Service Members Home Ownership Tax Act Of 2009
BREAK IN TRANSCRIPT
Mr. McCAIN. Madam President, simply put, this motion to commit would be a requirement that we eliminate the one-half trillion dollars in Medicare cuts that are envisioned by this bill--one-half trillion dollars in cuts that are unspecified as to how, and one-half trillion dollars in cuts that would directly impact the health care of citizens in this country--Medicare Advantage cuts totaling $118 billion; an independent Medicare advisory board that would cost $23 billion; an expansion of Medicare hospital penalties totaling $7.1 billion; home health care cuts totaling $42.1 billion; and hospice--of all the things--payment changes. The list goes on and on.
All of these are cuts in the obligations we have assumed and that are the rightful benefits people have earned--particularly our senior citizens--across this Nation. This eliminates one-half trillion dollars in cuts to Medicare that are cuts that are unspecified.
I eagerly look forward to hearing from the authors of this legislation as to how they can possibly achieve one-half trillion dollars in cuts without impacting existing Medicare programs negatively and eventually lead to rationing of health care in this country.
That is what this motion is all about. This motion is to eliminate those unwarranted cuts. All of us know there are enormous savings in fraud, abuse, and waste that can be identified. No expert I know of believes that would come up to one-half trillion dollars. Hospitals are cut by $105 billion. Nursing homes are cut by $14.6 billion. Hospices are cut by $7.6 billion.
These are not attainable cuts, without eventually rationing health care in America and rationing health care for our senior citizens, who have earned these benefits, and we have guaranteed them these benefits.
For the life of me, how the AARP can support this 2,000-page legislation is beyond my imagination. Seniors all over America, including Arizona, including the 330,000 senior citizens in my State who are under the Medicare Advantage Program, which will be drastically cut by some $120 billion, are outraged. The more they find out about it, the more angry they are becoming.
Here we are, as my colleague from the great State of Iowa, a leader on health care, articulated, with a totally partisan measure before the Senate, in which no Member on this side of the aisle has been consulted in any way. I point out that, historically, there has never been a major reform implemented by the Congress of the United States unless it is bipartisan in nature, and I don't believe the American people want this 2,000-some-page monstrosity, which is full of all kinds of provisions that they are either unaware of, or even in the study of this legislation, many of us have also become unaware of. But fundamentally, the Bernie Madoff/Enron accounting that has been going on with this bill is dependent upon envisioning one-half trillion dollars in cuts that are not attainable. If they are attainable, it would mean a direct curtailment and reduction of the benefits we have promised the senior citizens of this country. That is not acceptable.
What this motion to commit does is send it back to the Finance Committee: Come back with another bill. Only this time, don't put the cost of it on the backs of senior citizens of this country. Don't do it. It was back last summer, 3 months before he was elected President, on a campaign stop not far from Washington, DC, now-President Obama vowed not only to reform health care but to do it in a new way. He said:
I am going to have all the negotiations around a big table, televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents and who are making arguments on behalf of the drug companies or the insurance companies.
Americans wanted to believe this would be true. Republicans offered to work with the majority on our ideas. But that was rejected. So what has happened? Business as usual. Let me read from a report of this past weekend about business as usual:
The Associated Press has moved a story saying that health care lobbyists and other interests have made 575 visits to the White House between January and August. The report is based on records released by the White House on Wednesday.
The timing of the release smells of a classic Washington tactic--dumping bad news on the getaway day before a long weekend. Clearly, the White House, which prides itself as being the most transparent administration in the history of the world, hopes this nugget gets lost over the four-day Thanksgiving weekend.
AP's Sharon Theimer:
Top aides to President Barack Obama have met early and often with lobbyists, Democratic political strategists and other interests with a stake in the administration's national health care overhaul, White House visitors records obtained Wednesday by the Associated Press show.
All of my fellow citizens watching, I urge you to call the White House and say you want to have an appointment to meet with the President or members of the administration in the White House. Five-hundred-seventy-five special interests were able to get in. Why can't you? Give them a call. Tell them you want to meet with the members of the administration. That is what 575 lobbyists have been able to do. Give them a call.
Continuing to quote:
The records show a broad cross-section of the people most heavily involved in the health care debate [except for average citizens] weighted heavily with those who want to overhaul the system.
It talks about who were among them.
The list also includes George Halvorson, chairman and CEO of Kaiser Health Plans; Scott Serota, president and CEO of Blue Cross and Blue Shield Association; Kenneth Kies, a Washington lobbyist who represents Blue Cross/Blue Shield, among other clients; Billy Tauzin, head of PHARMA, the drug industry lobby; and Richard Umbdenstock, chief of the American Hospital Associations.
