the c.m.s. goes on and says, "c.m.s. noted the medicare cuts in the bill could jeopardize the beneficiaries' access to care. "now, that's serious, that's serious. it found that roughly 20% of all part-a providers, hospitals, would become unprofitable, 20% of all part-a providers, that's hospitals, would become unprofitable within the next ten years as a result of the proposals in the reid bill. well, you know, i know profit is a bad word on the other side of the aisle, but the simple fact is if you do not have profit in a hospital, the odds are pretty good you're going to go out of business. you're going to go out of business because you can't pay the cost of operating that hospital. even nonprofits have to have some sort of cushion in order to make it through. and now we have the c.m.s. actuary telling us that 20% of the hospitals in this country are going to go into a negative cash flow situation, going to become unprofitable as a result of what this bill proposes. well, colleagues, senators, why would we vote for a bi

the c.m.s. actuary be any more significant than, say, what we have -- have seen coming out of the congressional budget office? well, mr. president, the -- the chief actuary of c.m.s. is -- is kind of the independent arbiter, if you will. they look at both the private and public health care expenditures. the chief actuary provides actuarial details that i think we recognize can be critically important for certainly my state, for any of other states' economists to develop individual state estimates of the financial impacts, the effects of the health care reform proposal. as important as discussion on the broader scale is, the people back in my state want to know, well, what does it mean for us in alaska, what does it mean for increased access, what does it mean for us in terms of our premiums? are they going up? are they going down? how do we as a state that is very, very unique in its marke markets, geographically dislocated, smaller population, how does this health care reform proposal impact us

or c.m.s. but we know the general directions that are required, and we have everything in this bill that we can to explore it. somebody's actually taken a bit of a look at this. they focused hard and they admit that their findings aren't as solid as, you know, a full actuarial report. but the commonwealth fund does a lot of work in this area and they're very good people. and here's what they conclude. "the effect of national reform on total national health expenditures and the insurance premiums that family would likely pay is this. we would save $683 billion or more in national health spending over the ten-year period 2010-2019." $683 billion. and where do they go for that? to things like administrative expense. remember, i pointed out the problem of administrative expense and transactional inefficiencies? currently, nearly 13% of insurance 3r50e78 yums -- insurance premiums are accounted for by administrative costs. things that we do in this bill can reduce that. they say -- they make a very

we come down here day after day to talk about the c.m.s. actuary's report, the center for medicare services about the cost of the bill and how it would impact the cost of health care in this country. so we continue to come down here and talk about the bill. now, the other side, the one thing they don't do is they don't come down here and talk about the bill. i don't hear democrats coming down here and offering full-throated defenses for this bill because the bill, mr. president, is indefensible. it's 2,700 pages, and it doesn't do anything to lower the cost of health care, according to the congressional budget office. so we come down here day after day, talk about the congressional budget office report, come down here, talk about the c.m.s. actuary report. they come down here and talk about how bad the current system is, say this is going to fix it, but then when they are challenged on the c.m.s. actuary report and the congressional budget office report, they don't -- they can't defend that. now, what they should be doing instead of accusin

that's what the c.m.s. actuary said, that the total amount that we spend on health care in this country, which today is about 17%, ten years from now will be almost 21%. so the amount spent on health care as a percentage of our gross domestic product goes dramatically up, not down. and $234 billion is what the c.m.s. actuary said health care costs would go up by in the next ten years. and of course, we had previously the c.b.o. essentially saying the same thing. the congressional budget office, for those who live outside of washington, is sort of what the nonpartisan estimator, if you will, of what a lot of these federal programs are going to cost. the congressional budget office said that under the bill put forward by the senate majority here, the democratic leadership in the senate, it would increase health care spending by $160 billion over the next ten years. again, bending the health care cost curve up, not down. and so now you have the experts, the congressional budget office, the center for medicare

and c.m.s. have said. these will kick in, and the question is: are they sustainable or will congress legislatively override their authority to cut the spending? mr. ensign: if my friend will yield, there is one part, actually one of the best parts in this bill. but there's so much other bad parts of this bill -- and you've mentioned we've talked about a lot of them. the one place that they actually have improved our health care system would be the part that allows people to have larger discounts for healthier behaviors. safeway was the model this have where today they can discount up to 20% of their health care premiums for people who engage in healthier behaviors, for not smoking, for being the proper body weight compared to their height; doing things like that. even if they're a nonstphoerbg they get a lower premium. if they quit smoking, and safeway paid for the smoking cessation products and things like that. to be fair, that is actually in the bill. senator kaerp and i got that, in the finance committ

