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ms. stabenow: mr. president i would ask suspension of the quorum call. the presiding officer: without objection. ms. stabenow: thank you mr. president. thank you. mr. president, i think the american people deserve to see the contrast between how nominees were treated last decade during the bush administration versus how they are treated this decade during the obama administration. when former president bush nominated john ashcroft to be attorney general. it was controversial. i was one of 42 democrats who opposed the nomination. and yet it only took 42 days for john ashcroft to get a vote on confirming his appointment because neither i nor other democrats stood in the way and blocked actually having a vote. now, i agree that was a different time where filibusters were not used every single day

on every single issue. unfortunately. but i remember at that time when our republican colleagues came to the floor and said elections have consequences, when a president is elected he or she has the opportunity to put forward their nominees and have a vote. and day after day people came to the floor and said just let us vote. just let us vote. and we did. let the vote happen. as of today president obama's nominee for attorney general loretta lynch has waited 157 days and counting. and we intend to count the days. 157 days between john ashcroft who we opposed and loretta lynch

157 days. in fact, since the judiciary committee reported loretta lynch's nomination, out of committee, she has now waited longer for a vote on the senate floor than the last seven attorneys general combined. seven attorney generals combined she has waited longer than seven attorney generals combined. the u.s. senate has the constitutional responsibility to provide advice and consent to the president as it relates to his appointments. that's a serious responsibility. and we're not asking that someone vote yes if they want to vote no, they have a right to vote no. we've had enough members now come forward that it's clear she

actually has the votes we have had enough members indicate they would support her they know if we could get a vote on the floor that she would in fact be confirmed as the attorney general but everyone has a right to state their piece vote as their conscience would have them vote. but, unfortunately our republican colleagues have so far withheld the respect given to other presidents, to president bush, they have withheld that from this president. if this is frustrating to me, i can only imagine how frustrating it is to loretta lynch who i know is eager to get on with the work of our nation's top law enforcement official. i had the opportunity to meet with ms. lynch in early december. she impressed me with her passion for upholding the rule of law and her belief that law

enforcement could be a partner in building stronger and more cohesive communities. i talked to her about how the justice department could play a role in supporting ethnic diversity in communities like detroit and flint and other communities across michigan. she understands the devastating effect that racial profiling has had on the relationship between the police and the public and i'm pleased to learn of her support for police body cameras and so many other policies that would help in that regard. in addition she understands the threat posed by those who would intimidate americans from participating in elections. i regret that loretta lynch has not yet been granted the opportunity to play her role in promoting access to the polls and preventing groups from being disenfranchised. i regret that our f.b.i. with

all it must do for the safety and security of americans does not have a permanent attorney general to direct it. i regret that there is not a permanent attorney general to advise prosecutors about actions to take against banks that have committed fraud against homeowners. i regret that our republican colleagues are continuing to perform the same stunts with the majority as they did in the minority. to govern by holding government functions hostage. for those who oppose the nomination you have every right to vote no. every right to fight to defeat this nomination. but if you continue to refuse to give the advice and counsel and perform your duty you're sworn to uphold in the constitution, and continue to block a simple

vote on a nomination from the president of the united states for the attorney general of this country, you are doing a disservice, i believe to our country. we have heard so often from people that they are so tired of congress obstructing and not acting. i would urge colleagues to get on about the business of a nomination that has been held on this floor for too long, too long. 157 days is too long. it does a disservice to all of us to see this continue. we need loretta lynch as our attorney general. we have a lot of business to conduct in the senate on a lot of very, very important topics

coming up. and we need to get about the business of allowing this vote however it goes is how it goes. we indicated we have the votes if we're allowed to votes but everyone has a right to express themselves put in place a competent, strong attorney general for the country and then move on to other serious issues that we have to address here in the united states senate. it's time to vote. thank you mr. president. mr. sessions: mr. president? the presiding officer: the senator from alabama. mr. sessions: mr. president, i have been a strong advocate and a believer that it's time for us to fix the physicians payment

method for medicare and medicaid for providing of health care by doctors and put it on a permanent basis. right now we have 17 times we've passed last-minute legislation to avoid what now would be a 21% cut in doctors' reimbursement rates for doing medicare work. that's not acceptable. we need to end that. they don't need to be worried every year whether congress is going to cut their pay or not in fact, they cannot do the work with a 20% cut. i mean, they won't do it and they can't do it financially and it would be a devastation to the -- to medicare.