Several lobbyists for powerful health care interests, including insurers, drug companies, and large employers also visited the White House complex, the records show.
Again, citizens, why don't you call the White House and ask for an appointment? The lobbyists and special interests--big donors--get it. They are not ambassadors. They are lobbying the White House on this issue.
Health care reform should have been about both sides sitting down together and fixing what is broken, reducing health care costs, while preserving the highest quality health care in the world.
Somewhere in the course of this debate, in the process of this legislation, we have lost sight of the fundamental problem with health care in America, and that is the cost of health care in America, not the quality. This legislation will destroy the quality and the availability, if the cuts envisioned in this legislation--this Enron accounting measure, where the first 4 years after this legislation--suppose this legislation were signed on the 1st of January by the President of the United States. Immediately benefits will begin being cut. Immediately taxes will go up. Guess what. None of the benefits will be given to any American citizen for 4 years. That is how you get deficit neutrality. That is how you get deficit neutrality.
If you started giving the benefits at the same time you raise the taxes, you have got about $1.3 trillion in deficit in a $2.5 trillion bill--a $2.5 trillion piece of legislation. Here we are with the highest deficits in history, with deficits and debt as far as the eye can see, with a stimulus package that has done so well that we now have 10.2 percent unemployment, and many predict it will go even higher. Wall Street is doing fine, and lobbyists are doing fine. Mr. Tauzin, the PhRMA lobbyist, is doing fine. I understand his salary is a couple million dollars a year, not to mention all the other perks. But the average citizen, including the 330,000 citizens of my State, who have the Medicare Advantage Program, are going to see it cut and cut over and over again--about $120 billion worth.
So what happened? The White House engaged in the tradition of handing out favors to special interests, including PhRMA, AARP, and AMA. Shame on AARP and shame on the AMA. We know there are many commonsense reforms that Americans want.
By the way, in this monstrosity, find me any significant, real medical malpractice reform. The threat of medical malpractice causes physicians to practice defensive medicine. The CBO estimates it would be roughly a savings of $54 billion over 10 years. That does not take into consideration the cost of defensive medicine that doctors have to practice because of fear of being sued.
I ask the distinguished chairman of the committee: Where is any meaningful medical malpractice reform in this 2,000-page bill? Where is it?
I had a townhall meeting the other day in Arizona, as I do quite frequently. There were a lot of doctors, nurses, and caregivers who came. I asked them: What do you do about medical malpractice reform? Every one of them said: We practice defensive medicine. We prescribe additional tests and procedures. We have to do it because we will find ourselves in court by the trial lawyers.
Do not underestimate, I say to my friends, the many special interests and their influence in this legislation, but do not underestimate the stunning success of the American Trial Lawyers Association that has made sure there is no provision in this bill that has to do with medical malpractice reform.
By the way, if there is an example, it is called the State of Texas. The State of Texas enacted meaningful and yet not draconian medical malpractice reform. Premiums have gone down. Cases have gone down. Doctors are flooding back into the State of Texas. It has worked.
We are going to hear from the other side that there may be demonstration projects, there may be this, there may be that. The demonstration project is the State of Texas. That is all we have to do. It has already been proven.
Instead of a reform which could save tens if not a couple hundred billion dollars, what are we going to do? We are going to cut hospitals by $505 billion, nursing homes by $14.6 billion, hospices by $7.6 billion, and the list goes on and on, up to one-half trillion dollars. My motion will send it back to the Finance Committee and tell them to remove these unnecessary, unneeded, unwanted, harmful cuts in the Medicare system, which will not allow us to fulfill our obligation to the senior citizens of this country.
Buried in this partisan legislation, as I mentioned, are 10 years of tax increases and Medicare cuts, a total over $1 trillion. Using CBO numbers, this stack of partisan legislation costs $2.5 trillion over its 10-year implementation.
Let me put this in different terms for you. Suppose you want to buy a house. You go and buy the house, but the terms of the contract of purchasing the house say you have to make payments on the house for the first 4 years and then after 4 years you can move in. That is why this is Bernie Madoff accounting. It is a sham. It is a sham. It is a sham to make people pay taxes and have their benefits cut for 4 years and then only after 4 years do the benefits kick in. That is the way, with this kind of accounting, they get to deficit neutral. It is crazy. It is crazy.