c.m.s., estimates that figure will increase to 20%, $1 in every $5 will go to health care. c.m.s. estimates that after spending about $6,000 per capita on health care in 2003, we will spend more than $13,000 per capita in 2018, more than doubling our per-person expenditures in 15 years. this translates directly into unsustainable costs for the american people. according to the kaiser family foundation, thousands fewer of our businesses are offering insurance than a decade ago, a clear sign they can no longer contain cost increases of 6% or more year after year. if we do nothing, these costs will continue to rise at a rate which will swallow the budgets of families, businesses, and government. we cannot wait any longer, because even for those fortunate enough to have insurance where they work, are increasingly unsure that it will be there when they need it most. every member of this body has heard from constituents who thought that they had solid health insurance only to find out that their i

the c.m.s. for new screening authority. also limit providers in other ways by more oversight when fraud is suspected, like limiting the number of durable medical equipment providers because we know that d.b. is fraught with fraud. we also require under the bill to require providers to have compliance programs to make sure providers know the rules. also, increase penalties for fraudulent activity. that's in this bill too. but most importantly, this bill would give c.m.s., h.h.s., o.i.g., more tools at their proposal to protect the integrity. so the bill does a lot to protect fraud. i must say, i know this is on his time but this is a bit unusual, this procedure here, and i appreciate the indulgence of the chair as well as the indulgence of the senator from florida. but there were -- you won't believe, senator, the number of amendments that were offered, bipartisan basis, in the finance committee as well as the "help" committee and were adopted in both committees. it's very, very transparent, very

you have the c.m.s.ctuary saying if you close 20% of the hospitals that 17 million people who get insurance through their employer are going to lose it, that the medicare cuts are not sustainable on a permanent basis in this legislation and that most of the, a lot of these tax increases will be passed on in the form of higher premiums which are mainly going to be borne by people who are trying to provide insurance to their employees. if you're sitting there as a businessperson and you're looking at that balance sheet and looking at that income statement and somebody is trying to sell you on an idea about health care reform that has the features i just mentioned, how do you react to something like that? i see what small business organizations are saying, but you've been there. tell me how you view -- mr. corker: i just met with a business man in tennessee on one of my more recent trips. they have an annual payroll of $4.2 million -- no, their health care costs are $4.2 million a year for their employees.

mccain: i don't know if the senator has seen the c.m.s.stimates this morning that these will be dramatic increases in health care costs. and you may be able to expand the access to it but given the dramatic increase, one, it still affects the medicare system; and, two there, will obviousl obviously -- and two, there will obviously be increased costs if you see the adverse selection such as we're talking about. i'd ask my friend, i see our staff is getting very restless. i'd ask my friend if maybe we could do this again during the weekend and during the week. i appreciate it. i think people are -- are helped by this kind of debate and discussion, and i do respect not only the passion but the knowledge that the senator from illinois has about this issue. mr. durbin: thank you. i ask now consent that morning business be closed. the presiding officer: morning business is closed. the clerk will report. the clerk: conference report to accompany h.r. 3288, an act making appropriations for the departments of transportation and housing and urban de

president, we have heard from both c.m.s. and cnn, and when will our colleagues on the other side of the aisle respond to either the cold, hard facts or the american people? they argued to make history. it is clear that this would be a historical mistake of gargantuan proportions, a historical mistake of gargantuan proportions. the only history we're making here is a historical mistake. we know from the experts it won't achieve the goal. we know from the american people they don't want us to pass it. it's time to stop this effort and to start over and go step by step to fix the problems the american people sent us here to fix regarding the american health care system. mr. president, i yield the floor. the presiding officer: who yields time? time will be charged equally. mr. kyl: mr. president? the presiding officer: the senator from arizona is recognized. mr. kyl: thank you, mr. president. mr. president, i wanted to speak for a moment about the vote that we're about to take here to proceed with the so-called omnibus appropria

and c.m.s. is breaking the law today, and with the new medicare commission, they're going to break it even further under this bill. section 1801, nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine or in the manner in which medical services are provided or over the selection, tenure, or compensation of any officer, employee of any agency or person providing health services. or to exercise any supervision or control over the administration or operation of any such institution, agency, or person. that says the federal government can't practice medicine. that's what it says. section 1802 -- and this is why it's really important for my medicare patients and every medicare patient out there. "any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title, if such institution, agency, or perso

what both the c.m.s. actuary and the congressional budget office have now said is, no, both are not true. there is only one sum of money. you can either extend the life of medicare with that money or you can buy a new entitlement under the bill with that money. but you can't do both. so if that money is spent on the new entitlement, for example, it cannot extend the life of medicare. it cannot show a budget surplus of $130 billion. in effect, they're saying you can't sell the same pony twice. now here's exactly what the congressional budget office had to say about this this morning. and, incidentally, we were tipped off to this by a comment that was in the body of a letter from the c.m.s. actuary last week, or actually december 10. and as we read through this and then tried to analyze the new amendment that was just filed, it suddenly became clear that in effect that is precisely what is being done by the other side. and i'm not suggesting duplicity. what i'm suggesting is that they too have been misled b

