, what is the compensation of these insurance companies' executives, these medicare advantage plans? aetna's -- of the c.e.o., the total compensation of the c.e.o. of aetna is $24 million a year. the total compensation of the c.e.o. of coventry is $89 million. wellcare is $8 million a year, humana, $4. million a year. united healthcare, $3 million. now, people should be able to make some money and officers of companies should be able to, you know, do okay, but here we're talking about very high salaries that these insurance companies pay to their top executives, and, frankly, if there's a 10%

reduction in $1. trillion over7r ten years, they could, you think, take some of that 10% maybe in salary reduction or dividend to stockholders, make other cost savings. it doesn't have to come out of their -- the beneficiaries. and it's , they the executives, that are making these decisions of where the 10% -- and it's they, the executives, that are making these decisions of where the 10% is allocated. i just bottom line want to say i'm not opposed to medicare advantage plans. frankly are i think it's good that we have medicare advantage plans. medicare advantage plans provide a little competition to medicare. they just -- they help make -- keep the system on its toes. but we have an obligation here as members of this senate, to taxpayers, to seniors to cut waste and to -- and cut overpayments in a way that does not harm beneficiaries.

and these are reductions recommended to congress by the best executive, best advisory board of experts we could find. they didn't just come out of members of thin air, members of congress think this up. they were recommended to us by the medpac advisory board. and, second, there is no reduction in guaranteed benefits to seniors. that's just -- that's absolute . there's no reduction in guaranteed benefits to medicare advantage participants. so, a, we're being fair. this chart shows it. we're trying to find the right level of reimbursement set up in a way so there's no reduction in -- in beneficiaries' benefits. in fact, under this legislation, we add more benefits for all medicare -- medicare advantage as well as traditional fee-for-service medicare. and i might add in this legislation, we give an increase to medicare advantage plans that show demonstrated improvement in quality. as i mentioned, medpac said a

lot of these plans are totally inefficient, a lot of these plans have no coordinated care, a lot of these plans do not have any quality but they get the extra money. so we're saying, let's get the compensation level fair, we do it in a competitive bidding basis. i think the average bid for an area where we also say let's make sure that there's no reduction in -- in guaranteed benefits at the same time. i think that's the responsible thing to do. so all these arguments, these sound bites, frankly, that you hear on the other side of the aisle are just that, they're sound bites. they're not really an honest analysis of what's going to here. so i just encourage us to keep in mind, keep in perspective what we're doing here so we can help provide a better health care system for our country. this is only one part of it. there are many other parts but this is just one. mr. president, i'd now like to yield to the senator from michigan.

ms. stabenow: thank you. thank you. mr. president? the presiding officer: you have 14 1/2 minutes. i'm sorry, 13 1/2 minutes. mr. baucus: i see senator dodd's on the floor. could you, senator, maybe five minutes? we could probably get some more. ms. stabenow: seven minutes would do. mr. baucus: take what you want. we'll find the time. ms. stabenow: thank you. mr. president? the presiding officer: the senator from michigan is recognized. ms. stabenow: thank you, mr. president. and, first, i want to thank our distinguished chairman of the finance committee for debunking what has just been said on the floor by our colleagues on the other side of the aisle, laying out the facts of what is and is not happening with medicare advantage. and i'd like to build on that as well. i would encourage anyone who is interested to go to the web site of aarp. one of the organizations we know to be champions for seniors and take a look at what they say about the myth that health care

reform will hurt medicare. and they lay out several things. one is "none of the health care reform proposals being considered by congress would cut medicare benefits or increase your out-of-pocket costs for medicare services." and then just this week, in supporting our efforts, they've put out a statement that -- a letter that at the end, again, they reiterated, "most importantly, the legislation does not reduce any guaranteed medicare benefits." i find it interesting, mr. president, that our colleagues who a few years ago quoted aarp all the time when we were debating the medicare prescription drug bill. i would guess that every single one of our republican colleagues used their support in putting forward their bill. now they are trying to disparage, which i

which is a very cricial organization because they don't a-- credible organization because they don't agree what are aarp is saying. but the millions of people that belong to aarp will be throichg what they are saying -- listening to what they are saying because we are not, in fact, cutting the guaranteed medicare benefits. and in addition to that, we have the alliance for retired americans, the national committee to preserve social security and medicare all saying that they support what we are doing and that they have debunked the republican scare tactics point by point. so what is really happening here, mr. president? the reality is that colleagues on the other side of the aisle, since the inception of medicare, have been fighting even the existence of medicare. it was democrats and a democratic president in 1965 or 19 -- 1965 that passed medicare over the objections, the same arguments we're hearing today we

heard then. now everyone sees that medicare's a great american success story. but we have seen so many effor efforts. in the 1990's, when i was a member of the house, speaker gingrich inside his "contract with america" in 1994 that they wanted to come in, they wanted to -- to change medicare, they couldn't directly do it so they would do it through the back door and let it wither on the vine, those famous words that we heard at that time, in terms of trying to privatize medicare, which is what i believe medicare advantage really is. recently in the debate on the house of representatives, we had 80% of the house republicans support an effort to do away with medicare at all as we know it as a guaranteed benefit. and, instead, give vouchers to seniors to go buy from private for-profit insurance companies. so we know what the reality of this is. this is about the for-profit

insurance industry that right now is receiving overpayment at every -- whether it's congressional budget office, whether it's medpac, any analysis will say that they are receiving overpayments right now and we are trying to ratchet that back. and what is happening? why should folks care? of course, taxpayers care about overpayments much but we have about maybe 15% or so, 15% to 20% of seniors right now that are in the medicare advantage program, and we've been told by the budget office that the 80% to 85% that have not, have seen their premiums go up to pay for overpayments to for-profit insurance companies. that's not fair, mr. president. that is not fair that the vast majority of seniors and people with disabilities would see their premiums go up under

medicare to pay for for-profit insurance companies to get a piece of the action under medicare. secondly, we know that the medicare advantage program, as the chairman has said in reading the report, has actually made the solvency of the medicare trust fund worse. it's going to run out of money sooner if we don't stop these overpayments. our legislation, rather than having it run out of money 18 months earlier, will increase the solvency by five years. and we are committed to increase and continuing the solvency of the trust fund and protecting medicare for the future because we do believe it is a great american success story. and we're quite proud that democrats created medicare with a democratic president. and we're proud that it's democrats now coming forward to make sure that we protect medicare for the future.

so what is really happening here is that we are seeing a variety of stalling tactics, a variety of efforts on the other side, not only to stop us from moving forward on health insurance reform, but efforts time and time again to protect the for-profit insurance companies. and so for the record, mr. president, i just want to read to you that the list of medicare benefits that everyone receives now and the benefits that will continue regardless of this. regardless of whether we cut back on some of the profits of the for-profit insurance companies. in-patient hospital care and nurses, doctors' offices, lab tests, preventive screening, school nursing, hospice care, home health, durable medical equipment, emergency room, kidney analysis, out-patient mental health, physical therapy,

imaging, x-rays, and so on, organ transplants and welcome to medicare physical. they're covered now and they will be covered under this legislation much the difference is we will take the overpayments to the for-profit insurance companies and put it back into medicare to reduce the cost for prescription drugs, what's now become the infamous doughnut hole, the gap in coverage. we're going to begin to close that by taking the excess profits of the for-profit companies, putting it back into medicare. we're going to reduce the premiums that seniors pay for drugs and medical care, eliminate co-pays so that people can get preventive care without a fee and we're going to strengthen medicare for the future. mr. president, i would just wrap-up by saying this: this legislation in total is about saving lives. it's about saving money. it's about saving medicare.

we admit our goal is not to save the profits of for-profit insurance companies. we're guilty of that. we are focused on making sure medicare is strong, vibrant, solvent for the future, for our future generations as well as our seniors today. and, by the way, we're going to make sure that we are saving lives and saving money in the process. so i would strongly urge us to oppose any effort that is put forward that would be done in the interest of the insurance industry at the expense of seniors in america. that's what these efforts to recommit -- to commit are all about. and i hope that we will reject them. thank you, mr. president. mr. dodd: mr. president? the presiding officer: the senator from connecticut is

recognized. mr. dodd: let me commend our colleague from michigan who is a member of the finance committee and stalwart defender of the medicare program and the elderly not only in her state, but around the country. she has offered coming enter and worth -- cogent and worthwhile information on this subject matter. we keep going around and around and around in this debate. and it's a little bit frustrating because we're talking about basically whether or not we're going to limit to some degree the profits of some private insurance companies that are under the rule of something called medicare advantage. again, these are private companies that are receiving subsidies supported by medicare beneficiaries and the taxpayers of this country. and we're talking about not eliminating medicare advantage, but rather restraining. we had a great chart up here a

few minutes ago that senator baucus had. i'll get it up here in a pew minutes much it -- if -- in a few minutes. we're not eliminating it. we're where based on performance an quality, we give bonuses in medicare advantage. so contrary to the argument you've heard by those who are heralding medicare advantage, despite the fact that the very companies who argued for it -- to begin with promised to reduce costs, be more efficient, in fact, today, it's quite the opposite. you're looking at a situation where you have people actually paying about $1.14 -- right now the government pays these medicare advantage insurance companies $1.14 to do the same things for seniors that medicare does for $1. that's basically on average what it amounts to. the question is: can we reduce

the cost of these overpayments which are basically ending up in the pockets of the people looking for the profit. there's nothing wrong with profits at all in these private companies. but let's declare them what they are. this is not traditional medicare. these are private companies that are anxious not only, i presume, to provide benefits to their beneficiaries, but are also looking to make a profit. there's nothing wrong about that. but since the premiums were set by statute, as they have been in this area, and basically we have an obligation to try keep our costs down, we're trying to do so because the promises initially made have not been kept. in fact, the costs are vastly exceeding the promises that were made. the amendment that we're going to be hearing about from our friends on the other side is nothing more than a recycled compilation, mr. president, of some of the greatest hits we've heard, stalling with, of course, arcane obstruction practices,

standing up for the private companies here, at our expense. i have no trouble withstanding up for private companies that do a good job. when you do so at the expense of scaring seniors with baseless claims, then i do object. and that's what's going on here. quite frankly today, over 80% of our elderly are paying $90 a year in additional premium costs without getting any benefit from it whatsoever to provide benefits under the medicare program. that's not equitable. the 80% of our elderly need to know in all of this that you're being disadvantaged by this. what the finance committee is trying to do, under the leadership of max baucus, is trying to bring equity back. nothing in this bill does away with medicare advantage. nothing. what we're trying to do is get it back to a sense of reality and not, again, disadvantage --

talk about advantage -- disadvantage 80% of our seniors. right now it's medicare disadvantage it ought to be called because that's what it does. it disadvantages. why should 80% of the elderly in this country pay higher premiums and no benefits at the expense of the 20% who are going to get some advantage out of this. get very little advantage. most of it ends up basically with the profits. i'll tell you why that happens in a minute here. just to make my point, according to the oppenheimer analyst carl mcdonald, in a report issued less than a month ago, between 2006 and 2009 -- this is a report, now, from them, oppenheimer capital, we estimate, a quote, that medicare advantage accounted for 75% of the increase in gross profits among the larger plans in the industry. high lighted by an -- a gross profit increase of $1.9 billion in 2009 relative to commercial

risk earnings with gains of $600 million. i know the chairman of the finance committee made that point, but it deserves to be made over again. 35% of the increase in gross profits came in the medicare advantage plan. these profits come out of the pocket of the american taxpayer, because of our subsidies, and, of ours, the medicare beneficiaries who are paying those extra dollars. -- every year without receiving any of the benefits at all. so the -- our bill will protect and strengthen medicare and extend the life of the trust fund, as you heard over and over again. but it deserves to be repeated. that's not a fact to dispute. that is a fact. we extend the life of the medicare program. it's part of the way our bill adds to the use of medicare is by eliminating wasteful overpayments and that's what these are. these are overpayments. far beyond what was anticipated when the program was written. and, as i mentioned a moment ago, the government pays insurance companies in medicare advantage program, $1.14 to do

the very same thing for seniors that traditional medicare does for $1. so those are the overpayments we're trying bring back. there's no evidence that the wasteful overpayments do anything to improve the care of our seniors. at the same time they speed medicare's dissent into bankruptcy and raise premiums for all medicare beneficiaries, as i mentioned. our bill would end that waste, use the money they save to help seniors pay for prescription drugs, by closing the doughnut hole. for the second time in less than a week, our friends on the other side are using tactics to halt progress for -- the payments that come out of the hide of our taxpayers and elderly. that's all that it does. if you look at the chart, if you go to 2019, almost 10 years from now, what is the difference between what our bill does and what those who want no change in this whatsoever do?

the difference is $20 billion. we allow this in the post-reform period in 2019 for $183 billion going to medicare advantage. what the opposition wants is to hold it at $204 billion in 2019. that's $20 billion. that's a savings we're looking for in that year. -- in order to reduce the overpayments and, again, provide those resources so that our elderly can afford prescription drugs. now, you want to side with these companies, they're still going to make a profit, mr. president. this is not depriving them of that at all. it's bringing down the profit margins to far more realistic levels an eliminating the needs for the subsidies we're talking about or at least reduce them as well as the payments being made by the elderly today who receive nothing under this program at all. let me make my case to you on this point. again, i note senator stabenow enlisted the guaranteed ben -- listed the guaranteed benefits,

and i know the chairman did as well. we add benefits. in addition to the in-patient hospital care and doctors' office visits and kidney dialysis, emergency care, occupational therapy, organ transplants, all of these issues, we also do things under our bill that presently aren't available. one, we are reduce the size of the medicare doughnut hole. which is huge for people. it's an added benefit. we reduce premiums for seniors to pay for drugs and medical care. that's a huge breakthrough. we eliminate the co-pays. ask if you would like to eliminate co-pays or let some private companies make an additional $20 billion in 10 years. which is the better choice? you ask the overwhelming majority of our seniors, which would they rather have? to eliminate the co-pays they're paying today or continue to provide excess profits for the companies here that have made so much under the medicare advantage program and, lastly, of course, and most importantly,

we help keep medicare solvent. let me make two cases to you. people say, give me examples of what you're talking about on why these differences exist. i've got a couple of examples, mr. president, from my home state that highlight the point. one, the c.m.a., it's a nonprofit organization as most of my colleagues know that does casework on behalf of individuals who need assistance dealing with medicare advantage plans. they gave me -- i said are there cases out here that can highlight these differences between medicare and medicare advantage? so they provided two cases from my state. i presume most of my colleagues could find cases in their own state. a woman living in madison, connecticut. a shoreline community of connecticut. she has lou gehrig's disease, a.l.s. we're all familiar with a.l.s. the stories of what people go through with that. she was in a medicare advantage plan. she was denied coverage for home health care because she is said to be stable. that was the quote, she is

stable. it's not a valid reason for denial, and she was hardly stable with a.l.s. c.m.a., the center for medicare advocacy, had to go to federal court to get her case -- her care covered despite firm, written support regarding her medical condition and the care of her doctors. so here's the woman again under medicare advantage with a.l.s. being declared by medicare advantage she was stable. her doctors said anything but the case. so when my friends talk here about a rationing of care under the present system, there's someone at medicare advantage, a private firm making a medical decision between she and her doctor that she was stable when they said anything but was the case. now, they eventually got it overturned but they had to go to federal court to get it overturned. that would not have happened under medicaid. had she been just under medicare, she would have gotten that help, no questions asked. so when people tell me there's

no distinction, there is a live case for you. let me give you the second one. a woman from vernon, connecticut, and her husband traveled to florida to visit their daughter who was living there. on that trip to florida, when she got to florida, she fell down and sustained some injuries, physical injuries. while being treated in florida at the hospital for the injuries, it was discovered she had a brain tumor which is the reason she had the fall. she had no idea this beforehand. medicare advantage plan covered treatment for the fall as an emergency, which medicare advantage plans must cover even if out of network, by the way, but not any diagnosis or treatment for the cancer, for the brain tumor. the woman had another daughter that lived in utah, a nurse there, so they traveled from florida to utah where they went for the cancer treatment for the brain tumor. while undergoing chemotherapy, this woman had a life-threatening reaction to one of the medications from which she almost died. the medicare advantage plan denied coverage for all of this

care because it was out of network. she was in utah. they said no. leaving the client and her husband with $100,000 in bills. now, again, the center for medicare advocacy went to court again and battled in court, and they were successful in recovering $90,000 out of the the $100,000. now, this woman is now deceased, mr. president, but she and her family were left with over over $10,000 in bills, all of which would have been covered under traditional medicare, but she had gone into the medicare advantage plan. in both instances, they would have avoided having to be in federal court, having to fight as hard as they did, going through the trauma and the turmoil. bad enough you've got to wrestle with cancer. bad enough you have to wrestle with a brain tumor. but then you get saddled with with $100,000 in bills and medicare would have taken advantage of you. this medicare advantage program disadvantaged her in the process. and these are examples of how private medicare advantage don't always operate in good faith.

