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Health Care And Education Reconciliation Act Of 2010

Floor Speech

Location: Washington, DC


Mr. McCAIN. Madam President, I thank my friend from Tennessee. May I say I am going to offer an amendment that would remove some of the remaining sweetheart deals. To be honest with my colleagues, I don't think we are going to find out all of what was in this 2,733-page legislation for a long time.

As you know, it is that size, and it takes an expert, even though I read the bill, to go from one point to another. For example, it took us a long time to figure out that the State of Connecticut has a $100 million deal to build a hospital in Connecticut.

Now, you wouldn't know that at first glance, but after going through it, you figure out it is there. There are a lot of provisions in this 2,733-page piece of legislation that we will find, but we are going to try to get rid of some of them in this amendment, which is, by the way, a commitment I thought had been made but obviously was not.

The most egregious have been removed. The ``Cornhusker kickback'' has been removed, and I believe the ``Gator aid'' provision has been removed as well. But we certainly have a number of others that remain in the bill, and we will be finding them in the future.

I ask my colleague from New Hampshire, is it in order for me to propose the amendment? What is the parliamentary situation?

Mr. GREGG. As I understand it, the majority would like to see the amendment, which is certainly reasonable. We will give them a copy of the amendment, and then hopefully at the end of our debate time we will be able to set my amendment aside. We will get a copy.

Mr. McCAIN. I say to my friend from New Hampshire, while we are on the subject, it is not only the sweetheart deals that are carved out for individual Members, the latest being additional Medicaid funding for Tennessee hospitals, which was just added, I understand, within the last 48 hours or so, but there is also the part that is really hard for us to amend, as I am sure the Senator from New Hampshire knows--for example, the PhRMA deal, the deal that was cut for the pharmaceutical manufacturers.

The Senator from New Hampshire may remember that back in August, there was a story in the New York Times:

Drug industry lobbyists reacted with alarm this week to a House health care overhaul measure that would allow the government to negotiate drug prices and demand additional rebates from drug manufacturers.

In response, the industry successfully demanded that the White House explicitly acknowledge for the first time that it had committed to protect drug makers from bearing further costs in the overhaul. The Obama administration had never spelled out the details of the agreement.

``We were assured: `We need somebody to come in first. If you come in first, you will have a rock-solid deal.' '' Billy Tauzin--

By the way, I understand he has a salary of over $2 million a year--

the former Republican House member from Louisiana who now leads the pharmaceutical trade group, said Wednesday: ``Who is ever going to go into a deal with the White House again if they don't keep their word? You are just going to duke it out instead.''

A deputy White House chief of staff, Jim Messina, confirmed Mr. Tauzin's account of the deal in an e-mail message on Wednesday night.

``The president encouraged this approach,'' Mr. Messina wrote. ``He wanted to bring all the parties to the table to discuss health insurance reform.''

I say to my friend from New Hampshire, while we are awaiting approval of this amendment from the other side, how many deals were cut with PhRMA? What were the deals cut for the AMA? What were the deals cut with the hospital association? What were the deals cut with all these other organizations that have caused Americans to be so unhappy with this process we have gone through?

There really is not any way, I say to my colleague from New Hampshire, that I can amend the PhRMA deal. We tried to have drug reimportation from Canada. We tried to have pharmaceutical companies compete for Medicare recipients. As Mr. Tauzin said:

``We were assured: `We need somebody to come in first. If you come in first, you will have a rock-solid deal' ''. .....

I don't know whether it was the President found himself on the road to Damascus or what caused the conversion from then-Senator Obama who strongly supported drug reimportation from Canada for prescription drugs to the administration now opposing it.


Mr. McCAIN. Madam President, I thank my colleague, the Senator from Montana, for his courtesy.

This amendment removes some of the remaining egregious sweetheart deals contained in the health reform legislation. It removes the following items from the health reform legislation: additional Medicaid funding for Hawaii hospitals; additional Medicaid funding for Tennessee hospitals; the ``Louisiana purchase'' provided special Medicaid funding for Louisiana; special Medicare funding primarily for reclassified hospitals in Michigan and Connecticut; the UConn proposal that provides $100 million for a Connecticut hospital; the frontier funding provision providing new Medicare money for Montana, South Dakota, North Dakota, and Wyoming; the provision allowing for certain residents in Libby, MT, to participate in a new Medicare Program.