an audit of the bill by richard fost he, the chief -- by richard foster, the chief actuary of c.m.s., a division of health and human services, and this is the chief actuary, found that the pace of national health care spending will increase 2.1% over ten years or about $750 billion. senate majority leader harry reid's bill grows just as fast as the house version. and yesterday -- the day before yesterday we got a new actuarial report that actually addressed the reid bill, as opposed to the house bill, and we talked about that fairly extensively. i haven't seen any articles about it yet. but just one summary comment on it is that, according to this actuary of c.m.s., a part of the administration, said that the cost of health care under the reid bill will increase by .7%. that doesn't sound like much. but it is .7% more -- move -- than if we did nothing. that's not bending the cost curve down. mr. holtzs-eakin says each bill sets up a new entitlement program that grows at 8% annually, as far as the eye can see, faster than the economy will grow, faster than tax revenues will grow, and j

according to the c.m.s. actuaries, h.h.s. actuaries, medicare is projected to go broke in about year 2017, but c.m.s. has estimated that this act will actually extend solvency to the year 2026. that's very important, mr. president, an important message to senior. the medicare solvency of the trust fund will be extended in this legislation for at least nine more years, beyond 2017. i wish it were farther but that's a lot better than not extending solvency. extending solvency for that period of time. the bill also would increase the number of -- the percentage of h insurance from about 83% to 94%. that, too, is no small matter. on legislation would reform the insurance market, protect those with preexisting conditions, prevent insurance companies from discriminating and capping coverage, and require insurance companies to renew policies as long as policyholders pay their premiums. let me just say a bit more and whittle more precision about premium costs. the centers for medicare and medicaid, the office of actuary have confirme

yesterday, we heard from both c.m.s. and cnn.s., center for medicaid and medicare services, the actuary reported that this bill will not bend the health care cost curve. i would call your attention to a letter, september 17, 2009, from six of our democratic colleagues, cole, mccaskill, and others, saying, quote, if we pass health care reform legislation without addressing the issue of health care spending, we will have failed. so c.m.s., the actuary, an objective person who does this all the time says that the rebill doesn't pass that test. now, the other entity we heard from was cnn and i cite them as one example of growing evidence that the american people are opposed to this bill. we saw two weeks ago in a poll that there was a 9% more americans oppose the bill than supported it. we saw last week in another poll, 14% more americans oppose the bill than supported it. and then now we see in the cnn poll, 61% oppose and only 36% in favor. the argument i hear my friends on the other side are making or imploring their members to ma

so the two different accountings, one from c.m.s. says one thing and one from c.b.o., which has a unified budget accounting, a different process of accounting for federal expenditures. both say good things, but both can't be accurate. both members say, c.b.o. says you can't count it twice. c.m.s. says you can't count it twice. this is not a little matter. so i would just urge my colleagues to -- the presiding officer: the senator's time has expired. mr. sessions: i thank the chair and urge my colleagues to access this information on the c.b.o. website and my website if they would like. the presiding officer: under the previous order, the time until 2:00 p.m. will be controlled in alternating one-hour blocks of time, with the majority controlling the first hour. the presiding officer: the senator from montana is recognized. mr. baucus: mr. president, it's been nearly five weeks since the majority leader moved to proceed to the health care reform bill before us today, and it has been more than two months since the finance committee rep

the c.m.s. actuary noted that the medicaid cuts in the bill -- medicare cuts in the bill could jeopardize medicare beneficiaries' access to care." i just heard the senator from rhode island basically come out and say that was a fabricated thing on somebody's part on this side of the aisle. i'm quoting the chief actuary, the president's chief health care budgetary person the actuary said "it could jeopardize medicare beneficiaries' access to care." he goes on to say he also found that roughly 20% of all part-a providers -- hospitals, nursing homes, et cetera -- would become unprofitable within the next ten years as a result of these cuts. hospitals will close. nursing homes will khroefplts this isn't fabrication. this is the chief actuary for the center of medicare and medicaid services who is part of this administration. the c.m.s. actuary found that further reductions in medicare growth through the actions of the independent medicare advisory board -- this is the advisory board that's being set

the c.m.s. actuary projects a net $469 billion in medicare and medicaid savings over ten years, slightly more than the congressional budget office. it extends the life of the medicare trust fund, according to the office of the actuary, by nine years. that's longer than anyone's projected in previous forecasts. but it's a significant increase, almost doubling the life of the medicare trust fund over what it currently would be. it reduces premiums by $12.50 a month by the year 2019, or $300 per couple per year. slowing medicare growth with lower -- will lower health care costs for seniors welz younger -- as well as younger americans. not only will there be a premiums savings but coinsurance will fall as well. the senate bill slows the growth of health care costs. the actuary report that we have here, for example, says that reductions in medicare payments updates for providers, the actions of the independent medicare advisory board and the excise tax on high cost employer-sponsored health insurance

