RECOGNITION OF THE MINORITY LEADER -- (Senate - December 05, 2009)
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Mr. KERRY. Mr. President, just one moment?
Mr. BAUCUS. If the Senator will yield, I thank my colleagues for staying on the floor. I appreciate that.
Mr. KERRY. Mr. President, I just was notified--I wish to respond to a few of the things here. The Senator from Arkansas has the pending amendment. My amendment is apparently not quite ready to be called up. What I want to do, if I can make a couple comments so the conversation doesn't stay where it is, prior to the Senator from Arkansas and then I will yield and then I would like to be able to come back after that with my amendment.
I wish to say to our colleagues on the other side of the aisle, I have listened carefully, obviously, for a number of days now. I notice most of them have, indeed, disappeared--as the Senator from Montana suggested. It is pretty hard to have a legitimate debate in the Senate when people speak and then leave the floor and we can't actually test the things that have been said.
One of the things that was said a moment ago by the Senator from Utah was, you cannot find any doctors who support this plan. Can you find doctors who oppose it? Absolutely. I will give him that. But don't come to the floor of the Senate and suggest there are not huge numbers of doctors across the country who are desperately waiting for the Senate to pass health care reform and, in fact, this plan. In fact, the AMA--this is what the AMA says. They represent tens of thousands of doctors across the country, and they said:
[We are] working to put the scare tactics to bed once and for all and inform patients about the benefits of health reform.
We have heard an incredible amount of scare tactics, Senator after Senator standing there, jumping up, pounding out one sort of misstatement or one distortion or another. The bottom line is, they have stood there for the last hour or so, claiming they are standing there to protect seniors. It is ironic, when one Senator, the Senator from Arizona, who said yesterday and sort of repeated it today--this is what he said yesterday:
I will eagerly look forward to hearing from the authors of this legislation as to how they can possibly add $ 1/2 trillion in cuts without impacting existing Medicare programs negatively and eventually lead to rationing of health care. .....
That is the Senator from Arizona today.
Only a year ago, when he was running for President of the United States, this is what the Senator proposed:
"John McCain would pay for his health plan with major reductions to Medicare and Medicaid,'' a top aid said, ``in a move that independent analysts estimate could result in cuts of $1.13 trillion in 10 years to the government programs.''
Consistency, obviously, has never constrained anybody in politics. We know that. But to stand there, over the last half hour or 45 minutes, and say: Seniors are going to get hurt and seniors don't support this and we are here to protect seniors--just a few days ago the organization that represents 40 million seniors in America, it is the largest single representative group of seniors in our country--we all know it, it is called AARP. It is the American
Association of Retired Persons. It represents people from 50 years old on up. There are a total of about 90 million of those in the United States of America, so they represent about half the seniors in America.
Their interest, day to day, is making sure those seniors' interests are not hurt by what we do here in Washington. Here is what they said, on November 20:
Opponents of health reform won't rest. [They are] using myths and misinformation to distort the truth and wrongly suggest that Medicare will be harmed. After a lifetime of hard work, don't seniors deserve better?
This is what AARP said a few days before that, on November 18:
The new Senate bill makes improvements to the Medicare program by creating a new annual wellness benefit, providing free preventive benefits and--most notably for AARP members--reducing drug costs for seniors who fall into the dreaded Medicare doughnut hole, a costly gap in prescription coverage.
The Federation of American Hospitals said the following:
Hospitals always will stand by senior citizens.
They have no intention of pulling out the support that exists today.
The American Medical Association:
[We are] working to put the scare tactics to bed once and for all and inform patients about the benefits of health reform.
The Catholic Health Association of the United States:
The possibility that hospitals might pull out of Medicare [is] very, very unfounded. Catholic hospitals would never give up on Medicare patients.
So everything we have just heard continues the scare tactics, trying to gin anger in America that is unfounded, based on the basics of this bill. Let me call attention--this is the report this year in March that came out from Medicare--it is about Medicare payment policy. It is a report to us, the Congress, by MedPAC. As we all know, MedPAC is the entity that oversees the administration of Medicare, and its concern is maintaining the viability of Medicare, making sure Medicare patients are not hurt by a particular program.