they're not always there when you need them if you're out of the same area. so there are significant differences. traditional medicare, you know what services you get. and i'll ask consent to put this list of services in the record so people can read about it if people haven't already done that. all necessary hospital and doctors' office visits are covered in medicare. you know you can get these services from any medicare provider anywhere in the country, not out of network. you get this kind of help. whether it be in utah, florida, or vernon, connecticut, where she was from, medicare would have provided that. here they are bouncing around the country and being denied at one place after another under medicare advantage. they don't have to worry about a private insurance plan playing games with their coverage. medicare advantage, these plans run the show. they change the benefits. cost sharing goes on. this is why medicare advantage

is not like traditional medicare. so when people say it's just like medicare, no, it's not just like medicare. and if you doubt me, then you call that family in madison, connecticut, or you call that woman's family from vernon, connecticut, ask them whether or not medicare advantage was just like medicare. you'll get an earful from them about what they went through. we should be clear that we're not eliminating medicare advantage. and again, i appreciate senator baucus making this point. it needs to be made over and over again. we're not about eliminating it at all. we are reducing the overpayments to private plans and making the system work more uniformly. we actually give those plans bonus payments for care, coordination and quality improvements, and they can use -- these plans can use those payments to improve benefits for their beneficiaries. so hardly eliminating it at all. we're making it work better. i have serious reservations about how this plan operates, i'll tell you that, mr. president, but i would not advocate on the floor of the

united states senate the elimination of medicare advantage. but i do want to make it work better and i do want to cut back when you have overpayments occurring, and i don't think it's fair that 80% of the seniors in my state or elsewhere are paying $90 a year extra to cover this program and get none of the help from it, and that people under medicare advantage could have been protected or not because they opted to be in that plan and then find out it's anything but what they thought it was. so, mr. president, you're going to hear these arguments over and over again about medicare advantage. a little truth in advertising is necessary here so people understand it's not medicare and it's not an advantage, not in its present system, not at all, and that's what we have been trying to say over and over and over again here so the people understand. this is a good bill. this is a solid bill. this took a tremendous amount of work in the finance committee that had the responsibility in crafting these provisions which are highly complicated and very delicate in what you do, but what we've done here is preserve

and strengthen our medicare system, expanding the benefits for people, eliminating co-pays, allowing those preventatives, screening services to be available to our elderly, seeing to it they'll have the prescription drugs at lower costs. that's all in this bill. that's a great advantage. what a tragedy it would be if in these next few days when we have to debate all of this we would lose all of the work that has been done here to make these kind of improvements in our health care system, and i commend again my colleague from montana and his colleagues in the committee that worked so hard to put this together, this balance together here that can make such a difference in people's lives. so with that, mr. president, i also want to thank our colleague from rhode island for offering his amendment which we're going to be considering at some point here when we get to vote occasionally on some matters around here. and again, i hope at some point we can start to do that. we've done it a couple of times, but frankly, this has been over a year of debate and discussion. i think the american people would like to see some action

and they deserve to have it. we think we have a good bill on the class act which i know has been hotly debated and discussed. it's going to take on an important health insurance market reform that will ensure that americans will get access to health care promised by their insurance plans. it's going to make sure that if someone loses his or her job they can get insurance. it's going to improve the quality of health care and focus our system more on prevention and wellness. on top of all these things, it's going to reduce the deficit. as we've heard over and over again, c.b.o. is talking about saving $130 billion in the first ten years and $650 billion in the second. you know, i've got to say something, mr. president. the other days when we got the news that c.b.o. had said that the premiums on the individual plans, the small group -- or small business plans and the large group plans were actually going to reduce premium costs by 20% in one area and as little as 3% in another. i would have thought there would have been wild applause. even those that opposed the bill would have said isn't that great news? what you got here was almost a

sense of deep disappointment that c.b.o. had come out and given us a report here that actually people were going to save money under this bill and proposal. and then all of a sudden to attack c.b.o. because you didn't like the results coming out of c.b.o. i'll guarantee you that had they come back and said we're going to increase premiums, we would all be talking about that. so here we get reports that actually we're going to save premium costs, reduce the costs of the federal budget as has been pointed out. and now senator whitehouse is going to offer an amendment that makes clear these savings we're talking about used to strengthen social security, reduce the deficit and contribute to the long-term solvency of the class act will be for that purpose and that purpose alone. and the third part of his amendment is particularly important. many of our colleagues have come to the floor in the last few days to claim that class act will be a long-term drain on the budget. it's just not true, mr. president, thanks to our colleague from new hampshire. senator greg, the class act will be required by law to be solvent for 75 years. which is not in our original

proposal. it was added in the health committee markup by senator gregg and i thank him for it. it was unanimously adopted by senator gregg in our markup. the c.b.o. says it produces produces $72 billion in savings for the federal government over the first ten years of its existence and it will save nearly $2 billion from medicaid. they further added language to the bill to require the secretary to maintain enough reserves after the first ten years to be able to pay out any claims that may emerge. and we have included language to prevent federal appropriations from being used to pay benefits to ensure the program is selffunded. and finally, at the request of several senators, the distinguished majority leader made sure that we did not lose any of the savings from the class act for any other purpose other than to pay for the class act itself. this amendment offered by senator whitehouse will give senators a chance to commit themselves to that purpose. senators who claim the class act will hurt the federal budget of course should vote for this amendment because statutorily it

will prohibit any of those funds from being used for any other purpose other than for the class act and the recipients of people who want to use it. so i commend him for those moves and we thank him. when that vote occurs, i would urge my colleagues to vote for the whitehouse amendment. mr. president, i lastly would like to ask to be included as a cosponsor along with my colleague from maryland, senator mikulski, of senator coburn's amendment number 2789 which adds members of congress to the public option. we had -- we had -- we added that provision to the "help" committee bill. senator coburn offered that amendment. senator kennedy and myself and others voted for that coburn amendment. i think it may have shocked the senator from oklahoma that we actually voted for his amendment at the time. i know that senator brown has been added as a cosponsor. i have no objection to that amendment. that's how much that i think the public option will be worth. if we have a public option in

this plan -- and my hope is that we will -- then i think there is nothing wrong with insisting that members of congress be included in that public option proposal. and so his amendment suggests that. we support it in our committee, and i'm prepared to support it again here on the floor of the united states senate. and again, i point out that i think that's a wonderful -- i just wish we could get members as well who are reluctant to support this bill to recognize that as members of congress today, we all have pretty good health care plans under the federal employees benefit package, some 23 different options every year that are available to us along with the eight million federal employees in this country under those plans. i just wish we could get others to recognize how valuable that is to all of us and our fellow employees who are federal employees. unfortunately, that doesn't seem to be the case, but i hope before this is concluded we'll have far more support for this effort that we have crafted and provided to our colleagues for their consideration.

again, i compliment the finance committee and compliment my friend from montana for the work he has done on this issue. it's very well thought out, very balanced, very fair. and again, i've said this over and over again. i challenge any member to come to the floor and identify a single guaranteed benefit under medicare that is cut out in this bill. there is not one. and wait to go this day. three days have gone by. identify a single guaranteed benefit under medicare that we cut. you will not find one, not one, mr. president. mr. president, i see my friend from wyoming has come to the floor, and i know i have probably gone over a little bit of time here, but i yield the floor. the presiding officer: the senator from montana is recognized. mr. baucus: we're kind of playing things by ear. i would ask unanimous consent that the senator from wyoming be allowed to speak -- be recognized to speak for debate only, and at a later point we'll figure out allocation of time on both sides. if he wishes to speak now?

mr. enzi: yes, mr. president, i would like to speak. the presiding officer: the senator from wyoming is recognized. without objection. so ordered. the senator from wyoming. mr. enzi: mr. president, thank you. it was my understanding i would be in charge of the next 30 minutes and then it would revert to the other side for 30 minutes after that. at some point, though -- mr. baucus: the next 30 after that. the presiding officer: without objection, so ordered. mr. enzi: it's also my understanding that at any time there is an agreement for a vote, we'll kind of cancel out what we're doing here, but there is no agreement yet, and i'm not not -- so i -- i wanted to thank the senator from connecticut for setting up my speech so well. he said that there wasn't anyplace that anybody can show any decline in guaranteed benefits.

in what i'm about to say, i'll try to do that. of course, the word guaranteed benefits really doesn't show up anywhere in what we're doing. benefits does but not guaranteed benefits. and in my opinion, getting to be in a nursing home or being able to see a doctor, some of those ought to be kind of considered guaranteed benefits, but ill get -- but i'll get into that in my speech here and cover some of these areas that i think are very important to seniors, because i am opposed to the half a trillion dollars in medicare cuts in the reid bill that are not going only to solve medicare. now, some of my democratic colleagues have attempted to argue that this bill doesn't cut the medicare program. they have further said that such cuts are justified and will not harm the program. they have also argued that no beneficiaries will lose their benefits, their guaranteed benefits -- and they're very careful on that and i understand why they are very careful on that because there are other

benefits that are being cut that will be considered by those people who lose that benefit to be a guaranteed benefit. unfortunately, all of those statements are false t. does not matter how many times -- false. it does not matter how many times my colleagues repoet these claims, they do not -- repeat these claims, they do not become any more accurate. this bill cuts $464 from the medicare program. it slashes payments to hospitals, nursing homes, home health agencies and hospice. the money from these cuts does not go to shore up medicare. the money goes to new programs for others. these cuts will affect the care provided to medicare beneficiaries. the american health care association, which represents nursing homes, said that the cuts in the reid bill would force layoffs, lower salaries, reduce benefits, and ultimately would hurt patients' quality of care. a commission was set up to make

even more cuts to save medicare. it's in the bill. there's a commission in there. so with the side deals, though, that have been made with lobbyists, the only place these cuts can come from is from seniors, and i'll cover that in a little more detail later. i've heard similar statements from home health providers, that's more than $40 billion in cuts. hospice providers, that's $8 billion in cuts. and hospitals, that's $130 billion in cuts. now, if these medicare cuts go into effect, it could drive many providers out of the medicare program. that will mean patients do not have the care they expect and they need. some of my democratic colleagues that accused us of trying to scare medicare beneficiaries. if seniors are scared by our statements, they should be terrified by what the administration has to say about the democrats' health reform bill. the administration's own chief actuary, richard foster,

recently wrote that the steep medicare cuts in the house-passed health reform bill would make it difficult for many providers to remain profitable and cause them to end their participation in medicare. he went on to note that this could jeopardize medicare's beneficiaries' access to care. as the senior senator from tennessee noted yesterday, it's the medicare cuts in the reid bill that are actually scaring seniors. medicare beneficiaries understand that if providers are no longer able to take medicare patients, they, the seniors, will not get care. a lot of grandmas and grandpas have figured it out and they're not going to stand for it. now, the chairman of the finance committee has repeatedly said that this bill will not cut or reduce any guaranteed medicare benefit. that statement seems to ignore what this bill will do to providers. if a medicare patient cannot get into a nursing home, they don't have nursing home benefits.

if they can't find a home health aide willing to take medicare patients, they don't have health home benefits. now, the promise for coverage, which you can't get a doctor to see you, is not health care. you don't have benefits if you can't get a provider to treat you and, unfortunately, that's exactly what this bill will do. some of my democratic colleagues have also attempted to justify the medicare cuts in the reid bill by arguing that many of the trade associations representing health care providers have endorsed this bill. they're correct that several washington-based trade associations and their lobbyists have endorsed the reid bill. it's probably worth exploring why some of the groups have chosen to endorse this legislation. in some cases, motivations are obvious. some drug manufacturers are clearly motivated by self-interest and greed. they negotiated a secret deal with the white house that will actually increase how medicare spends on brand-name drugs.

brand-name drugs. they didn't touch the ger erics, they're interested -- generics, they're interested in the brand-name drugs. under the deal, the drug manufacturers will provide discounts on brand-name prescription drugs when the seniors will in the medicare coverage gap, known as the doughnut hole, now, they make the payments directly to the customer. it doesn't go through medicare, directly to the customer. that way they can maintain the customer contact and keep them addicted to the brand name. generics are cheaper. a lot of people when they go into the doughnut hole switch to generics. that saves them money and it saves us money. because when they get through the doughnut hole, they will stay with whatever they're on in the doughnut hole. so if they're forced to stay on a brand name to get a little extra discount as they go through the doughnut hole, they'll stay with the brand name when the taxpayers are paying for it when it goes above the doughnut hole, which is the rest of the year.

that could be a huge number. so while it looks generous by the drug companies, beware. their generosity is suspect with what they will make when it gets through the doughnut hole. under the terms of the sweetheart deal between the white house and the drug makers, discounts are provided for these brand-name drugs. this will encourage seniors to continue to get those more expensive drugs and it will actually cost the taxpayers $15 billion because the deal will actually increase medicare costs. in other cases, provider groups were promised special deals if they agreed to support the reid bill, or whatever bill we were working on at that time. for instance, recent press reports have described how the american medical association has promised -- was promised a permanent fix to the medicare payment formula for doctors if they agreed to support this bill. or a one-year fix if there was

an end to junk lawsuits. under current law, doctors' medicare payments are scheduled to be cut by more than 40% over the next decade. that's already in place. that's not a part of the bill. the cost of fixing this flawed government mandated formula will be more than $250 billion, and we know that because we've debated it on the floor and we decided that we were going to have to pay for that if we were going to do it. let's see, with $464 billion in medicare money that we're using on other things. that's why i keep saying that medicare money only ought to go to medicare benefits. and that $250 billion in fixing the doctors might make it possible for people to see the doctors. now, i can understand why doctors want to fix this flawed government price-control system, and that's what it is. they're telling the doctors what they can charge a customer, regardless of how long a time it's going to take them to take care of that patient. and for a lot of them, they've

discovered that it costs more than what they're able to get. and if they continue to do that, they have to go out of business. that's kind of a small business philosophy. you take in less money than what it costs you to be in business, you're out of business. so i don't think they like that kind of a government price-control system. and as a result, 40% of the doctors won't take a patient on medicaid, and it's -- it's growing in percentage now on medicare the same way. when you fix the price, some people can't afford to provide it for that. they can't take those patients. talking to a friend of mine from florida who said, every time you call a doctor now, they say, are you on medicare. if you say you're on medicare, they say, "we're not taking any new patients." if you can't see a doctor, you don't have a benefit. now, it shows the exact problems is a result from letting government bureaucrats use price controls to set payment rates. what i don't understand is why

the a.m.a. continues to support the bill when they got nothing for their deal. we didn't fix the $250 billion problem and we haven't fixed the junk lawsuits problem. i remember the president appearing at the national convention of the american medical association and promising that there would be tort reform, that there would be an toned these junk lawsuits. all of our attempts, either in the "help" committee or in the finance committee to even -- even bring that up have been either voted down or denied, and as a result, there's nothing in this bill that's going to solve that problem. now, the bill does nothing to fix the medicare payment formula for the doctors. instead, it cuts $464 billion from medicare and uses that money to cover the uninsured. even if these cuts can be made without hurting seniors, the republicans are saying use the

money only for medicare. medicare money for medicare. medicare funds should be used to fix medicare's problems, such as this flawed payment formula that keeps doctors from taking seniors. taking hundreds of billions of dollars out of a medicare program now will only guarantee that it will be much harder to permanently fix the doctor payment issue in the future. i can understand why the a.m.a. continues to support -- i cannot understand why the a.m.a. continues to support this terrible deal for doctors. if you can't see a doctor, your benefits, your guaranteed benefits have been cut. apparently, the members of the a.m.a. don't like the deal either. at a recent convention, up to 40% of the current membership of the a.m.a. voted to reject this deal. i know that's not a majority, but most associations survive by consensus agreements. that means that almost all of

their membership agrees with the tack that they're taking. not just slightly more than half. now their membership is less than 20% of all doctors. it's a dwindling association. let's see, so les so less than f the doctors, had 40% that opposed it. we're getting down to some pretty small percentages of ones that supported what the a.m.a. did in their deal. now, finally, many provider groups have been reluctant to speak out against this bill because they've received threats from the white house and congressional democrats. nursing homes, home health agencies, and hospice providers have all reportedly been threatened with further cuts -- further cuts -- if they speak out against the bill. is that freedom of speech or is it just bad ethics? they've reportedly been told that any public statements of opposition to the reid bill will lead to even more severe cuts.