however, the reid bill establishes a new c.m.s.nnovation center which will be for the first time granting c.m.s. broad authority to decide which treatments to ration. last one -- last rationer, it's like the four horsemen. the u.s. preventive services task force -- right here, the u.s. preventive services task force. they got a lot of headlines here recently and i'll go into that here in just a moment. it's yet another panel of appointed experts. we've got four panels here, none of them elected, so-called experts. this will make -- this particular task force will make recommendations on what preventive services patients should receive. currently the task force recommendations are optional but the reid bill bestows this unelected, unaccountable body with substantial new powers to determine insurance benefit requirements in medicare, medicaid and even the private market. and the task force has already revealed the types of recommendations that it will be making. just recently, it decided to reverse its long-standing recommendation th

. -- but c.m.s. doesn't do that. this bill cuts the benefits in half. the extra benefits that medicare patients have by being signed up on medicare advantage that everybody has who can afford a supplemental policy. i want to address one other thing, if the senator would allow me. the majority whip said, don't we want to get rid of conflicts of interest? yes. but his arkt was specious -- but his argument was specious. because the prices set for an x-ray who are a mammogram or a c.t. or a blood test, they are set a by medicare -- they are set by medicare now. there's no arbitrariness. the government sets the price for every medicare test out there by region. so there's no way to game it, as the senator from illinois said it was gamed. the best reason to have a lab and a doctor's office is so you don't have to wait and come back for another visit to the doctor that charges medicare another $60, because you get the answer right then. we want to eliminate that. so what will we do? there's no cost savings

yet where we are nearly five months later, the administration's own scorekeeper, the c.m.s.actuary -- that's the center for medicaid and medicare services actuary -- says the democratic bill will actually drive costs up, exactly the opposite of what the debate was all about in the beginning and exactly opposed to what the president indicated on july 22, that he wouldn't sign such a bill. remember, the purpose of reform was to lower people's insurance premiums as well, and here's what the president had to say about that. a direct quote -- "i have made a solemn pledge," said the president, "that i will sign a universal health care bill into law by the end of my first term as president that will cut the cost of a typical family's premiums by up to $2,500 a year." that's the president campaigning for president, june 24, 2007. "a solemn pledge that i will sign a universal health care bill into law that will cut the cost of a typical family's premiums by up to $2,500 a year." yet now we're being told by the administration's own nonpartisan scorekeeper -- again the c.m.s. actuary -

as for the third goal, the fact is -- attested to by the c.m.s. actuary and c.b.o., 31 million more americans will be able to have health insurance as a result of this legislation. we say that so often, i think we forget the power of it. 31 million people who don't have health insurance today will have it after this bill passes. that is a giant step forward for our society. it is not only the right thing to do, but it will also eliminate the so-called hidden tax that each of us who has health insurance today pays in higher premiums when someone who has no health insurance gets sick and goes to the hospital to be treated. that's real progress on the third fundamental goal of health care reform that i mentioned. now, is there anything in the bill that worries me? well, of course there is, and i'd say most of all i worry that we and future congresses will not have the discipline to keep many of the promises we've made in this bill to control costs by transforming the way health care is delivered, because some of these reforms are controversial, and t

c.m.s. rates as above average in overall plan quality." this is what medpac says, that's the nonpartisan experts that help advise congress in what reimbursement levels, what they should be. now, we've heard day after day this this bill is cutting medicare benefits for our seniors. what my colleagues on the other side of the aisle realize that this bill does not cut, reduce, or eliminate a single guaranteed benefit. they turn their argument to medicare advantage. i think they finally recognize that there are no guaranteed benefits cut in this legislation so they turn to medicare advantage and they argue that the efficiencies and savings would be achieved by ending billions of dollars of overpayments to these private plans will either end the program or dramatically cut services to beneficiaries. but let's just look at the numbers. i have a chart behind me. this chart shows the yearly spending for medicare advantage in billions of dollars. so you can see from the chart that in the year, say, 2

when we did part-d of medicare -- of medicare, they had to hire over 500 people in c.m.s. and so we'll have to hire all kinds of people, including -- listen to this -- including the internal revenue service. i bet you'd have a hard time finding an american that thinks it is a good idea to get the i.r.s. involved in delivering our nation's health care. and the worst thing we can do is borrow another $2.3 trillion, create additional federal programs and put a bigger burden on the engine of job creation. i find this especially troublesome after hearing the centers for medicare and medicaid, their chief actuary. last week, under the original reid health care bill, they said costs will go up, not down. in fact, according to his analysis, the federal government will spend $234 billion more on health care if this legislation became law than without it. $234 billion more with this legislation than what we're spending right now. and it's not just the federal government, as i discussed in some detail last week, most states will have new fiscal obligations of about $26 billion under