What is in this bill--that Senator Baucus and those of us on the Finance committee put in the bill--is precisely what MedPAC told us we should do and could do without harming seniors. Let me share, specifically, what they said we should do:
The recommendation is that Congress should eliminate the market basket increase for 2010 and advance the planned reductions for coding adjustments in 2011 to 2010 so that payments in 2010 are reduced by 5.5 percent to 1990 levels.
They suggested that. They did it because they know it will make the program sounder and it will allow them to make payments in other areas of Medicare that wind up taking care of Medicare beneficiaries more effectively. They said:
The Congress should direct the Secretary [of health and human services] to rebase rates for home health care services to reflect the average cost of providing care.
That is precisely what we do here. But the other side jumps up, and they will take any change, anything that reflects a shift from one place to another--they will exploit shamelessly in an effort to scare seniors and pretend it is somehow going to affect them.
What is interesting--and America ought to take note of this--they keep coming to the floor and they keep opposing what is here. They keep wanting to strip something out. They keep wanting to send the bill back so that ends this process altogether. But they do not come to the floor of the Senate and show us how we could fix it more effectively and, in fact, serve seniors better, rather than just embracing the status quo. Everyone in America knows the status quo is unacceptable. We cannot afford it. Medicare will go bankrupt within the next 10 years, and then where are we going to be?
This is the time for responsible action, and every step we have offered offers that kind of responsible action without reducing care.
I will make one last comment and I will yield to the Senator from Arkansas and then come back and talk about further ways in which this, in fact, serves seniors and others more effectively. But as they have talked, for the last moments they have been talking about home care cuts.
I have an amendment that shortly we will talk about that will prohibit any reduction in home care, that will guarantee we are clear that we are prohibiting any reduction in home care. But I have long been an advocate for better home care, more home care capacity. In the Finance Committee, I offered amendments to sustain that home care quality.
Nobody worked harder than our late colleague Senator Ted Kennedy, with whom I worked for years on this, to try to extend home health care, protect home health care patients and augment home health care. Here is what the people who represent home health care in America have to say. This is from the National Association for Home Care & Hospice, a letter they sent to Senator Baucus. It was a letter they sent yesterday.
The National Association for Home Care & Hospice supports making health care available to all Americans. We believe that every-one must be willing to sacrifice to make this happen. [The National Association for Home Care & Hospice] has agreed to do its part by reducing costs and payments in a manner that makes the Medicare home care program more efficient and less susceptible to abuse. We are grateful for the opportunity to make these improvements and at the same time protect the thousands of ethical providers who are participating in this important program. We are pleased to have the opportunity to work with your staff to make this happen. For all these reasons, [the National Association for Home Care & Hospice] supports the provisions of your health care reform legislation as they relate to home health care. We look forward to working with you and your staff .....
Thank you for [the] important work [you are doing].
Who better to speak to the concerns of home health care? The folks who have continually been distorting this debate and who continue to try to scare people, or an association whose sole existence, whose payroll every day is put to the use of protecting the folks they represent in home care? I think the answer is self-evident to anybody who wants to listen to common sense.
Mr. BURR. Will the Senator yield for a question?
Mr. BAUCUS. It will have to be on your time.
Mr. BURR. I would ask the Senator from Massachusetts, relating to the quote from Senator McCain that he showed, is the Senator aware that the day after that, factcheck.com said that was false?
Mr. KERRY. What I am aware of is that the individual who was running for President of the United States never stood up and said it was false. I don't have any quote of Senator McCain ever refuting it. All I can say is that throughout the campaign, that was the operative language. It was debated. It was never refuted.
I yield the floor.
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Mr. KERRY. Madam President, I will yield myself such time as I will use.
There have been times during this debate that I have listened with astonishment to the minority. They agree with the diagnosis--that our health care system is in need of treatment. But they offer no remedy, no prescription, no cure.
We don't need a second opinion on what the problems are with our health care system. Our country leads the world in the advancement of medical science. We have the best doctors, the best technology and the best hospitals in the world. It is no surprise to see kings and queens come to the United States for medical treatment.
But for all that, the system is dysfunctional, wasteful and abusive. It rewards quantity over quality. And it delivers profits more than care. It is a system in which too many American families are just one illness or one injury away from financial ruin.