these providers have had to make the choice to silently accept devastating cuts rather than oppose them and risk being utterly destroyed. now, one of the medicare advantage providers is humana, and i'll use them as an example. c.m.s. said they couldn't let their customers know what was about to happen and chastised them for sending out a letter. i thought the customer deserved to know and that we were in a new era of transparency. that doesn't sound very transparent to me. so how can that happen in america? at any rate, i hope my colleagues and the american people will take these facts into account when they hear senators talk about provider groups supporting this bill. unfortunately, health care provider support for this bill is being driven primarily by greed or stupidity or fear.

we know this bill will not fix the problems in the american health care system. it will not lower health care costs. it will not lower insurance premiums. it will still leave 25 million people uninsured. what this bill will do is spend $2.5 trillion and guarantee a much bigger role for the government in dig at in dictatw health care will be provided in this country. if you're not under medicare, yes, your government is going to tell you what is adequate coverage and they're going to force you to buy it or pay a penalty. now, given the recent experiences the doctors have had with medicare price controls, this is not an outcome that bodes well for the america's health care providers or their patients. and i remind everybody that in august, there was an uproar and that uproar continues. now, we don't notice it as much because we're not going to get to go home this weekend and talk to our constituents. that might be by design because

we already know what our constituents are saying. they're saying this bill is a bad deal for us. where's the promise that you were going to cut costs for us? where are the other promises that were made with this health care reform? i would mention that the c.b.o. found that premiums in the individual market will rise by 10% to 13% more than if congress did nothing. that's c.b.o. family policies under the status quo are projected to cost $13,100 on the average, but under this health care bill should jump to $15,200. that's not very good news for the people in my state or any other state. no big cost rise in u.s. premiums is seen in the study, said the "new york times." "the washington post" declared, "senate health bill gets a boo boost." the white house crowed that the

c.b.o. report was more good news about what reform will mean for families struggling to keep up with skyrocketing premiums under the broken status quo. finance chairman, the senator from montana, chimed in from the senate floor that health care reform is fundamentally about lowering health care costs. yeah. lowering costs is what health care reform is designed to do. lowering costs. but then he said, "and it will achieve this objective." except it won't. c.b.o. says it expects insurance sponsored insurance costs to remain roughly in line with the status quo. that is a failure under this bill. meanwhile fixing the individual market is -- which is expensive and unstable largely because it does not enjoy the favorable tax treatment given to yo job-based coverage. if you're buying insurance on your own, you're not getting a tax break, if a company buys insurance for the people who

work for them, they get a tax break. in my 10 steps to solve health care, i mentioned and worked on making that fair. you've got to be fair for both sides. the wyden-bennett bill makes it fair for both sides. this bill doesn't make it fair for both sides. now, i'm talking about fixing the individual market and that is expensive and it's largely unstable, as i'll say again, but it's due to the favorable tax treatment given to job-based coverage, which is supposed to be the purpose of reform. c.b.o. confirms that new coverage mandates will provide premiums higher. democrats are declaring victory, and that the claims don't count because they're offset by new government subsidies.

57% of the people who buy insurance through the bill's new exchanges that will sub plant today's market will require subsidies that require two-thirds of the total premium. the bill will increase the costs, but disguise the costs. higher costs can be conjured away because they're suddenly on the government balance sheet. the reid bill has $371.9 billion in new health taxes that apparently are not a new cost because they can be passed along to consumers. or perhaps will be hidden in lost wages. this is the palio-liberal school of brute wealth, away from the repeated white house claims that reform is all about bending the cost curve. the only thing bent here is the budget truth. moreover c.b.o. is almost certainly underestimating the cost increases based on its

county-by county actuarial data the insurer wellpoint has calculated that this bill would cause some premiums to triple in the individual market. i don't go by wellpoint. i go by what i found out in wyoming itself. and that's an accurate picture, particularly for the young people in our state. those who are young and healthy will see 300% increase. i think they're going to notice that. i don't think they're going to be happy with it. other associations have come to similar conclusions. and the reason for that is the community rating, which forces insurers to charge nearly uniform rates regardless of customer health status or habits. habits is an important one on that. c.b.o. doesn't think this will have much of an effect, but costs inevitably rise when insureinsurers are not able to e based on risk.

that's why today some 35 states impose no limits on premium variation an six allowed wide differences among consumers. now, that's not just wellpoint that's saying that. i have some peer-reviewed documents that also show that same thing from people from different colleges. they have found that state community rating laws raised premiums in the individual market by 21% to 33% for families. and 10% to 17% for singles. in new jersey, which also requires insurers to accept all comers, so-called guaranteed issue, premiums increased by as much as 227%. let's see. we just had some elections in new jersey and things didn't go well there. probably wasn't just type two insurance cost. there are plenty of alternative that's really would reduce the cost of insurance.

now according to c.b.o. -- this is according to congressional budget office, which we quote a lot, they did a an evaluation on the relatively modest house g.o.p. bill. the republicans in the house, they were limited to just an amendment. there were three amendments total in a one-day debate and passage of the health care bill over there. that rowed a lot of -- roused a lot of people in america too. if you only get one amendment, they avoided what we've done. we have four different bills out there that solves what the president said he wanted solved, and that doesn't include the wyden-bennett bill that the president also said that he wanted, that's not included in this bill. the house put together, it is relatively modest. it would reduce premiums by 5% to 8% in the individual market in 2016 and 20% -- 10% to 20% in

businesses. the g.o.p. reforms would do so without imposing huge new taxes. we've concentrated the last few days talking about the medicare money that's being stolen to provide for the changes. we haven't talked yet about the extra taxes that are going to be put into place. that's the other half of the package. but the democrats don't care because this bill, they say, is really about lowering costs. no, it's about putting washington in charge of health insurance at any cost. i see that the senator from wyoming is here and we have 10 minutes remaining on our time if the senator would like to make some additional comments. he and i have been traveling wyoming and hearing the comments from our people.

the presiding officer: 7 1/2 minutes. mr. enzi: 7 1/2 minutes. i'll yield the time to my colleague. the presiding officer: the senator from wyoming is recognized. mr. barrasso: thank you very much, mr. president. i would actually ask my colleague from wyoming, who i have the privilege of serving with, because i saw a -- a story today, a large story, in "u.s.a. today", and this story says, "senate keeps medicare cuts in the bill." this is going to continue. and what it said is, "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 for millions to tens of millions of uninsured americans." so i read this and it says that the republicans tried to keep

the medicare money for people on medicare, but the democrats want to take $460 billion away from seniors who depend upon medicare and use it to start a whole new government program. am i reading this correctly? mr. enzi: that's the way i read it. that's the way that the people in wyoming are reading it. and that's apparently the way people all over the country are reading. particularly seniors. it's the seniors that are really upset about what's happening. and it's easy to see why. even though the aarp says that this is -- this is a good bill, they're saying, wait a minute. now, wait a minute. i know people in the nursing home and i know people -- i remember -- some of them are saying, i'm in a nursing home. i hear what's going to happen to my nursing home if these cuts go into place? as i said continually, we can call them anything that we want, but the seniors are saying, those are cuts. those are cuts in my benefits.

those are cuts in what i expect. and that's cuts in what i've been getting. so whether you call it guaranteed benefits or just plain old benefits, or whatever it is, they're saying, yeah, we're being cut. mr. barrasso: mr. president, i would say that when my colleague from wyoming and i held town hall meetings around the state of wyoming, people said, don't cut our medicare. but you know what? i see this bill cutting our medicare and specifically right now there are thousands and thousands of people in wyoming who are on a program called medicare advantage. and there's an advantage to this program and that's why so many americans have signed up for the program. as a matter of fact about one in four americans who depend upon medicare for their health care in this country have chosen medicare advantage because there's some advantages of being in this program called medicare advantage. dental vision, hearing, fitness.

also as a practicing doctor for 25 years taking care of families in wyoming, what i saw people in wyoming, the reason they liked this if they were on medicare, because it dealt with prevention and it helped coordinate care. one of the things that medicare doesn't do as well is really coordinate care and work with prevention. well, we know how important prevention is in helping people keep down the cost of their care, how long -- how good it is in terms of giving people opportunities to stay healthy. i means that why they call it prevention. well, the -- the bill in front of us, as i see, and i ask my senate colleague from wyoming, to me this is a bill that's going to cut $120 billion from medicare advantage, the program that the people in our state like. mr. enzi: mr. president, the senator from wyoming is absolutely correct. and we're getting a lot of calls, e-mails, and letters about that. another -- another thing that

the president promised, of course, is that everybody would have catastrophic coverage. it kind of fascinates me that the wyoming people and the people across the country have figured out that medicare doesn't have catastrophic coverage. but medicare advantage provides catastrophic coverage as well as a number of other things that medicare doesn't cover. and i think they realize too that if medicare advantage goes away, yes, they can get medigap, but it is more expensive and it's also interesting that the aarp sells medi-gap. mr. barrasso: i heard somebody said that medicare advantage isn't really -- isn't really medicare. but if you just turn to the centers for medicare and medicaid services 2010 official government handbook -- you know, we're going to go into 2010 in just next month, if you go to the official handbook in the -- it is called "medicare and you."

it says that a medicare advantage plan is another health coverage choice you may have as part of medicare. it's a choice you may have as part of medicare and people who actually look at this, they choose this. they make the choice because they say, hey, this is a good deal for me. and that's what americans want. they want to get value for their money. a recent poll said in terms of americans when they send money to congress, how much of that do they get in value? they think about 50 cents on the dollar. that's a national gallup poll. a gallup poll on this for a long, long time, and it is the highest number ever of what americans think in terms of the fact that they're getting very little value for their tax consider for their tax dollars. they see games being played. and that's what i hear when i have telephone town hall meetings in wyoming. they know that senator reid's bill steals $464 billion from

medicare. they know that it raids the health care program that they depend upon. not to make medicare stronger, knots to make medicare more solvent, but, as my colleague from wyoming tells me, to create a brand-new entitlement program. they are raiding medicare to start another government program that is -- that itself is going to be insolvent. and so i ask my colleague from wyoming, are you seeing what i'm seeing? mr. enzi: i'm seeing what you're seeing. i'm noticing that some people don't know what an entitlement actually is. that's a bill that goes on forever that the secretary of health and human services has to make sure gets paid in perpetuity unless there is some other major congressional action that happens. we keep paying that bill over and over and over again. and i think the senator from wyoming recognizes entitlements

and some of the difficulties that there are involved with that. mr. barrasso: well, it's interesting, mr. president, because an article in bloomberg yesterday said that the kaiser family foundation poll released this past month found that 60% of seniors said that they'd be better off -- 60% of seniors said they'd be better off if congress did not change the health care system. just not change at all. well, we know we need to do some changes. but this massive bill, this 2,000-page bill that weighs 20 pounds is not the right change that we need. and for our seniors, people who rely on medicare for their health care, to just absolutely raid dz 4-dz 64 billion - -- $6,464,000,000,000 from medicare, almost a half trillion dollars, the baby boomers, more and more added to the medicare rolls every day, to raid this program to start a new program is not right prescription for america. it's not what our seniors want.

it's not what they signed up for. it's not why they're choosing medicare advantage. it's because it's a choice that they make and that's why we right now have 11 million americans who are on medicare advantage. we have 11 million seniors. that represents almost one-quarter of all medicare patients in this country. mr. enzi: we're being notified that our time is up. we'll continue this at a later time. and i have several letters from wyoming organizations that want to be put in the record, too. we'll do that at a later time. i thank the president and i yield the floor.

mr. dodd: mr. president? the presiding officer: the senator from connecticut is recognized. mr. dodd: mr. president, a few moments ago, i started to describe an amendment that would be offered by our colleague from rhode island, senator whitehouse, regarding the class act. let me take a moment or so. first of all, a little bit of background. the class act is a proposal that was originally conceived by our former colleague and dear friend ted kennedy of massachusetts years ago. the idea behind it being we ought to try to figure out a way

to support people in this country who end up with disabilities, but their stabilities are not so dramatic that it would deprive them of the opportunity of continuing work, but are serious enough that they would require some additional help in order to provide basic standards of living conditions, either a driver or some help on food assistance, whatever it may be. and so the idea was because under present disability formulas which are basically income replacement bills, that in order to get some help if you're disabled, you almost have to go through and impoverish yourself to qualify for them and then be restrained by how much you can actually earn outside if you want to continue to work. so while it has been a good program, it's certainly helped a lot of people, in a sense, there are catch-22's in it, in the sense that to qualify for it, you have to divest whatever you have acquired or earned to impoverish yourself to qualify for it. and then even though you may be

capable of continuing to work, you're limited on how much you can actually earn under those programs. and so it was the vision of senator tend years ago to try to come up with a different idea not to replace that but an idea that might allow for people who are disabled to be able to get some help during that period of disability, however long it might last, without necessarily having to then impoverish yourself or to limit your outside earnings, given the fact that you may be able to continue to perform and in fact would like to continue to work. so the idea was how could you do this, particularly in light of the fact that you don't want to necessarily be adding a cost to taxpayers, and so it was his idea to come up with a totally voluntary program, totally voluntary that individuals would have to contribute to -- out of their own pocketbooks, not out of the taxpayers' pocketbooks, by putting aside resources on a monthly basis over a period of

years -- five in the case of this bill -- where the plan would become vested in a sense, and then to contribute that amount thereafter, and then in such case as you found yourself disabled and their criteria that would determine whether or not you've met those thresholds, you would then qualify based upon the fact that you paid into this program continuously without exception of your own money to receive as much as $75 a day providing assistance to you so that you might get along and be able to continue to operate without having to impoverish yourself or put limitations on your work. and that would provide as much as around $18,000 to $20,000 a year for those individuals who need it. but again, entirely voluntary, your money, no public money, no taxpayer money goes into the plan. five million people,

mr. president, under the age of 65 living in the community have long-term care needs. and over 70,000 workers with severe disabilities in the nation today who need daily assistance to maintain their jobs and their independence. long-term care support and services are an area that is not currently affordable or accessible for millions of our fellow citizens. it is estimated that 65% of all those who are 65 today or over will spend some time at home in need of long-term care services which costs can run roughly around $18,000 a year. 1.5 million people today are in nursing homes and roughly nine million of our fellow elderly americans will need help with activities of daily living during the current year. by the year 2030, mr. president, that number will increase to 14 million, as we watch the baby

boom population and thereafter, along with the quality of care and longevity tables extending the life of individuals, and while that life will be extended and hopefully the quality improve, we all accept the notion that as we get older, we have greater needs physically, and that certainly is something anyone over the age of 65 can tell you. and so as the years progress, the quality of care, longevity tables increase, the number of people who will need some form of services or another will jump from nine million today to roughly 14 million. and those numbers are apt to increase. many people that need long-term services, mr. president, and support rely on unpaid family and friends to provide that care. they've got children or grandchildren who are around to provide that kind of assistance. a lot can, of course. but ultimately, many of these individuals will have to imupon issue themselves to qualify for

medicaid. you know what happens? they transfer the house, they transfer their assets, they love everything over to their children or someplace else so that they qualify for that title 19 window. they become desperately poor, at least on paper so they can then qualify for that assistance. medicaid which remains the primary payer for these services. the class act is designed to avoid that. it can in as many cases as possible by providing a lifetime cash benefit, voluntary, totally paid for by the beneficiary that offers seniors and people with disabilities some protection against the costs of paying for long-term care services and supports and help them obtain services and supports that will enable them to remain in their homes, reside in their communities, and in many cases continue to work. let me tell you how the program works. class -- the program is

voluntary, totally voluntary, self-funded insurance program with enrollment for people who are currently employed. affordable premiums will be paid through payroll deductions if the individual's employer decides to participate in the program. totally voluntary. nothing required whatsoever. if the employer doesn't want to participate, the employee would have to find some other way to do it. if the employer decides to allow it to be a payroll deduction, they can do that, purely voluntary. participation by workers, again, entirely voluntary. selfemployed people or those whose employers do not offer the benefit will also be able to join this program through a government payment mechanism. individuals qualify to selfbenefits when they need help with certain activities of daily living and they have paid premiums for at least five years and have worked for at least three of those five years. beneficiaries receive lifetime cash benefits based on the degree of impairment expected to

average roughly $75 a day or $27,000 a year. benefits can be used to maintain independence at home or in the community and should be sufficient to cover typical costs of home care services or adult daycare. benefits can also be used to offset the costs of assisted living and home health care. the issue is raised about are we going to be protected under this program. all class act benefits are paid by voluntary participants, not taxpayers. the class act actually will save taxpayer dollars by reducing medicaid costs. according to the c.b.o., almost almost $2 billion. the class act premiums must be set at a level sufficient to guarantee actuarial soundness of the program. we thank senator gregg of new hampshire for requiring that amendment in the debate of the class act bill when it came up in our committee.