Let me say that I believe many of these proposals, including the Libby, MT, proposal, may be worthwhile, but what are they doing in a health care reform bill? What is the purpose except to put in a special deal for a favored group? They may need this help. They may possibly very badly and urgently need it. It seems to me, if that were the case, we could make that argument and provide the people in Libby, MT, the ability to participate in a Medicare Program as it stands. It is something that is not in keeping with health care reform.

The funding for Hawaii hospitals is there.

I want to say a word about the ``Louisiana purchase.'' The Senator from Louisiana comes down and forcefully and very convincingly argues that this is very needed for the State of Louisiana, and Louisiana was hit by Hurricane Katrina. I point out that the State of Mississippi was also hit and devastated by Hurricane Katrina, but we do not have anything in here for the State of Mississippi. I know the Governor of Mississippi would argue that the devastation on the Mississippi coast was equally as terrible as that for Louisiana. Instead, we have $300 million providing special Medicaid funding for Louisiana.

There are also States, including my own, that have suffered devastating acts of God, acts of nature also from time to time.

Here we are at the eleventh hour with a situation where there are still these backroom deals done that possibly we could address with an amendment. The other deals we cannot because they were side agreements, such as the pharmaceutical companies I just read from, such as the deal with the American Medical Association, the ones with the hospitals, the others that were cut in order to get Members to come on board and support this legislation. This provides for an opportunity to remove these provisions from the bill.

Comments made by Senator Reid's office:

You will find a number of States are treated different from other States. That's what legislation is all about. It's compromise. We worked on a number of things to get different people's votes. There are many things you will look at in this legislation and say: I wonder why that happened? A lot of times you think something was done and, oh, that's how you got their vote. Most of the time, that's really not true. Some of the time it is.

If I could quote to my colleagues again the recent article from March 21 called ``Inside the Pelosi Sausage Factory,'' I quote from the Wall Street Journal article:

Never before has the average American been treated to such a live-action view of the sordid politics necessary to push a deeply flawed bill to completion. It was dirty deals, open threats, broken promises and disregard for democracy that pulled ObamaCare to this point, and yesterday the same machinations pushed it across the finish line .....

As for those who needed more persuasion: California Rep. Jim Costa bragged publicly that during his meeting in the Oval Office, he'd demanded the administration increase water to his Central Valley district. On Tuesday, Interior pushed up its announcement, giving the Central Valley farmers 25 percent of water supplies, rather than the expected 5 percent allocation. Mr. COSTA, who denies there was a quid pro quo, on Saturday said he'd flip to a yes.

Florida Rep. Susan Kosmas (whose district is home to the Kennedy Space Center) admitted that in her own Thursday meeting with the president, she'd brought up the need for more NASA funding. On Friday she flipped to a yes. So watch the NASA budget.

Democrats inserted a new provision providing $100 million in extra Medicaid money for Tennessee. Retiring Tennessee Rep. Bart Gordon flipped to a yes vote on Thursday.

Outside heavies were enlisted to warn potential no votes that unions and other Democrats would run them out of Congress.

The list goes on and on.

Again, eight times the President of the United States said in the campaign that all negotiations on health care reform would be conducted with C-SPAN cameras in the room. He said: We will find out who is on the side of pharmaceutical companies, who is on the side of the voters. Unfortunately, these deals were made out of the view of the C-SPAN cameras--in fact, behind closed doors.

This is a pretty simple amendment. I repeat, it removes the additional Medicaid funding for Hawaii hospitals; additional Medicaid funding for Tennessee hospitals; the ``Louisiana purchase;'' special Medicare funding primarily for reclassified hospitals in Michigan and Connecticut; $100 million for a Connecticut hospital; the frontier funding provision providing new Medicare money for Montana, South Dakota, North Dakota, and Wyoming; and the special provision for Libby, MT.

I know, again, that people will stand and defend each one of these provisions. They are provisions that were not allowed or provided to every other State in America. That is what makes them a special deal. That is what makes Americans think that the way we do business around here is not in their interest. It makes Americans believe we are cutting these deals in order to secure votes. Whenever these deals are cut, then the residents of other States are the ones who foot the bill.

I hope my colleagues will consider this amendment and remove all of these remaining provisions. I cannot assure my colleagues or my constituents that we have found them all, but at least it is a step in the right direction.

Mr. GREGG. Will the Senator yield for a question?