I would like to thank Majority Leader REID, Chairman BAUCUS, Chairman DODD and Chairman HARKIN for getting us to this important point in our long march toward a health care system that is affordable and available to all Americans. Their efforts have presented us an opportunity to cast a vote that will make life better for every single American. It isn't often that we get a chance to do that. But we have that chance now.
I know the majority leader, the Senate Finance Committee, and the Health, Education, Labor, and Pensions Committees have each tirelessly worked on the provisions in this bill and have taken great care to ensure that Medicare beneficiaries will maintain access to their guaranteed benefits and will receive additional preventive benefits and expanded prescription drug coverage.
The amendment offered Senator JOHANNS is very similar to the MCCAIN amendment we debated over the last few days. Once again, the opponents of this bill are endorsing the status quo that leaves Medicare on the brink of going bankrupt and seniors facing higher costs. My amendment simply ensures that no beneficiary would receive a reduction in their guaranteed Medicare home health benefit.
Let me remind my colleagues again what will happen if we stick with the status quo. The status quo means Medicare will be broke in approximately 8 years. The status quo means seniors will continue paying higher and higher premiums and cost-sharing due to wasteful overpayments to providers. The status quo means that each year billions of Medicare dollars will continue to be wasted on lining the pockets of private insurance companies. And the status quo means that seniors will continue struggling to pay for prescription drugs.
The stakes for seniors and for the Medicare Program have never been higher. Senators have a choice: Endorse the status quo or strengthen Medicare. Regarding Medicare changes for home health providers, let me describe what is in the Senate bill.
As most of my colleagues would agree, home health care is an important benefit in the Medicare Program. Today more than 3 million Medicare beneficiaries receive home health services across the country--including those with acute illnesses and injuries and those afflicted with numerous chronic conditions.
Across the country, more than 9,800 home health agencies provide care to seniors in their homes. This care helps seniors get better and avoid expensive rehospitalizations. Home health providers make a real difference in improving seniors' health. We should support their efforts.
While I have great respect for the services of home health providers, we also have a responsibility to protect the Medicare Program. As part of this, we must make sure Medicare is paying appropriately--and not overpaying--for Medicare services. We must also take action to root out fraud and abuse in the Medicare Program. I believe the policies in the Senate bill achieve both goals.
First, the Senate bill would ``rebase'' home health payments to ensure payments reflect actual costs of providing care. These changes are based on MedPAC recommendations, which is the nonpartisan group that advises Congress on Medicare.
When the current home health payments were set, seniors received an average of 31 visits per episode. Today, they only receive 22 visits. The Senate bill directs CMS to ``rebase'' payments to reflect this change. That is common sense.
The Senate bill also roots out fraud in the system by revising how Medicare pays for ``outlier'' cases. Medicare provides an extra payment today for providers who treat sicker or ``outlier'' patients. Unfortunately, the GAO found that some providers were gaming the system and getting more outlier payments than they deserve.
For example, GAO found that in one Florida County, providers were receiving 60 percent of all total outlier payments--even though the county had less than 1 percent of the total Medicare population. Clearly, something was going on there that needs to be changed.
The Senate bill addresses this problem by placing a cap on the amount any individual provider can receive in outlier payments. In addition, it establishes a productivity adjustment for home health providers beginning in 2015. These changes ask home health providers--like all other providers--to offer more efficient and higher quality care over time.
I believe the Senate policies are fair and reasonable. In making these changes, we worked closely with the home health industry to ensure these changes were reasonable and fair. On the rebasing policy, MedPAC recommended we fully implement these changes in 2011. To ensure providers could adapt to the new payment rates, the Senate bill phases-in the changes over 4 years. The home health providers support this phase-in.
The outlier policy and fraud changes were actually suggested by the home health industry. The home health industry fully supports these changes. For the productivity changes, the Senate bill holds off on applying these reductions while the rebasing policy is taking effect.
This will give providers extra time to adapt to the payment changes and is much less aggressive than the proposals put forth by MedPAC, the House bill and the administration, which require all of these payment changes to be implemented at the same time.
Finally, the Senate bill includes special protections for rural home health providers. From 2010--2015, rural providers will receive a 3 percent extra payment each year. This payment will ensure that rural providers are protected as we reform the broader home health system. In total, the Medicare delivery reforms in the Senate bill strike a fair balance between ensuring seniors have access to care, while also rooting out inappropriate payments from the system.