so i believe and i think all of us have believed in that and for 17 different times when this issue has come up since 2003, we paid for it, republicans particularly have insisted that okay we're going to find the money through some sort of other reduction in spending in the government and move that over to pay for this critical need without which medicare would collapse. so i thought, you know, that now that we do it permanently it should be done in a way that's financially sound does not add to the debt and has good policy in it. i let my colleagues, some of which have already talked about the policies that would be in this legislation i'm not prepared to be a big critical of -- critic of that, i'm sure it could be done different ways. my focus is from my experience as the budget committee and the spending that we're doing in

congress to try to get the thing done right so it's paid for. the bill that is sought to be advanced today contains over 250 pages, it was rushed through the house of representatives with the promises that -- quote -- "it pays for all new future spending" -- close quote. and -- quote -- "it offsets all new spending" -- close quote. well both of those statements are not true. they're just not true. it's not paid for and it does not offset the new spending. and an attempt was made and a desire was made i think by the house that the senate on the night we completed work at 3:00 a.m. before recess on

the budget, that we would just pass it without even really an official good score at least not one that we were able to examine over a period of time and without any knowledge of that was in the bill and senator mcconnell and members of the congress said no, we're not going to rush this through. $200 billion-something over ten years and 3:00 a.m. in the morning and nobody has had a chance to look at it and we had 700 amendments filed to the budget act so we didn't pass it that night and it's been moved forward, we have a deadline tonight was presumably if we don't do something physicians will begin to see cuts in their pay. and, of course, too often that's what happens around here. too often a bill that's not sound financially is moved at the very last minute, and members are told if you don't pass it now then something

bad's going to happen. in this case, doctors that we respect and admire and need are not going to be able to get the pay they deserve and have been receiving and going to have these dramatic cuts. well, there are opportunities to extend this. we could pass legislation this afternoon, tonight that would extend this for a period of time if need be. but the reason we're at the end, the last minute, is because it was designed that way. now, only days after passing a senate budget that we were proud to say balanced with a $3 billion surplus we're talking about passing new legislation that would add $174 billion to the debt.

or the next ten years. estimates show that over 20 years, it's a $500 billion addition to the debt of the united states, a half a trillion dollars. and now the bill violates the budget act. the budget control act that we passed in 2011 set a limit on how much spending could occur and there are eight -- let me repeat eight -- violations of budget rules that are involved in this legislation. the budget committee is looking at this. these are numbers in -- that violates section -- violate section 302 of the budget control act by spending in excess of the budget committee's allocation over the next fiscal year the next five years and over the next ten years. two, it violates section 311-a a-2-a by spending $7.4 billion

in excess of the aggregated top line agreed on for fiscal year 2015 this year. that we're in. three, it violates the senate paygo rules. the bill increases the on-budget deficit by $74 billion over both the five- and ten-year budget periods thus exceeding the balance on the senate paygo scorecard. four it increases in short term deficits over the ten-year budget window and would increase receives says by $141 billion over ten. in so $141 billion and $174 billion. what's the difference? well when you spend $141 billion more than you're supposed to over ten years and all of that money since we're in deficit every penny of it is border so it can -- provide so it can be spent -- borrowed,

you have to pay interest on the money you borrow. it's not 141 it's 174. that includes the interest on 141 over ten years that has been accumulated and will continue to accumulate in the next decade and the decade after that f. it increases long-term deficits. it increases -- it violates section 306 of the budget act by including language that falls within the budget committee's jurisdiction that has not been reported or discharged from the budget committee. seven, it violates section 303-a of the budget act by creating new spending in a fiscal year without a budget resolution. eight, it violates section 401 of the budget act by creating new entitlement spending during the fiscal year. we try to contain ourselves and one of the things we rightly did is create a budget violation to

try to prevent creating a new entitlement program during the current fiscal year. so these are not technical violations that it might appear to some. they are mechanisms by which the crafters of the budget act deliberately set about to try to contain ourselves from figuring out ways to gimmick and get around spending limits. so they create all these steps that -- each one of which based on history fors most part, were designed to stop abuses. and so it violates these provisions. well it just violates it because it spends more money than we're supposed to be able to spend and that we agreed to spend. so h.r. 2 increases long-term deficits. according to the nonpartisan