the current class act includes significant improvements over earlier versions such as tighter eligibility standards, a new reserve requirement and an absolute prohibition on the use of taxpayer dollars to pay benefits. the congressional budget office determined that the improved program is totally actuarially sound. this bill, the patient protection and affordable care act, our overall bill, creates a voluntary insurance program. under the program, working people pay premiums, as i said, for at least five years before it would vest. after that point, if the individual who has paid in for five years and worked for at least three of those five years develops a disability, they can receive a cash benefit of no less than $50 a day, as much as $75, for as long as that disability persists. contrary to popular belief, mr. president, medicare and most private health insurance only pay for long-term care for a short period of time, meaning

that most people pay out of their own income or assets or their family's assets to provide these kind of benefits. those with the most intense needs will frequently exhaust as i said a moment ago these assets that they have to rely on medicaid. thus impoverishing themselves in order to qualify. the class act provides essential options for 65% of those aged 65 and older who need long-term care services at some point in their lives as i mentioned earlier, and for the 70,000 workers with severe disability in the nation today who need daily assistance to maintain their jobs and their independence. ooze i said, the program -- as i said, the program is not -- is not financially stable. it amounts to nothing more than a ponzi scheme as some have called it. some say this will create a new government entitlement program. it is not a government entitle program. anything but. the class act does not infer

rights or obligation on the government funding nor does it affect receipt of or eligibility for other benefits. the program stands on its own financial feet. as i said earlier, it has been determined by the c.b.o. to be actuarially sound for the next 75 years. the class act is solvent according to the congressional budget office as i mentioned. the program would run on only its own cash flows. c.b.o. estimates the average monthly premium of $123 for an average daily cash benefit of of $75 for those who qualify. it may not seem like much, $75 a day, but over a year, that would provide needed, needed assistance for those who have achieved or suffer under those disabilities. c.b.o. used a very conservative participation rate. c.b.o. assumes participation rates that do not consider class but offer a lifetime cash benefit. endorsed by the government and provide a convenient way for

employees to autoenroll through their employers with a voluntary optout. all of these features would increase participation rates which result in lower premiums, encourage enrollment, and make the program even stronger financially. the solvency of the program is bolstered by flexibility to adjust the program. in their november 25 letter to the congress, the c.b.o. acknowledges that the legislation gives flexibility to the health and human services secretary to adjust premiums and benefits where or ever needed. this provides a lever to ensure that the program stays solvent even if real life does not perfectly mirror the models of the c.b.o., as good as they are. the congressional budget office discusses the class act would function just like any other private long-term care insurance program which finances benefits -- which finances benefit payments for a premium reserve and interest income off that reserve.

due to budget scorekeeping, the congressional budget office finds that premium revenue exceeds benefit payments in the third decade but does not take into consideration accumulated reserves and income off those reserves that keep the program fiscally independent. beyond being selfsupporting and voluntary, mr. president, this program can actually generate savings in medicaid. direct offset of the $75 daily benefit is applied toward any medicaid long-term care costs. beyond that, the class act program will help people live independently at home or in their community, and when people with disabilities get the services they need, they are less likely to spend down to get medicaid and less likely to enter a nursing home or hospital, all of which generate additional medicaid savings. and, of course, what we don't calculate here -- because i don't know how you would calculate it -- is that notion of independence. i suspect maybe all of us know people who are on medicaid, and

the frustration particularly for someone who is otherwise healthy but suffers from disabilities, they would like to work and want to keep independent, and yet if you go to the medicaid program, there are huge restraints on your ability to do so. and so by this program, aside from financially reducing medicaid costs, we're actually -- we're actually providing that additional sense of human dignity and decency, that just because you have a disability and you need help doesn't mean you don't want to be self-sufficient and keep working. you have the gratification of knowing you're contributing in some way, other than being shuttered away, having impoverished yourself by getting rid of all your assets, relying on family or others to take care of you because you don't have those resources. this idea that senator kennedy generated years ago and now has been improved i think because of the amendments and ideas that have been suggested by a number of our colleagues here as well as others, we have actually

strengthened i think the concept to give it the kind of financially -- financial independence that members want to have, sheltering these dollars against being used for other purposes such as going off to some of their programs that people may have a great desire to fund, by tapping into these resources. we prohibit that from happening. if employers don't want to have a payroll deduction, they don't have to. no one is required to join the program. we believe, though, that when members of our country and society see the benefits of this, they will -- they will gravitate to it as a wonderful way to ensure against that dreaded problemmability that all of -- probability that all of us face, and that is becoming disabled, unable to work as much as we like, needing additional assistance and help, and of course having very few places to turn to get it. now, the disability groups and others who support this, 275 organizations, aging, religious groups, disability organizations across this country.

i'm not going to read all of them here because 275 names is a lot, mr. president. but i have the list of all 275 organizations that have strongly supported this proposal. i can't think of any finer way to celebrate the memory of our former colleague, who cared so much about this bill that we're now engaged in debating. and who brought this idea years ago to the table and to have championed it for so many years. today we have a chance to include this wonderful concept, this creative, innovative idea that saves money, provides independence for people, gives them a chance to lead good lives, provides the kind of support for their families who otherwise have to bear a lot of that burden. and none of us want your children or your grandchildren to have to bear burdens as they're trying to raise their own families. so here's a little idea that has generated support totally by voluntary contributions.

no government money involved at all. you give people a chance to have to live out the remaining times of their lives with decency and dignity, the sense of making a contribution, making a difference? all of those factors, i can't put a dollar amount on it for. i can't tell you what the financial benefit is of someone getting up in the morning, getting a little help or going off to a job and knowing that you're needed, you have worth and value as a human being. what benefit, what's the dollar amount on that? i can't tell you, mr. president, except i know it has value in our country. or the alternative, getting rid of all your assets, impoverishing yourself, relying on that family or friends to take care of you in order to try and survive, when you could be doing more. so, mr. president, i hope that my colleagues will support the whitehouse amendment when it's offered to strength then program and that they will resoundingly defeat the effort to cut this program out of the bill altogether. i can't think of a worse thing

we could do with a piece of legislation that's designed to be creative, innovative, reduce costs and make a different for millions of our fellow citizens. and a growing number, as is pointed out by the year 2030, 14 million americans in our country, and i suspect more, will be in need of services like this. i see my colleague and friend from iowa who's been as strong a champion as this congress has ever had when it comes to the disabled in our country, having been the author of the americans with disabilities act, along with others, but nonetheless the principal architect of that effort. and he can speak more eloquently thaeloquentlythan any human beir known about why this program is important and what it means -- what it means. so, mr. president, i'd ask consent that the 275 organizations that strongly endorse and support senator kennedy's class act be included in the record at this juncture. the presiding officer: without objection. mr. dodd: and i yield the floor. mr. harkin: mr. president? the presiding officer: the senator from iowa. mr. harkin: mr. president, i want to thank my friend and our leader on this issue, senator dodd, for his eloquence in supporting what so many of our elderly in this country want

more desperately than just about anything else and that's the peace of mind of knowing that if they should become disabled, that they won't be forced to go into a nursing home, that they'll have some support that they'll be able to live in their homes and in their communities. talk to anyone with a disability, not just elderly, anyone with a disability. and they'll tell you how important it is that they have that kind of assurance, that if, god forbid, that they become disabled, that their only hope is to go into a nursing home for the rest of their natural lives. senator kennedy has worked on this for years, and the couple of times that i talked to him this summer and this spring, this is what he wanted to talk to me about, about making sure that we included this in the bill. this was his cause, to make sure that we had a program that

people could contribute to, that would afford them some support if, in fact, they became disabled. now, i don't understand the move by my republican friends to strike this. this is not a mandatory program. this idoesthis does not force ao pay a dime. it's all voluntary. we say, if you want to put some money aside during your working years in a fund that will vest and that if in case you become disabled you can get some support, to stay at home maybe with your own family, maybe just enough support so that you can get another job and work, even though you have a disability. this is voluntary.

i ask my friends on the other side of the aisle: why are you against a voluntary program that will enable people to have that kind of peace of mind? well, you know, i've heard it said, well, you know, maybe the taxpayers will have to pay for this and everything. well, mr. president, i will tell you this, that in the committee, senator gregg -- senator gregg from new hampshire, republican senator gregg, my good friend -- offered an amendment to make it sure that the contributions were the only thing tha that would sn programsustain this program, tht wouldn't become an amendment. he said, "i offered an amendment that would require that the premiums be based on a 75-year

annual actuarial analysis of the program's costs. my amendment ensures that pro- we don't promise more than we can offer and that it will be fiscally solvent and we won't be passing the buck to future generations. i'm pleased the "help" committee unanimously accepted this amendment." and, mr. president, the c.b.o. has scored this. this is completely paid for over 75 years. over 75 years. i -- i don't understand why anyone would want to strike it. now, what senator whitehouse has said -- and, again, i think this is very appropriate for this -- that any savings that we get from this be reinvested either in the class act so that when people do get disabled, maybe they'll get a little bit more money. so we have some savings from the class act. what senator whitehouse has said is put those savings back in the class act for social security. makes sense to me. makes sense to me. so again, i think it's an

improvement on the bill what senator whitehouse has suggested. mr. president, i plead, i plead with my fellow senators, don't kill this program. we stood here on this floor 19 years ago, july the 20th, 199 1990. we stood on this floor to pass the americans with disabilities act. and there were a few votes against it. in fact, there was one or two people still here that voted against it. i think -- i think if you'd ask them now, i think they'd say it's been a pretty darn good bill. it's broken down a lot of barriers, opened a lot of doors for people with disabilities in our country, changed our environment in this country. not only in terms of physical

access but i think more importantly it's changed how we view people with disabilities. no longer looking at people with a disability to say, what is their disability. we now look at people and say, what are your abilities, what are your abilities, what can you do, not just looking at someone's disabilities. so we've come a long way. the one thing that we've never been able to really do is to set up a functioning system so that -- that people could put some money aside to protect them in case they got disabled. well, this is it. this is our chance. this is a big part of this health care bill, a big part. well, maybe i suppose if you're trying to kill the bill, if you're trying to kill the bill, i suppose that's what you'd want to do, you'd want to kill the class act. but this is vitally important to our country.

it is really the next logical step after the americans with disabilities act. it's going to provide for so many people in this country that security and that peace of mind of knowing they won't have to go to a nursing home or an institution if they -- if they become disabled. and it can happen to any one of us here on the senate floor. our families, our staff, our loved ones. no one knows what might happen to us either from an accident, a physical ailment. no one knows. but shouldn't we at least have some part of this health care bill that provides that kind of voluntary program? no one's forced into anything. and i guess that's what perplexes me more than anything

else is why my republican friends want to prevent something like a volunteer program -- a voluntary program from going into existence that would do this. that's fiscally sound for 75 years. i just don't get it. so i hope -- i hope we will support the whitehouse amendment, make sure that this fund is totally solvent. i think he's on the right track. if there are savings, put the money back in there so that maybe that $75 a day could be maybe $80 a day or something like that to help people out. and i see, mr. president, we now have a statement from the aarp about the class program and here's what they said. they said that decades of

talking to our members tell us that older americans want to live in their homes as they age. that's why aarp strongly supports the community living assistance services and supports program, the class program, which recognizes that older individuals and people with disabilities should have the right to live independently in their own homes and communities and to receive the help they need without having to spend down to poverty." so, mr. president, i would ask unanimous consent to have that letter from the aarp printed at this point in the record. the presiding officer: without objection. mr. harkin: now, mr. president, i'm going to put this in personal terms. personal terms. i've told this story before and i'm going to tell it again. because i think it indicates why we need a program like this. i have a nephew, kelly, my sister's boy. he got injured at a very young age. he was only 19 years old. made him a severe paraplegic,

almost quadriplegic. my sister and her husband, they didn't have any money at all and yet kelly was able to go to college, go to school, he was able to get a job, able to live in a house by himself, had his own little home, had his own van that he drove that had a lift on it and he could get his wheelchair in there and drive it to work. actually started a small business, employed some people. and he's lived a full life. he's now a man of about 50. he's had a great life. even with that disability, he's been able to get around and do things, a taxpayer. he's paid taxes. he had employed people. -- he's employed people. every night when he goes home, he has to have a nurse come in the and get him ready for bed and do his exercises and things like that.

then in the morning he has to have another nurse come in and get him out of bed and take care of his needs, get him ready to go. actually, kelly gets his own meals and stuff, then he goes off to work, comes back. this happens every day. now, how is he able to afford to do that? he doesn't have an any money, ay insurance. how is he able to afford to do that? he got injured in the military. he got injured in the military. so for all of these years the veterans administration's been paying for this. it's been wonderful. kept him out of an institution. kept him out of a nursing home. allowed him to live by himself, go to school, work, be with his family, be with his friends. reich often thought this is wund -- i've often thought, this is wonderful. but why should that just be for people who are injured in the military? what about so many other people

who get injured like my nephew kelly who are not in the military. maybe even injured before they could go to the military. he was only 19 when it happened to him. so for all of these years i thought we should have some system in this country that would allow people like my nephew who are not in the military, but who, through an unfofortunate accident, became disabled. that they could have that same kind of life where they could live in their own communities, with their own families, have their own friends. that's why this is so important. this is perhaps one of the most important things that we have done since the passage of the americans with disabilities act. to make sure that people with disability conviction havdisdis,

enjoyable, productive, quality life. i hope that senators will decisively defeat the amendment that wants to strike this. say yes. say yes to so many people with disabilities and young people today and working today, say yes, that we'll have a system where by you'll have a peace of mind of knowing if you want to contribute the money, you'll be protected. say no to the amendment that would strike that. say yes to the white house amendment that actually supports the class act. makes sure that any savings from it is reinvested in that program. i thank the president and yield the floor. mr. dodd: mr. president, before we go to the next speaker -- the presiding officer: the senator from connecticut. mr. dodd: if i could request that the next half-hour is

equally divided. is that okay with my -- the presiding officer: the republican deputy leader. mr. kyl: mr. president, i had hoped to take the next half-hour. but if we could do 40 minutes equally divided. i could take 20 and i think i could conclude. mr. dodd: 40 minutes equally divided? mr. kyl: and would i be able to take the first 20 minutes? mr. dodd: that would be under the same order as we had before, i ask the chair? the presiding officer: is there objection? without objection. mr. kyl: thank you. mr. president? the presiding officer: the senator from arizona. mr. kyl: thank you. mr. president, we are discussing the hatch amendment to preserve medicare advantage. and i wanted to give a little bit background about the medicare advantage program. it was established with the goal of ensuring that beneficiaries all across the country would

actually have medicare choices. under the program private health plans receive government payments in order to serve medicare beneficiaries, in addition to offering part-a to hospitals and part-b to physicians services. and there is part-d. the central goal is to ensure that beneficiaries across the nation, not just those in populous areas, would have access to health plan options. and under the law medicare advantage plans must provide all physician and hospital medicare benefits. and here's the key. and i hope my colleagues will think about this for a motel because this has -- for a moment because this has been a little bit perhaps distorted in the conversation we've had. if a plan's cost to provide all of the medicare benefits, is less than the government payment, then by law the plan must apply the difference to

provide additional benefits to the beneficiary or to reduce premiums. and it seems to me that's what this whole reform was about in the first instance. to try to ensure quality care and reduce the cost of insurance to beneficiaries. well, what are these extra benefits? we've heard them discussed. they include, first of all, lower cost sharing. including out-of-pocket limits on the beneficiary's share of costs. as well as specific health benefits like vision, dental, vision, routine physicals and cancer screenings and so on. plans can offer management services, which can be particularly important to beneficiaries with chronic illnesses, and that's a protection, by the wakes that does not exist in regular fee-for-service programs. since 2003, a number of medicare beneficiaries enrolled in private plans has nearly doubled

from $5.3 million t to $10.2 million in the year 2009 according to kaiser family foundation. so these are very popular plans and growing in pop alertcy. let's go back in time just -- popularity. let's go back in time in history back to 1972. because in past years, my colleagues on the other side of the aisle were all for medicare advantage. over the years congress has tried to control spending by reducing payments to private medicare plans. one problem was that severe payment reductions resulted in the elimination of plan options. for example, in 1997 the balanced budget act reduced payments by dz 4-dz .5 billion over 10 years -- $4.5 billion over 10 years. what happened? three-quarter of the beneficiaries from 1999 to 200 had to change plans. this included less populous and more rural areas of the country, but also areas like long island,

new york. well, congress heard from these seniors loud and clear and they were angry about losing their coverage. many remember that the medicare modernization act was a landmark achievement, but it was necessary for another reason as well, and that was to respond to the call of the seniors who wanted their private options back. so in 2003, the medicare modernization act expanded plan options to include regional p.p.o.'s and restored plan and paissments it was a deliberate, bipartisan decision -- payments. it was a deliberate bipartisan decision to increase the plan's payments to include rural areas and some urban areas, as i mentioned long island. let me remind my colleagues, former senator clinton from new york, for example, said that these medicare plus choice plans, we now call them medicare advantage plans, and i'm -- quote -- "ing are feeling the squeeze in a system caught between rapidly exploding costs and rapidly imploding finances.