The opponents of these Medicare changes do not have a plan to protect seniors and strengthen the Medicare Program. They advocate doing nothing. The opponents of health reform are now claiming that Medicare beneficiaries will be harmed by this bill. And here is what AARP--for example--has said about these claims:
Opponents of health reform won't rest. [They are] using myths and misinformation to distort the truth and wrongly suggesting that Medicare will be harmed. After a lifetime of hard work, don't seniors deserve better?
I would like to remind my colleagues of the positive changes in the bill. It improves the solvency of the Medicare Program by 5 years. It puts $30 billion back into the pockets of seniors in the form of lower Medicare premiums. It makes prescription drugs more affordable. It guarantees that seniors can continue to see the doctor of their choosing. It provides free wellness and prevention benefits to Medicare beneficiaries. And it also includes fair and appropriate changes for home health that protect access to care.
The truth is the Johanns amendment is harming seniors, harming the Medicare Program, and harming taxpayers. For this reason, I urge my colleagues to oppose the amendment by Senator JOHANNS and to support my home health amendment which ensures that no beneficiary would receive a reduction in their guaranteed Medicare home health benefit.
I just listened to my friend, Senator Grassley. He and I have a good relationship; we work together here; we both serve on the Finance Committee. I have enjoyed a lot of the things we do together. Clearly, whatever I am saying is going to be substantive, but there is nothing personal in it. I have to say there is a lack of reality here in a lot of the comments we are hearing from our friends on the other side of the aisle, and a persistance in perpetuating a myth.
A lot have seen the politics of this country where, if you say something over and over, no matter how true it is, it can have an impact. I know that personally. But let me tell you, I heard the Senator from Iowa say--I am going to quote him; I wrote it down:
Certainly if $450 billion is being taken out of Medicare, it is hurting Medicare.
That is what he said. Let me review what is happening here. I want to go back to the comments of the Republican nominee for President last year. This is a quote. John McCain, from an article in the Wall Street Journal:
John McCain would pay for his health care plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion.
After I said that on the floor, the Senator from North Carolina, Senator Burr, stood up and said:
Have you seen factcheck.org?
I said I haven't read the specific article but we didn't see that corrected in the course of the campaign.
Now I have seen the article. I wanted to know what the Senator from North Carolina was referring to, so I went and got factcheck.org. Factcheck.org went through the Obama campaign ads and their ads and fact checked what was being said. The McCain adviser is a fellow named Holtz-Eakin. In a conference call with reporters after the ad was released, what he said was:
No service is being reduced. Every beneficiary will in the future receive exactly the benefits that they have been promised from the beginning.
That is the same thing as we are doing. No benefit is being cut. But he didn't say he was not going to reduce the overall amount of money. What he said subsequently, and I am quoting from factcheck.org--here it is as late as October 17, about 2 weeks before the election--Mr. Holtz-Eakin said in a telephone conference call with reporters, representing the campaign for the Republican party:
Any shortfall in McCain's health care plan will be covered without cutting benefits by such measures as Medicare fraud and abuse reduction, employing a new generation of treatment models for expensive chronic diseases, speeding adoption of low-cost generic drugs, and expanding the use of information technology in medicine.
That is exactly some of which is happening right here--some of which is happening right here.
Let's get this conversation into a place of reality. Here is what happened in arriving at the reductions in overall Medicare expenditures, which does not reduce any benefit to any senior citizen, which is why AARP, that represents 40 million senior citizens, is supporting the Democratic legislation. They have written that to us as late as yesterday.
Madam President, $120 billion comes from reducing overpayments in Medicare. Someone on the other side of the aisle has to explain to me how you hurt Medicare by stopping the charging of a $90 overprice of premium to seniors, which is what happens. Do you know how the overpayments are paid for? Every senior couple, in a traditional Medicare plan, pays an additional $90 per year in order to finance the overpayments. What they are suggesting is, we shouldn't cut overpayments. What they are suggesting is, Medicare is OK, paying seniors in a certain group an overpayment that doesn't even go to the seniors. Guess whom it goes to. It goes to the insurance company. Are you telling me we ought to go to the taxpayers and say: Hey, folks, we know we are paying a 14-percent overpayment for the service compared to what we pay for everybody else and we are going to keep on paying it. That is exactly what our friends on the other side of the aisle are saying.
