young and take care of our elderly. our social safety net. here's the former reagan economic advisor mr. bruce bartlett. former reagan economic advisor. here's what he said. of "distributionly,ally, the -- distributionally the ryan plan is a phopb -- monstrosity. the rich would receive huge tax cuts while the social safety net would be shredded to pay for them. shredded to pay for them." again, youdon't have to take th. i think the bishops had something to say about that. when the bishops said "the ryan budget fails the moral test." "the nation's catholic bishops reiterated their demand that the federal budget protect the poor and said the g.o.p. measure 'fails to meet these moral

criteria'." the ryan budget -- the ryan budget. well, mr. president, a centerpiece of the ryan budget again is its promise to repeal the affordable care act. obamacare, they want to repeal that. well, again, once you get pass past this political -- past this political theater and look at what the repeal of the obamacare would mean, not a pretty picture. it would reopen the drug doughnut hole, requiring seniors to pay about $600 more per year on average for prescription drugs. thanks to the affordable care act, obamacare, about 86 million americans received at least one free preventive service in 2011,

and almost one million ayatollahians received at least one free preventive service in 2011. that would be repealed. that would be repealed. then they would be charged. americans now get services like mammograms, colonoscopies, other cancer screenings. as i said, morse than 85 million -- 86 million americans received free preventive services. this is in keeping with obamacare's goal this changes from a sick-care society to a health care society. rather than focusing all of our attention and money on emergency room care or on when people get the sickest, we start to move it more up front to preventive care. getting people early, preventing illness, keeping people eliminatey and out of the hospital -- keeping people healthy and out of the hospital in the first place. the ryan budget shreds all that.

back to the old system we've already had: no preventive care. when you get sick, go to the hospital, go to the emergency room. that's busting us as a country. it's breaking our budget. we've got to put more into prevention. yes, mr. president, your mother was right, an ounce of prevention is wounds worth a pf cure. i don't know why we haven't learned that? well, we did learn that. we put that in obamacare. now the ryan budget says, no, we want to get rid of that. repeal of obamacare would allow insurance companies to deny people coverage because of a preexisting condition. nearly half of americans have some form of a preexisting health condition, and the aaffordable care act right now covers all children and in 2014, just one year and three months from now -- actually, a little

over two months from now -- everyone, everyone, will be covered, even if they have a preexisting condition. this is eleanor pierce from cedar falls, iowa, denied heth insurance when she lost her job because of her preexisting condition. high blood pressure. without coverage, she racked up $60,000 in medical debts. so, the repeal of obamacare, more than 30 million people would be denied access to affordable and comprehensive health insurance, would make insured americans pay more than tens of billions of dollars of uncompensated care when they show up in emergency rooms, and actually repealing obamacare would cost american families an average of over $1,100 in annual premiums that we're paying right now for uncompensated care when people shop in the emergency room. -- show up in the emergency

room. repeal would kick more than 3 million crunk people off their parents' policy. that hurt people like emily schlichting, a young woman in omaha. she said, "young people are the fume of this country and we are the most affected by reform -- we're the generation that is most uninsured. we need the affordable care act because it is literally an investment in the future of this country." with she suffers from a rare autoimmune disorder that in the bad, old days made her uninsurable. thanks to the obamacare, she is ease now covered under her parents policy until she's age 26. guess what? she'll be there next year in 2014 and then her preexisting condition will mean nothing. she'll be able to get affordable health insurance. the ryan budget says sorry, emily, sorry, you're on your

own. you're just on your own. well, these are just a few of the ways in which the ryan plan to repeal obamacare would drag us backwards, backwards. to the bad old days when the insurance companies were in the driver's seat, millions of americans were one illness away from bankruptcy. now, over the last few weeks, governor romney and representative ryan have been saying that the president's health reform robs medicare, robs it. i heard that he said that in florida last night. mr. president, i don't know how else to say this, but that's just totally false. that's untrue. first, nonpartisan economists have certified that the president's health care plan, obamacare, has strengthened the medicare program, extends its

solvency by eight years. if we were robbing the medicare program, how could it extend its solvency by eight more years i? the affordable care act doesn't rob makers it makes the program more efficient, more reliable. it saves $700 billion, not from beneficiaries, not from recipients who are on medicare, but from overpayments to private insurance companies, providers, pharmaceuticals, cracking down on fraud, waste, and abuse. and now what's really interesting is that the ryan budget has exactly the same savings in his budget as obamacare has in his plan, in the plan that we passed here. the same, exact, to the dollar,

written the same way. as president clinton said, you know, you got to give him one thing; it takes some brass to attack a guy for doing what you did. ryan put in his budget exactly what we had in obamacare, and now they're attacking president obama for what they have in their budget. go figure. go figure. and both of his budget proposals -- in both of his budget proposals, mr. ryan keeps all of the affordable care act's medicare improvements. but i just heard mr. romney in florida attacking president obama for doing what mr. romney said was marvelous about mr. ryan's budget. in short, mr. president, mr. ryan's medicare plan would end medicare, and this -- there's seelings tha something i

hear them say all the time. they say that they're going to protect everyone over age 55. under the ryan plan, he says, well, they're going to go to this voucher care, but anyone over age 55, they're protected. i got to ask, protected from what? i mean, if it is such a good deal, ha why don't we do it for everybody? yet, mr. ryan and mr. romney say, no, no, they're going to -- everyone over age 55 stays -- they all have the same medicare system, they don't get voucher care. iit is only under age 5. well, there must be something wrong with it then. if it's so darn good, why don't you put everybody in there right away? or, conversely, if you're protecting everyone over age 55, why don't you protect everyone under age 55?

got it? if you're age 55 and under, you're unprotected, you're voucher-care. that's the dirty little secret they're not telling you. well, again, by repealing -- by repealing the affordable care act, obamacare, 439,000 ayatollah seniors will be forced into these vouchers, 60,000 iowa seniors will be forced back into the doughnut hole paying more for their drugs. and 400,000 iowa seniors would pay more for preventive services that they now get at no cost. more than 30 million people, more than 30 million people would be denied coverage under the ryeian budget. -- the ryan budget. obamacare ensures more than 94% of all men's. that's what would happen. they would be denied coverage. the bottom line, mr. president -- and i'll close with this --

president obama -- obamacare, protects medicare. keeps it solvent. keeps everyone covered. the ryan budget shreds the social safety net for medicaid and destroys medicare by turning it into a voucher system. obamacare protects americans from insurance company abuses, expands coverage, increases the quality of care, shifts more into prevention and keeping people healthy. the ryan budget does away with all that. and it drags us backward to the bad old days. mr. president, when you look at the ryan budget, the romney-ryan budget, since mr. romney called it "marvelous," when you looks at that, you just got to shake your head in disbelief. that they really would take

america back that far after we've come so far in covering people, getting rid o of preexisting condition clauses, taking off caps on lifetime coverage, if you have a serious illness o so you don't go bankrupt, making sure kids can stay on their parents' policies. we don't want to go back, mr. president. and that's why -- that's why this ryan budget must be totally defeated. mr. president, with that, i'd yield the floor. mr. akaka mr. sanders:man? the presiding officer: the senator vearmt. mr. sanders: i want to congratulate my colleague, senator harkin, for his remarks and i certainly agree with him. i want to just pick up perhaps, or amplify a point that senator harkin just made.

there was a remarkable storks a frightening story, in "the new york times" today. i don't know that people have digested it, but the headline is, "life expectancy shrinks for less educated whites in the united states." and let me quote -- generally speaking, the trend for life expectancy in the united states and all over the world has been going up. and the goal of a good society and a strong health care system is to see that people live longer, healthier, happier lives. but as a result of the devastating attacks in a variety of ways on the working class of this country over a period of years, over a period of years, not just starting yesterday, this is where we are. let me quote from this article, and i hope people hear this because this is really shocking stuff. and i quote:

"the steepest declines in life expectancy are for white women without a high school diploma who lost five years of life between 1990 and 2008." whose life expectancy went down by five years. this is astronomical. and going back to the article it says, "said jay oshanski, a public health professor at the public university of illinois in chicago and the lead investigator on the study published last month in 'health affairs,' "by i by 2008, duringn 18-year period, life expectancy for white women without a high school diploma declined by five years. white men lacking a high school

diploma lost three years of life. life expectancy for both blacks and hispanics of the same education level rose the dad --e data shows. but blacks over all do not live as long as whites while hispanics life longer than both whites and blacks." so let's digest what that means. i held as chairman of the subcommittee on aging and primary care, last year we held a hearing entitled "poverty as a death sentence." and what that hearing pointed out, that people who are in the top 20% live, as i recall, about six years longer than people in the bottom 20%. but what new evidence is suggesting is that people

without a high school degree, the least educated people in america, often the poorest people in america are now seeing both women and men a significant decline in their life expectancy moving in exactly the wrong direction. now, the authors of the study are not exactly sure why this is taking place. many low-income, uneducated people are using drugs, cutting short their lives. health care, lack of health care is certainly one of the reasons. more and more low-income people can't access health care. which is why it is so important that we defeat the obama-ryan effort to devastate, as senator harkin just said, medicaid and throw millions and millions of people off of health insurance.