congressional budget office's letter to speaker boehner enacting this bill in its current form would increase the nation's long-term deficits. long-term deficits are those deficits created after the first 10-year window. a lot times they'll write a bill so it looks like it's okay for 10 years knowing that in the future it will add to the debt but nobody cares about that so we made a budget point of order to try to identify long-term abuses, a good provision i submit. but let me just say this. we had before the budget committee a month or so ago a professor from boston, boston university, i believe and he talked about the real threat to america's financial condition. he says we're on an unsustainable path that we cannot continue on this path. it will result in financial dislocation and damage to

america. and the most important thing to consider, he said, is, what does a piece of legislation do to the long-term liabilities of the united states. does it add to our unfunded liabilities or not? and we need to be reducing our unfunded liabilities because they are so great -- hundreds of trillions of dollars -- that they -- those unfunded liabilities threaten the very future of america financially. so this adds to that. we need to be figuring out ways to reduce the unfunded liabilities. i thought that's what our goal was. that's why we passed a budget that balances. according to the congressional budget office our independent accountant -- quote -- "taken as a whole h.r. 2 would raise

federal costs relative to current law in the second decade after enactment. in other words it increases the deficits in the second decade. some have tried to argue that in the second decade there's extra money coming in some way and it will all be paid for. not so. so let's explain. in its report to speaker boehner, the report that was used by the house as it proceeded to vote on this bill the congressional congressional budget office indicated that not only would h.r. 2 increase short-term deficits by $141 billion over the next 10 years but that it would also increase long-term deficits over the second 10-year window. the committee for a responsible federal budget estimates that this legislation would have a half a trillion dollars to the debt.

in the next 20 years. a half a trillion dollars is real money. $500 billion. we're struggling right now to figure out how we can fix permanently our highway bill have a long-term highway bill that's paid for. we need about $10 billion $15 billion a year to achieve that. we're seeing a reduction in gasoline revenues and we want to spend more than that congress does and we're looking for that money. so this is $500 billion over 20 years, $174 billion over 10. these are huge sums of money. the federal highway bill is now under $50 billion a year. federal aid to education is about a hundred billion dollars a year, and this is just indicative of how much we're overspending here.

so the office of the actuary the chief financial person at the center for medicare and medicaid services -- that's -- we call it c.m.s. -- they're responsible that office is for conducting and directing the actuarial program for c.m.s. and directing the development of and the analysis of health care financing issues. on april 9 mr. spitonic released a review of the estimated financial effects if this legislation becomes law. an analysis conducted by the heritage foundation actuary's report indicates that the drafters of the bill actually double counted certain funds. while the bill anticipates higher premiums for medicare parts b and d and cuts to medicare part-a those savings would be $55 billion and

$32 billion respectively. medicare part-a is the trust fund that american working people's money goes into off their paycheck every week. so most americans believe they pay for medicare and they do, for the most part, although we're now taking in less money than is going out to a significant degree. so what did this bill do? this bill cut the expenditures for medicare part-a the trust fund part. and it is claimed that that money $32 billion and $55 billion respectively, is now available to spend on the physicians to pay for their fix. but the physicians' medicare part, when you go to a doctor

and medicare pays for that, that's not trust fund money. that's general revenue treasury money. and so what is happening? so they're cutting the cost -- really hospitals and doctors and other costs. hopefully -- they claim it won't affect the benefits that accrue to people who need health care but it probably will. you cut the costs of providers of health care services, you start cutting them, it begins to reduce the benefit that actually goes to the provider -- to the patient. so that money how does it get from the trustees of medicare, who are supposed to manage this program take the money in that comes off our paychecks and goes to medicare, how does it get over here to pay something outside of medicare part-a? well they -- they -- they take

an oath to be responsible and faithful to the trust -- as trustees of medicare. they don't give it to the u.s. treasury. they loan it. they're the debt instrument. the money is loaned to them and the federal government pays interest. and that's where we get the $30 billion-some-odd in interest over 10 years. part of it. so this -- the money that's being used to fund that portion of it that they claim is actually paid for i say is not paid for. the congressional budget office has told us this technique is double counting. the money cannot be used to benefit medicare and at the same time fund a new expenditure. we really have got to watch this. it's something i've come to realize is one of the biggest gimmicks ever. and when the obamacare bill was passpassed december 23, the nice

before it passed, we got a letter from the congressional budget office at my request -- and i read it on the floor december 24, the day the bill passed -- and he said, i think it was $400 billion $500 billion in double-counted money that they said was available to fund the affordable care act. i just would say colleagues we've got to be careful. do you want to know how a country goes broke? it's managing money this way. huge sums of money. well we i don't understand this gimmick actuarial for c.m.s., paul spionic, goes on to say