The increased taxes and Medicare cuts begin impacting Americans and our economy in 32 days, if this is passed. Let me repeat this. Starting in January 2010, just 1 month from now, the majority begins tax increases and Medicare cuts, starting in January, and incredibly delays implementation of this bill for 4 years. That is 1,460 days and 208 weeks of new taxes and Medicare cuts before implementation. That is playing games with the American people.
If they were not playing games by delaying implementation of the bill 4 years after the tax increases and Medicare cuts, we would not even be discussing this pile of legislation because it would be scored as adding over $1 trillion to our deficit.
If the other side wanted to be honest and reject the Madoff-Enron accounting, they would be talking about the first 10 years of real costs and the first 10 years of their tax increases and Medicare cuts.
The respected dean of the Washington press corps, David Broder, pointed this out just last week in his column in the Washington Post entitled ``A Budget-Buster in the Making.'' By the way, the majority leader then felt compelled to come down and trash one of the most respected columnists in America whom I don't need to take the time to defend; he can defend himself and so will many others who have great respect for David Broder.
David Broder's column said:
It's simply not true that America is ambivalent about everything when it comes to the Obama health plan.
The day after the Congressional Budget Office gave its qualified blessing to the version of health reform produced by Senate Majority Leader Harry Reid, a Quinnipiac University poll of a national cross section of voters reported its latest results.
..... by a 16-point margin, the majority in this poll said they oppose the legislation moving through Congress.
Broder went on to say:
I have been writing for months that the acid test for this effort lies less in the publicized fight over the public option or the issue of abortion coverage than the plausibility of its claim to be fiscally responsible.
This is obviously turning out to be the case. While the CBO said that both the House-passed bill and the one Reid has drafted meet Obama's test by being budget-neutral, every expert I have talked to says that the public has it right. These bills, as they stand, are budget-busters.
Here, for example, is what Robert Bixby, the executive director of the Concord Coalition, a bipartisan group of budget watchdogs, told me: ``The Senate bill is better than the House version, but there's not much reform in this bill. As of now, it's basically a big entitlement expansion, plus tax increases.''
These are nonpartisan sources, but Republican budget experts such as former CBO director Douglas Holtz-Eakin amplify the point with specific examples and biting language. Holtz-Eakin cites a long list of Democratic-sponsored ``budget gimmicks'' that made it possible for the CBO to estimate that Reid's bill would reduce federal deficits by $130 billion by 2019.
Perhaps the biggest of these maneuvers was Reid's decision to postpone the start of subsidies to help the uninsured buy policies from mid-2013 to January 2014--long after taxes and fees levied by the bill would have begun.
Even with that change, there is plenty in the CBO report to suggest that the promised budget savings may not materialize. If you read deep enough, you will find that under the Senate bill, ``federal outlays for health care would increase during the 2010-2019 period''--not decline. The gross increase would be almost $1 trillion--$848 billion, to be exact, mainly to subsidize the uninsured. The net increase would be $160 billion.
But this depends on two big gambles. Will future Congresses actually impose the assumed $420 billion in cuts to Medicare, Medicaid and other federal programs? They never have.
Why don't we tell the truth to the American people and take these supposed cuts out of this bill? Tell them the truth about what it costs and tell them the truth that this is a dramatic expansion of entitlements, but at the same time those presently eligible, those senior citizens, such as the 330,000 who are under the Medicare Advantage Program in my home State of Arizona, will not see that program maintained. You cannot reach these kinds of savings, these kinds of reductions, these kinds of cuts without impacting existing programs. I know of no expert who says it will who is an objective observer. I believe Dr. Coburn, Dr. Barrasso, and others in the medical profession will say the same thing. Every time Congress has enacted so-called cuts in Medicare or contemplated it, they have never taken place.
That doctor fix? We took care of that problem. We just took it out of the bill. But you know what we are going to do about the doctor fix. Every year we are going to delay it, delay it and delay it and it will never happen. That has been the history of the so-called doctor fix since its beginning.
And will this Congress enact the excise tax on high-premium insurance policies (the so-called Cadillac plans) in Reid's bill? Obama has never endorsed them, and House Democrats--reacting to union pressure--turned them down in favor of a surtax on millionaires' income.
The challenge to Congress--and to Obama--remains the same: Make the promised savings real, and don't pass along unfunded programs to our children and our grandchildren.
That means taking this legislation back, taking out these cuts in Medicare and programs that are vital to the citizens of this country and come back with a realistic--a realistic--piece of legislation that has malpractice reform, the ability to go across State lines to get the health insurance policy of your choice, rewards for wellness and fitness, expansion of health savings accounts, and medical malpractice reform.