if life expectancy for low-income people is now going down, think of what it will mean if we throw millions more off of medicaid. it is a death sentence. mr. president, i also want to say a word on the issue of social security and i want thank you and senators whitehouse and senators begich for joining me yesterday and in releasing a letter which had 29 signatures on it for members of the united states senate, and that letter was pretty simple. what it said is that social security has not added a nickel to the deficit because social security, of course, is funded by the payroll tax and it said that social security has a $2.7 trillion surplus, can pay out all benefits to eligible americans for the next 21 years. so that it is absolutely wrong

and bad public policy to be talking about cutting social security within the context of deficit reduction when social security has nothing to do with the deficit. the reason that we are in a deficit situation today in a significant way, the reason that we have gone a very long way in the wrong direction since january, 2001, when bill clinton left office with a $236 billion surplus, has nothing to do with social security. it has everything to do with bush and those people who voted for two wars and forgot to pay for them, added it to the deficit. those people who gave huge tax breaks, much of it going to the richest people in this country, forgot to pay for it, passed the medicare part d prescription drug program, 23er got to -- forgot to pay for it and a recession called by wall street which resulted in lower revenue

coming into the federal government. those are the reasons why we're in a deficit, not because of social security. and what concerns me, mr. president, is that four years ago -- i understand republicans want to cut social security. that's what they do. they're not very sympathetic to social security, have opposed social security for years, don't believe that government should be involved in retirement security, want to balance the budget on the backs of the elderly, the sick, the children, the poor, give tax breaks to the rich. i understand that. more and more americans understand that. but i'll tell you what i am concerned about, mr. president. i am concerned about president obama. four years ago, the president was very, very clear on this issue. and when the president was running for election against senator mccain, this is what he told aarp, ironically he just spoke to oorn, i believe it was today.

so four years ago, same venue. this is what he said four years ago. john mccain's campaign has suggested that the best answer for the growing pressures on social security might be to cut cost of living adjustments or raise the retirement age. let me be clear, i will not do either, end of quote, candidate president obama four years ago. well, president obama is in the white house now. we have people like billionaire pete peterson, who has been pushing deficit reduction on the backs of working people for years now spending huge amounts of money to make sure we do deficit reduction not by asking the wealthiest people in this country to pay their fair share but balancing it on the backs of the elderly, the children, the sick, and the poor. these guys have come up with a strategy called the chained

c.p.i. nobody in america outside of capitol hill knows what the chain c.p.i. is. and what it is a new formulation as to how we determine cost of living adjustments, colas, for seniors. and with these -- what these economists have decided, these right-wing economists have decided, colas today are formulated in a way that are too generous, too generous for american seniors and for disabled veterans. and they want to reformulate how we come up with these colas. if they get their way -- and i have a great deal of fear that unless some of us stop them, unless the american people stop them, they will in fact get their way. what this will mean if is if you are 65 years of age today, by the time you're 75, you'll lose about $560 a year in your benefits. and if you're 65 years of age

today, in 20 years when you're 85, you lose a thousand dollars a year. let me be very clear. i do not believe you should move to a deficit reduction on the backs of a senior citizen living on $14,000 or $15,000 a year and take $1,000 away from them and then get on the floor of the senate and talk about how we have to give more tax breaks to billionaires. i think that is not only morally inexcusable, i think it is bad economics. bad economics. and what we're talking about in this so-called chain c.p.i. which will cut benefits for seniors, you're also talking about cutting v.a. benefits for disabled veterans. so i want to hear all these tough guys here who think we should balance the budget on the backs of the elderly and

children, let them get up here and tell us why you think when somebody fought in a war to defend the united states, maybe they lost their legs or their eyes or their arms, you want to cut their benefits and give tax breaks to billionaires. well, the american people don't want to do that. so i think we've got to get on the phones right now, we've got to call our senators and we've got to call members of the house and we have got to call president obama. mr. president, four years ago you told us you weren't going to cut social security. is that still your position? four years ago, you came up with an idea that is, in fact, exactly the right idea. you made the point that multimillionaires are contributing the same amount of money into the social security trust fund as somebody making $110,000. and four years ago you made the point that if we lift that cap -- and you don't have to start at 110. you go up to 250.

you lift that cap above $250,000, you can bring in enough revenue to fund social security for the next 75 years. that was your position, mr. president, four years ago, is that your position today? are you going to stand up to the republicans and the wall street folks who want us to cut social security? that is where we are right now. last point that i want to make. i want to comment on the much-discussed remarks that governor romney made that were released recently in that video that has gone all over the internet. and there's a lot that can be said about it and i suspect everybody has said a lot that can be said about it. i just want to pick up on one point, and maybe -- i feel strongly about this point, mr. president, because i am the son of working -- a working-class family, of a

father who never made a lot of money but worked hard his entire life and of a mother who raised her kids as best she could. so i take this kind of personally. and this is what mr. romney said. in connection with the famous 47% of the people who don't pay taxes. which is not really true, of course, as we know they pay social security and gasoline taxes, medicare taxes but be that as it may, that's not the issue i want to get to. this is what he said. mr. romney says "my job is not to worry about those people. i'll never convince them they should take personal responsibility and care for their lives" -- end of quote. let me repeat that. "i will never convince them that they should take personal responsibility and dare care for their lives" -- end of quote. well, he was talking about my parents. he was talking about the parents

of millions of people who worked hard their whole lives and don't need advice from a multimillionaire who went to elite schools and had all the money and privileges that his family could provide him, we don't need advice from him to families who have worked and struggled their whole whole lives to, in fact, take personal responsibility to make sure that their kids did well. that is an incredibly arrogant statement from a guy surrounded by money, speaking to millionaires, who should not be making that statement. people on social security today, people on medicare in many cases have worked their entire lives, have done the best that they can to provide for their kids, have seen their kids go to college, many of the people on social security, medicare have fought in wars defending this country.

they do not need advice from a multimillionaire about how they should take personal responsibility for their lives. that is an insulting remark and it would become governor romney really to apologize for that remark. and with that, mr. president, i would yield the floor. mr. hatch: mr. president? the presiding officer: the senator from utah. mr. hatch: i'm going to ask how much time i have. the presiding officer: there's no controlled time. you have as much time as you like for now anyway. mr. hatch: mr. president, i have to say i always enjoy my colleague from vermont. he's a very sincere, dedicated man. and i like him. no use kidding about it, can't help but like him in my eyes but i don't know any senator in this body, republican senator who wants to cut social security.

we want to save social security. i don't know anybody who really wants to cut medicare and medicaid. we want to save medicare and medicaid. and everybody in their right mind who looks at this knows that we've got to do some things and change some things or we're not going to have medicaid and medicare for our people and we're not going to have social security continue. it's in better shape than medicaid and medicare. it's only $18 trillion in unfunded liability where medicaid and medicare are around $38.5 trillion. at least medicare is and medicaid is almost that bad. so, you know, and with regard to -- with regard to mitt romney, yes, he was inare articulate. there's no way in this world that mitt romney meant his comments to be taken the way that have been taken by the left in this country. all he's saying is look, there are too many people riding in

the wagon, not enough people pulling the wagon and we're going to have to get jobs for those who should be outside the wagon pulling the wagon and help them to have the self-esteem that comes from working. that's that what the whole welfare bill of 1996 was all about. and having a work requirement. we're going to help you, we're going to subsidize you, give you job training, but at the end of a certain period of time if you don't have a job, you're off the dole. and that's just -- and literally two-thirds, almost two-thirds of the people have been on the dole, some for generations, went to work. now, that's the republican approach to get people back to work. to get this economy moving again. and not particularly to hurt anybody. and so you can exaggerate these things to pint where sometimes sometimes -- point where sometimes it becomes confusing

to the american people and that's not right, either. i know mitt romney. i know how he cares for people. i know what he did when he was a bishop in the l.d.s. church, the church of jesus christ of latter day saints. i was a bishop when i was running for senate and i've got to tell you, i spent at least 30 hours a week at my own time and expense because there is no paid clergy in the l.d.s. faith other than the general authorities. those are very few people. and we all volunteer our time. but help, we help people from every walk of life. now, i'm here today to talk about some very important things that are related to what i've just been saying. mr. president, there's been much discussion by president obama about the source of our current economic and fiscal challenges. the president seems to suggest that we could easily return to the prosperity of the 1990's by adopting the policies of president clinton.