h.r. 2 raises -- quote -- "important long range concerns that would almost certainly need to be addressed by future legislation. when the bill's 5% annual bonuses in physicians' payment expire as scheduled in 2024" -- nine years from today -- "a major payment cut for most physicians would follow the next year," according to his report. "the payment structure were also be troublesome in years with high inflation. so in essence by 2024, another round of doc fix would be needed." in other words not only does this bill add massively to the debt and engage in improper -- i hate to say "dishonest," -- improper accounting but it also fails to even provide long-term solutions that it promises. it promises we're going to have a permanent fix of the

physicians' payment. so that's not a permanent fix. within nine years we're going to be back in a situation that's unacceptable and will have to be dealt with again by more money. by making these cuts out here in the out-years colleagues it hides the real costs. so you put the costs into the -- you have a proposal that provides these increases for doctors for the next nine years and then you begin to show reductions and claim somehow that this is going to pay for it but we're not going to allow those reductions to take place either. because -- we're not going to be cutting doctors 5% a year for any indefinite -- any one year, most likely. so it's not too late to make things right. the bill needs to go through the

regular order. it the hasn't gone through our committee in the senate. the house said that bill was going through the regular order. it didn't go through the -- hasn't gone through the regular order. hasn't been to a committee and had amendments in the committee. it's coming up on the floor. we're hardly having any amendments. i understand maybe we'll have three amendments. each side. or something. that's a pretty minuscule discussion frankly. all when it supposedly has to be passed today so the cuts won't take place at midnight tonight. so i'm going to -- so, colleagues, i want you to understand the importance of what we're doing. the legislation pushes almost the -- adds almost $200 billion to the debt in 10 years. it breaks our past commitments and precedent we've established by paying for these doc fix. in fact, the republicans have

been most insistent that before we put the extra money in for the physicians, we find a pay-for some responsible reduction in spending elsewhere so we can set priorities and pay for the doctors. this is substantially abandoned in this legislation. it disregards i think congress' commitment to honest accounting the principles that we've established about how to accurately calculate the cost of legislation. it breaks the budget that we have agreed to in 2011, the spending reductions of the budget control act and it violates the budget the senate just passed a couple of weeks ago. so mr. president we need to think through this. i -- i hate to object because i truly believe we need to take

care of the physicians' payment. it is absolutely wrong and congress has been negligent in failing to address this for years. it's been over a decade we haven't dealt responsibly with this. so i salute the house colleagues for saying we're going to develop a bill that fixes this over time. unfortunately, i.t. not it's not a permanent fix like i originally thought it would be. but, number two a responsible fix, a grown-up fix a kind of action that the american people are looking at congress and hoping that they'll see is not occurring because it adds to the debt. so we want to do something. we want to fix the doctors' problem. but we don't want to cut

spending anywhere else. faced with that difficult choice this legislation -- at least to a two-thirds degree -- does what we too often do: we just spend the money commit to spending the money and then add it to our credit card, add it to the debt, this that's $18 trillion now ans and growing dramatically, producing an annual interest payment of $220 billion ans putting us on the path to have an almost $900 billion interest payment in ten years. that's not good management of the people's business, i believe. i thank the chair. i appreciate the opportunity to share these grim remarks and to lament the difficult situation

we find ourselves in. i do breeive the believe the lee amendment will fix this. maybe other amendments will, too. but we certainly need to step forward and make sure that we don't continue down this path. i thank the chair and would yield the floor and i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

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mr. blumenthal: madam president? the presiding officer: the senator from oregon. mr. blumenthal: i ask unanimous consent to vacate the quorum call madam president and to speak as if in morning business for up to 15 minutes. the presiding officer: without objection. mr. blumenthal: madam president, it is my hope that soon the senate will start voting -- mr. wyden: voting on legislation that in one fell swoop will improve health care for millions

of americans. and this discussion should start with a medicare milestone. that milestone is abolishing once and for all the outdated, inefficiency rewarding commonsense defying system of paying physicians under the medicare program. as my colleague from new hampshire knows what i'm talking about in the technical lingo of health care is the s.g.r., the sustainable growth rate. it is a horrendously flawed formula for paying doctors and providers who treat our medicare patients. and yet despite this very sour pedigree, it has dominated much of the discussion about medicare since 1997. now, i wish we had put this