There are many cost-saving measures we can enact to bring the cost of health care in America under control and preserve quality. Instead, we are doing the opposite.
If you are going to make these kinds of cuts--the $420 billion in cuts to Medicare and Medicaid and other Federal health programs--then you are going to impact the provision of health care in America.
Americans have been clear overspending has to stop, nor do the American people believe empowering Washington bureaucrats in a new Federal health care entitlement is health care reform. The other side disregards the message from the American people all across the country, and the bill does the opposite.
I wish to talk just for a minute about a provision in this bill that is very important; that is, the transfer of power, the massive transfer of power in this bill to the Secretary of Health and Human Services. This is a huge transfer. ``HHS would become federal giant under Senate plan'' by Susan Ferrechio:
A quick search of the Senate health bill will bring up ``secretary'' 2,500 times.
That's because Health and Human Services Secretary Kathleen Sebelius would be awarded unprecedented new powers under the proposal, including the authority to decide what medical care should be covered by insurers as well as the terms and conditions of coverage and who should receive it.
I wish to repeat that. In this bill, the Secretary has the ``authority to decide what medical care should be covered by insurers as well as the terms and conditions of coverage and who should receive it.''
We saw a little precursor of that the other day with, for example, recommendations concerning mammograms. A board recommended that women under 50 should not get routine mammograms. Of course, the response was incredible and justified. Women all over America are now alive today because they had mammograms prior to the age of 50. The Secretary of Health and Human Services said that would not be carried out, et cetera. We are creating a situation where the Secretary of Health and Human Services and a board would decide that.
``The legislation lists 1,697 times where the Secretary of Health and Human Services is given the authority to create, determine or define things in the bill,'' said Devon Herrick, a health care expert at the National Center for Policy Analysis.
For instance, on Page 122 of this 2,079-page bill, the secretary is given the power to establish ``the basic per enrollee, per month cost, determined on average actuarial basis, for including coverage under a qualified health care plan.''
The HHS secretary would also have the power to decide where abortion is allowed under a government-run plan, which has drawn opposition from Republicans and some moderate Democrats.
And the bill even empowers the department to establish a Center for Medicare and Medicaid Innovation that would have the authority to make cost-saving cuts without having to get the approval of Congress first.
``It's a huge amount of power being shifted to HHS, and much of it is highly discretionary,'' said Edmund Haislmaier, an expert in health care policy and insurance markets at the Heritage Foundation, a conservative think tank.
Haislmaier said one of the greatest powers HHS would gain from the bill is the authority to regulate insurance. States currently hold this power, and under the Senate bill, the federal government would usurp it from them. This could lead to the federal government putting restrictions and changes in place that destabilize the private insurance market by forcing companies to lower premiums and other charges, he said.
``Health and Human Services doesn't have any experience with this,'' Haislmaier said. ``I'm looking at the potential for this whole thing to just blow up on people because they have no idea what they are doing. Who in the Federal Government regulates insurance today? Nobody.''
``The health care reform legislation would rely on the U.S. Preventive Services Task Force for recommendations as to what kind of screening and preventive care should be covered. Last week, the group, which operates under HHS, drew sharp criticism for advising that mammograms should begin at age 50, a decade later than the current standard.''
``Critics of the bill said this was an example of how the new bill could empower HHS to alter health care delivery, but Democrats argue they would rather have the government making these decisions.''
That is the key to it. They would rather have the government making these decisions. If you like the way the post office is run, you will love the way HHS runs health care in America.
I understand the amendment of the other side may address some of this, but under the Reid bill the Senate moved to consider, beginning in 32 days, the language from the bill on page 1,189 authorizes the Secretary to modify benefits under Medicare pursuant to task force recommendations. As I mentioned, how many women would have died if the coverage provisions guiding the new Federal plan under mammograms had been implemented? Then, on the following page, 1,190, the Secretary is authorized to deny payment for prevention services that the task force recommends against. So if this unelected panel changes the preventive recommendation for some other type of cancer, the Federal Government plan would not cover it. I don't think the American people want their health coverage decisions coming from a panel in Washington.