particularly by raising taxes to the level they were at during his presidency. at the recent democrat national convention president clinton himself made a similar argument. but the positive and economic and fiscal history of the 1990's was not owing to higher tax rates and the economic and fiscal calings that we face today, in particular, are $16 -- fiscal challenges that we pace today in particular are $16 ril yon national debt, and exploding entitlement spending programs, cannot be fixed by higher tax rates. during his convention speech, president clinton claimed that president obama inherited a damaged economy. put a floor under the crash, began the road to recovery and laid the foundation for a modern, well-balanced economy. tell that to the 12.5 unemploy unemployed -- 12.5 million unemployed americans who continue to struggle with unemployment. explain to americans how redistribution, massive expansion of refundable tax

credits, balloon transfer payments, and an interventionist federal reserve represent a foundation for future growth of the economy. explain how this economy is -- quote -- "well-balanced" when government spending represents as much as 25% of g.d.p., debt is higher than the entire year's worth of the output of the economy, and we have an activist federal reserve which has increased its balance sheet by well over $1 trillion? president obama does admit that we are not where we need to be. so instead, he asks whether we are better off than when he took office. and he answers in the affirmative. putting aside the rhetoric and spin and considering the facts this is a dubious claim, at best. relative to the beginning of 2009, when president obama took office, jobs are down by 261,000 and unemployment remains above 8%. but, wait. democrats say the president cannot be held responsible for bad things that happened during

his presidency. those things were inherited or due to europe or caused by uncontrollable forces. all right then. let's look at the president's jobs record after the end of the recession, which the national bureau of economic research says was june of 2009. since then, job growth under president obama has been only 73,600 jobs per month, on average, far too weak to move the unemployment rate below 8%. democrats say the only reason we don't have more jobs is because republicans will not agree to more keynesian stimulus. never mind that the previous dose which cost over $800 billion and was promised to deliver unemployment below 8%, failed to get unemployment down. remember those promised shovel-ready jobs that became a source of amusement to the president. remember the promised infrastructure. americans should ask themselves where all those things are. where are the jobs?

well, the president makes claims of saving millions of jobs because of stimulus magic, the federal reserve claims millions of jobs saved from its so-called quantitative easing. there you have it. the president's foundation of well-balanced economic growth rests on debt-financed keynesian stimulus and federal reserve stimulus. absent anything but a dismal record on jobs, president obama has decided to run on president clinton's record. so let's consider president clinton's rose-colored nostalgia. a revisionist history adopted by president clinton -- or president obama and his surrogates. president clinton's view goes like this. i came into office with a weak economy. i raised taxes. the economy boomed. president clinton's depiction of the roaring 1990's is missing a few chapters. in his first years in office, democrats controlled congress. he and the democrats raised income taxes and gas taxes. he tried to impose a b.t.u.

energy tax, attempted a government takeover of health care known as hillary-care, and proposed a $31 billion stimulus while putting off welfare refo reform. the first few years of the clinton presidency can fairly be characterized as prioritizing tax-and-spend economic policy. but hillary-care failed and american voters decided to make some changes. they faced uncertainty over taxes, health care, energy costs, deficits and runaway government spending. after two years of complete democrat control of washington, american voters decided in 1994 that republican control of the senate and house was desirable. does this sound familiar? a new democrat in the white house, complete democrat control of congress, prioritizing higher taxes, a government takeover of the nation's health care system, and more spending? followed by a popular uprising

that gave some republican balance in congress, the first republican congress in over 40 years. but in contrast to president obama's refusal to heed the message of the 2010 election, president clinton listened to the american people and moved to the political center. he embraced a republican goal of a balanced budget and after two vetoes signed g.o.p. welfare reform legislation shortly before the 1996 election. in 1996, president clinton was reelected but republicans retained control of congress. now, president obama claims that these were the good ole days because president clinton raised taxes. let's consider that tax landscape. president clinton did raise the top income tax rate in 1993 and democrats credit that increase with shrinking the deficit and unleashing future economic growth. however, he -- he also agreed with republicans in 1997 to cut the capital gains tax rate to

20% from 28%, which contributed to revenue and economic growth. i know because it was the hatch-lieberman bill that they followed in doing that. joe lieberman had the guts to stand up on that issue, as did i. and it happened. the democrats said we would lose revenues. the revenues tripled. because people didn't feel gouged anymore. funny how that chapter gets left out of the democrats' 1990 story. in 2000, president clinton left office with federal seats -- fel receipts measuring 20.6% of g.d.p., well above the 17.5% seen in 1992, before he took office. but those receipts were boosted by capital gains realizations associated with the internet stock bubble that formed toward the end of the clinton presidency. even more notable and something the democrats do not discuss in relation to the clinton presidency is that he left office with federal outlays

measuring 18.2% of g.d.p., significantly below the 22.1% seen in 1992, before clinton took office. significant reductions in federal outlays as a share of g.d.p. occurred once republicans gained control of the congress. in contrast, president obama has preside over the largest spending spree since world war ii with outlays as high as 25.2% of the entire economy. something that hasn't happened since the height of world war ii, when the federal government almost took over the economy. in his 1996 state of the union speech, president clinton took credit for budget improvements and spending restraint imposed by republicans in congress. he famously stated that the era of big government is over. but in a nod to the republicans' role in containing the budget, in that same speech he said -- quote -- "i compliment the

republican leadership and membership for the energy and determination you have brought to this task of balancing the budget." compare that to the sentiment of president obama when we tried it their way and it didn't work. president obama and those democrats who embrace the history of the 1990's also conveniently neglect to give any credit to ronald reagan, whose ending of the cold war led to a peace dividend which helped president clinton to curtail growth in federal defense outlays. in summary, the democratic nostalgia for the 1990's is based on a very limited recollection of events. they see the clinton -- see that clinton raised taxes, the economy grew and the budget improved. apparently, correlation is all that is necessary to establish causality in their world, particularly when it works in their favor. what also gets left out of the standard democratic history is the stock price bubble that was actually the basis of much of the growth in the 1990's.

so, mr. president, let's consider the clinton bubble further and ask what it could possibly mean for the recent financial crisis. one of the charges levied by president clinton which echoes a familiar democrat talking point is that americans should be wary of republicans because we champion deregulation that -- quote -- "got us into this mess." but who generated the mess? the mess was a devastating financial crisis. and who sowed the seeds of that crisis? first consider the significant financial deregulation under the bush administration. the fact is, there wasn't any. so where did the deregulation in finance come from? whose policies promoted financial markets prone to bubbles and irrational exuberance and bailouts? it was under president clinton's watch that warnings were ignored about riskiness of derivatives. it was uer his watch that risky derivatives led to the

collapse of the hedge fund long-term capital management or ltcm, and to an event bailout arranged by the fed. it was under his watch that the fed left market participants with a belief that stlud be significant market turbulence -- should there be significant market turbulence, the fed would be there to bail them out. it was under his watch that the gramm-leach-bliley act was signed into law, repealing part of the glass-steagall act of 1933. and aand as a basis for strong, fundamental growth in the economy, president clinton's stock bubble was lacking and numerous companies crashed. a bursting stock bubble along with corporate accounting scandals, which included the enron debacle, left a mess for president bush, who, by the way, didn't whine about it for four straight years. it was under president clinton's watch that significant growth began in risky, subprime mortgage lending which ended up at the heart of the recent financial crisis and warnings were ignored. even the warning by the "new york times" in the late 1990's.