flawed reimbursement system in the dust bin of history last year as some of my colleagues know i had sought to do that along with the support of others. but i think now we have reached the point on a bipartisan basis where we have a chance for seniors and their providers to cross the victory line and be better off and have a better system for all americans. and i thought i'd take just a minute or two before discussing some of the other health care efforts that i hope will go forward today to describe how this happened. a little over a year ago there wasn't much reason to think that we wouldn't just keep patching this leaky boat. that's essentially what the senate had been doing for years and years with this flawed

program. in fact, i remember one of our younger members of this body was where the president of the senate was sitting and i said at this rate, we're probably going to be on patch number 70 or 80 by the time we get around to really fixing this. so people weren't very optimistic a little over a year ago. since then however since that 17th patch we saw members on both sides of the aisle saying it is time to start getting serious and getting traction for a permanent repeal and replace of this flawed reimbursement system. in january of this year, momentum finally began to grow. in other words we used that period in 2014 as a springboard. discussions began with the

speaker, speaker boehner and leader pelosi. their discussions were really based on the bipartisan, bicameral framework that was developed in 2014 when leaders of the other body and the senate got together and the finance members, the ways and means members, the energy and commerce members and the combination of that work and speaker boehner and leader pelosi coming together leads us to where i hope we'll be here before long, and that is once and for all abolishing this flawed reimbursement system. if you didn't take this action and in effect it really has to be done now madam president without taking people through the root canal work of how the reimbursement system works at the medicare center, what's called the c.m.s., we do know if congress doesn't intervene

we would see physicians cut 21% 21%, and that would in my view cast a very strong shadow over our ability to serve america's older people. i mean particularly in the rural areas of this country we've got a lot of those practices that serve older people walking on an particular tightrope right now trying to figure out how to pay the staff and pay for equipment and lighting and everything else, a 21% cut would be enough in my view to really put some of those small rural practices out of business. so it was the judgment of this bicameral group that worked through 2014, that leader pelosi speaker boehner picked up on, this year to come up with a very different kind of model to replace the medicare reimbursement system that was so

flawed the s.g.r., with a merit-based incentive payment that rewards those who provide high-quality high-value care. that in my view is how we get the best value for america's seniors, who, of course, want to get the right amount of care at the right time and they want it to be of high quality. and a major part of this legislation will in my view help to promote better coordination of care. american health care is so fragmented and so strewn kind of heather and yon very -- hither and yon, very often a senior can be treated by a variety, nobody rides point on it the senior ends up in the emergency room and at that point when pride earns say who should we be in contact with, the

senior isn't even sure of all the people, particularly if that senior has multiple chronic conditions perhaps diabetes and a heart problem the senior won't even know the array of providers they've seen, let alone have someone coordinate their care. the good thing about this reform is it promotes that kind of care coordination. also, physicians as part of this will have clear incentives to enter alternative payment models that are going to promote team services, services where there is a team of health care providers, and it will require more medicare transparency, more information about various services that are provided to older people so that there is some sunlight on this incredibly complicated system and

particularly the medicare program that takes over $500 billion a year and spends it in a way that has not been particularly transparent. and i want to thank senator grassley for working with me closely on this for a number of years. finally, this legislation also makes permanent what's called the q.i. program again fancy health care lingo for an important program that pays the premiums the outpatient premiums for low-income older people. and i think that is especially important, because it says for older people and particularly those of modest, you know, income that there's going to be some assistance for the outpatient services, what's called part b which are so critical in terms of keeping

older people out of long-term care facilities. my guess would be in new hampshire and oregon, like in my home state of oregon, having that kind of assistance for low-income people in the community is really key to avoiding institutional care. now, i do want to note that i think all of us are going to say this bill doesn't meet the test of perfection. i happen to believe that the bill would have been stronger had this body been involved in all of the negotiations. but clearly to have a milestone for medicare, and that is what i think you get when you eliminate what really pretty much, madam president is a fraud. the medicare reimbursement system has been honored more in the breach than in the

observance. year after year it's waived, it's patched and i think to replace it with what i have described really is something that when the history of medicare is written people are going to look back and say this was an important day these were sensible changes improving care coordination, putting a new focus on quality data transparency, coordination of health care teams the kinds of things that this proposal does are very much in the interest of seniors providers and taxpayers and i think that this day will be remembered for making a very important contribution in the history of medicare. now, i do want to mention several other amendments that i hope will be offered. i also feel very strongly about the need for this legislation to