they get c.m.s. to score it as if it's saving medicare. now, i was a federal prosecutor for a long time. i know the responsibilities place odd -- placed on presidents of corporation. and if a president of a corporation would have issued a prospectus and asked people to invest money into his company and support his program, his agenda, and he said i've got $400 billion or $400,000 i'm going to spend in it and he knew that the money was being spent on something else and he didn't really have that money, that's a criminal offense. and people would go to jail for it. i'm really worried about. this is unbelievable. so we're going on get to the bottom of this. if i'm wrong, i'd like to see where the money's coming from. so the question to my colleagues is -- and apparently this has been asked by staff for weeks and never gotten a straight answer -- where do you get this $871 billion? how much of that are you counting coming from savings in medicare? and where precisely are you getting it from medicare? and if you're going to spend it on the new

that has to do with the administrative functions of government in existing law, c.m.s., that in my opinion has used incomplete data to cut cardiologists, particularly that are needed in a state like florida, where, in fact, so many senior citizens are needing the service in medicare of cardiologists. here's another major thing in this bill. we are setting up a nationwide insurance plan that will be sold on these health insurance exchanges, and it will be operated by the office of personnel management, the same office that governs our federal employees, members of congress health insurance. there's a part in this bill on tort reform. it sets upstate grants to test alternatives to litigation. and in my remaining minute, let's don't forget the 31 million more people that are going to come in insured and how this over time is going to bring down the cost on medicare. it's not going to cut medicare, it's going to save medicare. and it's going to do that with efficiencies, such as electronic records and accountable care organizations and emphasis on primary care physicians. and to conclude, mr.

the c.m.s. letter made a number of points. remember, when we started down it read road, the president said he wanted to do three things. one, he wanted to expand coverage so that uninsured would be covered. two, he wanted to bend the out-year cost curve of health care in this country so we could afford t and, three, he wanted to make sure that if you had insurance, you get to keep t if you like jury insurance, your employer plan you have, you get to keep t what did -- one of the actuariys, this isn't the republican side. this is an independent, fair, analysis of the reid bill. what did they say on the three points that the president held up as his test of what health care should be? on the issue of whether or not this bill bends the out-year cost curve, which we have to do, by the way, if we don't get health care costs uncontrol, there's no way to get our federal budgets under control. what the actuaries say? total -- this is a -- quote -- "total national health care expenditures thunder bill would increase by an estimated --

according to the c.m.s. actuary, these proposed deep cuts will threaten medicare's fiscal stability and push one in five hospitals, nursing homes, and home health care providers into the red. many of these providers, i fear, would simply stop taking medicare patients which would jeopardize care for millions of seniors. now, mr. president, i want to make clear that i do believe there are savings that can be found in the medicare program. for example, far too much is lost each year to fraudulent claims. that's an area where we need to crack down. as we put in place the health care reforms that have widespread support on both sides of the aisle, we could also achieve real breakthroughs that would improve the quality of care while lowering the cost. but, mr. president, that's not what we're talking about in the underlying bill. instead we're talking about essentially across the board cuts, deep cuts, cuts that are going to hurt some of the most vulnerable people in our country, our seniors and our disabled citiz

this is taken from the congressional budget office and from the c.m.s. actuary. and finally, in addition to the medicare advantage, the actuary says simulations by the office of the actuary suggest that roughly 20% of party providers -- and that's hospitals, nursing homes, home health care, would be unprofitable within the ten-year projection period as a result of productivity adjustments, meaning they would go out of business. obviously, seniors' care is going to be affected by this legislation, and we believe negatively so. that's an honest debate to have, and it's one which we would like to have. but finally, my colleague turned the world upside-down by arguing about the only reason that we're here the week before christmas is because of republican bad behavior, that we ruined the holidays for the professional staff because we followed the procedures of the senate that require the reading of the bill. now, it's true that that requirement is usually waived, but then we usually have plenty of time to know what's in a bill. usually a bill works its way through co

these are all -- i might add, too, the c.m.s. innovation center and independent payment advisory board suggests some of these. the bill makes it easier for employers to offer workplace wellness programs, to give employers greater flexibility to offer premium discounts for workers who are committed to leading healthier lifestyles. there is a lot of emphasis on wellness and lifestyle. we're giving incentive to employers to have wellness programs and preventative programs which will help, obviously, the worker, but in addition to that, addition to cut down costs. there are other provisions here. this bill keeps getting stronger. the so-called freshman package led by senator warner would give the senate the authority to expand the scope of the medicare board to the private sector. there are many other here, mr. president. i have a long list. i ask that they be included in the record as if read. the presiding officer: without objection. mr. baucus: i also ask consent that an excerpt from dr. gawandi's article in "the new yorker" be pr