his presidency pushed financial deregulation and it showed inattention to the beginnings of speculative excesses in housing and mortgage markets. the financial crisis was, indeed, severe and seeds of the crisis were sown during president clinton's presidency and then nurtured by many years of regulatory inattention. to say that republican deregulation caused the recent crisis is simply false. mr. president, we have faced crises before. president obama is not unique in this respect. what is unique is how poorly he has handled our economic and fiscal crisis. in february 2009, president obama said that his presidency would be a -- quote -- "one-term proposition" if the economy did not recover within three years. well, it has been over three years and the economy has not recovered. therefore, by the president's own metric, his administration should be a one-time propositi proposition. no, he wants four more years to

do more of the same. mr. president, the president has no plan. i get a kick how the media is already badgering romney about "where's your plan" when he wrote no apology and plenty of his plan is in there. he's -- he's more than expressed a plan. now, the president claims to want to get our deficit under control by raising taxes on the wealthy and keeping the tax burden on middle-class americans where it is. but the president's tax proposals don't work, as we learned from his buffett tax, which fell over $800 billion short of his plan to use the tax to pay for a long-term alternative minimum tax patch. the unpleasant fact facing the president is that there simply isn't enough revenue from taxing the so-called rich to fill his desires of permanently larger government. taxing business owners who the president thinks are undeserving of their success will simply not

pay for his redistributionist dreams. of course, contrary to obama's -- president obama's disdain for business, americans who own and operate businesses did build them and they also paid taxes which built the roads and bridges that they use. and make no mistake, business owners iowners and american word build america. mr. president, they did build that. now, mr. president, let me just go back just a little bit here. i made the comment with regard to all of this media criticism of -- of governor romney, that he was inarticulate in a private meeting where no press was invited. and he's the first to admit that. and he certainly has tried to

explain it since. but he's right. he's right. that there are at least 47% of americans who don't pay a nickel or a penny of income taxes. the standard answer by my friends on the other side, is "well, they pay payroll taxes." well, everybody does that. that's social security, basically. we all do that. but 23 million people get refundable tax credits are more than they pay in payroll taxes. and a little less than 16 million get refundable tax credits or a little bit more -- they get refundable tax credits that are more than they and their employers pay in payroll taxes. now, do republicans want to tax the truly poor? heavens, no. this is a great country. we can take care of the truly poor. the question is are all of those in the -- according to the joint tax law, 51% who do not pay a

penny of income taxes, are all of those in the truly poor category? the answer is no. what does governor romney mean? he means that, like i said at the beginning, there are too many people who are riding in the wagon and not enough pulling. it isn't their fault in many cases except there are millions who won't even look for a job now who are perfectly capable of holding a job. because they are discouraged, and i don't blame them with this economy. but they ought to be looking for jobs anyway. i would do anything if it was me. i would do anything to be able to support my family other than beyond the federal largess. but that's the way it is today. governor romney's goal in this life is to pull us out of this mess, get spending down to no more than 20% of the g.d.p. which would be a remarkable

downturn in spending compared to where we are today and also get people to work. get them to where they have the self-esteem that comes from working. that which we did on welfare reform in 1996. and i worked hard on that bill, as did so many others at that time. and given the self-esteem that comes from supporting themselves. that's what he meant. that's what is meant here. and frankly, let's just be honest. the mainstream media is not for governor romney. we all know that. anybody with brains knows that. all you have got to do is watch it. that's been the way it has been here ever since i have been in the congress. and frankly, they're not going to treat governor romney fairly. but i tell you this. mitt romney will put america to work. he knows how to do it. this man has been successful in everything he has ever undertaken to do. he doesn't need this job as

president, but he is running because he knows this country is in trouble. he knows it isn't following good economic practices. he knows that this administration is a disaster from a jobs standpoint, among other things. he could have the most lovely life, and he has taken this kind of unmitigateed crap and trying to do that which he knows is right for this country. i think we ought to be more fair in these presidential elections. i wish the media was split 50-50. it's not. everybody knows it. i care to differ with our friends in the media, but there is nobody with brains that doesn't understand that it's heavily -- especially the mainstream, here in washington, d.c., new york, los angeles, et cetera, is heavily stacked in favor of -- of president obama.

and i like president obama, too. i have known him as a senator, i have known him as a friend, and i have known him as a president, and what i'm saying here is that he hasn't done the job, i don't believe he's going to do the job, i don't think he has the background to do the job, and for us to not put somebody who does in there may be catastrophic for the future of our country. with that, mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from mississippi. mr. wicker: i ask unanimous consent that my friend from alabama and i be allowed to engage in a colloquy. the presiding officer: without objection. a senator: would the senator yield for a unanimous consent request? i ask unanimous consent that my full remarks be placed in the record at this point. the presiding officer: without objection. the senator from mississippi. mr. wicker: let me say from the outset that this senate is -- and this nation are profoundly fortunate to have had the services of senator orrin hatch

for decades and decades. the speech that he just delivered to this body was profound in so many ways and true in so many ways. it was made at 10 minutes until 6:00 on a friday night when perhaps americans are looking elsewhere, but just so much of what the senator said is absolutely the truth, and our country needs to hear it, and i appreciate him coming and delivering it in such a talented way. mr. hatch: if the senator would yield, i want to thank my friend and colleague. i really appreciate it. i enjoy serving with him, as i do with everybody in this body. mr. sessions: senator wicker just talked a fair minute about this. what do you think? wouldn't it be great to have the chairman of the finance committee named senator orrin hatch? mr. wicker: he well, -- well, it

would be, it would be. i think with the leadership of people like senator hatch, we would not be ignoring what we have out there facing us in america today, and that is nothing less than a financial crisis. and the senator from utah is correct, the president of the united states is doing everything he can to change the subject from that real central issue of our faltering economy, and yes the mainstream media is out there playing trivial pursuit and talking about everything that is not important and that is a distraction. but you just cannot get around the facts, and the facts are these. we have a $16 trillion staggering debt in this country, and this government has added

$6 trillion in three and a half short years. just a fact, and you can't get around it. you also cannot get around these absolute truths. we have had no appropriation bills come out of the senate this year. now, our republican friends in the house, it's a different story. they have done their work and they have passed product after product like they are supposed to do, and my hat is off to the chair, the gentleman from kentucky for chairman rogers for getting the appropriation bills done. we haven't done that in this democrat-led senate. we haven't passed a defense bill. first time in half a century that we will have gone through a whole session and not passed the defense bill at a time when we have troops at war, troops in harm's way. our men and women putting -- putting themselves at risk and fighting and dying. we don't have a defense bill.

mr. sessions: senator wicker, isn't it amazing that we don't have a defense bill. you serve on the armed services committee, as i do, and it came out of committee unanimously, bipartisan vote. and for some reason, the democratic leadership has failed to bring up the bill to the floor for the first time in 50 years. isn't that amazing? mr. wicker: no question about it. and it -- it does not -- it doesn't make me comfortable to point fingers, but there is no getting around the fact there is one person on this planet that can call a bill up before the senate, and that's the majority leader of the senate. he hasn't brought the defense bill. we also don't have a budget resolution. now, again, our friends in the house, the republican-led house under speaker boehner have during the two years of their stewardship brought budget resolutions to the floor, passed them, sent them over here only to be ignored.

now, the president has submitted budgets. didn't get a single haute in the house of representatives, didn't get a single vote when we called it up as sort of a test vote here in the senate, but this senate under the leadership of the democratic majority has not followed the statute. it says you bring a budget resolution up every year, haven't done it. we're into our fourth year now. but the senator and i were talking, and i'll toss it to him on this. beyond that, they don't have a budget deficit reduction plan. it's one thing to have a resolution that could say anything, but what the american people need, what our future generations are crying out for is a plan to reduce this debt, and i look forward and hope to see the day when my friend from

alabama is chairman of the senate budget committee, and i would just ask him to assure everyone within the sound of our voices today that under his leadership as chairman of the budget committee, we will see a budget resolution brought to the floor and debated according to statute. mr. sessions: senator wicker, you ask a very good question, and every american needs to be thinking about that, and i have given a lot of thought to it. we haven't had a budget in three years. 1,241 days we have not had a budget brought to the -- passed on this floor of the senate. we didn't even bring one up this year. if we are blessed by the american people, we, the republican senators, to have a majority in this body, and while i am honored to have the opportunity to lead the budget committee, we will have a budget.

failure is not an option. it cannot be that we will not comply with the law. but more than that, senator wicker, the question is we have got to have a plan to get us off the course to financial disaster. and the budget is the way you lay that plan out. and don't you agree that the difficulty our democrat colleagues had is, i suppose anything they thought they could agree on and bring forth would not be possible with the american people, and they didn't want to subject themselves to having to debate it on the floor and having to vote on amendments as the budget act allows even though it can pass a budget with the simple majority cannot be filibustered. and i ask you, senator wicker, when you don't bring a budget because you can't agree or are unwilling to step forward with the plan, what you are really doing is failing to provide the

leadership we were elected to give to america, and you don't have a plan that you are willing to announce to try to get us on the right course. a budget, wouldn't you agree, is sort of a plan to deal with the crisis that we are facing if we have not seen one in this body. mr. wicker: it's one of our basic responsibilities. as i said, the discretionary part of it is the appropriation bills. not one single appropriation bill has cleared this senate during 2012. and yes indeed, at a time when we are running the debt of $6 trillion, when we are seeing our friends and allies across the ocean teetering on the brink, we're seeing all the warning signs and we have time in this capitol, in this capital city, the shining city on a

hill, to be an example to the world, i could only answer your question by saying the president's budget was so unpopular it didn't get a single vote. there is not one single -- the most left-wing, left-leaning senator would not step forward and embrace that budget, and i can only assume that what they would have suggested would have been very much like that. but when you're in the majority, you have a responsibility to lead. we all have a responsibility to lead, mr. president. but in particular, when you are the only vehicle for bringing bills to the floor, you have a responsibility to lead in a time of crisis, and that's what we have been lacking here in the united states senate. of course we do have the federal reserve.