while we debate medicare, we need to recognize there are people in our states who depend on these plans today. and the current senior senator from massachusetts said at the time, and i quote, i urge my colleagues to support the additional funding that is urgently needed to strengthen the medicare plus choice program for seniors. this should be among our highest priorities in this year's medicare debate. mr. president, it was. and we did. so these -- this is not something bad that we provided this money to these plans. we provided it so the plans could provide the benefits to seniors, particularly in areas where otherwise they wouldn't have those choices. so why has this all of a sudden become unpopular with our friends on the other side of the aisle? obviously first and foremost they need trillions of dollars to fund their bill. so they look around where they can get some money. they can get $120 billion from this and that's one way to pay for the new entitlements under their bill. but then there has to be a

justification to take that money. so the idea is, well, it's not fair that the government would pay money into this program for extra benefits for seniors when that money could be spent on regular fee-for-service medicare. of course, that argument presupposes that government health care is always superior to the plans offered in the private market, which these seniors have made clear by doubling the enrollment in the private plans is not the case. as i said, they've made their preference clear. and they asked us for choices like members of congress engerman they want access to private plans and these benefits and we delivered as promised. we gave them the choices, republicans and democrats alike. now they need the money, so they decide this is a way to pay for their new entitlement. our friends on the other side of the aisle have been talking about overpayments. there is no such thing as an overpayment in this program under the law. any money doesn't go to the

plans. it's not as if the insurance companies get the money from the government. the insurance companies, if they -- if their bid is under what the traditional medicare is, they have to return 25% of it to the united states government. and the other 75%, by law, must go to their beneficiaries. either in the form of lower premiums or additional benefits. so these aren't overpayments to the plans, as has been represented. as i said, 75% of the additional payments must be made to use to provide seniors with extra benefits which could include lowering premiums, including chronic care management and so on. the other 25% is returned to the government. so there is no overpayment. some on the other side argue they're protecting guaranteed benefits. this is he is mattics. -- si mattics. what we are pointing out and

what this amendment would prevent from happening is that the benefits under the medicare advantage would not be cut. and there's no question. nobody can deny that those benefits would be cut. in fact, according to the c.b.o. by the year 2019, they would have been cut by 64%. a huge almost $90 -- over $90 in actuarial value. so my point here is that seniors, of course, would like to keep what they have. and i guess what about this promise if you like what you have, you get to keep it. sorry, not if you're on medicare advantage. as i said, according to the congressional budget office the legislation would cut benefits from $135 a month actuarial value to $49 a month actuarial value. that's a real cut. it may not sound like a lot to some people, but to our seniors, it's a huge hit. there's an interesting memo, mr.

president, by james capparetta and robert book, who write for the heritage foundation on the medicare cuts. here's what they say, reforms should mean more patient choice and health plan accountability. but the current proposals would lead in the opposite direction, toward a system of less choice, less accountability, and eventually lower quality health care. that's what the hatch amendment is attempting to prevent, mr. president. to preserve these benefits for seniors. now, i have gotten tons of calls -- about 500 calls just in the last several days opposing cuts to medicare advantage. and i haven't, by the way, received a single call from a senior citizens asking us to make these cuts. let me just -- i've been reading from these letters. i read about a dozen of these letters. and let me just read from a few of constituents who tell you the real effect that these cuts would have on them. and bear in mind in my state we

have about 329,000 seniors who are enrolled in medicare advantage plans. one constituent from phoenix says, for the past month i've heard about proposed medicare cuts. finally after years of being self-employed and only affording high-deductible insurance, i now have medicare and in the medicare advantage plan. please tell me you're not cutting medicare advantage. have a heart. leave mair and medicare advantage a-- leave medicare and medicare advantage a loan. a constituent from peoria, arizona, says, i have two families receiving health care under the medicare advantage program. the care has been consistently outstanding due to the efforts of our case manager in coordinating patient care between privates and patients. we have a voice in determining type and scope of our care. please do not cut medicare advantage. here's a note from a constituent. i have heard reports that the government new -- the new

government plan would do away with medicare advantage. if so, it would double my health care costs with my current health care provider. i do not want any legislation passed that would take away the medicare option for seniors. end of quote. another constituent from peoria. president obama has said that we can keep the insurance we have if we like it. but has said he wants to cut or eliminate medicare advantage. what happens to the millions of people who have medicare advantage? these are all seniors, many of whom cannot afford to pay more. why should so many seniors have to sacrifice to -- in order to help pay for universal coverage? why do we not hear more about debate on this issue? well, to my constituent from peoria, that's what this debate is all about. we are trying to prevent these cuts. here's a constituent from prescott valley. i have medicare advantage. my husband wants to retire from his job where he has excellent health coverage for serious health concerns. so long as he has good health

coverage, he does well. should medicare advantage be cut, his health would necessarily suffer after his retirement. we cannot afford supplemental coverage. i don't want to lose my husband. i have spent many a sleepless night wondering how to keep hi husband healthy when he retires. i have several friends undergoing chemotherapy and wonder if their health is in jeopardy once medicare advantage is cut. are we not worth saving. clearly there are many who want to spend money on their own priorities. thank you for advocating on our behalf. these are real concerns from real people. they don't want us to cut medicare advantage. a final point i want to make is, one of our colleagues was talking about there are bad medicare advantage plans and good medicare advantage plans. how do we know which ones are good and bad? it turns out the senior senator from florida devised a formula which protects a lot of folks in his state especially in broward

county, miami-dade county and palm beach but don't protect very many other folks, so maybe this is the definition of good versus bad. there are few that are protected in colorado, maryland, oklahoma, and texas. for example, in my home state of arizona, with a lot of retirees, very few are exempted from the cuts. this is not going to go over well. to exempt only a few in certain key areas and none of the others. again, what happened to the promise that everyone gets to keep what they have? mr. president, my bottom line here is in supporting the hatch amendment is that we should not punish seniors who have signed up to have the choice of medicare advantage. there are better ways to reform health care. we've talked about those ways. our senior citizens have paid into the program, they have asked us for this program. democrats and bottom lines have supported it in the past, and now simply because somehow or other we have to scrape up money for the new entitlements in this legislation, we're going to

attack the very program that all of us in the past have supported. it's unfair, it's not right, we need to defeat those cuts in medicare. that's why the hatch amendment to preserve medicare advantage should be supported by my colleagues. mr. grassley: mr. president, do we have time on this side? the presiding officer: six and a half minutes remain. mr. grassley: mr. president? the presiding officer: the senator from iowa. mr. grassley: before the senator from arizona leaves -- before the -- before the senator from arizona leaves, the point you made and the efforts by the members of the other party to strike medicare advantage, i have a letter here that was sent to members of the medicare

conference september 30, 2003, with more democratic signers that are still in the senate than republican signers that are in the senate that set out all of the reasons why medicare advantage was so, so very important and why it needed to be -- why it needed to have more money put it in the year 2003. for instance, i would read from this letter." for nearly five million medicare beneficiaries across america, medicare choice "-- and that's what it was called before it was called medicare advantage --" is an essential program that provides compensation affordable health coverage. these seniors and disabled americans have voluntarily chosen to receive their health benefits through medicare h.m.o.'s and other private sector plans because they have excellent value. to preserve this important option for seniors across the country, bipartisan legislation was introduced in the senate s.

590 at that time called the medicare choice equity and access act, cosponsored by senators schumer and santorum. s. 590 sought to increase reimbursement rates and add new reimbursement options." et cetera, et cetera. we have plenty of history in the united states senate that's a bipartisan history that we ought to maintain medicare advantage rather than do an injustice to it as this present piece of legislation before the senate is trying to do, and i'd like to place this in the record, mr. president. the presiding officer: without objection. mr. grassley: i would -- does the senator from wyoming want the remainder of our 20 minutes? the presiding officer: the senator from wyoming. mr. barrasso: thank you, mr. president. i would like to do that, to first correct something that i heard a little earlier op the floor today when the senior senator from connecticut had

some concerns about -- he highlighted, he said how private health plans deny claims, and what his statement was is that he said that medicare does not deny claims. in the united states of america, the number one deaner of claims for health care is medicare. the -- the study that's out from a full year, march, 2007, to march, 2008, medicare rejected 475,000 claims of its 6.9 million claims filed. that's a rate of 6.85%. when you compare that to private insurance companies, the industry average for the claims that are rejected is about 4%, 4.05%. so medicare rejects by number ten times more than the largest private insurance company, and a lot of these claims -- and i

followed this closely because i have been the medical director of something called the wyoming health fairs where people can get their blood tested, it's very low cost and it gives people an opportunity to check how they're doing, to stay healthy. it's a prevention designed program, but yet medicare refuses to pay for prevention, refuses. it refuses to pay for these blood tests because they are preventative as opposed to diagnose a specific problem and a specific patient with a specific symptom. so what do people in america do? what do our seniors do? they turn to a program called medicare advantage because it's an advantage for them to choose this program. it's one of the choices they have under medicare, and at this point 11 million americans have chosen to participate in medicare advantage to receive their health care through medicare advantage. we're talking about seniors who depend on medicare for their health care.

the number of people signing up for medicare advantage has continued to increase over the years to now 11 million people, one out of every four seniors on medicare is in this medicare advantage program, and they know who they are and they like the program, and the reason that they like the program is because they get additional services, services beyond what someone on the traditional medicare program receives. dental care, hearing care, eye care, preventative care, coordinated care. you know, we hear a lot about the failings of the health care system and there are many in this country today and one of the problems is that care is not coordinated. people go from specialist to specialist. we need coordinated care. medicare advantage does a much better job at coordinating care than regular medicare, than the traditional medicare. so it is baffling to me, mr. president, that the plan in front of us today in the united states senate try -- is trying to eliminate medicare advantage to the tune of over

over $100 billion. when one takes a look at the cuts that are approved in this plan, $464 billion in medicare cuts, is 35 billion for hospitals, $42 billion for home health agencies, $15 billion from nursing homes, $8 billion from hospice providers, but but $120 billion from medicare advantage. the program, mr. president, that more seniors as they learn about it want to sign up for, because it is an advantage to them to deal with it, to have their health care through a program which focus on preventative care, coordinated care, helps them stay healthy, helps them live longer, and yet this senate and this senate bill that senator reid has brought to this floor is trying to completely gut that program and deny our seniors who rely upon it from receiving the care that they have earned.

mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from montana. the senator from wisconsin. mr. feingold: mr. president, i rise in strong support of the community living and assistance services support act or class act which was introduced by the late senator ted kennedy. the class act would create an optional insurance program to help pay for home care and other assistance for adults who become disabled, and those choosing to participate would pay monthly premiums into an insurance trust, and after five years could access a cache if they become disabled and need assistance. over ten million americans are currently in need of long-term care, and that number is expected to rise to 15 million in the next ten years. these individuals struggle to remain independent with limited assistance and may turn to medicaid as an insurer of last resort. in order to qualify, however, people need to go through a substantial spenddown of their assets and commit to unemployment to remain eligible.

mr. president, this is totally inefficient. instead of ensuring that an individual can remain independent and a functional member of society, the current policy requires that to receive assistance, a person basically has to become a ward of the state. medicaid pays for half of long-term care costs and increased expenditures are expected to add another another $44 billion each year to medicaid over the next decade. not only is this unsustainable, it's actually nonsensical. mr. president, this is about as much -- this is about as much about protecting people's dignity as it is about fiscal responsibility. too many americans fall on hard times, becoming disabled from an accident or illness with no safety net to help them stay independent. ensuring that these people have an alternative to medicaid so that they can remain active and independent will reduce the federal deficit by $73.4 billion over ten years and save medicaid

medicaid $1.6 billion in the first four years that the benefits are available. medicaid savings will continue to grow over time as more beneficiaries utilize the class act benefits instead of medicaid. thanks to amendments accepted in the senate health education and labor pensions committee, the bill language is stronger than ever. senator gregg, my colleague in the budget committee, amended the bill to require the secretary of health and human services to set premiums that are actuarially sound for a 75-year-old window and maintains a sustainable enrollment and benefit structure. while some have suggested that the class act is fiscally not sound, the gregg amendment should put those concerns to rest. mr. president, long-term care reform has been a cornerstone of my work in public office since my first days in the wisconsin state senate. i've seen how important it is to give people options so they can match the level of care and assistance to their personal needs. pushing anyone and everyone into medicaid or into a nursing home is a waste of potential, a waste

of opportunity and a waste of money. medicaid and our nation's nursing homes have a critical hole to play for some americans, but for many americans, it's simply not the right fit. the class act will ensure that taxpayer dollars are spent enrolling only those who truly need medicaid into the program and then help others save for a time when they might need some assistance to remain independent. the class act is a critical part of this health care reform bill, and i urge my colleagues to oppose any effort to weaken or strike the program from the bill. mr. president, i yield the floor. mr. dodd: mr. president, my colleague from rhode island wants to be heard. mr. whitehouse: mr. president? mr. president, i will just speak for a moment because i know the distinguished senator from pennsylvania wishes to speak, and when he comes to the floor, i will quickly yield to him, but while there is a moment in between, i did want to speak to

some of the arguments that we have heard. there is the question always of the substance of an argument. there is also the question of the credibility of an argument, and i think as people who are watching this debate discuss the credibility of the concern expressed by our friends on the other side of the aisle about the deficit impact of the class act, it's worth considering a few facts just to evaluate that. the first thing is that the class act is required to be actuarially self-sustaining. people pay into it and from those funds under the insurance principle, funds come back out. it is required to be self-sustaining that way.

second, it is voluntary. nobody has to contribute. if you want to contribute, then you become eligible for the benefit once you vest it, but nobody is forced into this. it is entirely voluntary. the congressional budget office on which we rely in bipartisan or nonpartisan fashion has said that this is solvent for 75 years. and finally, because we think at least on this side that this matters, it will help the disabled and the elderly at that critical point of decision when your ability to stay home, your ability to stay independent, your ability to stay at work depends on just a little bit of help to accommodate your age or disability, and it's at that point that this will really make the difference and what a difference it will make in human lives. i know the distinguished senator from connecticut wishes to use an example, and i will yield to him on his signal.

but we've seen this before. we saw this not long ago on the public option. the public option would compete with insurers head to head on a fair, level playing field. it was required -- it was completely voluntary. nobody's required to sign up for it. completely voluntary. and it had to be actuarially self-sustaining. it had to meet the solvency laws of the state in which it operated. in both cases our colleagues on the other sides have run to the floor to talk about deficits and how this would contribute to the deficit. these are both actuarially self-sustaining programs required to stay solvent. and yet, here they come to raise the specter of deficits. but this is the same party that pays for 14% subsidies to private insurers to compete with medicaid. well, as my son would say,