or take what c.m.s. did to all the oncologists in this country, they said we're paying too much for epigen, it is an acronym for a chemical that is kicked out by your kidneys to cause you to make red blood cells. well, when you get chemotherapy for breast cancer or colon cancer, like i've had, sometimes that chemotherapy not only kills your cancer, but it kills your blood cells. so because we were using too much epogen, medicare puts out a rule limiting epogen and said unless you have a hemoglobin of x amount, you can't take out epogen and the doctor will get fined if he gives it to you if you don't meet the guideline. so what happens? well, for 80% of the patients it worked fine. but for those patients who had other co-morbid, other conditions like heart failure or emphysema where significant drops in hemoglobin caused organ failure in other areas of the body, there was no exception made by c.m.s. for a physician to make a judgment in saying this rule shouldn't apply here because this patient's going to

i can assure you, every provider knows who and what c.m.s. is. and the u.s. preventive services task force. there's four of them, the four folks who have the ability to ration care by almost executive order unless the congress would come in and overturn it with a -- with a supermajority. this bill puts the rationing infrastructure into place. the u.s. preventive services task force recent change to its guidelines pertaining to mammograms was a perfect illustration of how your health care will be rationed under this bill. for those who don't know -- and you should know -- the task force recently reversed its long-standing advice that women should start getting regular mammograms to detect breast cancer at age 40. now, why is this important? because under this bill, the recommendations of this task force will carry the weight of law for both government-run -- i.e., medicare -- and private insurance. also private insurance. if the task force recommends a particular treatment for a particular set of patients, then medicare and private insurers must cof it. if it

and we do that because c.m.s. failed to competitively bid it because when it was written -- and i understand who wrote it -- when it was written, we didn't make them competitively bid it. so you could get the same savings, exactly the -- actually you could get more savings and not reduce benefits in any amount if you competitively bid that product. but we've decided we're not going to do that. second point i would make with my colleagues is the vast majority of people on medicare advantage are on the lower bottom of the economic. they can't afford an aarp supplemental bill. they can't afford to pay an practice $150 or $200 a month. and so what most of the time happens with medicare advantage is we bring people up to what everybody else in medicare gets because most people can afford -- 84% of the people in this country can afford to buy a medicare supplemental policy because medicare doesn't cover everything. so your idea to try to save money, i agree with. but cutting the benefits, i don't agree with. and you're

i'd ask unanimous consent the list of what the enrollment is by the c.m.s.medicaid and medicare advantage enrollment as of august 2009 be placed in the record. the presiding officer: without objection. mr. mccain: and the point of all of this that the senator from florida, a member of the finance committee, felt so strongly that medicare advantage was at risk that he decided to carve out -- was able to get a majority on a party-line vote of the finance committee to carve out a special status for a group of seniors under medicare advantage in his state. this amendment simply says that everyone that the senator from oklahoma just made reference to has that same protection. that's all that this amendment is about. mr. cornyn: if the senator would yield for a question, if this amendment does not pass, which protects all medicare advantage beneficiaries, all 11 million of them, 532,000 in my state, and as a result of not only these cuts but perhaps additional cuts to come in the future to medicare advantage, which makes it harder and harder to -- for medicare ben

it says that c.m.s. and o.m.b.st certify that no funds are being used to fund the additional activity in this bill that does not relate to medicare with medicare funds. it does not say that medicare savings -- it agrees to the medicare savings. those medicare savings would be used for the purpose of reducing the out year fiscal imbalance of medicare. so it doesn't contest the medicare savings as proposed in this bill, although those amendments -- we've already voted on a number of those. we voted on home health care, swreeted on medicare advantage. but to the extent those savings go in, these cuts in medicare benefits go in, they cannot -- the revenues from those cuts cannot be used instead to expand the size of government someplace else that has nothing to do with senior citizens. mr. barrasso: well, if i could ask my colleague, as i read "the new york times," it said the bennet amendment was completely meaningless. the bennet amendment was meaningless and it also goes on to say that senator mccain is trying to ke

so the senate bill directs the c.m.s. to rebase payments to reflect this change. it's common sense. medpac recommended it. medpac thinks it's got to keep up with the times because times have changed over the years and that the payment systems reflect that change. something else i think is very important as most of my colleagues agree with. that is the senate bill roots out fraud that unfortunately exists in home health care as well as some areas of medicare spending. it roots out the fraud -- it tries to root out the fraud and medicare payments for outliar cases. medicare provides an extra payment today to providers, home health folks who treat sicker people or otherwise known as outlier patients, really sick. fortunately, the -- unfortunately, the general accounting office found that some providers were gaming the system and getting much more outlier payments than they deserved. for example, the general accounting office found in one florida county alone, home health providers were receiving 60% of all total outlier payments. that's nationwide, one county getting 60%, even though t

