quote -- "medicare fraud and abuse reduction, employing a new generation of treatment models, expansive -- for chronic expansive diseases, speeding adoption low-cost generic drugs and expanding the use of information technology in evidence." that is exactly some of which is happening right here, some of which is happening right here. so let's get this conversation into a place of reality. here's what happened in arriving at the reductions in overall medicare expenditures which does not reduce any benefit to any senior citizen, which is why our -- that represents 40 million senior citizens is

supporting the democratic legislation. and they have written that to us as late as yesterday. $120 billion comes from reducing overpayments in medicare. someone's got to explain to me on the other side of the aisle how you hurt medicare by stopping charging a $90 overprice of premium to seniors, which is what happens. you know how the overpayments are paid for? every senior couple in a traditional medicare plan pays an additional $90 per year in order to finance the over payments. what they are suggesting is we shouldn't cut overpayments. what they are suggesting is that medicare is okay paying seniors

in a certain group an overpayment that doesn't even go to seniors. guess who it goes to. it goes to the insurance company. are you telling me we ought to go to the taxpayers of the country and say hey, folks, we know we're paying a 14% overpayment for the service compared to what we pay for everybody else, and we're going to keep on paying it? well, that's exactly what our friends on the other side of the aisle are saying. what we're saying is no. we think we ought to reduce that payment and that's $120 billion. that doesn't cut one benefit per senior, but it makes the program more effective. let me go further. here are the people who have come together in a series of meetings to say yes, we can live with a reduction in our overall medicare payment because we can be more efficient. the hospitals came to the white house and said we're willing to reduce the payments that we're

receiving by $150 billion. guess what, madam president? way didn't -- we're not even doing that. we're only asking them to reduce their payments by $106 billion. that's what's in this bill. and the hospitals have agreed, i represent hospitals in massachusetts. we have one of the best hospital systems in america in the network of hospitals that we have. people come from all over the world to come to our hospitals. i see the senator from minnesota here. they come from all over the world to go to some of the hospitals that minnesota has. the fact is those hospitals agree that we can do this more efficiently, and we can reduce the overall payments under medicare, and we've worked very hard to protect the way that we do that so it doesn't do injury. the insurers have come to the table. home health care came to the table. i read the letter earlier from the home health care services.

it's from the president of the home care and hospice association of america, and the -- he says we support the provisions of your health care reform legislation as they relate to home health care. that's what we're debating here on the floor, and they do support it, and the fact is that the senator from georgia who stood up and said well, in our state we have a letter that says -- well, first of all, that's based on an earlier assumption. secondly, we have no idea what the assumptions are in the analysis that they made. thirdly, it's based primarily on the house bill which has has $13 billion more in reductions than we have. so before we get stuck there, we ought to listen to the national association that is working with us on a daily basis where we agree on what the reductions ought to be. the skilled nursing facilities, the rehab facilities, the long-term acute care hospitals have all come to the table and

said we can do this. now, is that their preference? do they love it? nobody wants their budget to be tightened where they have to make changes to try to be more effective, but the bottom line is every single one of them has agreed with what we are doing on this side of the aisle. and notwithstanding that, our friends on the other side of the aisle keep coming back and keep trying to stand up for grandma or stand up for some senior citizen that is being falsely scared into believing that their benefit is going to be cut or that medicare is somehow going to be less available to them. and my amendment, which we will ultimately vote on, will guarantee that no benefit is going to be cut for any senior under this plan, and that's what we are going to do. now, madam president, in addition to that, let me just go quickly.

let me remind my colleagues and people who are listening what this bill does. this bill actually improves the solvency of medicare. we've heard any number of people say medicare is going to go bankrupt by 2017, and indeed it is. well, we stretch that out. we improve that so that we can then take the improvements in the health care system -- i yield myself an additional couple of minutes. it improves the solvency of the medicare program by five years. it puts $30 billion back into the pockets of seniors in the form of lower medicare premiums. it makes prescription drugs more affordable. it guarantees that seniors can continue to see the doctor of their choice. it provides free wellness and prevention benefits to medicare beneficiaries. they are busy talking about the cuts when this actually improves what medicare beneficiaries are going to get. they don't have wellness and