"duh," if you're getting 14% extra, it's pretty easy to compete. when they asked for that deal, they promised they'd drive costs down. in fact, they've driven costs up, they've put them in their pockets. and it isn't fair to the insurers who aren't in the program. it is greedy on their part. do we hear concerns about the deficit problem on the 14% subsidy for the medicare advantage programs? no. dead silent. guess what? because it helps the insurance industry. when the part-d program came in, our friends on the other side forced through a provision, a unique provision that gave the pharmaceutical industry the special privilege that the united states government couldn't negotiate with it over price. couldn't negotiate with it. lord knows how much that has added to our deficit. but have they ever come to complain? no, because the beneficiary is the pharmaceutical industry.

but when things help regular people, when things help competition in the insurance market, even where they're required to be actuarially self-sustaining and solvent, then suddenly they turn up. they can detect the threat in deficit in parts per billion when it helps somebody. but a patent actual, living, breathing deficit-enhancing subsidy that is on the books right now, they don't care about if it helps the pharmaceutical industry or the insurance industry. i think since we had this discussion that is a point worth bearing in mind because it is not the substance of an argument, it is the credibility of an argument that counts. i said i would yield to the senator from pennsylvania when he arrives, and he has arrived. without further add due, i yield the floor. -- without further adieu, i yield the floor. the presiding officer: the senator from pennsylvania.

mr. casey: i want to thank my colleague from rhode island who has been the most forthright, in particular to what brings us to the floor at this moment. principally, his work and the work over many years that senator kennedy did for the so-called class act, the community living assistance services and supports act. what is this all about? i wanted to talk for a couple of minutes about how it works. i think sometimes when we get lost in the discussion about the finer points of a policy or program, we tend to forget what it means. here's what it means. here's what it means for an american who is working and wants to continue working to support his or her family or to support himself, contribute to our economy, demonstrate that people who happen to live with a disability of one kind or another can be so significant in

our economy, can contribute so much with their ability and their brainpower and their ability to contribute in a very positive way. so we're talking about here the dignity of work, whether or not the united states senate is going to stand up and say with this act, with this program for someone who happens to have a disability and wants to work and wants to voluntarily contribute premiums so they have some, some security, some peace of mind down the road if they should need this help, we're talking about the dignity of that work. and this is a test of the united states senate, whether we're going to stand up for people who have a disability and their opportunity to work or not. it's a very simple question. you either stand with them or you don't. it's also about one important word, i think: independence, whether or not we're going to say to someone who wants to work

and has a disability, are they going to have the independence, the freedom to be able to work and live the life that they choose? but here's how it works. this isn't complicated. this isn't some mysterious program. here's how it works: individuals -- here's how they qualify to get these benefits. they qualify to receive benefits when they do about three things. first of all, when they need help with certain activities of daily living. we all know what those are. there are so many people out there who can work and can contribute if we just give them a little help, just a little bit of help that we're talking about here today. to do the basic things in life, to be able to wake up in the morning and maybe have someone, if you have a disability, someone help you get ready for work whr-rbgs that's going to the shower or shaving or whatever you have tpo do to tkpw*et ready for work in the -- whatever you have to do to get

ready for work in the morning. that's the first thing you have to have, is that need that we can all understand. secondly, this person would have to pay premiums for at least five years before they could benefit from the program. now, i said premiums. i didn't say a government subsidy. we're talking about premiums here. and this is a program that certainly has its origin in government, but this isn't, this isn't similar or exactly similar to the children's health insurance program, for example, or medicaid, where it is a government program that helps a particular person, a person who happens to have a disability or is a child n. this case people are paying premiums and they have to pay those premiums for five years. five years. thirdly, in addition to the need and paying premiums, the third

requirement is they have had to work at least three of those five years. so we're talking about people who are employed, working people, who happen to have a disability. and this is a creative program to help them do that. why do we get the opposition we do from across the aisle? well, i think it's pretty simple. you've got a lot of folks across the aisle here who want to kill this bill. so they're going to try to strike the class act, which is really outrageous and insulting. they're going to try to strike whatever they can if they can to kill the bill. so this is a bill-killing exercise. this isn't, you know, a debate about the finer points of the class act. this is a bill-killer exercise. it's very simple. and i think it will tell a lot about where people stand. let me go into a couple more details. i know we're almost out of time. here's what happens to that

beneficiary. person working, a person who has a need, and a person who has paid premiums. that beneficiary receives a lifetime cash benefit based upon the degree of impairment. not just any old formula here. we want to make sure that the benefit corresponds to someone's impairment. their inability to do their job or live their life the way they would hope to do. and the expected, expected to average about $75 a day or more in the case of an individual. so that's what we're talking about here. now we're not talking about, in this case, a government entitlement program. now, few people are as passionately supportive of the children's health insurance program or medicaid as i am; okay? i believe that there are programs that are funded by the government, run by the

government that work very well. but in this case we're not talking about that kind of a question, or that kind of a program. we're talking about a program that doesn't confer rights or an obligation on government funding. nor does it affect the receipt or eligibility for other benefits. the program stands on its own financial feet because people are paying premiums out of their own pocket for five years to be able to save for that day when they have a need because they have some kind of disability. and it's solvent; okay? solvent. okay? and it's a program that people sign up for voluntarily. so it's a voluntary program. so, when you line up all of the reasons to support this program that senator dodd, as the chairman of our committee, the

health, education, labor, pensions committee, this summer we're debating this, he carried the ball for senator kennedy in the chairmanship this summer in our hearings, but also for this program. so i'm grateful for his leadership. also grateful for senator harkin's leadership to support this voluntary program. and also grateful that senator whitehouse has lent his voice and his expertise and his focus on getting this program as part of our health care reform bill. but it makes a lot of sense. it's solvent, and it will help those who have a disability, who just want to work, who just want to go to work every day and live a full life. and with that, mr. president, i will yield the floor. mr. dodd: mr. president, i yield whatever time we may have, have left here to senator kirk of massachusetts, who has done an incredible job in very

difficult circumstances, replacing our beloved former colleague, ted kennedy from massachusetts. and he's been a valuable contribution over these days he's been here. i know he'd like to say a few words about this as well. the presiding officer: the senator from massachusetts, there's three minutes left. mr. kirk: thank you, mr. president. and thank you, senator dodd, and also senator baucus for your tireless leadership on this entire health care bill. just a word about the class act. you've heard senator dodd and others say that this was the core element of this health reform bill championed by senator edward kennedy. i would say if he were here today, he would say this is not about politics. this is about the content of the character of our nation. and he believed, as i do -- and

i know senator dodd does -- this nation is judged, or should be judged on how we treat the infirmed and the weakest among us. and this class act, as was just eloquently pointed out by senator casey of pennsylvania, no taxpayer funds, fiscally solvent, and does the things that everyone would say we must do, providing independence, self-respect and dignity to the infirmed in our society. secondly, keeping the caregivers and the loved ones from carrying that burden all by themselves, and not having to sacrifice their jobs and their time and their heartache to be able to share their children with their,

with perhaps one of their parents and dividing that family in that way. this is at the heart of what our country should be about. it's not who wins, the republicans or the democrats. it's not a government program. it's self-funded. it's voluntary. there's no taxpayer money involved. and so what other reason could there be but politics would keep people from coming together on this. i urge my colleagues all on this side and my republican colleagues on the other side to think about those families who are facing this plight. they are republicans. they are independents, and they're democrats families as well. this is an american program for some veterans and others who have sacrificed. and i think the only thing we can do, the only right thing we can do if this is going to be a reflection of the character of

this nation, is to support the class act. and i thank senator dodd once again. i'm proud to be standing at the desk of senator edward kennedy, who believed deeply in this, started way a long time ago and wanted to see it fulfilled this afternoon. i yield the floor, mr. president. the presiding officer: the time controlled by the majority has expired. mr. dodd: mr. president, what is the -- okay. i note the absence of a quorum, equally divided. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

mr. dodd: mr. president, i ask unanimous consent that the call of the quorum be reas i understanded. the presiding officer: without objection. mr. dodd: i am bea to propound a unanimous consent request. mr. president, i ask unanimous consent that at 3:30 p.m. today, the senate proceed to vote in relation to the following amendments and motion to commit as listed in this agreement, that no other agreement -- amendments, motions to commit, or any other motion, except a motion to reconsider and table upon conclusion of any vote being in order during the pendonnive this dpreament. further that prior to the second and succeeding votes, there be two minutes of debate with all time equally divided and controlled in the usual form that any amendment or motion covered under this agreement be subject to an affirmative 60-vote threshold, and that if any achieve that threshold, that the aagreed to and the motion tube to reconsider be made and laid on the able that p it doess not achieve that 60-vote threshold hold, it be withdrawn. after the first vote in the sequence, the succeeding votes

be ten minutes in duration. senator whitehouse amendment re social security, fiscal responsibility; the republican leader's designee or the republican leader's amendment, fiscal responsibility; senator stabenow's side-by-side amendment re medicare advantage, and senator hatch's motion to recommit medicare advantage. further, once this agreement is interksd the republican leader's designee be recognized to call up the fiscal responsibility amendment and that once it has been reported by number, senator stabenow be recognized to call up the medical advantage side-by-side amendment. that upon disposition of the amendment and the motion to this agreement, the next two matters for consideration will be a senator lincoln amendment regarding the insurance executive compensation and republican leader's designee motion to commit regarding home health agencies that. for the remainerder of today's session, no further amendments or motion to commit be in order.

at the same time -- for the same time until then be equally divided between the leaders or their designees, with members permitted to speak up to ten minutes each. the presiding officer: is there objection? mr. mcconnell: mr. president, reserving the right to object, and i will be not be objectin o, i see the assistant majority leader on the floomplet i think it would be helpful as soon as the majority leader or someone on that side could indicate at what point during the day tomorrow and at what point during the day on sunday we might be having additional votes. it might be helpful to our colleagues on both side of the nile terms of planning for the weekend. mr. reid: mr. president, we're going to come in at 10:00 in the morning. at this time it appears that we will have senator lincoln offer an amendment and i would hope that we can be ready that the time to have whatever the

minority wants to in regard to that amendment. and then we are going to have an amendment offered by the republicans, and i would hope that we can dispose of those two amendments tomorrow, maybe in the early afternoon, by maybe 2:00, 3:00 start voting on them. mr. mcconnell: so am i correct in assuming that the votes are most likely going to be in the afternoon tomorrow or both morning and night? mr. reid: yes, in the afternoon. i think we'll need some debate in the morning. then sunday morning, at the request of the republican leader, we aren't going to come in until noon or thereabouts. mr. mcconnell: i think we're probably going to need some debate time, are we -- well, we're happy to have it in the afternoon. and then on sunday, obviously, we won't go in until noon on sunday and then -- mr. reid: yes, there is an event in washington that a number of senators are obligated to go to. that's in the evening. so we'll get everybody out of here by 6:00-6:30 that night at

the latest. the presiding officer: is there objection? mr. reid: i would also say, mr. president, through you to my friend, we democrats are going to have a caucus -- we're ttentively going to have one sunday afternoon. the presiding officer: is there objection? without objection, so ordered. mr. thune: mr. president? the presiding officer: the senator from south dakota. mr. thune: mr. president, i'd like to call up amendment 2901 and ask for its immediate consideration. the presiding officer: the clerk will report. the clerk: the senator from south dakota, mr. thune, proposes an amendment numbered 2901 to amendment numbered 2786. beginning on page 1925, strike

line 15 and all that follows through line 15 on page 1979. mr. thune: mr. president? the presiding officer: the senator from south dakota. mr. thune: mr. president, i would like to speak to the amendment that we just filed at the desk. and what this amendment would do -- it's very straightforward and very simple. it does what a number of my colleagues on the other side have asked to do, and that is to strike the class act from the underlying health reform bill -- the health care reform bill that's being debated on the floor of the senate right knew. and i want to read for you some excerpts from a letter that seven democrat senators, including the chairman of the senate budget committee, senator conrad, put together asking in this class act not be included as part of this legislation. they said this, "we urge you not to include these provisions in the senate's merged bill, nor to use the savings as an offset for other health items in the

merger. while the goals of the class act are laudable, finding a way to provide long-term care insurance to individuals, the effect of including this legislation in the merged senate bill would not be fiscally responsible for several reasons. " and it goes on to say that nearly all the savings result from the fact that the initial payout of benefits wouldn't begin until 2016 even though the program begins collecting premiums in 2011. it is also clear that the legislation increases the deficit in decades following the first ten years." they go on to say had this letter, mr. president, "we have grave concerns that the real effect of the provisions would be to create a new federal entitlement program with large, long-term spending increases that far exceed revenues. this is especially the case if savings from the first decade of the program are spent on other health reform priorities." that, mr. president, is a letter that was signed by the chairman of the senate budget committee, senator conrad from north

dakota, senator lieberman, senator landrieu, senator lincoln, senator warner, senator nelson, and senator bayh. seven democrat senators who have gone on the record saying the class act shouldn't be included in this legislation because it's not fiscally responsible. the fact of the matter is, mr. president, the senate -- the chairman of the senate budget committee, senator conrad, has gone on to say and describe this as a ponzi scheme of the first order, something that bernie madoff would be proud of. i've my colleagues on the other side get up and talk about how solvent this is and what great program this is. well, there are programs out there that are available for people to buy long-term care insurance. the problem with this one is, it takes all the money that comes in in the early years and spends it on other government programs, in this case health care reform, but who knows what other government programs radio going to be created that will -- what

other government programs are going to be created that will use the revenue from this plan that supposedly a lot of people are going to sign up for. c.b.o. says that fewer than 4% of people will actually sign up for it. in fact, no senior today is going to benefit from it because you have to work for five years. if you are a senior who is retired, you are not going to see any benefit from this. this doesn't impact seniors, contrary to the assertions of some of my colleagues on the other sievmentd who it will impact are future generations of americans who are going to be stuck with the deficits and the debt that gets piled on them because i in the out years whent liability is incurred, people start getting paid out from having paid in, there's no money there. it is -- it is a classic definition of a ponzi scheme. the money comes in today, gets spent on other things, and then someday when the liability comes in and people start saying, oh, i paid into this program; i should get some benefit, there's going to be no money there. so we're going too borrow for it or tax for it or something else.

but because they say -- they say we'll tax you over 75 years, well, maybe because you're running surpluses in the early years but in the later years you're running huge of the deficits. in the early year, the surpluses reasonable care spent. they're not being put into paying benefits out for this program when the benefits start being demand by the people who participated in the program. but just look what the others have said about this program, mr. president. i'm -- i quoted for you what the chairman of the budget committee, senator conrad, said with regard to this program. that it is a ponzi scheme of the first order. but that is being echoed by others. this is what the chief actuary in the administration -- the administration's chief actuary said about the class act. said it would result in a net federal cost in the longer term. the chief actuary also determined the program faces a significant risk of failure because the high cost will attract sicker people and lead

to low participation. the congressional budget office agreed, saying the class program included in the bill would generate net receipts for the program in the initial years when total premiums would exceed total benefit payments but it would eventually lead to net outlays when benefits exceed premiums. in the decade following 2029, the class program would begin to increase budget deficits. now, this particular quote could come as a bit of a surprise because this comes not from the c.b.o. or the c.m.s. actuary, but it comes from "the washington post." "the washington post" called the class act "a gimmick designed to pretend that health care is fully paid for." the "post" g.n.p. goes on to say, mr. president, that the money that flows in during the ten-year budget window will flow back out again. "these are not savings that can honestly be counted on the balance sheet of reform."

even "the washington post" recognizes this for what it is. it is a sham. this is a budget gimmick, mr. president, that is designed to obscure the cost of this program by generating surpluses in the early years. $72 billion it's supposed to generate in the first ten-year window. so that counts on the balance sheet of health care reform to make it look better. but this program is going to run deficits -- deficits, as far as the eye can see. once the chickens come home to roost. and who is going to pay the bill for that? future generations of americans. mr. president, this is not good policy. certainly, if you look at programs that we already have on the books, medicare is destined to be bankrupt in the year 2017. we got big problems down the road, unfunded liabilities in social security. what this would do is create a huge new liability down the road that would be unfunded because all the money that comes in in the early years is going to be

spent. this is more of the same old business-as-usual in washington, d.c., that the american people are fed up with. we can make people happy today by saying we're creating this new program that makes the majority's health care reform bill look better because it obscures the real cost of this thing by rolling in these revenues in the early years, but the long-term impact, according to the c.b.o., according to the actuary at health and human services, according to a lot of our colleagues on the other side -- seven democrats who signed a letter, including the chairman of the budget committee, who, as i said, has called this program a ponzi scheme of the first order, something that would make bernie madoff proud. now, i don't know how my colleagues on the other side with a straight face could come over here and say, well, this is a really great program. it is actuarially sound. and sure it may be of benefit to a few people.