the leader of the federal reserve announced the other day he is going to print $40 billion extra each month. now, that's his solution. i would counsel against this. i think most members on this side would counsel against this, but at least as a plan. we have had no indication from the leaders of the senate whether they like that plan or not. we passed a surplus bill over here that cost almost a trillion dollars. unemployment has gone up. under this bill that was supposed to jump-start the economy, it was supposed to do two things -- jump-start the economy and keep the unemployment rate 8% or less. of course we know for 42 months now, the unemployment rate has been over 8%. and the last thing the surplus bill did was jump-start the economy. it has been going downhill ever

since. it's hard to put a pretty face on this situation. and of course, the result, a staggering 23 million american citizens either don't have a job, are underemployed or have stopped looking for work. in addition, of course, the president promised in 2008 -- you will remember that promise, senator sessions -- that he would cut the deficit in half by the end of his first term. this is the end of his first term. the deficit has mushroomed, not been cut in half. and so we're in a financial crisis, and everybody on television seems to be trying to paint a rosy picture and avoid the subject. so i am glad to join with my

friend, the budget ranking member to suggest that we will have a plan, as house republicans had a specific plan in black and white to address this unbelievable financial crisis that our country faces. mr. sessions: well, as a challenge, we have to face, it's not easy. it will be a challenge and difficult, force us to make difficult choices. but i feel, senator wicker, how -- i feel very frustrated. we were, small towns in america where we grew up. if you had a tough choice to make and somebody came up with an idea and stood up and defended it -rblgs you respected

them even if you didn't agree with it. if you didn't have a better plan and all you did was criticize their plan, people wouldn't think much of you, would they? that's the way real people live. what we've got in in body, when the budgets are brought up, they brought up the house budget, the ryan budget. we brought up the president's budget. senator toomey and others had a budget. every one of them were brought up. our democratic colleagues voted against every one of them. not in one instance setting out before the people what they believed in, what they would advocate for, what they would fight for, what they believe would fix the american economy and put us on the right track. and they have invested a tremendous amount of effort in attacking congressman ryan and the house's budget. and let me just say this about that budget. any budget is going to be subject to some complaint here or there. but it was historic. it would change the debt course

of america. it would reduce our deficit by $3.5 trillion. it would create economic growth, resigned not just to be a budget-cutting, frugal budget but to also try to create growth and prosperity in this country and get this country moving again and get businesses hiring again. it's an historic good budget that would change the debt course of america and put us on the right path. and all we've heard from our colleagues without anything themselves is criticism of him. and i believe that the house has, like you said, will fill their duty. mr. wicker: i tell you what else it would do, senator and mr. president, it would tell the truth to the american people about what we're facing. and i like what our young nominee for vice president said. we've got time to fix this, but we need to fix it, and we don't

have much time. and speaking of telling the truth, i'd like to pivot, if i could, to a question that has been raised on this floor in the last couple of days about this senate's lack of compliance with the budget act. there's not a more learned expert on the federal budget act of 1974 than my friend from alabama. and i will just ask him to clarify, if he would, the statements and misstatements and charges and counter charges that have been made about the fact that there has not been a budget resolution brought to this floor for consideration and amendment. mr. sessions: i thank senator wicker for raising this point, because we need to discuss it.

and the american people need to ask themselves who's telling the truth about this? who's accurate about this? because a group of us spoke, 40 or more republicans, expressed frustration with the lack of action in this body, the likes of which we've never seen perhaps in our history really with regard to not passing an appropriations bill, historic research has been done. we've not passed a single appropriations bill two times: 2010 and this year, both under this democratic leadership. the only time in history no appropriations bills ever been passed. but senator reid yesterday used this language. it kind of hurt my feelings because i said we didn't have a budget. i'm ranking member of the budget committee. maybe 10 or 15 republicans talked about not having a budget. he said "it's a lie to say we

don't have a budget." now i don't know if that violates the rules of the senate about personal attack, but i don't try not to use that word "lie." i try not to say my colleagues are lying. and if i ever would say something like that, i'd want to be sure i had absolute proof to back it up. and that's a responsibility -- we like harry reid. he can be so charming. and i consider him a friend; i really do. he's always treated me fairly on the floor. but i've got to tell you, the majority leader shouldn't have said that. first of all, it's not accurate. for example, senator reid announced unequivocally he had no intention of passing a budget. this is what he said back in,

last year. "there is no need to have a democratic budget, in my opinion." it's a statutory requirement. it doesn't say you'll go to jail if you don't pass one. and the people are crying out for a plan to get out of the financial condition we're in. he said there's no need to have one, in my opinion. and he went on to say at another time -- quote -- "it would be foolish for us to do a budget." foolish for us to do a budget. well -- and they did not do one. there is no budget. and for him to say it's a lie to say we don't have a budget is inaccurate. i would just point out, as the senator knows, that the budget act -- the united states code defines what a budget is.

it says some of the things, it has to be a part of the budget and the process for how one is produced, has to be in the committee by april 1. sets out the date, april 1. then you have to have a floor vote by april 15. and when it comes to the floor, the rule says you have unlimited amendments, 50 hours of debate, and debate ends. you can't filibuster it. 50 hours, about one week. it can be done. six, seven days at most. mr. wicker: it's the one thing that can't be filibustered. mr. sessions: absolutely. a party with a majority, 53 senators, ought to be able to pass a budget. we passed a budget with 50 senators. 51. 50, i think one time. so -- this is -- and a budget allows to you control everything but social security. you can't touch social security.

but you can deal with medicare, medicaid, food stamps, pensions, most any -- as well as a discretionary accounts. and so, that was all avoided. senator wicker, you've been around here and in the house for a number of years, but it seems to me it would have been a healthy thing indeed had we brought to the floor a budget, the democrats had even if i didn't agree with it, and then we had a national public debate about these difficult choices the nation faces, and we actually had senators having to vote on it. do you believe balancing the budget is worth cutting some spending here? how much taxes are you saying we ought to raise? how much do are you -- are you really cutting spending? and actually debating and voting

on these things. that's what the majority leader and his colleagues wanted to avoid. mr. wicker: it's what every city council, every state legislature cannot avoid. they don't have a printing press down in montgomery, alabama, or jackson, mississippi. and i know the senator has seen the local delegations, county officials coming in talking about economic development, and they tell me, senator, now we've had to cut back on this. we've had to cut back on that. we've had to do this to our budget. we used to be able to afford these things, and we can't afford them anymore. they have had made sensible decisions. councils and legislatures, republican and democrat have faced the hard choices, and it can't be any fun for them. they have to face the voters and

say we paid for this last year. we don't have the money this year. and families have had to do that, senator. mr. sessions: i couldn't agree more. just in my hometown -- mobile, alabama -- they voted, fell one vote short of raising the sales tax because of the financial challenges they were facing. and they had a big debate about it. but they didn't duck the vote. they had the vote. and they decided they didn't need to raise the taxes, but it wasn't a question of the city council being able to avoid a vote. but we in the great united states senate, we travel the whole state over and over and over again, and we asked for this tough job. you know, my wife got a good phrase about it. she says when i complain, don't blame me. you asked for the job. you know, we asked for this job.

nobody said it was going to be easy. and this is not easy, because we have never, roger, been in a more fundamental -- we've never faced a more fundamental financial crisis because of demographics in history and trends that are going on, and our population situation is such that it is going to be difficult to meet these challenges. mr. wicker: we can meet these challenges. i've got grown children -- 32, 28 and 25. they may be about to age into the next year. but they wonder if they'll even receive medicare when it comes time to retire. you know that retirement for them will come sooner than they think. it seems like forever. but they don't really believe, that generation doesn't really believe medicare will be there for them.