prevention benefits today. it provides for them, guarantees they're going to see the doctor of their choice. it actually puts $30 billion back into their pockets, and it also includes fair and appropriate changes for home health that actually protects access to health care. madam president, the truth is the johanns amendment is the amendment that actually would wind up hurting seniors. this amendment provides additional benefits. and we all understand the importance of this. the senate bill releases home health care payments so that those payments actually reflect the real costs of providing care, and we do that not in a partisan way. we do that based on the nonpartisan medpac commission recommendations to us of how you can improve medicare. so i think our colleagues have a

long way to go on the other side to really begin to talk about this real health care change here. this bill roots out fraud from the system. it revises how medicare pays for the outlier cases. that's the cases that treat the sicker or what we call outlier patients. unfortunately, g.a.o. found -- guess what? some providers were gaming the system and getting more outlier payments than they deserved. do they want us to continue to overpay people? providing service that people either don't need or charging more for the service that they do need but could have gotten at a lower price? those are the changes that we make. and i think the american people would be proud of it. let me give you an example. the g.a.o. found that in florida county, providers were receiving 60% of all of the other outlier payments, even though the county had less than 1% of the total

medicare population. that is absurd. and what we do is fix those kinds of absurdities that make americans so angry about the administration of their tax dollar in washington. i believe the senate bill addresses a number of these problems in a thoughtful way. i'd ask unanimous consent that the full text of my statement be put in the record as if read so others can speak. but, madam president, we need to have a debate about what's really in this bill and what the real impacts are and what the negative impacts are of not doing these things. our colleagues stand for the status quo, and i think that this is going to be historical when we pass it because it is going to benefit people in so many different ways. getting rid of pre-existing condition restraints, not having people kicked off of insurance that they thought they had, but when they get sick, they find it's gone. we end that. and we get 31 billion more

people covered in a way that spreads the risk of being sick in america in a sensible way and reduces the costs for other americans. that's common sense, and i'm proud of what we're doing here. mr. mccain: madam president? the presiding officer: the senator from arizona. mr. mccain: madam president, it seems that as much as i'd like to put the last presidential campaign behind me, we seem to be continuing to dredge it up in a false -- totally false manner time after time. i would ask unanimous consent that my campaign paper -- position paper on a specific plan of action lowering health care costs be made a part of the record at this time. the presiding officer: without objection. mr. mccain: then i would ask to be made part of the record the factcheck.org of november -- of october 20, 2008, that says -- "false -- obama's false medicare claim," which were the

attacks on me which were not based on fact, and i quote from factcheck.org --" these claims are false based on a single newspaper report that says no such thing. mccain's policy director states unequivocally, no benefit cuts are envisioned. mccain does propose savings." et cetera, and i did, and i did propose savings, and we can make savings, and nowhere, nowhere in my wildest imagination did i ever believe we were going to cut benefits in order to create a $2.5 trillion new entitlement program when the system is already going -- going broke. a senator: reserving the right to object. mr. mccain: i will have those put in the record. if the senator from massachusetts wants to distort my record, that's fine, but it gets a little -- the presiding officer: any objection into inserting the documents into the record?

mr. mccain: as ronald reagan once said, facts are stubborn things. i yield. mr. kerry: madam president? the presiding officer: the senator from massachusetts. mr. kerry: i'm not going to object to putting something important in, but i'd like my colleague to stay for a moment because this is very important. madam president? the presiding officer: the majority time has expired. the senator from iowa. mr. grassley: i yield to senator thune. mr. kerry: i have objected to the statement being put in unless i have a chance to explain it. i would like to get it in there. the presiding officer: the objection has been heard. mr. mccain: i would ask unanimous consent that the senator from massachusetts be allowed three additional minutes and i be allowed two additional minutes. the presiding officer: is there objection? mr. kerry: madam president? the presiding officer: the senator from massachusetts. mr. kerry: i thank my good friend from arizona because this is the way the senate ought to work, and i totally agree with what the senator just said, and i want the senator to know i agree with it. he is correct that the statement