but i got to ticialtion somewhere down the road when the chickens come to roost, there is going to a huge liability that will be facing future tmtio tax, future generations of americans as we pile up more debt as a result of this ponzi sceesm that is sham, mr. president. i hope that my colleagues will support this amendment. it would strike the class act from the underlying bill, not allow those revenues to be assumed in paying for or understating the cost of this bill and not pile mountains of debt on future generations. mr. president, i reserve the balance of my time. mr. dodd: mr. president, how much time remains? the presiding officer: the senator from connecticut. 19 minutes. republican side, 10 1/2. mr. dodd: i see my colleague from minnesota. does he wish to be heard? how much time does my colleague need? mr. franken: thank you, senator

dodd. i need three minutes. mr. dodd: take four. mr. franken: i'll take it. mr. president, i rise today to ask unanimous consent to be added as a cosponsor to senator coburn tofs amendment number 2789 to require all members of congress to enroll in the public option. i'm pleased to cosponsor this amendment because i strongly support the public option, and i will have no qualms at all enrolling in this plan. you know, there's a lot of misinformation about the public option, so i want to be clear about why we need a public option and why i would be proud to enroll in a public health insurance plan. we need a public option because health insurance premiums for minnesota residents have risen 90% since 2000, because 440,000

minnesotans went without health insurance in 1998. we need a public option because insurance executives continue to make bloated, obscene salaries tpr-fplt -- salaries. from twrou-2007 americans saw premiums double. during that same time we saw americans become uninsured. during that same period insurance company profits rose 428%. 428% in eight years. they're making outrageous profits by gouging american families, and that's why we need a public option. the public option will offer affordable premiums and a comprehensive benefits package for americans struggling with their health care costs. it's going to provide the kind of coverage that americans need to be healthy.

the public option will foster a a competition among private health insurance companies and lower long-term costs for minnesotans and families across the country. and there is no cost for the public option to the treasury. in fact, c.b.o. estimates it saves $3 billion. it's a win-win situation. it's important to remember that the public option doesn't mean that private health insurance goes away. in fact, after health reform, 188 million americans will have coverage through a private insurer. only 2% of the overall insured population is projected to enroll in the public option. this is just another option that you'll have. it's an option. because that's what the bill is about.

a senator: would the senator from minnesota yield? mr. franken:absolutely. pwr-pb pwreupb know you joined to push this amendment -- mr. brown: i know you joined to push this amendment that members go on the public option partly to show that we believe in it. it's a little curious that two of the sponsors at least -- senator coburn, senator vitter and some others -- are so much against the public option but they want to pass this amendment. it sounds to me like you're serious about going on it as i am. mr. franken:i talked to my franie. we've been married 34 years now. i said if this passes, we should do the public option. she said absolutely. so, yeah, i'm perfectly serious about this. the presiding officer: the senator from minnesota has consumed the four minutes allotted by the senator from connecticut. mr. grassley: mr. president? the presiding officer: the senator from minnesota has the floor. mr. grassley: i'm sorry. the presiding officer: who yields time?

the senator from utah is recognized for five minutes. without objection, the senator from minnesota's request to be added as a cosponsor of the coburn amendment is approved. the senator from utah. mr. hatch: mr. president, thank you so much. we're talking right now about a program that's well thought out, that was meant to help the poor and minorities, that was requested by bipartisan democrats and republicans, and has worked amazingly well, which is available to all recipients of medicare. medicare advantage came about in a bipartisan way to solve real problems. we weren't getting health care to rural america.

we weren't getting health care in many respects to some of the poor and some of the minority folks in our country. i just want to read a special letter here. in response to this letter -- let me read this letter, aeupbd know it may have been -- and i know it may have been read before. this is dated september 30, 2003. "dear medicare conferees" -- i happened to be on that conference. i was one of those who led the fight for medicare advantage. "we are writing to ask you as a member of the medicare conference committee to ensure the final medicare bill includes a meaningful increase in medicare-plus choice -- the predecessor to medicare advantage -- funding in fiscal years 2004 and 2005. while the senate bill makes a modest step toward this goal, we hope the stronger provisions in the house bill will be preserved in congress. for nearly 5 million medicare beneficiaries across america,

medicare-plus choice, the predecessor, is an essential program that provides high-quality, comprehensive affordable health coverage. these seniors and disabled americans have voluntarily chosen to receive their health coverage through medicare h.m.o.'s and other plans because of their excellent value. to preserve this important option for seniors across the country, bipartisan legislation was introduced in the senate as s. 509, the medicare-plus choice equity and access act. that became medicare advantage. cosponsors by senators schumer and santorum, it sought to increase reimbursement rates and add new reimbursement options for medicare-plus choice programs. if goes on to make a compelling case for what became from that conference as medicare advantage to the utter pleasing of everybody who signed this letter. and, by the way, let me just mention the democrats who signed this letter, who wanted medicare

advantage. john kerry, arlen specter, dianne feinstein, joe lieberman, patty murray, charles schumer, frank lautenberg, hillary rodham clinton, ron wyden, mark dayton, mary landrieu, maria cantwell, and christopher dodd. 14 democrats signed this letter along with a number of bipartisan republicans who believed that we really needed to do medicare advantage. and now to take advantage, our colleagues on the other side want to do away with medicare advantage except in four states that are for the most part democrat states, while leaving all the other 46 states high and dry. now let me just say this letter is in response -- was a letter

given to the medicare modernization conference committee. this conference committee gave them everything they wanted in medicare advantage. this legislative grant of power gave the senators the medicare advantage program which now 11 million senior citizens enjoy today. now those on the left want to do away with this important program that benefits seniors and minorities in an amazing set of ways. well, i'm against that. i hope our colleagues on the other side will realize what they're doing. it just isn't right. vision care and dental care and so many other approaches that really worked for this program will be taken away from these people. and they're going to have to spend $175 to $200 a month to get what they got for an average of about $54 a month. and these are people who need our help. let me just change the subject

for a minute because i understand my colleague from oregon was discussing medicare advantage and talking about c.e.o.'s of medicare advantage companies living -- quote -- "high off the hog" saying that that is a rationale for $120 billion in medicare advantage cuts. i have two responses to my good friend from oregon: this is not about medicare insurance company c.e.o.'s. this is about preserving the choice of coverage for seniors. the presiding officer: the senator has used the five minutes. mr. hatch: i would ask for another two minutes. the presiding officer: is there objection? mr. dodd: how much time remains, mr. president? the presiding officer: the senator from iowa controls 4 minutes and 46 seconds. the senator from connecticut, 14 minutes and 43 seconds. mr. dodd: we have 4 minutes left. mr. hatch: i'll put the rest of my remarks in the record.

the presiding officer: who yields time? mr. dodd: four minutes to the senator from michigan. the presiding officer: the senator from michigan is recognized for four minutes. ms. stabenow: thank you, mr. president. i have an amendment that will be sent to the desk pursuant to the consent agreement. i would now call up my amendment 2899. the presiding officer: the clerk will report. the clerk: the senator from michigan, ms. stabenow, proposes an amendment numbered 2899. at the appropriate place insert the following: section, no cuts in guaranteed benefits. nothing in this act -- ms. stabenow: i would ask that the amendment be considered read. the presiding officer: without objection. ms. stabenow: thank you, mr. president. mr. president, this is a very important amendment to clarify once again that we are not cutting any medicare benefits.

we are not cutting any of the guaranteed medicare benefits that people receive right now. in fact, aarp who has been saying this on their web site for months has released a letter now, and it quotes this sentence: "most importantly, the legislation does not reduce any guaranteed medicare benefits." not only aarp, but the association for the protection of medicare and social security, alliance for retired americans, and other senior organizations all agree. what we are talking about is saving medicare, mr. president. cutting down on overpayments that have been in place. right now the 80% to 85% of the seniors that get their benefits, their health care through traditional medicare are paying

more in premiums, according to the congressional budget office, than they otherwise would because medpac estimates that we are paying about $12 billion more for people in the private for-profit insurance system right now that's called medicare advantage. so the majority of seniors are subsidizing high insurance company profits and overpayments. what we have done in this bill is take out the overpayments and in fact put in competition, competitive bidding. i thought that's something that our colleagues on the other side of the aisle supported. competitively bidding for reimbursement so we're not continuing the overpayments in medicare advantage that are causing medicare to go broke more sooner and causing the majority of seniors to subsidize

high insurance company profits. what we are seeing on the effort, unfortunately, from my friends on the other side of the aisle is an effort to support huge subsidies instead of supporting competitive bidding that is in the bill. the reality is, mr. president, that the guaranteed benefits, inpatient care, doctor visits, lab tests, preventive screenings, skilled nursing facilities, home health care, prescription drugs, ambulance services, durable medical equipment, emergency room care, kidney dialysis, outpatient mental health care, occupational and physical therapy, imaging like x-rays. e.k.g.'s, organ transplants are all covered as they have been for all medicare beneficiaries. what we are doing is taking overpayments to for-profit insurance companies and putting that back into increased

benefits for every senior, cutting down on prescription drug costs by khroegs the dough -- closing the doughnut hole and strengthening preventive care, and the most important piece of all lengthening the solvency of the medicare trust fund. i would urge the adoption of my amendment at the appropriate time. thank you. the presiding officer: who yields time? mr. grassley: mr. president, i yield two minutes to the senator from florida. the presiding officer: the senator from florida's recognized. a senator: mr. president? -- mr. president, i'd like to ask unanimous consent -- mr. lemieux and if my colleague from michigan, concerning her amendment. this amendment, that i've been reviewing, it's very important to the people of florida, because it has to do with medicare advantage. and medicare advantage is a very important program. and it is not just some extra

frils. the idea that -- frills. the idea that our folks in florida can get eye care, hearing care, diabetic supplies. last week i went down to a medicare advantage clinic, these are wonderful places where our seniors are getting who willistic health care -- hollistic health care. i think this is to guarantee the benefits in medicare advantage. i'm not sure it is phrased that way. i've been reading the bill. title 18 of the social security act. and i cannot find the phrase, "guaranteed benefits." i would ask unanimous consent, mr. president, that the guarantee by law phrase in this amendment from my colleague from michigan be eliminated so that we would ensure that benefits of eye care, dental care, preventive care, diabetic supplies, all of the things

supplied in the medicare advantage are actually preserved. no one is objecting to lower costs. no one's objecting to a competitive situation where we have these companies providing more services for less costs. but we want to make sure that the services are still there. so i would ask unanimous consent to have that phrase guaranteed by law to be eliminated from the amendment. the presiding officer: is there objection? ms. stabenow: reserving the right to object, mr. president. the presiding officer: the senator's time has expire. is there objection? ms. stabenow: reserving the right to object. i would ask that my colleague -- we were happy to talk about how we might address what he's concerned about, but, unfortunately, the reality is that the for-profit companies are objecting to competitive bidding. and the language that my colleague has suggested, would include items that have been offered to get people in for-profit plans, like gym

memberships and other things that have been of great concern. and, so, given that, i would have to object at this point. the presiding officer: objection is heard. who yields time? the senator from ohio is recognized. mr. brown: thank you, mr. president. thank you, senator harkin. i watched from my office on c-span and then on this floor count -- been on this floor countless times in the last three or four days, listening to my friends on the other side of the aisle continue to do the bidding of the insurance companies. and, you know, i hear them talk about medicare advantage, how great it is. i was here, i was in the house of representatives 10 years ago when medicare advantage began when the insurance company said, we can save medicare 5% on all of its costs by bringing forward medicare advantage. well, then when the republicans took control of everything, that saving 5%, the insurance companies decided, no, we can't save 5% anymore. we need a 13% bonus.

the chickens have come home to roost for the insurance companies. an article in the dow jones story, entitled humana third quarter profits up 65%, see strong medicare advantage gains. let me excerpt from the first few paragraphs. humana's first third quarter earnings rose 65%. the company gave an initial 2010 forecast which the protects substantial medicare advantage membership growth resulting i in $32 to $34 billion, well above the estimate o of $29.6 billion. that forecast takes into a account reductions of medicare advantage overparticipates now. as the senator from rhode island knows and senator harkin and senator stabenow, all strong supporters of medicare. when we see people who oppose

medicare and posed the creation 40 years ago. they tried to privatize medicare with speaker gingrich down the howl in the house of representatives a dozen years ago. now their medicare's biggest defenders, i don't think so. what they have been is the insurance industry's biggest defenders. that's really what that debate the last three days was all about. what's important is we guarantee medicare services as we will. we quit subsidizing insurance companies, as we should quit subsidizing them. and then that $90 tax that every medicare beneficiary has to pay, that $90 -- that $90 that goes to insurance subsidies will be taken away. regular medicare members, 81%, 82% of medicare beneficiaries won't pay be the -- pay the insurance company republican tax that they had to pay since the subsidies to insurance companies

were increased. we need to get the bill moving. the stalling should be over. the presiding officer: who will yield time? the senator from iowa controls six minutes and 45 seconds and the senator from iowa controls two minutes and 24 seconds. mr. grassley: senator corker has asked for 1 minute. i yield -- one minute. i yield it. the presiding officer: the senator from tennessee is recognized. mr. corker: thank you, mr. president. interesting to hear my friend from ohio a minute ago. i want to say that i plan to support the hatch amendment regarding medicare advantage. but it's not because that i don't believe we need to do some things to cause medicare to be more solvent. and i do believe that medicare advantage does have some subsidies to insurance companies that are higher than they should be. the fact is, though, that this

bill is taking money from a program that is insolvent, medicare, and using that to create an entitlement. so i'm going to support the hatch amendment even though i would loof to work with -- love to work with my friends on the other side of the aisle to do those things to make medicare more solvent. but i think what is so objectionable to all of us is to know that we have an insolvent medicare program that the trustees have said will be bankrupt in the year 2017 and my friends on the other side of the aisle are taking money from the program to leverage a new entitlement. thank you, mr. president. the presiding officer: who yields time? the senator from illinois. mr. durbin: this is a basic choice. will we continue to subsidize private health insurance companies who are overcharging the medicare program by 14%? will we take that money out of

medicare to continue the subsidy for profitable, private health insurance companies? it is that basic. i would say to the senator from tennessee, the congressional budget office tells us, yes, untouched the medicare program in seven or eight yeast faces in-- faces insolvency. but this bill adds five years of solvency to medicare right off the top. right off the top, five more years of solvency. something that you won't acknowledge, but you should. let me also add, if we're going to bring down the cost of medicare so that recipients get quality care, we have to get rid of the outrageous subsidies to private health insurance companies, the medicare advantage program. we also have to be honest about those providers overcharging medicare. why does it cost twice as much in miami for the same services that given to medicare patients in rochester, minnesota? it shouldn't. somebody's ripping off the

system. if we can't ask those honest questions, then i'm afraid we're not going to put medicare on sound financial footing. we can do that. but we can't do that by saying we have to continue to subsidize private health insurance companies out of medicare. that's the amendment. i yield the floor. the presiding officer: who yields time? the senator from iowa controls the time. five minutes. the senator from rhode island is recognized. mr. whitehouse: i thank the distinguished senator from iowa for the recognition. i would make one point in my two minutes, which is that those of us who have been privileged to hear our friends on the other side debate the public option have seen a relentless insistence on the public option operating on a level playing field with the private insurance industry. i can't tell the number of times we've heard that.

indeed, even when we designed the public option so that it did operate on a level playing field with private insurance industry, they still complained. but now we have a situation in which we have private industry operating at a 14% advantage in subsidy against medicare. and suddenly the other side's interest in a level playing field has evaporated. suddenly their interest is in doing what is, once again, in the astonishing coincidence that characterized this debate in the interest of the insurance industry. i have yet to see an argument made by the other -- from the other side of the aisle that doesn't happen to coincide with the interest of the insurance industry. it could not be more stark on this point. if it's a public option, they want to compete on a level playing field. even then they're against it. if it's privately subsidized coverage getting advantage in the system, then for it.