What we are saying is: No, we think we ought to reduce that payment, and that is the $120 billion. That doesn't cut one benefit for a senior, but it makes the program more effective.
Let me go further. Here are the people who have come together in a series of meetings to say: Yes, we can live with a reduction in our overall Medicare payment because we can be more efficient. The hospitals came to the White House and said: We are willing to reduce the payments we are receiving by $150 billion. Guess what. We are not even doing that. We are only asking them to reduce their payments by $106 billion. That is what is in this bill. The hospitals have agreed. I represent hospitals in Massachusetts. We have one of the best hospital systems in America in the network of hospitals we have. People come from all over the world to come to our hospitals. I see the Senator from Minnesota. They come from all over the world to go to some of the hospitals Minnesota has. The fact is, those hospitals agree we can do this more efficiently, and we can reduce the overall payments under Medicare. We have worked very hard to protect the way we do that so it doesn't do injury.
The insurers have come to the table. Home health care came to the table. I read the letter earlier from home health care services. It is from the President of the National Association for Home Care & Hospice. He writes: We support the provisions of your health care reform legislation as they relate to home health care. That is what we are debating on the floor. They do support it.
The fact is, the Senator from Georgia, who stood and said: In our State, we have a letter that says--well, first of all, that is based on an earlier assumption. Secondly, we have no idea what the assumptions are in the analysis they made. Thirdly, it is based primarily on the House bill, which has $13 billion more in reductions than we have. So before we get stuck there, we ought to listen to the national association that is working with us on a daily basis, where we agree on what the reductions ought to be.
The skilled nursing facilities, the rehab facilities, the long-term acute care hospitals have all come to the table and said: We can do this. Is that their preference? Do they love it? Nobody wants their budget to be tightened, where they have to make changes to try to be more effective. But the bottom line is, every single one of them has agreed with what we are doing on this side of the aisle. Notwithstanding that, our friends on the other side of the aisle keep coming back and keep trying to stand for grandma or stand for some senior citizen who is being falsely scared into believing their benefit is going to be cut or that Medicare is somehow going to be less available to them.
My amendment, which we will ultimately vote on, will guarantee that no benefit is going to be cut for any senior under this plan. That is what we are going to do.
In addition to that, let me remind my colleagues and people listening what this bill does. This bill actually improves the solvency of Medicare. We have heard any number of people say Medicare is going to go bankrupt by 2017. Indeed, it is. We stretch that out. We improve that so we can then take the improvements in the health care system----
The PRESIDING OFFICER. The time of the Senator has expired.
Mr. KERRY. I yield myself an additional couple of minutes.
It improves the solvency of the Medicare program by 5 years. It puts $30 billion back into the pockets of seniors in the form of lower Medicare premiums. It makes prescription drugs more affordable. It guarantees that seniors can continue to see the doctor of their choice. It provides free wellness and prevention benefits to Medicare beneficiaries. They are busy talking about the cuts, when this actually improves what Medicare beneficiaries are going to get. They don't have wellness and prevention benefits today. It provides for them.
It guarantees they will see the doctor of their choice. It actually puts $30 billion back into their pockets, and it also includes fair and appropriate changes for home health that actually protects access to health care.
The truth is, the Johanns amendment is the amendment that actually would wind up hurting seniors. This amendment provides additional benefits. We all understand the importance of this. The Senate bill releases home health care payments so those payments actually reflect the real cost of providing care. We do that not in a partisan way. We do that based on the nonpartisan MedPAC commission recommendations to us of how you can improve Medicare.
Our colleagues have a long way to go on the other side to begin to talk about real health care change. This bill roots out fraud from the system, revises how Medicare pays for the outlier cases; that is, the cases that treat the sicker or what we call outlier patients. Unfortunately, GAO found some providers were gaming the system and getting more outlier payments than they deserve. Do they want us to continue to overpay people, providing service that people either don't need or charging more for the service that they do need but could have gotten at a lower price? Those are the changes we make. The American people will be proud of it.
Let me give an example. The GAO found that in a Florida county, providers were receiving 60 percent of all the other outlier payments, even though the county had less than 1 percent of the total Medicare population. That is absurd. What we do is fix those kinds of absurdities that make Americans so angry about the administration of their tax dollars in Washington.
I believe the Senate bill addresses a number of these problems in a thoughtful way.
We need to have a debate about what is in this bill and what the real impacts are and what the negative impacts are of not doing these things. Our colleagues stand for the status quo. This is going to be historic when we pass it because it is going to benefit people in so many different ways, getting rid of preexisting condition restraints, not having people kicked off insurance they thought they had but when they get sick, they find it is gone. We end that. We get 31 billion more people covered in a way that spreads the risk of being sick in a sensible way and reduces the costs for other Americans. That is common sense. I am proud of what we are doing.
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Mr. McCAIN. Then I ask unanimous consent to have printed in the Record a statement from FactCheck.org, of October 20, 2008, that says: ``Obama's False Medicare Claim,'' which were the attacks on me which were not based on fact. I quote from FactCheck.org:
These claims are false, and based on a single newspaper report that says no such thing. McCain's policy director states unequivocally that no benefit cuts are envisioned. McCain does propose substantial ``savings'' .....
I did propose savings, and we can make savings. Nowhere in my wildest imagination did I ever believe we were going to cut benefits in order to create a $2.5 trillion new entitlement program when the system is already going broke. I will have those put in the Record.
Mr. KERRY. Reserving the right to object----
Mr. McCAIN. The Senator from Massachusetts wants to distort my record, and that is fine. But it gets a little----
The PRESIDING OFFICER. Is there objection to having the document printed in the RECORD?
Mr. McCAIN. As Ronald Reagan once said: Facts are stubborn things.
Mr. KERRY. Madam President, I am not going to object to putting something important in, but I would like my colleague to stay for a moment because this is very important.
Mr. GRASSLEY. Regular order.
The PRESIDING OFFICER. The majority's time has expired.
The Senator from Iowa.
Mr. GRASSLEY. I yield the remaining time on our side to Senator Thune.
Mr. KERRY. I have objected to a statement being put in unless I have a chance to explain it.
The PRESIDING OFFICER. Objection is heard.
Mr. McCAIN. I ask unanimous consent that the Senator from Massachusetts be allowed 3 additional minutes and I be allowed 2 additional minutes.
The PRESIDING OFFICER. Is there objection?
The Senator from Massachusetts.
Mr. KERRY. I thank my friend from Arizona because this is the way the Senate ought to work. I totally agree with what the Senator said. I want the Senator to know I agree with him. He is correct that the statement in FactCheck.org calls the Obama campaign to account for a misstatement about his proposal. I agree. It did that. It did not recommend a reduction in benefits. But that is not what I suggested that it did. What I am talking about is, the Senator said--and his staff insisted--he could get the savings for his reductions that would benefit Medicare from waste, fraud, and abuse from new treatment models, from expanding the use of information technology and that there is a complete similarity between what we are doing in order to achieve these savings and what he was doing. I am trying to point out the similarity, not the difference. I am not here to debate the campaign ad. I think it didn't accurately reflect the Senator's position. But do I believe, if you read the whole article, which is why I will not object to it being put in there, you will see it clearly says he is supportive of savings in Medicare, so you can do it without cutting benefits, which is exactly what we are doing.
I yield the floor and thank my colleague for his courtesy.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. McCAIN. Madam President, I thank the Senator from Massachusetts. This has been a vigorous debate. I see my prime adversary, the Senator from Illinois, on the floor, whom I look forward to doing battle with additionally, as well as my friend from Massachusetts. The fundamental point, I would say to my friend from Massachusetts, is that I never envisioned, nor do I believe the American people ever envisioned, we would be ``cutting'' benefits or, as the Senator says, making savings in order to transfer that to a brand new entitlement program. That is what the debate is about, whether we are going to take a failing system that in 7 years is going bankrupt, according to the Medicare trustees, and then take all this money, no matter how these savings are made--and I believe they are cuts of huge magnitude--and then fund a brandnew entitlement program.
That is what this real debate is about.
I thank my friend from Massachusetts for his courtesy. I look forward to the rebuttal from the Senator from Illinois, as well as the Senator from Montana. Thank you.
I yield the floor.
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