in factclerk.org calls the obama campaign to account for -- fact check.org calls the obama campaign to account for a misat the same statement about his proposal. i agree it did that. it didn't recommend a reduction in benefits, but that's not what i just suggested that it did. what i'm talking about is that the senator said and his staff insisted he could get the savings for his reductions that would benefit medicare from waste, fraud, and abuse for new treatment models, from expanding the use of information technology, and that there is a complete similarity between what we are doing in order to achieve these savings and what he was doing, and i'm trying to point out the similarity, not the difference. i'm not here to debate the campaign ad. i think it didn't accurately reflect the senator's position, but i do believe if you read the

whole article, which is why i will not object to it being put in there, you will see that it clearly says that he is supportive of savings in medicare, so are we, that you can do it without cutting benefits, which is exactly what we're doing here. i yield the floor, and i thank my colleague for his courtesy. the presiding officer: the senator from arizona. mr. mccain: i thank the senator from massachusetts. this has been a vigorous debate and discussion. i see my prime adversary, the senator from illinois on the floor, who i look forward to doing battle with additionally, as well as my friend from massachusetts. but the fundamental point, i'd say to my friend from massachusetts, is that i never envisioned nor do i believe the american people ever envisioned that we would be -- quote -- cutting benefits or as the senator says making savings in order to transfer that to a brand-new entitlement program. that's what this debate is about. that's what this debate is about.

whether we're going to take a failing system that in seven years is going bankrupt, according to the medicare trustees, and then take all of this money no matter how these savings were made. and i believe they are cuts in huge magnitude. and then fund a brand-new entitlement program. that's what this real debate is about. i thing my friend from massachusetts for his courtesy. i look forward to the rebuttal from the senator from illinois as well as montana. thank you. i yield the floor.. mr. baucus: madam president? the presiding officer: the chair is in doubt. pwau madam president, i suggest the senator from iowa -- mr. baucus: madam president, i suggest the senator from iowa be recognized. mr. grassley: i yield time to the senator from south dakota. mr. thune: madam president? the presiding officer: the senator from south dakota. mr. thune: this is a great discussion. toeuf say the fundamental point in this discussion should not be lost on anybody in this chamber or on the american people.

and that is whatever was said during the course of the mccain -- during the course of the campaign last year was said in the context of protecting, preserving and prolonging the life span of medicare. the senator from mccain is very accurate in the way -- senator mccain is very accurate in the way he describes his position here. what the other side is proposing, a $2.5 trillion expansion of the federal government, financed with medicare cuts in the first ten years and as the senator from new hampshire said $3 trillion in the first two decades of this program does nothing to expand the life span of medicare by one day. nothing. what it does is it creates an entirely new entitlement program that's going to be paid for by future generations of american. and so medicare, which is destined to be bankrupt by 2017 is sitting out there floundering

with this tpaoupblg unfunded liability -- huge unfunded liability that is going bankrupt. we're talking about a new $2.5 trillion entitlement program on top of that. they can say these medicare cuts aren't real. you have 11 million people in this country who get medicare advantage benefits. and if there's going to be $118 billion cut, somebody's going to feel some pain. surely you jest when you say these cuts aren't going to hurt anybody. hospitals, home health agencies, $15 billion out of nursing homes. in the state of south dakota, home health care agencies, like they do in montana, provide service to people in rural areas. some people have to go 50, 60 miles to have someone serve them. what you're talking about doing in my state is cutting out $35 million out of home health care. these cuts are $500 billion. of course somebody gets hurt by

that. but what's probably most troubling of all, i guess, about the whole proposal that the other side has made is that after all that, cutting medicare, raising taxes, at the end of the day, 90% of the people in this country either have their health insurance premiums stay the same or go up. over 6%, if you're in the large employer -- in the small employer market. 5% if you're in the large employer market. double the rate of inflation. that doesn't change anything. if you're a family today and you're paying $13,000 for health care insurance, this is according to to the congressional budget office, in 2016 you will be paying over $20,000 a year for health insurance. that's a $7,000 increase. tell me how that reforms or helps anybody in this country. i want to show you how far we've come because the president said in 2007 when he was campaigning, when i become president, we will have a health care reform bill that reduces premiums for people

in this country by $2,500 in this family and covers everybody. we all know this bill leaves 24 million people uncovered according to the congressional budget office, raises premiums by 10% to 13% for everybody who buys in the individual marketplace. and keeps them the same -- when i say the same yearly increases of 5% to 6% year over year for the forseeable future for everybody else. the best you can hope for, america, 90% of america, is the status quo. how does that change the status quo? how is that reform? you can call this an overhaul. you can tall this a takeover, lots of things, but it's not reform. when american people think about reform, they're thinking about something that drives their health care costs down, not up. the congressional budget office has said under this bill, health care costs in this country will go up by $160 billion over the first ten years. not down.