i urge consistency and i urge that we support the efforts to bring some discipline to medicare advantage as the private insurance industry promised. we're doing no more than holding them to their words. i yield the floor. the presiding officer: who yields time? the senator from texas is recognized. mrs. hutchison: mr. president, i ask unanimous consent to submit senator kyl's remarks for the record. the presiding officer: without objection. mrs. hutchison: i yield 30 seconds to senator mccain. the presiding officer: the senator from arizona. mr. mccain: mr. president, i understand that the senator from pennsylvania, senator casey, has an amendment to twen twend $2.5 billion to protect medicare benefits for pennsylvanians. what's going on. why can't we protect every citizen. that's five states protected and spending extra of billions of dollars. let's have an amendment that every state is treated the same. let's do that. i tell my colleagues i intend to

introduce an amendment that will do so and that will take away the special exceptions that are taken for special states who have special influence around here. mrs. hutchison: mr. president, just to put this in a perspective. when i hear all of this debate, it's like everything has to be more government, bigger government, government is better than the private sector. mr. president, medicare advantage is an option. it's not a mandate. it's an option that allows seniors another choice to get hearing aids. mr. president, let's let these seniors have an option. we need more competition, not less. thank you, purchase. and i -- mr. president, and i yield the time. the presiding officer: who yields time? mr. harkin: how much time is left? the presiding officer: 2 1/2 minutes. mr. harkin: mr. president, it's interesting to hear the last speaker say, don't take away the option for seniors on medicare advantage.

yet, they have an amendment to take away the option for people to buy insurance against having a disability so they can stay in their own homes and have support. it's voluntary. it's not mandatory. no one's forcing anybody to do anything much i say to my friend from texas, yet, there's an amendment on that side to take that away. to take away that voluntary program, the class act, so that people can voluntarily put money into it to protect themselves against future disability. so i -- let's kind of keep our arguments a little bit straight around here. mr. president, a lot of people have talked about medicare advantage. i'm going to close on the necessity of keeping the class act in this bill. i've spoken many times about that. it's not partisan issue. it's like when we passed the americans with disabilities act. it was not a partisan issue. this should not be a partisan issue. we should not let politics get

involved in it. over 275 groups representing groups from disabilities, to the interfaith coalition support the class act. it was unanimously adopted by the "help" committee, unanimously adopted by republicans and democrats. senator gregg offered an amendment to make -- insist that it be actuarially sound over 75 years. and it is actuarially sound over 75 years. secretary sebelius has supported it, president obama supports it, broad base of support for the class act. mr. president, today we received some letters from people around the country. i don't have time to read them all, but just a couple much here's one from -- couple. here's one from arkansas. my wife has a journalism degree, cerebral palsy and brings money from state of arkansas with a stay-at-home job.

she can still earn money under the class act with an assistance of an attendant rather than having to go to a nursing home. here's virginia, i don't currently need the services under the class act, but having been born with a disability, i have always been acutely aware of the possibility of serious issues downs the -- down the road. it would be a good thing for me, a 30-year-old working person to be able to put some money away. i beg my colleagues for the sake of people with disabilities in this country, let's not adopt the amendment of the republicans to take away the class act. it was senator kennedy's premier goal -- the presiding officer: the senator's time has expired. all time has expired. under the previous order, the question occurs on amendment number 2870, offered by the senator from rhode island, mr. whitehouse. is there a sufficient second? there appears to be a sufficient second. the yeas and nays are ordered.

the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators who wish to vote or change their vote? if not, on this vote the yeas are 98. the nays are zero. under the previous order requiring 60 votes for the adoption of this amendment, the amendment is agreed to. the senate will come to order.

the senate will come to order. please remove conversations off the floor. mrs. hutchison: mr. president, parliamentary inquiry? are the next three votes ten-minute votes? the presiding officer: the senator from texas is correct. the next three votes are ten-minute votes. mrs. hutchison: thank you. the presiding officer: without objection. under the previous order, there are two minutes equally divided. who yields time? the senate will come to order. under the previous order, there are two minutes equally divided. who yields time? mr. dodd: mr. president? the presiding officer: the senator from connecticut. mr. dodd: mr. president, i urge my colleagues to support the class act and to vote against the, i believe it is the thune amendment which would strike the class act from the bill. as you heard, i hope, this afternoon, this bill is totally

voluntary. there is no requirement by employers or employees to be involved in this. this is a very creative idea of using individuals' money to contribute to their own long-term financial security if they're faced with disabilities. we have now, with the adoption of the whitehouse amendment, secured that these funds can never be used for any other purpose than for the class act. that was the concern most of our colleagues had, would these funds drift off. as a result of the gregg amendment in our committee, it has been determined these programs will be actuarially sound for 75 years. we fixed the problem c.b.o. raised with it. it is a solid program that can make a huge difference for millions of americans, allowing them to lead independent lives with dignity. it is deserving of our support. i urge approval of this program. the presiding officer: who yields time? mr. thune: mr. president? the presiding officer: the senator from south dakota. the presiding officer: mr. president, the class --

mr. thune: mr. president, the class act is the same old washington, same old smoke and mirrors, same old games. i want to read what the congressional budget office and the chief actuary for the administration said. "the program would add to future federal budget deficits in large and growing fashion." mr. president, if we don't take this out of this legislation, we allow this to become law, we are locking in future generations to deficits and debt as far as the eye can see. this is, as has been described by the other side, a ponzi scheme of the highest order. we need to take it out of this bill. i urge my colleagues to adopt this amendment. the presiding officer: under the previous order, the question is on the amendment number 2901 offered by the senator from south dakota, mr. thune. the yeas and nays have been requested. are there sufficient seconds? there appears to be a sufficient

second. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators in the chamber wishing to vote or change their vote? if not, on this vote, the yeas are 51, the nays are 47. under the previous order requiring 60 votes for the adoption of this amendment, the amendment is withdrawn. without objection. under the previous order, there are two minutes equally divided. who yields time? the senate will come to order. the senator from michigan. ms. stabenow: thank you, mr. president. this amendment is very clear.

my amendment states that nothing in this act shall result in the reduction or elimination of any benefits guaranteed by law to participants in medicare advantage plans. mr. president, right now c.b.o. tells us $12 billion extra -- the presiding officer: the senator will suspend. the senate will come to order. please remove your conversations off the floor so the senator from michigan can be heard. the senator from michigan. ms. stabenow: thank you, mr. president. mr. president, right now we understand from medpac that there's $12 billion in overpayments to for-profit insurance companies that are additional costs that we pay -- the taxpayers, medicare recipients pay -- beyond what is traditional medicare. 85% of our seniors -- mr. baucus: mr. president, the senate is not in order. the presiding officer: the senator from montana is correct. please take your conversations off the floor so that the senator from michigan can be

heard and also that other senators. the senator from michigan. ms. stabenow: thank you, mr. president. 85% of the seniors in medicare are in traditional medicare, and right now we're told that every single senior citizen and person with disability in medicare pays $90 extra, every couple pays $90extra to pay for the overpayments to private, for-profit insurance companies. as aarp has said this legislation does not reduce any guaranteed medical benefits. all we are doing is asking for competitive bidding for-profit conditions, competitive bidding, bring down the overat the same d i would ask for support sponsor the amendment. thank you. the presiding officer: who yields time? mr. lemieux: mr. president? the presiding officer: the senator from florida. mr. lemieux: this amendment, mr. president, i had a conversation with my colleague

from michigan, the phrase in here "guaranteed by law" doesn't guarantee anything. this isn't going to protect the benefits of medicare advantage. the benefits that our senior citizens enjoy -- i care, hearing care, dental care -- they're not protected by this. you can vote for it if you want to. it sounds good but it's just gift wrapping on an empty box. the presiding officer: under the previous order, the question occurs on amendment number 2899, offered by the senator from michigan, ms. stabenow. the yeas and nays have been ordered. is there a sufficient second? there appears to be a sufficient second. the yeas and nays are ordered. the clerk will call the roll. vote:

vote:

the presiding officer: are there my senators who wish to vote or change their vote? if not, the yeas are 97, the nays are 1. under the previous order requiring 60 votes for the adoption of this amendment, the amendment is agreed to. the presiding officer: without objection. the senate will come to order. under the previous order, there are two minutes equally divided prior to a vote in relation to the motion to commit offered by the senator from utah, mr. hat mr. hatch. who yields time?

the senate will come to order. please remove your conversations from the floor so the senator from montana can be heard. the senator from montana. mr. baucus: mr. president, the pending motion would strike the savings that the bill achieves from medicare advantage. why are we seeking savings from medicare advantage? because medpac tells us that the government pays the private insurance companies that provide medicare advantage 14% more than they pay for traditional medicare. because these extra subsidies to medicare advantage cause the four-fifths of seniors to traditional medicare $90 per month even though they get no additional advantage. because medpac says the additional medicare advantage payments hasten the solvency of medicare part-a trust fund by 18 months.

because the private insurance companies that provide medicare advantage are making three-quarters of their profits from these government overpayments, they can find some of the savings there. because private insurance companies who provide medicare advantage are paying their c.e.o.'s $24 million a year, $ million, $8 million and they can find some of the savings there. and because nothing we do in our bill reduces guaranteed benefits under medicare. therefore, i urge my colleagues to oppose the motion. a senator: mr. president? the presiding officer: the senator from utah. the senate will be in order so that the senator from utah can be heard. the senator from utah. mr. hatch: mr. president, i urge my colleagues to support my my motion to commit. it protects medicare beneficiaries currently participating in the medicare advantage program by eliminating the reid's bill $120 billion in cuts to the medicare advantage program. let me make this point as clearly as i can. a vote against my amendment is a

vote for slashing benefits for 11 million seniors and low-income americans, including vision benefits, dental benefits, home care for chronic illness, wellness programs, disease management programs, limits on cost sharing for primary care, physician visits, reduced premiums for part-b, reduced premiums for part-d, 14 democrats, when we did this, many of whom are sitting in the senate right now supported this development of medicare advantage. have no doubt when you vote against my amendment, you will be voting to cut these lifesaving and life enhancing benefits. the choice is yours and the choice is clear. our nation's seniors are watching much. the presiding officer: the -- watching. the presiding officer: the question is on the motion. is there a sufficient second? there are apatientl apparently t

seconds. the clerk will call the roll. vote:

the presiding officer: are there any senators who wish to vote or change their vote? if not, on this vote, the yeas are 41, the nays are 57.

under the previous order requiring 60 votes for the adoption of this motion, the motion is withdrawn. mr. baucus: mr. president, i move to reconsider the vote. a senator: move to table. the presiding officer: without objection. the senator from montana. mr. baucus: mr. president, i think the -- excuse me. the senator from arkansas wishes to be recognized to offer an amendment. the presiding officer: the senator from arkansas. mrs. lincoln: thank you, mr. president. i would like to call up my amendment. the clerk: the senator from arkansas, mrs. lincoln, proposes amendment number 2905. on page 2040, strike line 14 and insert the following -- mrs. lincoln: mr. president, i ask unanimous consent -- the presiding officer: without objection. mrs. lincoln: the further reading of the amendment be dispensed with. the presiding officer: without objection. mrs. lincoln: thank you. mr. president, i yield the floor. the presiding officer: the

senator from montana. mr. baucus: i think the senator from new mexico now wishes to be recognized. the presiding officer: the senator from new mexico is recognized. mr. udall: thank you, mr. president. mr. president, today i rise to honor a brave son of anthony, new mexico. army corporal anthony corosco jr. was killed november 4 after being hit by sniper fire while serving his country in iraq. he was 25 years old. corporal corosco, or tony as he was called by his family and friends, was a husband, father, and son. he and his wife johanna are expecting a child, and he had two small stepchildren who adored him. tony served as a truck commander for armored vehicles. it was his job to direct his vehicle down streets infested with roadside bombs and targeted by insurgents, attacking from the shadows of buildings.

tony understd accepted the riske died doing what he loved -- serving a country he loved. his fellow soldiers describe tony as an opt timist. -- as an optimist. his platoon sergeant put it best -- tony saw the good in everything. he was a soldier who never, ever complained. sergeant brown called tony the best soldier i ever had. as senators or as citizens, we cannot fully experience the sadness that tony's family and friends are feeling, but when a soldier dies, the nation as a whole feels the loss. we're linked to corporal corosco by the ties that bind a grateful nation to its faithful servant. his loss is ours. please join me in honoring anthony corosco in extending our sympathies to his wife johanna and his father antonio, his

mother and the rest of the corosco family. before i close, i want to acknowledge the recent passing of another brave new mexican, joseph giagos, a specialist with the new mexico army national guard, died of a heart attack while serving in iraq. while his death wasn't due to injuries suffered in combat, that fact does not lessen the pain of his loss. specialist giagos was 39 years old. he served with the guard as a light wheel vehicle mechanic. while not serving his country, he worked for the forest service on the carson back home in questa, new mexico. throughout his life, he also worked as a firefighter, an ambulance driver, a policeman. specialist giagos gravitated toward work that allowed him to help his fellow citizens. while working for the forest service, he even saved a life. spotting a burning truck one

day, he saw a man inside and pulled him to safety. as specialist giagos' brother donald said, he was always taking different jobs, but they always put him in the service of others. today i ask you to join me in thanking specialist giagos' family for his service and for his sacrifice. thank you, mr. president. i yield the floor. a. a senator:: mr. president? the presiding officer: the senator from nebraska. mr. jones: i have a motion at the desk. the clerk: the senator from nebraska moves to commit the bill back to committee with instructions on changes that do not include cuts in payments to home health agencies totaling negative $42.1 billion. mr. johanns: thank you. mr. speaker, i rise today to speak in favor of the motion that was just read.

one of the things that i say is so very important about a debate on the senate floor is we begin to understand what this legislation does to real people, and we have come to really understand that $466 billion in medicare cuts that are shown over my left shoulder here have real consequences to real people all across the united states. these cuts compromise care, they compromise access to services that real people need in their daily lives. robbing these funds from medicare to create a dramatic new entitlement program, in my judgment, is not sound policy and it's not sound government. that's especially true in this case, mr. president, when the impact on seniors dr seniors' health care is so profound.

these cuts will reduce the quality of care that many americans are receiving today and reduce the care that these americans deserve. i have to tell you, out of all of these medicare cuts, one of the largest head-scratching cuts is the one to home health. the senate bill cuts cuts $42.1 billion for home health care. home health is about 3.7% of the medicare budget. it's an important program, yet 9.1% of the medicare cuts in the senate bill are taken out of home health. medicare home health spends less today than it did over a decade ago, while serving a similar number of beneficiaries at less cost per patient.

that's the kind of program that we should celebrate, yet this bill has them on the chopping block. now, maybe there is some misunderstanding about what home health provides, so let me clear up the confusion. home health care agency cares for patients of all ages. it provides a broad range of essential health care and support services, real security in the comfort of a patient's home. 9,000 medicare approved home health agencies existed in 2007. i'm very pleased to report to you, mr. president, that 74 of those are in my home state of nebraska.

nurses, therapists, home care aids and others who serve elderly and disabled patients in their own homes drive nearly five billion, five billion miles a year to provide these much-needed services. they care for about 12 million real people annually with 428 million visits. each one providing that personal touch of care. the services that are provided to this very, very essential program include rehabilitation therapies, telemedicine, wound care, pain management, and skilled nursing. who is eligible to receive medicare home health services? we can answer that question by going to c.m.s. according to c.m.s., to qualify for medicare home health

benefits, a medicare beneficiary must meet one of the following requirements -- they must be confined to home. they must be under a doctor's care. they must need skilled nursing on a periodic basis. and they must have a continuing need for occupational therapy. these are truly some of the most vulnerable americans, yet in order to finance this new entitlement, this bill takes money out of that much-needed program and it places the cuts on the backs of these americans. our most vulnerable americans, yet these cuts risk leaving them without care. and what kind of conditions do people who utilize home health agencies suffer from? well, i'll turn to my own state to answer that question.

in nebraska, one of our agencies is in rural cherry county. cherry county is a very large county in western nebraska. in fact, larger than some states. who gets served in that county? a gentleman with class three congestive heart failure. he's awaiting a heart transplant. a gentleman who just lost a leg from come play occasions -- from complications from diabetes. they get home health care services. these folks are not striving to bill being the system. the payments that allow us to provide this much-needed service to them are not excess payments. these are just average folks who are striving to do their best to recover from their condition and manage the best they can. keeping these folks out of the emergency room