Mr. McCAIN. I will be glad to.

Mr. GREGG. It seems to me that what the Senator is trying to do is get back to what the other side claimed they were doing, which is health care reform. What the Senator is trying to do is take out of this health care bill a lot of special walking-around money events that did not have anything to do with health care reform; they just had to do with getting a vote--getting a vote here, getting a vote there. If they were going to do real health care reform, then it should rise and fall of its own weight. It should not require that these special deals be put in there to get a vote, should it?

Mr. McCAIN. I believe all of my colleagues are of the highest integrity, honorable people. I respect and admire their service to their States and the Nation. But there is no doubt, I say to my friend from New Hampshire, there is no doubt that these kinds of provisions in a 2,700-page piece of legislation create the appearance that some States are favored over others because of either the influence of their elected representative or in order to secure those votes. That is the appearance the American people have when we find these earmarks in legislation which are somehow inserted without votes, without debate, without discussion, and there they are.

Mr. GREGG. I guess my point is, independent of these amendments, Members should be able to vote on this bill up or down without these amendments in it. These amendments are extraneous to health care reform. The core of health care reform has nothing to do with any of these amendments. As the Senator from Arizona says, they may be worthwhile in some instances, but they are not tied to the purpose of this bill, which was allegedly health care reform; isn't that correct?

Mr. McCAIN. I totally agree. Again, I pointed out a short time ago--as in the day before yesterday--what was the rationale for adding $100 million in extra Medicaid money for Tennessee?

Why, after a year of debate and discussion on this, all of a sudden $100 million extra for Medicaid is deemed necessary for the State of Tennessee? This is what arouses the suspicion of the American people, I say to my colleague.

There will be a stout defense of every one of these. But the point is that if they are done in the regular authorization and appropriations bills, and certainly not in the name of health care reform, they are extra money. Where is the reform in $100 million for a hospital in Connecticut? What does that have to do with reform? Nothing.

I reserve the remainder of my time.


Mr. McCAIN. I would say to my friend, I had the exchange with the President specifically over the so-called ``Gator Aid'' amendment because 330,000 citizens of my State were enrolled in Medicare Advantage who are going to be placed at a great disadvantage because we had carved out a special provision for 800,000 citizens of Florida who were under the Medicare Advantage Program.

By the way, I remind my colleagues that I proposed an amendment to remove that on this floor from that bill. Does anybody really believe that if it had not been for the publicity surrounding these special deals that they would have voluntarily taken out the 800,000-person carve-out for the State of Florida? I do not think so because I proposed an amendment to take it out and it was defeated. It was kept in on a party-line vote.

Fortunately I brought it up at the White House with the President and the President agreed it was not a good idea. So, after voting to keep it in, after defeating an amendment that--I tried to remove it--fortunately there was enough publicity, there was enough focus on it that it forced them to take it out.

Unfortunately, there is not enough focus on the hospital in Connecticut and these other provisions which are special deals.


Mr. McCAIN. Madam President, I wish to summarize by saying I hope we will take out these deals. I hope every time we find another one in this 2,733-page legislation, we will take it out too. But I hope also that my friends on the other side of the aisle and the President of the United States will learn a lesson. Next time you want to sit down and enact a major piece of legislation, bring us in in the beginning. Bring us in so we can have true bipartisan negotiations, and any allegation to the contrary is patently false. I know because I have been involved in bipartisan negotiations and this is what happens when you have to go around shopping for votes to finally put you over the top. The American people, with the election of a new Senator from Massachusetts, have rejected this process. They have rejected this process.

Let's listen to the people of this country who say they want these things out. That is not how they want the Congress of the United States to do business. Let's take them out. Let's stop this legislation and let's start from the beginning and let's fix health care in America. And, certainly, let's all pledge to stop doing these kinds of backroom behaviors that the American people have grown sick and tired of.


Mr. McCAIN. I will summarize again. These deals were cut for special situations. We have had disasters all over America. We had a disaster in the State of Mississippi. There was nothing in this for the State of Mississippi, which was struck by Katrina as well. The fact is it was also done in a managers' package. There was no debate, there was no discussion. I certainly, and the rest of this side, was not told about it and I was not the only one.

It was a deal that was cut. These deals have all got to be removed. I certainly will support doing anything necessary to help any State in America that is struck by a disaster, not just Louisiana, but Arizona and California and every other State that has been. But I will not do it by inserting a special provision in what is supposed to be a health care reform bill.