if we tackle this problem, medicare can be there for the next generation. should be there for the next generation. it won't look exactly like it does for my father who is 88 years old today and depends on medicare, but medicare could be there. but not the way it's going now. we've got to tackle these issues. mr. sessions: you are so right. we're not going to have to cancel these programs. we can save these programs. it's just going to require us to confront reality and make some changes in how we do business. i'd just like to say one more thing about this budget before i forget. my democratic colleagues claim the budget control act was a budget, but it only dealt with discretionary spending. it didn't deal with all the other spending. it only set limits on expenditures. and it didn't have any debate on the floor. it was a secret agreement. there was a budget limitation

placed on spending. the republicans insisting we had to reduce some spending before we would allow the president to raise the debt limit. and that went on into the wee hours of the morning and they put togd -- together a messed up bill and now we're paying the price for it. but it did cut some spending and it limited how much spending we could do. but it didn't go through the budget process. it didn't cover all the government programs. it doesn't have anything like the indices of a budget. and when -- attempt was made, and successfully, to bring up the president's budget for a vote. and the motion was believed to be legitimate because there's no budget, and we were going to have a vote on it. and our democratic colleagues ran to the parliamentarian to try to argue that this cap on spending that was agreed to last

august was a budget, and they picked the parliamentarian. the majority hires the parliamentarian and courageously and properly the parliamentarian said no, it's not a budget. there is no budget in the united states senate. and the, president obama's budget was brought up and got zero votes. so i just wanted to share that. mr. wicker: i appreciate the senator sharing this time with me. mr. president, i guess in a moment senator sessions will yield the floor. then we'll go dark subject to the call of the chair and vote at midnight to sort of slink out of town. no appropriations bill, no defense bill, no dealing with the sequestration, meat-ax cuts to defense and other programs. and -- but we will have gotten

away under cover of darkness to face the voters. and in this country, that's -- they're the ultimate arbiters. but i'd just -- i just appreciate this opportunity to stand on the floor with a statesman like my friend from alabama and to thank him for his leadership in the budget issues, and to thank him for coming here and telling the truth to our colleagues and to the american people today. mr. sessions: senator wicker, you know, senator olympia snowe, who is not running again, is frustrated with this body, pointed out yesterday on the floor that we voted in this body a few years ago up until november 1 or something. we act like we've got to be out by the middle of september. we aren't going to do any work during october, and we'll come back maybe after the election in a lame-duck circumstance and see

how much junk can be shoved through here without a real vote. and isn't it true that we've had plenty of time since september to bring up the defense authorization bill, to bring up a budget, to bring up some of the appropriations bills, at least some of them? mr. wicker: day after day, hour after hour in quorum calls. it's very frustrating. mr. sessions: and i'd just -- mr. wicker: frustrating to the people who sent us here do a job. mr. sessions: thank you. i would say one thing, mr. president. in a recent interview in july on cnbc with mr. erskine bowles, who was president clinton's chief of staff, appointed by president obama to head the debt commission, this is what he said about the state of our finances. you've heard it said that 40% of what we spend every day -- 40%

of that is borrowed, really $4 billion a day that we borrow, and you probably think that's not true. you probably think that can't be true, that 40 cents of every dollar that we spend, that we put out the door, has to be borrowed from countries around the world and from others who will loan us the money and we pay interest on it. this is what mr. bowles said. "if you take last year, 100% of our revenue came -- that came into the country, every nickel, every single dollar that came into the country last year was spent on what we call 'mandatory spendinspending' and 'interest e debt.' medicare, medicaid, and social security, the entitlement programs. what that means, every single dollar we spend last year an these two years, national defense, homeland security,

education, infrastructure, high-value-added research, every single dollar was borrowed." "and half of it was borrowed from foreign countries. that is crazy, crazy. it is a formula for failure in any organization." close quote. that's the man president obama chose to head the debt commission. a businessman who understands the threat this nation faces. we can get off this path. congressman ryan laid out a plan that would get us off this path. we have to get off this pasmgh . and as we head out from this senate to return to our states and visit with our constituents, and as we head into an election, i just would like to ask, is there one senator on the other side of the aisle who can defend

to the good people of this country the decision of this body to withhold a budget, withhold a financial plan from the country? can you defend that? can you defend not even attempting to do the fundamental requirement of congress, which is to appropriate the money to run the government, not even bring up a single bill for the second time in the history of the republic? and what about the defense authorization bill? came out of our armed services committee unanimously -- unanimously -- being refused to be brought up. the leadership has refused to bring it up on the floor. can you defend that? really, can you defend failing to deal with the fiscal cliff, the deep defense cuts and huge tax increases that will occur

january 1? wouldn't the economy be better if that uncertainty had been removed and we'd already been brought those bills up and voted on nowvment instead of -- you know how they're going do it? the leadership will meet over here and it will be december 23, the majority leader said we may be here until december 23. that's when they'll bring it all up. that's when the health care bill was passed. that's when -- christmas eve is when the health care bill was passed. so that' that's the kind of a p. bring it up at the end, everybody will have to vote for t the government will shut down and there will be a disaster. that's the kind of thing that i'm avoiding. i really bleive that the planks chaff -- i really believe that the complaints that have been made here today are not just political rhetoric, not just talktalk, but represent a legitimate, honest criticism on the leadership of the senate and i think the american people

should weigh that as they go to the polls. i thank the chair and would yield the floor. the presiding officer: the clerk will call the roll. quorum call: nor senator mr. president? the presiding officer: the senator from montana. mr. tester: are we in a quorum call? the presiding officer: we are. mr. tester: i ask that the quorum call be vitiated. the presiding officer: without objection. mr. tester: i ask that the senate recess until 11:30 p.m. today. the presiding officer: without objection. the senate stands in recess

to crack down on china when they cheat. then manipulate their currency. [applause] they still peasants and designs, have counterfeit goods demand and know they want to be irresponsible partner in the world of trade and commerce. they're going to have to understand, they can't take away jobs in an unfair basis. >> money investing in companies that uprooted from here and went to china. pioneers. now, you cannot stand up to china. all you have done is said to us in the march jobs. >> the campaign's new to the november elections. the first debate on domestic

issues will take place wednesday , october 3rd. audience members will get their chance to ask questions at a town hl debate on tuesday, the 16th. the final debate on foreign policy will take place the 22nd. also, what's the single vice-presidential candidate thursday, the 11th. follow coverage on c-span, c-span radio, an online at c-span.org. >> the medicare advantage program offers seniors health insurance that is administered by private companies. the affordable care act reduces payments to private insurers. congressman this morning the chaired the subcommittee meeting. one hour and 15 minutes. >> expected to come in the interest of time, and to insure we hear the witness testimony i ask unanimous consent that my opening statement be made part of the record without objection so ordered. i would also ask that we do,

that if we do get interrupted by votes i ask the members to return so that we can finish questions. also, before i recognize ranking member for the purposes of an opening statement, ask unanimous consent that all members written statements must be included in the record without objection so ordered. i now recognize ranking never start for five minutes for the purpose of his opening statement >> chairman, i asked my opening statement be made part of the record. >> without objection, so ordered. today we are joined by six witnesses, james cosgrove, director of the health care group at the government accountability of this. tim to prajna, fellow of the ethics and public policy center, karen, president and chief executive officer of america's health insurance plan.

dr. tim schwann, medical director of scan health plan. chief executive officer of medical associates of viola and marcia cold, senior fellow at mathematics policy research. mr. cosgrove, you are now recognized for five minutes. >> good morning, chairman, ranking member, members of the subcommittee. i am pleased to be here today as you discuss medicare advantage and gas plans which offer medicare beneficiaries an alternative to the fee-for-service program. for many years private health plans have played an important role. currently 13 million medicare beneficiaries, more than one out of every four receive health care from such plants. today i would like to discuss our recent work in three areas related to medicare health plans. let me start by summarizing our work on body plant -- quality

payments. foster high quality health care by paying bonuses to plans that achieve the very highest quality rating. more stars on the cms five star quality scale. however, and said in implementing these provisions they implement the quality bonus payment demonstration. this demonstration makes plans of average quality of the eligible for bonuses, increases bonus amounts and accelerates the phase in a bonuses. the cost of the demonstration is expected to exceed $8 billion about that as at least seven times larger than that of any other medicare demonstration conducted since 1995 how to read the bonuses are expected to offset 70 percent of the payment reductions for plans this year and about one-third of the reductions next year. the to the design of that administration most of the bonuses are paid plans of average quality. the intention is to testify that

the administration approach would encourage plans to more rapidly about water quality improvements. however, we believe serious shortcomings cast doubt on the ability to produce meaningful results. in march we recommended that hhs cancel demonstrations and allow the quality bonus payment system to take effect. did not agree with the recommendations. our findings gave rise to concerns about the agency authority to conduct a demonstration under the social security amendments of 1967 which does provide broad authority, however it is a lie to c-span letter to the secretary of hhs without the agency had not established the demonstration meets the criteria set forth in the statute. next, would like to discuss our most recent report which examined plans designed for beneficiaries duly eligible for medicare and medicaid. these plans were originally envisioned as an option to help julia eligible navigate that two very different health care

programs and obtain care appropriate to their needs. it does appear that they provide a benefit package that may be more tailored to the needs of pools and that duel's enrolled have somewhat different characteristics relative to those involved in other plants. however, not required to record information that could better hold plans accountable and helped c&s determine whether these are realizing their full potential. we found little available information on the and mount and appropriateness. furthermore, we found that they did not use standardized performance measures when reporting information on outcomes, making it difficult to compare and hold them accountable for results. we concluded there was insufficient to information on how well they are meeting the unique needs of dual eligible beneficiaries. we made several recommendations intended ted increase accountability and insure that cms is the information it needs to systematically evaluate these performances.