90% of americans, you stay the same, or your premiums, at worst, go up by 10% to 13%. that's according to to the congressional budget office. so, madam president, i want to point out how far in debate has evolved from what the goals were in the first place and some of the other comments colleagues have made -- senator stabenow: adding to the ranks of the uninsured at alarming rates. skyrocketing health care costs make our businesses less competitive in the global marketplace and costs us good-paying jobs. this is about jobs. and this proposal does nothing to help small businesses create jobs. it kills jobs, and that's why the national federation of independent business, the chamber of commerce, national association of wholesaler distributors, all the major business organizations are opposed to this organization because they know the skpwabgt it will have on -- the impact it will have on jobs. i want to read one final quote, and this doesn't come from a

business association. this comes from the dean of the harvard medical school. this is from an op-ed in the waurpblg. news reports can lead you to believe that legislation would tackle the costs. but that is not true. the overall effort will fail to qualify reform in dozens of discussions i have had with economists i find near unanimity in opinion that whatever is shaped, it will markedly accelerate national health care spending rather than restrain it. that is from the dean of the harvard medical school. he goes on to say this will make an eventual solution even more difficult. so, madam president, these medicare cuts are real. they're $500 billion in the first ten years, as the senator from new hampshire said, $3 trillion over the first two decades. cuts medicare advantage. 11 million seniors in this country who get medicare advantage, so don't say they're not going to get hurt. their benefits are going to go

down. of course they're going to get hurt. home health agencies, nursing homes, hospices. in south dakota, home health care delivery will feel an interact of $11 million where we have agencies closing up shops because reimbursements don't keep up with the costs. if you have to put them into a hospital, the costs go up by multiples. so much more efficient to have somebody served in a home health setting than to have them overnight stay at a hospital or successive overnight stays at hospitals. so, madam president, this is not reform. this actually drives up costs for 90% -- or keeps the same or drives up costs for 90% of americans. it does cut medicare and it does nothing to preserve the -- the presiding officer: the minority time has expired. mr. thune: i yield the floor. mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: i ask consent that ten more minutes of debate be allowed evenly divided.

the presiding officer: without objection. mr. baucus: hearing no objection. madam president? the presiding officer: yes. without objection. mr. baucus: madam president, i would just like to state as clearly as i possibly can so, that people understand, that the savings, the medicare savings here are being used for medicare. there is a strong implication by many senators that savings are not used for medicare, they go someplace else. that's not true. the medicare savings are being used for medicare. what are the savings? i think all senators would like to reduce waste. all senators agree there's too much waste in the current system. it makes good sense to try to attack that waste, root out that waste. and where there's overstaourbgs try to get the -- over expenditure, try to get the levels down to a reasonable

level. everybody knows that kphaeupbg is over -- we spend too many dollars for medicare advantage. that is why we're bringing that down. there is also waste, fraud in home health care agencies. in the state of florida, in one county in florida, 60% of the payments, extra money that goes for sicker patients was in one county. that county had 06% of the extra money. that is fraud. they rout out a lot of fraud. home health is very good. my mother is in home health right now. it works really well. reducing some of the overpayments. we're getting the waste out. and guess what? those savings, where do they go? they go back into medicare. let me repeat that again. they go back into medicare.

i don't know if any senator wants to open up his ears or her ears and hear that. they go back into medicare. and guess what? that's why the solvency of the medicare trust fund is extended. now, if these were so-called cuts we hear about on the other side were really cuts as implied by the other side, you'd think that would hurt medicare. you'd think that might reduce the period in which the trust fund will go insolvent. it would go insolvent at an earlier period. it's the opposite. these are savings in medicare which extend the life of medicare. please, please. i see my friend from iowa. i think he understands these medicare savings go into medicare. we're extending the solvency of the medicare trust fund. i see my friend from south dakota. i think he understands. he's sitting there and grinning at me now. i think he understands those savings go back into medicare and extend the solvency of the trust funds. let's make that very clear.