reaffirm and strengthen health care in america for our most vulnerable children. there are more than 100,000 of these youngsters in my home state alone and i'm talking about the children's health insurance program what is known as chip. and my hope, madam president is that we will have a chance here to vote to expand on what the other body has done and have a children's health program that will be extended for four years and not just two. the chip program has the support of almost 407 40 governors. they span the philosophical spectrum and they have achieved such strong support. because these governors who are right on the frontlines of a

program that involves very close coordination by the federal government and the state government want some certainty and predictability. they don't want vulnerable kids and their families to be in limbo. so i'm very hopeful that that amendment will be offered and that it will get the support of our colleagues. third, i hope that there will be an amendment to improve health care for women. i think we have all followed this debate that i think really is needlessly divisive. there's so many senators who want to find common ground to improve health care. we've gotten, you know, bogged down on how -- somehow virtually all the bills now seem to be a magnet for a debate about abortion. my colleague senator murray, would like to offer a very important amendment to expand

health care services and the availability of reproductive health services for women community-based care. i'm very hopeful that that will be offered as well. and finally on a bipartisan basis, senators cardin and collins would like to offer legislation to really set aside what are really outdated approaches with respect to how medicare provides services, therapy services for our citizens. we're talking here about physical therapy occupational therapy services with respect to speech. and senators cardin and collins want to get rid of these arbitrary therapy caps, and i'm very hopeful that their

amendment will be able to be offered as well. one last point madam president on a matter is not health care related. this legislation carries an additional program that is particularly important to the people that i represent and that's the secure rural schools program would be extended for two years. madam president, i wrote this law back in 2,000 with our former colleague, the senator from idaho senator craig because in most of our states -- the states where the federal government owns much of the land that's heavily, you know, forested as a result of changes in environmental policy and other changes a lot of these rural communities didn't have the money they needed for schools and roads and law enforcement and basic services. and we have extended it since

2000. we've had testimony indicating that we're going to need that safety net for some time even as you try to get the harvest up in a sustainable way and i'm very pleased that this program an economic lifeline to rural communities across oregon and other states is going to be extended for two years. i think that provides us an opportunity to come up with fresh strategies both are with respect to the safety net. i would like to, in the future, as the senate budget committee supported, i believe my colleague, the president of the senate, was interested in this to link secure rural schools with the land and water conservation program and the pilt program. we had bipartisan support for that. and i'd like to see us use these two years to strengthen the safety net and get the harvest up in a sustainable way. so i wanted to make mention of that before i wrap -- wrap up.

madam president in closing, i think the health legislation that i hope will be voted on here shortly represents one of those rare moments on a major issue -- i mean, i'd go so far as to say having worked with older people since my days with the great gray panthers -- i'd go so far as to say that i think what we're doing with the abolition of this outdated medicare reimbursement system is laying the foundation for what will be the future of medicare. the future of medicare, madam president, is not going to be what it was about in the 1960's when it began when a senior in new hampshire might need the hospital for a serious injury. maybe they'd see a physician get medicare part-b if think

broke their ankle. the future of medicare is going to be about dealing with chronic disease. it's going to be did diabetes and cancer and heart disease and stroke. and the reality is, is medicare hasn't kept up with the times and i think it's worth noting that in the big debate about the affordable care act chronic disease was hardly mentioned at all. not by anybody. and that's going to be the foundation of medicare for the future. more than 90% of the medicare dollars in the future, madam president, based on the challenge of dealing with older people with these chronic conditions is going to be about chronic disease. and the reality is when you abolish this flawed medicare reimbursement system and start promoting coordinated care what would happen in the state of new hampshire is i think you'd start seeing teams -- perhaps a nurse

a physician a pharmacist -- a team there in new hampshire and in oregon come together, particularly where there aren't the medicare advantage, you know plans and say we can give as our colleague from georgia noted not long ago senator isakson we can give better care at lower cost and do it for what is likely to be the type of health care services that dominates medicare in the future which is chronic disease. and we will be better able to tackle that with the abolition of s.g.r. so my hope is shortly we will vote to take that action that i believe constitutes a medicare milestone reaffirm our commitment to america's youngsters improve health care services for women from one end of america to another and get rid of this outdated system of

therapy caps that are restricting what those who need need -- physical therapy occupational therapy aand others -- can-- otherscould get. this could finally be a punctuation mark in this, the 50th year of medicare and an opportunity for all senators to see that they were part of adopting a fresh set of policies to provide a brighter and healthier future for all our people. with that, madam president, i yield the floor and i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

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