concurred with these recommendations. finally, i would like to share findings related to medicare cost plans. these differ from plants in that they're paid based on a reasonable cost of living medicare covered service. cost plans have been a part of the medicare program since the 1970's. when we examine plans in 2009 we found they tended to have higher quality scores. enrollment in cost plans has been low and has concentrated in the relatively small number of states. as of march medicare had 20 cost -- 20 contracts with cost plans and a roman was just under 400,000. this represents a 36% enrollment increase since 2009. plan enrollment is small, industry representatives told us that cost plans provide a managed-care option in areas traditionally that have had few or no plans. over the last three years the number of options available to

beneficiaries enrolled has declined. nonetheless, we found that as of march 99 percent of beneficiaries enrolled have at least one in a option available and that 80 percent had at least five options available. this concludes my prepared remarks and i'm happy to respond to questions. >> thank you. you're recognized for five minutes. >> thank you. i appreciate the opportunity to be here at this important hearing. i want to make a couple of points. first, contrary to what is often stated medicare advantage plans are not less efficient than the traditional medicare fee-for-service program. data from the medicare payment advisory system confirms the fact that comparing apples to apples, plans and especially in hmos can provide the medicare to seniors and the cost well below that of fee-for-service. in 2012 based on bids were the plans at pak reports the average

plan provides medicare benefits to 90 percent of fee-for-service costs and dna hmo plan, 95 percent of fee-for-service cost. it is clear that in hmos which have by far the largest enrollment numbers, a 11 million of the february 2012 have built the capacity over many years to deliver care more efficiently than fee-for-service which should not be surprising. medicare fee-for-service is an extremely inefficient model that breeds fragmentation and undermines coordination leading to low-quality care for to many seniors. the center for medicare and medicaid services on equality have been admirable but even more effective if fee-for-service or written on the same metrics. ample evidence the united states continue to experience much waste. the reason institute of medicine studies cast blue doubt about this fact, but what is often not stated is that the fee for service is a dominant player in

many markets and a rate regulations have become the default option for other payers to ensure medicare fee-for-service and insurers the entire delivery system is organized around incentives. looking for other reasons that we have too much fragmentation, like of coordination, and low-quality care and to many settings. they should look no further than the incentives. my second point is the reduction contained in the 2010 health care law will raise costs for seniors and force many out of their plan. the cat -- the cuts are very deep. its total 10-year cut is now estimated at 300 need billion. 156 billion in direct payment cuts and 152 billion for him in direct reductions from the interactions of the fee-for-service cuts contained in law. they will directly impact the beneficiaries as indisputable. according to the most recent trustees' report enrollment will be in 2013 at 137 million people

and then fall to 97 million in 2017. further, by law plans must provide some percentage of the difference between bids and benchmark to the beneficiary in the form of expanded -- expanded benefits. in the study i co-authored we estimated that this will be about $30,700 per enrollee by 2017. why has enrolling grown? that answer is relatively simple less than 10 percent of the scheduled medicare reductions have gone into effect. costs have been moderate because of the slow economy. more importantly cms has spent an unprecedented and unlawful $8 billion filling in over 70 percent of the cuts in 2012 alone. quite plainly the agency was

submitted impact of the customer required by the law. no rule or explanation of -- for what they're doing in this program. certainly there is no policy rationale that would justify it as the testimony from various government agencies as indicated . once the artificial and temporary bump up in payments is terminated as it inevitably will be plans will be forced to pare back benefits and the plans will drop. my third point is that plants are particularly important for seniors and cuts will hit this population the hardest. lower income seniors are disproportionately represented because they find the reduced cost sharing attractive, especially at premiums that are usually well below the cost of medigap coverage. in the 2010 study i co-authored with job previously mentioned, earlier findings made the beneficiaries with income between $10,800.201600 thousand,

19 percent more likely than the average beneficiary to enroll. the program has important features to the future of medicare program to and can provide innovations the ways that medicare future service cannot. the choice of the beneficiaries is important for program accountability. if we want delivery system reform and, i think we do, the program is subject to be built upon, not discarded. thank you. >> thank you. recognized for five minutes. >> thank you, mr. chairman. we appreciate the opportunity to testify today on behalf of a program that serves 27 percent of medicare beneficiaries. our testimony focuses on three things. the specific programs or members as implemented to improve the effectiveness of care. the value medicare advantage plan and the impact of future cuts to the program. and a premium tax that begins at

14. health plans and medicare advantage as well as those serving employers and individual purchasers of coverage a partner in what doctors and hospitals to change the way care is paid up paying for the effectiveness of care provided rather than the volume of services delivered. we are working to change what is purchased by rewarding successful outcomes and employing other strategies to ensure patients receive the right care and the right setting. for example, house plants offer customized programs and support services that are integral to avoiding hospital readmission and reducing emergency room visits. while also addressing health care disparity, providing the hotlines, and offering personal records, these programs and tools have been validated in peer-reviewed journals. health plans help patients receive the appropriate level of services posted discharge which includes fellow cost to ensure that patients understand their drug therapy, rehabilitation needs, and when they need to

follow-up with physicians. this also includes home health visits and instructions on how to use any medical equipment necessary and how. health plans have coordinating care to help patients with multiple chronic conditions navigate and increasingly complicated delivery system as well as part during with clinicians by supporting their ability to do complicated case management and improve quality of care by providing data about variations in care best practices, and efficiency and effectiveness of treatment. health plans also provide value to beneficiaries by providing strong consumer protections which are identified in our testimony, providing -- protecting beneficiaries against unpredictable costs and by establishing care plans for beneficiaries which encourage them to get the preventive care that they need in providing a more organized support system for those with chronic illness. cms is part burn with our plan for a variety of initiatives to expand tools into the

traditional program, and we believe these partnerships hold great promise. two days ago the centers for medicare and medicaid services announced information about the high quality affordable health plans versus that will be available in 13 and the medicare advantage program. this announcement is good news and clearly demonstrates that medicare advantage plans have been successful in delivering value to beneficiaries. looking forward, we are concerned about the impact of a see a future cuts to the medicare advantage program. our written testimony presented data from the congressional budget office. i just referred to the data. i won't repeat it, but given the scale and scope of these reductions of the next few years and says the majority of reductions have not taken effect , we are seriously concerned about the potential impact. in addition, another element to this and to scaling the impact a potential reduction is, it is going to be compounded by a new premium tax scheduled to begin

in 2014 which will amount to $220 per beneficiary in 2014. for medicare part c that tax will increase premiums by an estimated $9. given the size of the medicare advantage funding cuts in the new premium tax, across-the-board sequestration cuts are triggered under the budget control act of 2011. it could have serious impact on medicare beneficiaries and places a financial burden on clinician's participating in the program. as the payments can take effect, the medicare house plan would continue to do everything that they can to preserve benefits and keep coverage as affordable as possible for the millions of seniors and people with disabilities that they surf. however, given the size of these cuts along with the impact of the premium tax, we are concerned in the coming years about the potential for medicare advantage beneficiaries to face higher costs and cover its destruction. relief for to working with the committee to address these concerns and preserve make your

advantage as an it choice for current and future generations of beneficiaries. thank you very much. >> thank you. >> thank you, chairman. ranking member, and members of the house subcommittee. i am chief medical officer. long beach california. i am board certified internal medicine and have been working for nearly 25 years. i appreciate the opportunity to appear before you today to discuss the innovative programs that stan has put in place to meet the needs of our most vulnerable and frail members. my testimony will focus on scan's special need plans. a serve medicare beneficiaries with highly complex health needs there are three types. first, institutional serve individuals who reside in institutional settings or live in the community bill require institutional levels of care.

scan is the nation's largest community-based. at second, a chronic or which serve individuals living in the -- with multiple chronic conditions, a into the that focuses on end stage renal disease. the third dual eligible which serves dual eligible beneficiaries, as can lens california's only for integrated tool eligible steps. all in all, they serve 16,000 individuals in special these plants. in addition, the health plan is the nation's third largest not-for-profit medicare advantage plan. and we were founded in 1977 by senior citizens in long beach who worried about the prospect of declining health a loss economy. the citizen activists helped design the program with extra services and supports to keep their living in their own homes and not in a nursing home.

such * scan has helped 900,000 individuals avoid or postpone and nursing-home stay. when special needs plans came along in 2006 they reflected the mission to help seniors maintain their health and independence, specialized care and intention. ideally the model was the same. placing the beneficiary of the center of care, and natural transition to move for a beneficiary and continue with their personal care plan to my care transition assistance, management, and medication therapy management. this model can significantly improved commerce and bring down the costs of care. let me give you an example. in april 2012 study by cavalier health found that the dual eligible members have a hospital of readmission rate that was