second, we're using some of the money to reduce part-b premiums. that helps seniors. if part-b premiums are reduced that helps seniors. by how much? $30 million over ten years. that will reduce seniors' part-b premiums. we're helping seniors, giving more dollars to seniors in this legislation. in addition, there are additional benefits for seniors in this legislation. we're starting to close the doughnut hole. that's really something seniors talk about in prescription drug benefits. they want that doughnut hole closed. after that, we are -- other benefits here, new preventive benefits under medicare. mammograms, preventive screening, colonoscopies, annual wellness visits, all new benefits. so i want to make it very, very, very clear here that it's not true when some senators say

you're taking money away from medicare and creating a whole new entitlement program. we're not taking money away from medicare and hurting seniors. we're reforming how dollars are paid, taking the waste out and extra excessive payments, and we're putting the savings back into medicare. back into medicare. back for seniors. back for beneficiaries. and also, this legislation says not one penny of guaranteed benefits will be cut here. not one penny will be cut here. please, please people understand that the savings here go to help seniors. more benefits, extend the solvency of the trust fund. that's what we're doing here. keep that one firm point in mind, then maybe we can address some of the next steps that are in this bill. but that's very, very important. madam president, i don't know how much time i have left.

the presiding officer: the senator has 16 seconds left. mr. baucus: i see the senator from minnesota anxiously sitting over in the corner. maybe we can give him a couple -- mr. franken: i do have the microphone, and i thank you for the 16 seconds. i've used it up. i yield my time. the presiding officer: the senator from wyoming. mr. enzi: i ask unanimous consent that a, an article that was discussed earlier and had some objection to it, but that objection has been resolved from from factcheck .org be published in the record. the presiding officer: without objection. mr. enzi: i yield five minutes to the senator from maine. the presiding officer: the senator from maine. ms. collins: thank you,

madam president. and i thank the kphaerpbg of the bill. madam president -- i thank the manager of the bill. madam president, i rise in support by the motion offered by my colleague from nebraska to recommit this bill in order to strike the more than $42 billion in cuts in the medicare home health benefit. madam president, you too come from a pretty rural state, so i know that you understand just how important home health care is to the seniors in our states. home health care has become an increasingly important part where -- of our health care system. the highly skilled services and compassionate care that our nation's home health agencies provide have helped to keep families together. they have enabled millions of our most frail and vulnerable

senior citizens to avoid hospitals and nursing homes, and instead to receive care just where they want to be: in the privacy, comfort and security of their own homes. moreover by helping these individuals to avoid more costly institutional care, home health saves medicare millions of dollars each year. and that's why i find it so frustrating and so ironic that once again the medicare home health benefit is under attack. the bill before us would cut payments to home health providers by more tha than $42 billion over the next 10 years. moreover, these cuts are a double whammy because they come

in addition to $7.5 billion worth of cuts that have been imposed by the centers for medicare and medicaid services through regulation. these cuts are particularly unfair and disproportionate for a program that costs medicare less than $16 billion a year. that is simply not right. and it's certainly not in the interest of our nation's seniors who rely on home health care in order to keep out of more expensive hospitals, nursing homes, and other institutions. madam president, the medicare home health benefit has already taken a larger hit in spending over the past 10 years than any other medicare benefit. in fact, home health is a share

of medicare spending -- as a share of medicare spending has dropped from 8.7% in 1997 to only 3.6% today. madam president, there was an excellent article in today's "new york times" talking about the disproportionate impact that this bill would have on home health care. as the author -- the reporter points out, under this legislation home care would be absorb a disproportionate amount of the cuts. it currently accounts for 3.7% of the medicare budget, but would require to absorb 10.2% of the savings from medicare under the house bill and 9.4% of savings under the senate bill.