I urge my colleagues to remove all of these sweetheart deals.


Mr. McCAIN. Mr. President, may I ask my colleague whether he recalls when at Blair House our colleague from Tennessee began the discussion with the President and our Democratic colleagues, and he said at that time that the Congressional Budget Office said premiums would increase from 10 percent to 13 percent for individuals purchasing health insurance? That comes out to $2,100 more for a typical family. The President challenged that, as you may recall, and said: Well, we are going to settle this before the end of this--what later turned out to be 7 hours of fun.

So what was the answer to that, I ask Dr. Barrasso. What was the answer? Was Senator Alexander correct when he quoted the Congressional Budget Office that premiums would increase by 10 percent to 13 percent for individuals purchasing health insurance or was the President correct by saying that was not true?

Mr. BARRASSO. Well, Senator Enzi, who has joined us on the floor, was also sitting with us that day at Blair House, and my recollection and from doing the research afterward and the press reported that Senator Alexander was correct. Individuals buying health insurance in the individual market would see their health insurance premiums go up by 10 percent to 13 percent if this bill becomes law, and the President signed it into law today.

So the American public needs to know that their insurance premiums are going to go up as a result of what the President signed today, and I am bringing up an amendment opposed to that.

Mr. ENZI. That is exactly what was concluded in that Blair House meeting. It was supposed to be a listening session, but nothing appears to have been listened to. Nothing was included from any of the multiple suggestions the Republicans made there.

About the 10 percent to 13 percent that premiums are going to increase, there is a very important addition to that. It is 10 percent to 13 percent more than if we did nothing. The President keeps talking about how we need to do this bill because health care costs are escalating dramatically. And they are. But they are going to escalate even faster--10 percent to 13 percent more--than if we did nothing.

Mr. McCAIN. Could I ask Senator Enzi, then, what was the President referring to? In fairness to the President, what was he referring to when he challenged the assertion of the Senator from Tennessee that individual premiums would go up by some 10 percent to 13 percent?

Mr. ENZI. I am not exactly sure what he was referring to. He has used that in the numbers speeches, just as they keep using the number that this bill will reduce the deficit by $138 billion. Again, you have to read the rest of the sentence and find out that is if we don't take care of all of the things we normally take care of, such as the doc fix, which is going to cost $300 billion, which more than uses up that money.

Mr. McCAIN. So it seems to me pretty legitimate to hold the President and the sponsors of this legislation to their word; that is, if it doesn't increase the premiums, then they are true to their word, but if it does increase premiums, then the American people have not been told the truth. Therefore, this legislation should be scrapped and we should start all over.

By the way, may I add one point? I have grown a little weary--a lot weary--about when they say to do nothing will do X, Y, and Z. We are not talking about doing nothing. We are talking about medical malpractice reform. How does anybody excuse the fact that there is not medical malpractice reform in this legislation? There is only one answer. It is that the trial lawyers control this legislation, and that is disgraceful.

Mr. GREGG. If the Senator will yield, I think it is important to understand why the premiums go up so that the argument that they don't go up can be pointed out as being really transparently inaccurate. The reason the premiums go up is because under this bill, Americans who have health insurance will be forced to buy more expensive health insurance. They are going to be forced to buy health insurance which is at a much higher level of coverage for a lot of things which many Americans simply don't need and therefore don't buy it today. They are going to be required to buy that higher cost health insurance, and that is going to force up the premiums.

This is a classic, top-down you do what the government says relative to what type of health insurance plan you are going to be able to buy plan, which we should expect from this administration. But we should not deny that it has an immediate impact on the cost of that health insurance and that CBO has said--as both Senators from Wyoming have so accurately pointed out, CBO has scored this as increasing the premiums for individuals because of that; is that not correct?

Mr. BARRASSO. That is absolutely correct. The nonpartisan Congressional Budget Office says it is going to go up. The Joint Committee on Taxation says people are going to have to end up paying more in health care premiums than if there was no bill at all. The Chief Actuary for the Centers for Medicare and Medicaid Services said the same, as did eight additional private sector studies. They all confirm that the health care reform bill signed into law today will drive insurance costs up greater than if there was no bill at all signed into law.

There are mandates we are putting on young people who are going to be forced, many of whom are going to be forced to buy insurance, forced by this law--all of them are going to be forced to buy insurance that many of them don't need, many of them don't want, and many of them can't afford, because they are going to have to buy levels that are far in excess of what they might want. It is going to be very expensive, as many of them are going to be subsidizing others because of what is called the community rating and the way this whole program has been set up.

Mr. McCAIN. May I ask the Senator from New Hampshire--just a personal point. Suppose we had decided to do away with the tax benefit for employer-provided health insurance and given every American family a $5,000 refundable tax credit. Would we have then been able to provide the ability to acquire insurance to some 30 million Americans?

Mr. GREGG. Yes, I think the Senator is right, and the type of insurance they would have gotten would have been the type of insurance they wanted. If you are a young person today and you are not buying health insurance, it is probably in many instances not because you can't afford it. In fact, it is estimated that of the uninsured population, of the 47 million uninsured, approximately 20 million have incomes over $70,000, and they can afford insurance. They just simply decided they are not going to buy it.

If you gave them this refundable tax credit, what they could buy is a catastrophic plan so they could assure themselves of coverage in the case of that accident or that catastrophic disease that might wipe them out financially, and it would probably be more tailored to what they want as opposed to what some bureaucrat here in Washington wants or what the President of the United States wants or what somebody here on the other side of the aisle decided they should have.

Mr. LeMIEUX. If my colleague will yield, this is really a bait-and-switch. During the campaign, President Obama said this is about lowering the cost of health insurance. We know the cost of health insurance has gone up 130 percent in the past 10 years. The debate was: Don't you want your health insurance to be lower? And the American people said: Sure, yes. Of course they did. The switch is what this is all about, which is putting more people into Medicaid. It will put 15 million more people into a program that is failing; a program where Walgreens in Washington State is no longer taking Medicaid; a program where doctors are no longer taking Medicaid. It is not health care reform if the doctor is not in. But for the rest of Americans, the 159 million people who have health insurance, their costs aren't going to go down. In fact, their costs are going to go up.

I ask my friend, the Senator from Arizona, who comes from a State where there is a population just like Florida with a lot of seniors, what do we say to our seniors, our seniors who are now going to have a cut in Medicare of $500 billion-plus to finance this big expansion in Medicaid? How do we justify that to them?

Mr. McCAIN. And the program, I am sure Dr. Barrasso and Senator Enzi would agree, that is going to be cut the most is a program called Medicare Advantage where seniors do have some relative choice as to what type of care they wish to receive. Fortunately, the 800,000 enrollee carve-out has been removed because of the national attention it got.

Mr. BARRASSO. There is an advantage to Medicare Advantage. That is why people signed up for it, as 11 million Americans have. The advantage works with coordinating care, prevention of illness and disease. That is why people want to be in that program. But now the President is eliminating it.

My colleague from Florida talked about the 15 million people dumped onto Medicaid, and the New York Times reports that as Medicaid payments shrink, patients and doctors drop out. The President is not only dumping on 15 million through the health care bill, with the bill we are discussing right now, the reconciliation bill, it also adds another million people to those rolls dumped into Medicaid.

Mr. McCAIN. So perhaps the worst fraud being perpetrated in this entire legislation is the doc fix. No one who is an expert on health care believes we are going to cut physicians' payments for treatment of Medicare enrollees by 21 percent. No one. Yet that is calculated in so there can be this phony actual reduction in the deficit.

Mr. BARRASSO. And for the ginned-up numbers we have been presented by the Democrats to work where they say we have actually helped lower the deficit, for it to work, in the next couple of months they would have to cut doctors' fees for all of the Medicare patients they take care of by 21 percent and then keep those fees frozen at that low level for the next 10 years. Now, is that going to happen? But if it doesn't happen--and I ask the accountant from Wyoming as opposed to the surgeon from Wyoming--from an accounting standpoint, can you do that?

Mr. ENZI. The Senator from Wyoming not only is correct that we are going to have a huge problem, but something that is new in the reconciliation bill besides this 21 percent that, of course, we are going to have to fix and that is going to cost us $300 billion--and all of the proposals so far have not paid for that proposal--they slipped in a little cliff in there for Medicaid this time, too, and in 2 years we are going to drop off a cliff with Medicaid just the same way as Medicare. Does anybody believe we won't fix that? That is going to drive up the deficits too.


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