25 percent lower than dual eligibles in the medicare fee-for-service with identical risk profiles. the study also found that scan performed 14 percent better than fee-for-service on prevention quality indicator or p. q. why over all composite, keeping people out of the hospital to begin with. based on the results of the analysis, if california fee-for-service tools had the same hospitalizations and readmission rates this would result in at least $50 million in annual savings to medicare fee-for-service in california. studies are useful, but let me give you a real example. a native spanish speaker enrolled in a scant. like all, the initial health assessment revealed that the last few weeks he felt pressed

or helpless more than half take. able to reach them and perform an assessment. the manager identified three concerns, depression and suicidal ideation, poor relationship with his primary care physician and inadequate access to needed psychiatric care. it assessment was shared with the pcp and a behavioral health specialist but commended partial hospitalization. the team part in the medical group to coordinate services and address language related barriers. connected him with the spanish-speaking and psychiatrist and new pcp he has that and is visiting his psychiatrist regularly and is no longer having the suicidal ideations. the model of providing patients entered coordinated care to

vulnerable populations has been a success. unfortunately the authorization is set to expire at the end of 2013. congress should extend the at least five years moving quickly is imperative. must file notices for 2014 by november of this year. a multiyear extension would provide stability to beneficiaries, states, and no plans to ensure bit -- dangerous care. in addition i read testimony includes a number of other recommendations. people who are frail, disabled, week, they are served by fragmented models and deserve specialist treatment.

>> the ranking member starts. the members of the subcommittee -- i'm here today testifying on behalf of the medicare cost contractors alliance, the coalition of 15 medicare cost plans that currently serves over 400,000 medicare beneficiaries enrolled in plans in 14 states and the district of columbia. since 1972 they have proven to be a staple of quality alternative to medicare fee-for-service, particularly for beneficiaries living in rural areas and areas in which risk based plants have encounter challenges. we firmly believe that medicare cost plans should remain available as the coverage option and are grateful for the bipartisan support of the program. we wanted thank resented a paulson and representative kind

for introducing legislation to reserve this important program. there are 19 medicare costs plants across the u.s. located principally in rural areas or areas with comparatively low medicare advantage rates. 90 percent of cost plans are non-profit organizations. a large portion of medicare cost plans are either owned by or are affiliated with well-regarded medicated groups. the average medicare cost plan has been providing high-quality cost-effective services to medicare beneficiaries for over 20 years. for nearly three decades associate medicare health plan has been serving medicare beneficiaries under our cost base contract and five counties in iowa. four counties in wisconsin, and one in illinois. like most plans, our members are elderly average age of 76, and one-third of our members are 80 years of age or older. in fact, many of our members have been with us for 20 years

are more. our members, like a plan, we have less than 1% voluntaryism moment. medical assisted health plan is on by medical associates clinic which is the oldest multi specialty group practice clinic in iowa. nicholas as his health plan is part of the quality of services it offers to its cost plan members. in 2012 medical associates of plan was one of 12 cms contracts have a 569 that received a five-star rating. our wisconsin plan received a 4-star rating. if current law is not changed, over 230,000 beneficiaries will lose their cost plan coverage in ten states and jenny were first of the 14. medical associates would be forced to withdraw from four of the five counties and it's i was service area. this is despite the fact that medical associates overwhelmingly the most popular medicare health plan and our service area and has the highest

quality rating as well. because of the cost plan to withdraw the vulnerable beneficiaries will face higher cost. they could also face disruptions and longstanding provider relationships since many have done medicare cost numbers for many years. as you know, medicare and vantage rates are scheduled to decline under current law. history shows that when payments to medicare risk based plans decrease plans to withdraw from the program or reduce service areas resulting in beneficiaries' losing medicare health plan choices, particularly in rural areas in order to prevent 230,000 medicare beneficiaries from losing the medicare cost plan sores in 2014 and to ensure the beneficiaries have an ongoing

chores of quality medicare managed care plans. it is imperative that congress pass legislation this year. we very much appreciate the opportunity to testify before the subcommittee and look forward to continuing the work with members of this committee. thank you. >> thank you. ms. gold, you're recognized for five minutes. >> thank you. chairman, ranking member, members of the subcommittee. i am a senior fellow at mathematical policy research an independent nonpartisan public policy organization. i want to make seven. today that i elaborate on in my remarks. first, the program today is strong with rising enrollment that is expected to continue into 2013. while the hca sought to scale back payments to achieve closer alignment between payments made from beneficiaries race is the traditional program, it was acting in line with the origins

of the program and consistent with the recommendations of congress' non-partisan advisory meant back. they see any changes serve to extend the life of the medicare trust fund and slowly increase the premiums for all beneficiaries. second, plans are still paid considerably more for similar beneficiaries in the traditional program. considering future policy change, it is difficult to see rationale on a national basis for paying private plans more than medicare currently spends on the traditional program. particularly when there is so much concerned with the federal deficit and debt. third, although some suggest otherwise, i have studied these plans in debt for more than 20 years, and there was no strong and consistent evidence that private plans in general are better at cost control than traditional medicare is word that health plan competition will produce enough savings to

address current fiscal concerns. fourth, polls show traditional medicare remains popular with beneficiaries. that means that paying more for private plans is effectively attacks on their chores. the part b premiums will increase with no gain in benefits. clearly, palmer reduction that some point can discourage plans from participating in inmate, but we are not there now. even if we were, the question is how much payment is warranted to preserve choice, especially if it costs rather than save money. overpayments also involve a substantial transfer of funds from government firms, a few of whom, at the market. the congressional budget office has concluded that medicare premium support programs to reduce government contributions to medicare or shift costs to beneficiaries and limit the health and financial protection that the program provides tolerable beneficiaries.

we have a role to private plans in medicare, but it is not a voucher a premium support program. the defined benefit medicare provides a difference when the mentally from the fixed contribution plan. although premium support proposals vary, most would fundamentally change the traditional way that medicare program operates and somewhat eliminate traditional medicare altogether. it takes traditional medicare with its define the national unified benefits have served as a valuable protection to beneficiaries. it provides to find a national uniform benefits to all medicare beneficiaries. some proposals say that they maintain its traditional medicare plan option, but they do not appear to finance it. this arguably presents a false assurance about the future availability of traditional medicare as we know it now. the program would be different and beneficiaries would pay

more. our health care system is inefficient. private plans face challenges in containing costs. a fundamental reform of the system to reduce costs ultimately cannot be achieved without someone paying the price, whether that is the beneficiary plan provider medicare or some combination. one person's waste his of his income. it also is not that easy to define medically necessary care, especially an individual level. the 1990's managed-care backlash to the policy makers should not expect the private sector or beneficiary to engage in battles from which they themselves want distance. medicare beneficiaries already pay a considerable amount out of pocket for health care, as my written testimony indicates. other programs show that strong oversight and risk adjustment of -- are important to unfair marketing practices and enrollment abuse and protecting vulnerable medicare beneficiaries.

when there absence candles occur in people are hurt. brisket desman is critical, and all of these will be more important if tool eligibles until the program. in closing, all the decisions about the future of medicare will inevitably reflect the values considered socially susceptible by a variety of staplers, the evidence suggests there are no easy dilemmas -- and -- answers to the festival as. >> thank you. >> thank you. i read in your report that the cms m.a. quality of a spin a deposition will cover up nearly one-third of the obamacare cuts to plans over the life of the demonstration. is this correct? >> the the restoration would offset about one-third of the cuts, yes. >> can you please protect your estimate of how much of the cuts would be offset each year? >> this year, to c-span, just

over 70 percent. next year, 2013, one-third. the final year, but 60 percent. >> this seems to be the administration is trying their hardest in using any means necessary to hide these cuts until after this election. as you well know, obamacare is cuts to medicare advantage are real, especially to the beneficiaries that are enrolled in these plans. in fact, not too long ago, cuts of the medicare health plans which were far less than those in obamacare resulted in millions of seniors losing access to their health plans. in fact, in some counties and in northern california to my district i represent, seniors lost all choice of private health plans after the 1997 cuts

, even the medicare actuary highlights the fact in this year's report which stated that as a direct consequence of the plan termination, the percentage of medicare beneficiaries who enrolled in private health plans declined each year from 2000- 2004. what the cuts to medicare advantage and obamacare have of real and lasting impact on seniors access to the ma plan they have and like? >> two comments. one with respect to the past, which i remember very vividly. i think the lesson there was that congress responded by putting additional resources and targeted toward specific counties, northern california as an example in the upper