The Reid bill drives up costs and premiums. Just today the CBO released its assessment of what will happen to health insurance premiums under the new entitlement compared with premiums today. The CBO dealt a blow to claims the health care bill introduced by Senator Reid will lower premiums when they released an analysis showing that premiums will go up significantly in the individual market. Premiums for individuals without employer-sponsored coverage would increase 10 to 13 percent or $2,100 per family in 2016. The Democrats' bill therefore requires individuals to purchase insurance that is more expensive than would be available under current law. For small businesses and employers, the bill largely preserves the status quo and does little if anything to lower the cost. In fact, CBO estimates that under the Reid bill the average family with employer-sponsored coverage will soon pay more than $20,000 per year for health insurance.
President Obama said the following during the campaign:
I have made a solemn pledge that I will sign a universal health care bill into law by the end of my first term as President that will cover every American and cut the cost of a typical family's premium by up to $2,500 a year.
Well, CBO's analysis shows that the President is breaking that pledge by both failing to achieve universal coverage and raising premiums, just as it contradicts an analysis by MIT economist John Gruber released by the White House this weekend claiming that individual premiums would go down. In fact, even with the generous assumptions made by CBO in a number of areas, premiums will either go up or remain unchanged.
From the CBO report just today, CBO says premiums in the individual market would be 10 percent to 13 percent higher in 2016 than under the current law. Average premiums would increase by $300 for an individual policy and by $2,100 for a family policy. The new benefit and coverage mandates actually drive up premiums by 27 to 30 percent, and this increase is offset by other factors, such as new administrative efficiencies.
CBO says that little more than half of enrollees in the individual market would receive a government subsidy. However, the bill before us would still require nearly 14 million Americans to purchase unsubsidized insurance that is more expensive than they have today.
President Obama has promised that seniors will not see a reduction in benefits. In fact, he said recently:
People currently signed up for Medicare Advantage are going to have Medicare and the same level of benefits.
How did he get there? How do you get there when you are cutting Medicare Advantage by $120 billion? There is no math--old or new--that gets you to no change in the benefits that they have under Medicare Advantage and yet cutting $120 billion. Traditional Medicare doesn't offer coordinated benefits that can improve the quality of care. Traditional Medicare doesn't have many of the aids or benefits for our seniors.
President Obama has also promised several times, ``If you like what you have, you can keep it.'' The American people took those words as a promise that if they had a health benefit they were happy with, they could keep it. I want to make sure we are helping the President keep his promise. I want to help him keep his promise by sending this bill back, taking out the cuts that are in it on Medicare, on the $105 billion cuts to hospitals, nursing homes by $14.6 billion, hospices cut by $7.6 billion, Medicare Advantage by $120 billion. I want to send it back to the Finance Committee and come back with a bill that the American people can believe in that will preserve the solemn obligations we have made to our senior citizens.
Medicare Advantage provides the only choice in the Medicare Program allowing an option for seniors who want additional benefits or a better option. Medicare Advantage is working for nearly 11 million seniors to give them a choice about their health care and better benefits. As I mentioned, 330,000 beneficiaries in my State of Arizona are in Medicare Advantage, and they will see benefit reductions or their plan disappear. Eighty-nine percent of seniors need and have some form of supplemental coverage on top of Medicare to provide protections against out-of-pocket costs or additional benefits. Many low-income Americans and minorities rely on Medicare Advantage as their supplemental coverage.
Some have claimed that cutting the ``extra payments'' to Medicare Advantage plans reduces insurance company profits. Under Federal law, that is simply not the case. The fact is, 75 percent of those ``extra payments'' go directly to better benefits for seniors under current law. The other 25 percent goes back to the Federal Government. Unfortunately, those extra benefits will be taken from seniors who are enrolled in Medicare Advantage.
This bill contains $120 billion in direct cuts to private Medicare plans. Common sense says you can't do that without affecting benefits. The Congressional Budget Office thinks so as well. CBO assumes the Reid bill will cut benefits by more than half, from an average of $98 in additional benefits to $41 a month.
I see one of my colleagues is waiting to speak, but I hope the American people will understand what we are trying to do. All we are trying to do is send this back to be reworked, to be fixed on a bipartisan basis, and not to force $400-some billion in cuts and benefits that we have promised the American people. We want to send it back and come out with a bipartisan approach. Sit down, for the first time, Republicans and Democrats, have the C-SPAN cameras rolling--the way the President promised he would a year ago last October.
Let's sit down together and figure out how we can fix this.
The best way to fix it is to preserve the quality of health care in America and bring down the cost, not to pass a 2,074-page monstrosity that is full of the measures that would impair the ability, particularly of our senior citizens, to keep the benefits they have earned and we have promised them.
Madam President, I yield the floor.
BREAK IN TRANSCRIPT