unfortunately, the medicare beneficiaries, the c.m.s. actuary, found that 20% of hospitals and nursing homes would go into the pred within the next 10 years -- red within the next 10 years. as if that were not enough, the reid bill would also cut payments to medicare advantage plans by roughly $120 billion, plans that 11 million seniors enjoy today. these cuts, according to the actuary, will result in 3.7 million seniors losing benefits under medicare causing many to pay more out of pocket each month for the drugs and services they lost. the reid-pelosi bill will make it harder for seniors to find treatment or afford care when they are sick. that's all. thank you. the speaker pro tempore: for what purpose does the gentlewoman from pennsylvania rise? mrs. dahlkemper: i ask permission to address the house for one minute. the speaker pro tempore: without objection, the gentlewoman is recognized for one minute. mrs. dahlkemper: mr. speaker, i rise today to honor one of my constituents, an extraordinary woman in erie, pennsylvania. claire war

and we do that because c.m.s. failed to competitively bid it because when it was written -- and i understand who wrote it -- when it was written, we didn't make them competitively bid it. so you could get the same savings, exactly the -- actually you could get more savings and not reduce benefits in any amount if you competitively bid that product. but we've decided we're not going to do that. second point i would make with my colleagues is the vast majority of people on medicare advantage are on the lower bottom of the economic. they can't afford an aarp supplemental bill. they can't afford to pay an practice $150 or $200 a month. and so what most of the time happens with medicare advantage is we bring people up to what everybody else in medicare gets because most people can afford -- 84% of the people in this country can afford to buy a medicare supplemental policy because medicare doesn't cover everything. so your idea to try to save money, i agree with. but cutting the benefits, i don't agree with. and you're

the chief actuary of c.m.s. believes that the cuts in the bill that we have before us will for providers constitute a substantial portion of their business, and they could find it difficult to remain profitable and might end their participation in the program. i mean, every american understands this. if we pay less money to health care providers, they're going to offer less benefits or more and more they're not going to participate in medicare. the medicare payment advisory commission found in june of last year that 29% of medicare beneficiaries who remember *f who were -- who were looking for a primary care doctor had a problem finding one to treat them. this is of grave concern to the 3 million floridians who are on medicare. if a doctor won't see them, what kind of health care plan is this? these seniors, our greatest generation, have paid into this program their whole life, and it is i will illusory if they can'a doctor who will treat them. one of my constituents, earl bean, from sanford, florida, recently t

the c.m.s. actuary actually said that the medicare cuts are unlikely to be sustainable on a permanent basis. we all know around here that we're not going to cut a trillion dollars out of medicare when -- over the first 10 years when it's fully implemented. that just doesn't happen here. and so what happens? all that money is going to get borrowed. it's going to get put on the debt or they're going to have to raise taxes to pay for it. you can't have it both ways. as we get into the debate about the debt limit, i think it's important to put things into context. i want to say again $132 billion savings, which is what they're saying they get by this health care reform bill with all of the tax increases and the medicare cuts, is suspicious in the first place given the fact that the s.g.r. $200 billion isn't included, the $72 billion class act is and the $47 billion they achieve by front end loading the tax increases and back end loading the spending brings you to $177 billion deficit and that doesn'

the c.m.s. actuary last week said, in addition to all the other things they mentioned, the overall cost of health care is going to go up, 20% of hospitals are going to close, that the medicare cuts that are being proposed cannot be sustained on a permanent basis. well, if that's true, how is this going to be financed? either with more taxes or borrowing it, putting on the debt and handing the bill to future generations. that's what we're left with because once you lock in a $2.5 trillion expansion of the federal government, it is going to be very, very hard to reduce the cost of it. the spending is not going to go away. the way it's going to be paid for if the medicare cuts are not sustainable is the tax increases -- and there are already tax increases in here -- would have to be increased even further. or worse yet for future generations if you're a young american, you're going to get it put on your bill. the senator from texas and my colleagues who are here this morning, we voted yesterday to

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

mark mcclellan, former head of -- of c.m.s. and daniel kessler estimated adds $1,700 in additional costs per average family. addressing this reform alone could save more than covering all of the uninsured. so you see the democrats say that their bill will eliminate the so-called hidden tax. well, my friends seem to come up short on that one, and also my friends add new hidden taxes that will burden middle-class americans. so i ask my friends to be transparent when they are talking about getting rid of the hidden tax. the democratic health reform bills actually make things worse. i yield the floor. a senator: mr. president? the presiding officer: the senator from utah. mr. bennett: mr. president, last night i held a telephone town hall meeting. as usual, with those we get over 10,000 people that end up on the telephone town hall talking to us. i said this is a meeting that's open to any subject you can talk about. overwhelmingly, they all wanted to talk about health care. and the -- i had one call of a fellow that said he liked

even the c.m.s. actuary has certified that because of the medicare provisions contained in this bill, the solvency of the medicare part-a hospital insurance trust fund will be improved by five years. so, that -- what they're saying with respect to that is simply not true. they also claim that medicare cuts are used to pay for coverage expansion. this statement actually ignores the benefits that seniors receive from this bill. and i think it also is important to remind people how the medicare financing system works. i just talked about the medicare solvency in the part-a program. the part-a program is paid through payroll tax. the part-b program and the prescription drug program is paid through a combination of general revenue contributions and enrollee premiums. and they pay, i think, about 25% of the total program cost is paid through the premium, and 75% is paid by the general revenues. part-d financing works exactly the same way. this bill reduces medicare spending by a total of $463 billion. does

and, if so, will you be calling c.m.s. and medicare and asking them to be -- to change what they say explicitly on page 50 of the medicare handbook? mr. baucus: that's a very interesting question because when i was told about the medicare handbook, that's exactly what i was going to do, call up medicare and say hey, that's misleague because it's inaccurate. and because it is misleading, it is inaccurate. these are private companies and it is not part of medicare. mr. dodd: it's a private -- mr. wicker: even though they put it in their handbook, had it for several years, that's wrong, it's not part of medicare? mr. dodd dodd: that's wrong. it's a private health care plan. it's a private health care plan. medicare is a public plan. medicare advantage is not medicare and it's certainly not an advantage given the overpayments that have occurred. mr. wicker: isn't it in part-c of the medicare legislation? mr. dodd: benefit plan. it's a -- my colleague understands that, i hope. medicare advantage is a private plan. you know that

the democrats do not address the cost shift from defensive medicine, which former c.m.s. director, mark mccellend -- addressing this reform alone could save more than covering all of the uninsured in america. so, you see, my friends on the other side say that their bill will eliminate the so-called hidden tax. well, my friends seem to come up short on that one. also they add new hidden taxes that will burden middle-class americans. so i think the present situation, the legislation before us, and the language used by debaters on the other side should be transparent. these people should be transparent when they're talking about getting rid of the hidden tax. the pending health care reform bill makes things from these three perspectives worse. madam chairman, i'd be happy to yield the floor for a minute -- for the purpose of a colloquy to senator boxer on another subject. mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: i'd like to -- well, i'd like to address a colloquy with senator grassley, as he said on another subject that's not

. -- but c.m.s.doesn't do that. this bill cuts the benefits in half. the extra benefits that medicare patients have by being signed up on medicare advantage that everybody has who can afford a supplemental policy. i want to address one other thing, if the senator would allow me. the majority whip said, don't we want to get rid of conflicts of interest? yes. but his arkt was specious -- but his argument was specious. because the prices set for an x-ray who are a mammogram or a c.t. or a blood test, they are set a by medicare -- they are set by medicare now. there's no arbitrariness. the government sets the price for every medicare test out there by region. so there's no way to game it, as the senator from illinois said it was gamed. the best reason to have a lab and a doctor's office is so you don't have to wait and come back for another visit to the doctor that charges medicare another $60, because you get the answer right then. we want to eliminate that. so what will we do? there's no cost savings i

as for the third goal, the fact is -- attested to by the c.m.s. actuary and c.b.o., 31 million more americans will be able to have health insurance as a result of this legislation. we say that so often, i think we forget the power of it. 31 million people who don't have health insurance today will have it after this bill passes. that is a giant step forward for our society. it is not only the right thing to do, but it will also eliminate the so-called hidden tax that each of us who has health insurance today pays in higher premiums when someone who has no health insurance gets sick and goes to the hospital to be treated. that's real progress on the third fundamental goal of health care reform that i mentioned. now, is there anything in the bill that worries me? well, of course there is, and i'd say most of all i worry that we and future congresses will not have the discipline to keep many of the promises we've made in this bill to control costs by transforming the way health care is delivered, because some of these reforms are controversial, and t

the chief actuary of c.m.s. believes that the cuts in the bill that we have before us will for providers constitute a substantial portion of their business, and they could find it difficult to remain profitable and might end their participation in the program. i mean, every american understands this. if we pay less money to health care providers, they're going to offer less benefits or more and more they're not going to participate in medicare. the medicare payment advisory commission found in june of last year that 29% of medicare beneficiaries who remember *f who were -- who were looking for a primary care doctor had a problem finding one to treat them. this is of grave concern to the 3 million floridians who are on medicare. if a doctor won't see them, what kind of health care plan is this? these seniors, our greatest generation, have paid into this program their whole life, and it is i will illusory if they can'a doctor who will treat them. one of my constituents, earl bean, from sanford, florida, recently t