madam president, that does not make sense. home health care has consistently proven to be a compassionate and cost-effective alternative to institutional care. and in rural states where home health providers have to travel long distances to deliver care, the impact of these cuts will ultimately fall on our seniors. because home health agencies simply will not be able to afford to serve seniors who are living in smaller communities off rural roads in isolated parts of our states. these deep cuts are completely counterproductive to our efforts to control overall health care

costs. they also place the quality of home health services at risk, particularly given ever rising staffing, transportation and technology costs. madam president, as our nation faces the continuing challenges of caring for an aging population, now is not the time to be making such deep cuts in the medicare home health benefit. i urge support for the motion to recommit introduced by my friend and colleague from nebraska. thank you, madam president. mr. enzi: how many time do we have left? the presiding officer: the minority time has expired.

mr. enzi: thank you. the senator from montana. mr. baucus: notice the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

we -- you can't have a debate like this and throw things around. facts are stubborn things. we're entitled to our own opinions. we're not entitled to our own facts. you cannot stand up here and say this doesn't and wave your arms

and say this doesn't extend medicare one minute -- one day when the actuary from medicare says it -- the bill extends it for five years. i yield the floor. the presiding officer: the senator has no time. mr. enzi: madam president, the agreement was whatever time he took, our side would get. the presiding officer: the senator would then have two minutes. mr. enzi: thank you. madam president, first thing i'd like to do is mention some of these things are facts. particularly if you go to specific situations. in wyoming our home health care is a specific situation and we've had letters pouring in. and i have one here from the home health care alliance from

wyoming and i would ask unanimous consent that it be part of the record. the presiding officer: without objection. mr. enzi: it says over the past 10 years the medicare home health benefit has taken the largest hit in spending reductions than any other benefit as home health has become an increasingly important part of our health system with highly skilled an complex services that enable millions of senior citizens and disabled americans to avoid being hospitalized or admitted to nursing homes. these home health services save medicare millions each year. i believe further he reduction in the home health would put the home health services at risk. i urge you to oppose the cut in home health dollars in medicare agency to the nation. and the "new york times" today pointed out in the reid bill -- quote -- "home care would absorb a disproportionate share of the cuts. it accounts for 3.7% of the medicare budget but would account for 9.4% of the cuts in the senate bill according to the

congressional budget office." end quote from "the new york times". the last time congress made similar cuts in a balanced budget act of 1997, allowed 15% of home health agencies end their participation in medicare. there's a history on this that shows if we do what we're talking about doing, we will put people out of business and put an end to services to seniors and the more rural -- mr. baucus: would my friend from wyoming be allowed to be interrupted so that senators know what votes will be interrupted and continue? mr. enzi: sure. mr. baucus: i ask unanimous consent that with it be in order that senator kerry to recognize the majority side by side to the johanns motion that the senate proceed to a vote in relation to the kerry amendment. that upon disposition of the kerry amendment the senate proceed to a vote in relation to the johanns motion. that no amendments be in order -- upon disposition of these

above referenced motions, the leader's designee be recognized to call up an amendment related to the lincoln amendment. on sunday, december 6, after the senate resummed consideration of h.r. 3590, the time until 3:15 p.m. be for debate for lincoln amendment 2105 and the republican amendment identified above with the time on sunday with the time equally divided and controlled with senators permitted to speak 10 minutes each. upon disposition of amendment 2509, that the senate proceed to vote on it the republican amendment to the lincoln amendment, that all of the votes be to a 6 60-vote threshold and if it is achieved they be agreed to and the motion to reconsider be laid on the table. if they do not achieve the threshold they be withdrawn. prior to the second votes covered in this agreement there be two minutes of debate after the first vote -- that after the

first vote each succeeding vote covered here be limited to 10 minutes each, no further motion be in order except for the motion in order for the above respected referenced motion in order. the presiding officer: is there objection? mr. mcconnell: madam president? the presiding officer: the republican leader. mr. mcconnell: reserving right to object. and i will not be objecting. i want to make clear that the majority leader and i will have four votes tomorrow. not just two. four. bearing that in mind, i do not object. the presiding officer: without objection, so ordered. mr. baucus: i might say reserving the right to object on this side, that's our standing on this side as well. madam president? the presiding officer: the senator from montana. mr. baucus: i call up the kerry amendment at the desk and ask for the yeas and nays. the presiding officer: the clerk will report. the clerk: the senator from montana, mr. baucus for mr. kerry proposes amendment

number 2926. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll. vote:

vote: