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Public Statements

Health Care And Education Reconciliation Act Of 2010

Floor Speech

By:
Date:
Location: Washington, DC

BREAK IN TRANSCRIPT

Mr. McCAIN. Mr. President, I ask unanimous consent to engage in a colloquy with the Senator from Oklahoma, the Senator from Florida, and myself.

The PRESIDING OFFICER. Without objection, it is so ordered.

Mr. McCAIN. Mr. President, I strongly support the amendment. Let me also just for a moment point out where we are.

Where are we now that all the champagne has been drunk and all the celebration has gone on; the inside-the-beltway excitement has subsided along with the adoring media? Here we are: We have a budget deficit that is still $1.4 trillion. We still have 9.7 percent unemployment. Beginning right away we have $ 1/2 trillion worth of Medicare cuts that will take place over the next 10 years--$ 1/2 trillion beginning right away, $ 1/2 trillion worth of tax increases over the next 10 years.

Beginning in 4 years, $2.5 trillion in new health care entitlements spending begin. The plan still puts government in control. It still mandates that every American must purchase a government designed and approved health policy. It still mandates that employers have to provide health insurance or pay a fee, and 330,000 Medicare Advantage members in my State are going to be exposed to drastic cuts.

Fortunately, we took out one of the sweetheart deals so that now, at least the 800,000 who were carved out before in Florida will be subject to the same cuts. No one, no one, no one believes--the so-called doc fix--that the 21-percent cut in physicians payments for treatment of Medicare patients is going to happen.

You can put lipstick on a pig, but this is still a pig. I noticed the Senator from Illinois came to the floor this morning and said how great this is and how there is going to be real reductions in the deficit as a result of this legislation. I wonder what his response has been to one of the biggest corporations in the State of Illinois, Caterpillar, who sent him a letter saying:

In our fragile economy, we can ill afford increases that place us at a disadvantage versus global competitors that are not similarly burdened.

They state:

Elements of the legislation would drive up Caterpillar's health care costs by more than 20 percent, over $100 million.

The Senator from Illinois is sponsoring legislation that increases costs for one of the largest manufacturers and exporters in America that is going to increase their cost by $100 million. I wonder when he is going to go out and visit headquarters out there in Peoria. I hope it is soon.

The fact is, there are things in this legislation that are wrong, and there are things that are left out of this legislation that are wrong, including $100 billion a year that could be saved by medical malpractice reform. Is there anything in those 2,073 pages that have anything to do with medical malpractice reform? That is the dirty little secret. The dirty little secret in this body is that trial lawyers control the agenda, certainly as far as this legislation is concerned.

The State of Texas has reduced costs, has reduced premiums, and has increased the number of people who have been able to--lawsuit filings are down from defensive medicine increases for annual costs by 10 percent. Physician recruitment is up. The largest malpractice insurance company in the State has sliced its premiums by 35 percent, saving doctors some $217 million over 4 years in the State of Texas.

And I would like to ask my friend from Oklahoma why in the world we would not enact medical malpractice reform if we are truly interested in reducing the cost of health care in America.

The Senator from Oklahoma and our other doctor in the Senate, Senator Barrasso from Wyoming, can testify because of their experience of the requirement to practice defensive medicine, which could be as much as $100 billion a year. So here we are, looking at dramatic increases in cost, and the President is going around the country saying that insurance premiums will go down. Individual premiums will go up between 10 and 13 percent. You know, facts are stubborn things.

So I would ask my friend from Oklahoma if he might talk a little bit about not only what is in this bill but what is not in this bill, and medical malpractice reform is certainly something that anyone would logically assume would be part of any real reform if you are interested in reducing cost.

If you are interested in increasing government bureaucracy, I hear this bill could mean the employment or hiring of some 16,500 new IRS agents. We are trying to track down the facts behind that. So we are now embarked on one of the greatest expansions of government in the history of this country.

Mr. COBURN. I thank the Senator for his question. If you look at Thomson Reuters and several others who have studied the health care field, the estimate for defensive medicine costs is $250 billion a year. It is not just that we order tests that protect us from frivolous lawsuits, but those tests have consequences. Some of those tests actually hurt patients or expose them to radiation or, in fact, limit our ability to do what is best for the patient because we are more interested in protecting ourselves.

Mr. McCAIN. May I ask the opinion of the Senator from Oklahoma as to why he thinks there is no address of medical malpractice reform whatsoever in this legislation that has the slightest impact on reducing health care costs?

Mr. COBURN. I think there are two reasons. One is because there is large support of those who wrote this legislation by those who benefit from suing doctors. That is pretty straightforward. And the doctor's only defense is to order tests which they need but which the patient doesn't necessarily need. The second is because they couldn't get--or wouldn't put it in the bill because they knew it would pass and the American people would agree with it. You know, it is beyond me.

But let me go to the point of this current amendment. I have delivered somewhere over 4,000 babies, and 2,000 of those were Medicaid babies. Over half the babies I have delivered in my life I have cared for through Medicaid. The State of Oklahoma just cut, in February or March, Medicaid reimbursements 3 percent. They are going to cut it another 8 percent. Forty percent of the primary care doctors don't see Medicaid patients because the price that is paid for the coverage doesn't cover the cost, let alone any margin. It doesn't cover the cost of nurses, the rent, the malpractice, and everything else.

The second point is, of the specialists who are available, 65 percent of the specialists in this country won't see Medicaid patients. So when I am taking care of Medicaid patients, I have trouble finding somebody better than me in a specialized area to care for my patients.

What is the other thing we know about Medicaid? Even if you normalize for social factors, their outcomes are worse. The cost in terms of the number of procedures, the failure of therapeutics--all are worse.

So why is this a good idea? It is not just a political stunt. If Members of Congress are enrolled in Medicaid, the first thing that is going to happen is Medicaid and reimbursements are going to go up so that the availability of the finest and the best and the brightest in this country is available to Members of Congress. So it is not just a stunt to say we put our membership in Medicaid; it is a very important ulterior motive to improve Medicaid.

Think about it. If you are one of the 16 million people who are going to get health care under Medicaid, supposedly, in this bill--and I doubt that seriously, simply because we are going to see a marked decrease of 50 or 60 percent of doctors who won't see them--think about what is going to happen: You are not going to be able to find a doctor. You may have coverage, but you won't be able to get anybody to care for you. Is that coverage? Is that care? Is that prevention? Is that management of chronic disease? No. None of that will happen.

So the whole idea of placing us in a leadership position into Medicaid is so that we will lead and fix it and make it what it should be. There is only one health care system worse in America than Medicaid, and that is the Indian Health Service. That is the only one that is worse. Everything else outside of those two programs is better. So why would we consign 16 million Americans to a health care program that is failing today? So the way to fix that is to put us into it. And I guarantee you, the self-interests of the Members of Congress will fix Medicaid and make it what it should be.

With that, I yield back to the original author of the amendment.

Mr. LeMIEUX. I thank my friend and colleague from Oklahoma.

How could anyone in this body not vote for this amendment? Why should we have better health care than the 16 million people whom we are going to put into Medicaid, and now will be 50 million Americans? Why should we have it better? Why should we have a gold-plated premium health care plan?

Look, I have a family of five. We are going to have a baby any day--could be today--so it will be a family of six. I pay $400 a month on the government program--$5,000 a year. Could I get that in the marketplace? Of course I couldn't. There is a doctor here in the Capitol, a whole staff of them, anytime I want to see a doctor. I get fantastic health care as a Member of Congress.

Why shouldn't we have the same health care we are subjecting 15 million new Americans to and 50 million Americans in total? As my friend from Oklahoma says, certainly won't that make the point to us that this health care system is failing? What will happen when a Member of Congress tries to find a doctor and can't find a doctor who will take him? What is going to happen when he tries to find a specialist and no specialist will take him? You don't hear our friends on the other side talking about the fact that half of the people getting coverage under this legislation are going into a failing system. That is not one of their talking points, but it is the truth. So I challenge my friends who say that they should walk among the least of us to vote for this amendment.

I want to turn again to my colleague from Arizona. He and I have expressed our distress about this bill for lots of reasons, but a specific reason is that we both represent States with lots of seniors.

We have this Medicare Advantage Program that is going to get $200 billion cut out of it. That will really affect our two States. So I wonder--and I would ask my colleague, the distinguished Senator from Arizona, to speak on this issue--how is this going to affect seniors in Arizona when we are raiding Medicare to start this new program?

Mr. McCAIN. I thank my friend from Florida. The fact is, Medicare Advantage is a program that provides seniors with choices. That is one of the reasons it is a major target of the other side--because it doesn't fit in, then, with the government mandates this whole bill embodies. So I am worried about the 11 million Americans who have the Medicare Advantage Program.

I would like to refer my colleagues to an article--I know the Senator from Utah is waiting, if he would just give me another minute or so here--today in the Wall Street Journal titled ``Now, Can We Have Health-Care Reform?'' And I want to quote from part of it, as follows:

Health insurers, and indeed Corporate America as a whole, are like monkeys who are caught by staking a glass jar to the ground with a shiny trinket inside. They won't let go so they can't get their hands out of the jar. That trinket is the ruinous and regressive $250 billion-a-year tax benefit for employer-provided insurance.

That is the elephant in the room, my friends.

Corporate America isn't brave enough to argue against a direct subsidy to its employment costs, no matter how perverse its impact in insulating consumers from the true cost of their health care choices. Insurers are not brave enough to say: Give us a tax code that lets us go back to being insurers rather than a tax laundromat for the middle class's health care spending.

Almost any bill would have been worth having that fundamentally fixed this tax distortion, regardless of its other elements.

We say this because any bill, including the one signed by the President yesterday, will be revisited many times in the future. Millions of pages of rules will be written by regulators before we see how it really works. Congress itself will return in predictable ways: It will reverse the proposed Medicare cuts that created ObamaCare's illusion of fiscal probity. It will tighten the mandate that requires insurers to cover the sick at favorable prices. It will not tighten the requirement that the young and healthy buy insurance at prices that subsidize the old and unhealthy.

More and more tax money will have to be found to keep the jalopy on the road. More and more administrative controls on medicine will attempt vainly to keep the jalopy from bankrupting the Nation.

Under the law just signed, employers have even more incentive than they did yesterday to lavish excessive health insurance on their high-end employees.

Mr. President, I ask unanimous consent to have printed in the Record this entire Wall Street Journal article.

There being no objection, the material was ordered to be printed in the RECORD

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Mr. McCAIN. Mr. President, I thank my friend from Utah for his indulgence.

The other side is going around the country right now telling the American people things that simply are not correct, including the fact that these budget projections we know are patently false, not because CBO gave us false numbers but because the assumptions were wrong. One of the biggest assumptions--and we will be talking about this more--is the so-called doc fix. Is there anyone who believes we are going to have a 21-percent cut in Medicare physician payments this fall?

I would ask my friend, the Senator from Utah, who is very familiar with this issue--I know he has an amendment, but this is one of the reasons Americans are so angry. They know they are not going to cut doctors' payments from Medicare by 21 percent, and that is a fundamental part of the assessments as to the cost by CBO. It is a sham perpetrated on the American people.

So I would say to my friend from Florida and my friend from Utah, we will be back on the floor probably this fall sometime or early next year, and we will be talking about the fact that this doc fix--the doctor payments provision of health care for Medicare enrollees--was not cut 21 percent, as the other side is telling the American people that it will be. It is not fair to the American people, I would say to my friend from Utah.

Mr. HATCH. I agree with my friend from Arizona, no question.

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Mr. McCAIN. Mr. President, I ask unanimous consent to be included in the colloquy.

The PRESIDING OFFICER. Without objection, it is so ordered.

Mr. McCAIN. I would say to the Senator from New Hampshire that there is some recent information that I find hard to believe, but apparently it may be the case. As we go through this 2,733-page piece of legislation, the IRS may need up to $10 billion to administer the new health care program this decade, and it may need to hire as many as 16,500 additional auditors, agents, and other employees to investigate and collect billions of new taxes from Americans. Is that possible, in this legislation, I would ask the Senator from New Hampshire?

Mr. GREGG. The Senator is absolutely correct, and that does call into question the representation that this bill is not a tax increase on Americans that we need 16,000 new IRS agents to enforce it.

Mr. McCAIN. At $10 billion to administer. That is probably believable, given what is in 2,733 pages.

Mr. GREGG. Well, you are going to need one IRS person for everybody in America who doesn't have insurance, I guess, or however the ratio works out. Everybody has to buy insurance under this bill, and your local IRS agent is going to show up at your door to tell you that you better do it or else you will have to answer to the IRS.

We know there are no new taxes in this bill because that has been represented to us a number of times.

Mr. BURR. If I could add, it also adds some insight into how many people will choose not to have insurance and make themselves susceptible to the fine. The anticipation is the IRS is going to chase a lot of people to recover the fine.

Mr. McCAIN. I would also finally add that perhaps we could get some indication--I think we should before we vote on passage of this bill--as to how many new bureaucrats and bureaucracies there are going to be with 193 new boards and commissions and other layers of bureaucracy. I think the American people are owed at least a round figure as to how many new bureaucrats there are going to be to administer this program.

I see the Senator from Montana, and I don't want to impede on what has been the agreed-upon rule here, but I did want to continue and say to my friends very quickly that I think there are several myths here that have to be refuted by the facts.

One is that this legislation will result in a tax cut for the American people. I would say to my friend from New Hampshire, we have to rebut that in the next hour.

The next myth is that the health care bill won't increase taxes on individuals with incomes under $250,000. The fact is, millions of Americans with incomes below $250,000 will pay higher taxes.

Another myth: The legislation will reduce the growth of health costs--President Obama's stated goal for health reform--and premiums will go down. The fact is, national health expenditures and premiums will increase.

Another myth: The legislation is deficit neutral. The fact is, commitment to health care spending under existing obligations increases the deficit.

Myth: ``If you like the plan you have, you can keep it.'' Fact: Millions of Americans with coverage will lose their current coverage, including 330,000 citizens of my State who have the Medicare Advantage Program.

Finally, the myth is that the law will provide immediate coverage for children with preexisting conditions. The fact is, children are not necessarily protected against discrimination for preexisting conditions.

So I hope we have a chance, I would say to my friend from New Hampshire, to address the allegations about this legislation, and perhaps the first one is that legislation will result in a tax cut for the American people when the fact is that taxes will increase for millions of Americans.

I would yield to my colleague from New Hampshire.

Mr. GREGG. I thank the Senator from Arizona, who has been one of the most cogent and thoughtful speakers on the issue of what this bill really does. He has hit the nail on the head time and time again with his points. They are all absolutely accurate.

Has the Senator completed his statement?

Mr. McCAIN. Well, I just wanted to throw in here that perhaps one of the most egregious statements, and it is worth repeating, is this so-called doc fix. They are using an assumption that we will cut physicians' fees by 21 percent sometime this fall in order to make up--and please correct me if I am wrong--some $281 billion over 10 years, which we know is not going to happen. And the reason it is not going to happen is because doctors would refuse to take Medicare patients if they cut their reimbursement by some 21 percent.

So this is one of the fundamental assumptions they are selling this on, is that it is deficit neutral when it is not.

Mr. COBURN. If I may, I would like to add one other thing here. Think about it. We are talking about the cuts that are set to go. But since there is no tort reform in this bill, we spend $250 billion on defensive medicine and liability costs continue to rise. You could bring them back whole, but if you give them no increase, they are still going to quit seeing Medicare patients.

One other point I would like to make is with the student loan program being totally taken over by the government, 31,800 people in this country this July will lose their jobs. So we are going to lose 31,800 jobs in the private sector, but we will add 16,500 jobs at the IRS. I don't think anybody in America would like to see that happen.

Mr. McCAIN. The CEO of Caterpillar wrote a letter saying that the taxes for Caterpillar would go up by $100 million next year. What does that do to Caterpillar? It obviously makes them either not hire or lay off individuals as they pay an additional $100 million. And I might point out, as we all know, Caterpillar's headquarters is in Peoria, IL.

So, again, I would ask the Senator from New Hampshire, is this legislation deficit neutral?

Mr. GREGG. No, it is not deficit neutral if you actually score the number of years of income against the number of years of expenditures or you include the doctors fix. Either one would throw this into a deficit-negative situation.

Mr. McCAIN. Isn't that another of the great scams, that for 4 years the benefits are cut and the taxes are increased, and for most--not all but most--of this bill, none of the benefits really kick in until after 4 years?

Mr. GREGG. That is right.

Mr. McCAIN. So when you score it, that is the way you make it deficit neutral over 10 years?

Mr. GREGG. That is correct. And it is a bit of a scam, as you say.

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Mr. McCAIN. I ask the Senator from New Hampshire, while the Senator from Montana is here, maybe it is a legitimate question. Does the Senator from Montana believe that the assumption given to the Congressional Budget Office that the so-called doc fix, reimbursement for physicians who treat Medicare patients, will be cut by 21 percent? The Senator from Montana knows full well the AMA has been told in no uncertain terms it will be fixed between now and when it is supposed to take effect because the fact is, as the Senator from Montana knows, you can cut Medicare physician reimbursement. Then doctors will not treat Medicare patients. So maybe the Senator from Montana would tell us if that was a valid assumption given to the CBO, that there would be some $281 billion that would be accrued because physicians' payments would be reduced by some 21 percent?

Mr. GREGG. I simply ask the time of the Senator from Arizona come off ours and the time of the Senator from Montana for his answer come off his.

Mr. BAUCUS. Mr. President, that sounds fair.

Let me say to my good friend from Arizona, first of all, clearly this body, the Senate and the Congress, is going to not let the SGR problem expire; that is, doctors are not going to be cut 21 percent, whatever the rate is the first year or more and so on. That is not going to happen. First, from the seniors' point of view, second from the doctors' point of view, that is not going to happen. I do not want to take too much time on the subject, but the long and short of it simply is we are going to have to find a way, this Congress, to address that problem. If I might finish, it is not part of health care reform, and we will find a way. A question is going to be how much will be paid for. That is a judgment this body is going to have to make in the pretty near future.

Mr. McCAIN. I appreciate very much the acknowledgment, on the part of the manager of the bill, that the assumption that provides us with deficit neutrality is not valid. That is the point we have been trying to make. It is based on false assumptions. The assumption that doctors--I am very happy to hear the Senator from Montana state unequivocally what was given and assumed by the CBO when they gave us our numbers is not true. So we will be voting, in a short period of time, on a piece of legislation which is based on false assumptions. I think that is an unfortunate circumstance.

Mr. GREGG. I simply note the Senator from Montana made the case for my amendment rather eloquently because my amendment does address the doctors fix and it is paid for. Therefore, I certainly hope the Senator might consider voting for it.

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Mr. McCAIN. Mr. President, I read a lot about what has been going on in the
health care debate, and all of us have. Americans are very aware of it. I keep hearing the word ``historic'' this, ``historic'' that, ``historic.'' I agree. It is historic. This is a historic vote, and I think we are pretty aware of what the outcome will be sometime tonight, tomorrow, or the next day. It is the first time in history, the history of this country, that a major reform has been enacted on a purely partisan basis, the first time.

Every major reform throughout history has had significant--you can go down the list--bipartisanship votes. In the 1970s--this one, purely partisan, rammed through from beginning to whatever this end is.

It is historic, and it is the first time that a process called reconciliation has ever been used to affect one-sixth of the gross national product. I know the response will be: Well, Republicans did it--et cetera, et cetera. It will be the first time that 51 votes has been the measure of a decision on so-called reconciliation. Now, that is historic. That is historic because we have basically broken down the 60-vote tradition of the Senate when we address it in this fashion--an issue of this magnitude.

Let me tell you, when the President of the United States was still a Senator--another time we were doing reconciliation--what he said:

You know, the Founders designed this system, as frustrating [as] it is, to make sure that there's a broad consensus before the country moves forward. ..... And what we have now is a president----He was referring to former President Bush--who ..... [h]asn't gotten his way. And that is now prompting, you know, a change in the Senate rules that really I think would change the character of the Senate forever. ..... And what I worry about would be you essentially have still two chambers--the House and the Senate--but you have simply majoritarian absolute power on either side, and that's just not what the founders intended.

That is what Barack Obama, the Senator from Illinois, said.

So here we are. Yes, it is historic. It is historic. And it is historic what we have seen take place from the beginning. We have seen the special interests. We have seen the votes, the provisions in these bills that carve out special deals for special interests and special States, such as the ``Louisiana purchase,'' the $100 million inserted in this 2,733-page document that builds a hospital in Connecticut. Why Connecticut? Why $100 million? Why is it that there are these special provisions for certain locations in the country?

It is historic in the special deals that have been cut--for PhRMA, for the American Medical Association, for the hospital association, for the unions in the taxation of Cadillac plans. Everybody has a deal but the American citizen--the average American.

How many Americans, how many ordinary Americans who are, say, enrollees in Medicare Advantage in my State, who are going to see the Medicare Advantage program cut drastically--how many of them were allowed in the majority leader's office? How many of them were allowed in the Speaker's office? How many of them were allowed in the White House as the special interests' representatives went in and out?

So there are winners and losers. That is what is being judged. The winners will be those who live in favored States who will have special deals. There will be those who are winners--PhRMA, the hospital association, the unions. Again, my congratulations to PhRMA. They are running $100 million-some worth of ads favoring this deal because they got a deal that is worth billions--worth billions.

As I have quoted on the floor several times, their head lobbyists, or $2 million-a-year lobbyists, said: A deal is a deal. We expect the White House to keep it.

So who are the losers? Who are the losers? Well, the first loser is the Senate because, as I said before, this reconciliation, requiring only 51 votes, is a radical departure from anything we have done in the past. I do not accept the statement that it has been done in the past--not when it affects one-sixth of the gross national product, and as a direct result of the vote in the State of Massachusetts that gave this side 41 votes. If they still had 60 votes, we would not be doing this on reconciliation. We would be doing it in the regular way we address legislation--legislation through the House, legislation through the Senate, a conference committee, and then, obviously, a final vote. But they cannot afford a final vote because there are 41 votes now, not 60. So the Senate is a major casualty of this process.

But the biggest losers probably are average citizens--average citizens who were told the Congressional Budget Office judged this to be deficit-neutral, and it would not cost the taxpayers additional money. I just had a conversation with the Senator from Montana who said clearly we are not going to cut physician payments by 21 percent; so, therefore, the assumption they gave the Congressional Budget Office is false--is false. So before we go any further, it is already a $150 billion deficit because everybody knows we are not going to cut physicians' payments by 21 percent.

So the American people are the ones who never had access to get a special deal. And 330,000 citizens of my State who have enjoyed and chosen the Medicare Advantage program are now going to see those benefits slashed. But the average citizen who thinks today there is a huge disconnect between their lives and that of the life that is led here and the way we do business here--last Saturday, I was in my own home State of Arizona. I did two townhall meetings, one in Prescott and one in East Valley Phoenix, and people are hurting. People are hurting, people are angry, they are frustrated, and they feel there is a huge disconnect between themselves and Washington. I come back the next day, and they are drinking champagne in celebration of a ``historic'' victory. Americans do not get it. Americans do not get it. They are angry. They are frustrated.

I want to assure them--I want to assure them--this fight is not over. We will take it, as I mentioned before, to the towns and cities of America. We will have townhall meetings all over the country. We will register voters. We will urge them to turn out. We will urge them to take part in one of the most seismic elections in the history of this country.

I know the liberal media is saying: The American people are going to move on. Well, they are not going to move on. They are not going to move on because they are sick and tired of the spending and the generational theft we have committed on future generations of Americans. This is only one part of their frustration. It is a big part, but it is only one part.

So I know I speak for my colleagues when I say this fight is far from over. This struggle to regain control of this body and this institution in Washington, DC, and give it back to the people of this country will go on.

I have great faith in this country and its future. That is why I am confident that over time, sooner or later, we will be back and we will repeal and we will replace--we will replace--this huge government takeover with medical malpractice reform, with going across State lines to get insurance of your choice, to reward wellness and fitness, to establish risk pools that insurance companies will bid on in order to treat people with preexisting conditions. We have a long list we will replace this mortgaging of America's future with that will be what all Americans want; that is, to maintain the quality of health care in America and, at the same time, bring costs under control.

I thank the Senator from New Hampshire for his leadership. I thank the Senator from Montana for his courtesy during this debate over these days and weeks and even months, on days and nights and weekends. I want to assure my colleagues this debate is far from over.

I yield the floor.

Mr. GREGG. Mr. President, I just want to thank the Senator from Arizona for his excellent summation of where this issue lies and its impact on the American people. I hope that statement will be read across this country because it was a reflection of the concerns which are legitimate and which are being expressed by vast amounts of Americans. It is not unusual it should be expressed by the Senator from Arizona because he is so much a personality of this Nation and a force within our political process.

I would reserve the remainder of my time.

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Mr. McCAIN. Mr. President, the amendment removes the following items from the legislation: additional Medicaid funding for Hawaii hospitals; additional Medicaid funding for Tennessee hospitals; provides special Medicaid funding for Louisiana; special Medicaid funding primarily for reclassified hospitals in Michigan and Connecticut; $100 million for a Connecticut hospital; frontier funding provision provided in new Medicare money for Montana, South Dakota, North Dakota, and Wyoming; a provision allowing for certain residents in Libby, MT.

I do not argue whether these are worthwhile or needed projects. I do argue the method in which they were inserted in this legislation--the one for Tennessee being as recently as yesterday or the day before--is the wrong process.

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