John Barrasso

Mr. BARRASSO

Mr. BARRASSO. When I talk to other doctors, they tell me, across the board they order a number of tests, expensive tests--call it defensive medicine--tests that do not necessarily help a patient get better, get well, but just to make sure they get covered in case they are sued. It is not unusual, when you look at the numbers, that we are talking $100 billion a year in tests that are done that do not necessarily help somebody get better, but they are doing it because of the legal atmosphere in this country. Here we are on the Senate floor on a Sunday afternoon. The President is less than 100 yards away, a former Member of this body. He ought to be involving all Senators. He is meeting behind closed doors, possibly cutting deals, trying to come to arrangements, twisting arms, asking people to march, follow his marching orders right off a cliff that I think is going to be coming for health care in America. I think he ought to be involving all Americans. We are talking to the Americans in this country. We are not hiding behind closed doors. People who aren't part of those discussions are completely cut out. I know my colleague from Tennessee has been outstanding and outspoken on these very issues, but we are here, and we want to visit with people because we do have solutions that work; that will not increase the cost of care, which is what we are seeing now; that are not going to cut Medicare, which is what the Democrats are proposing; that are not going to increase taxes, which the Democrats are proposing; and they are not going to drive up the premiums. The whole idea behind this was to get the costs under control. Senator Ensign's amendment does that by taking a look at the lawsuit abuse that we look at in this country. But I want to turn to my colleague from Tennessee, who I know has some more points he wants to make.

Mr. BARRASSO. On this floor have said the Democratic proposal is cutting the Medicare the seniors of this country depend on for their health care. We pointed out that they have taken $120 billion away from Medicare Advantage. Mr. President, 11 million seniors use Medicare Advantage. One out of four seniors is on Medicare. The reason they signed up for Medicare Advantage is because there is an advantage for the seniors--preventive care, coordinated care, things we know are important. Yesterday on this floor, the Democrats voted to cut away from home health care. This is a lifeline for homebound patients. It helps keep them out of the hospital and out of the nursing homes. Yet in spite of all the letters we have read from patients, as well as home health care communities in all of our States, they have cut back. Yet the majority whip came to the floor at the opening of the session today and said: Oh, we have handled all of that. He said: We have handled all of that with a wonderful resolution of the Senate by Senator Michael Bennet. The New York Times today, about that resolution, said: Democrats decided to respond to the Republicans saying: Hey, you are cutting Medicare for our seniors. ``Democrats decided to respond . . . with a meaningless amendment.'' The New York Times editorial today, ``a meaningless amendment.'' We knew it was meaningless, and we know they are cutting Medicare from the seniors who depend on it--Medicare Advantage from hospitals, from nursing homes, from hospice, from home health care. This is robbing the people who need this care, deserve the care. If you said maybe we should take a look at Medicare, then do it, Mr. President, to save Medicare, to save Medicare that we know is going broke. I see the Senator from New Hampshire is here. He has been an expert on this topic of the budget and ways we can save Medicare. I say to my friend from New Hampshire, is this not true that Democrats have proposed a meaningless amendment but they are cutting the guts out of the Medicare Program on which the seniors of this country are dependent?

Mr. BARRASSO. I agree with the Senator from Arizona. I looked at another one of his favorite newspapers, the New York Times, today because we--

Mr. BARRASSO

Mr. BARRASSO. I yield the floor.

Mr. BARRASSO. This letter talks about the devastating impact of the cuts proposed in this bill we are considering today. There are 43 home health agencies in Wyoming and a number of them are in communities--the occupant of the chair is from a State where there are a lot of rural areas. A number of our agencies are in communities that don't even have hospitals. So it helps people stay in their homes, in their home communities, stay out of the hospital, out of the nursing home, and it gives them the dignity and the opportunity and the independence they need to stay at home. Yet this bill, according to the folks in Wyoming and the folks nationally, is going to make it that much harder for our seniors to stay at home. Taking $42 billion from home health care, raiding that program to start another program, to spend it on a new government program is going to absolutely impact the ability of home health care providers in this country to offer services. These nurses, therapists, and home care aides all drive hundreds of miles on a daily basis in Wyoming, going from ranch to farm, to help care for people and to help them stay at home. It is all around the country. There is a front-page story in the New York Times today, a wonderful story of a delightful 94-year-old lady, Bertha Milliard. She lives in Maine. There is a picture of her with her nurse during a home health care visit. Bertha is very worried that they are going to lose this service, which is the service that keeps her out of the hospital. It just seems, as we look at this, that there is no way home health care agencies around the country are going to be able to sustain these kinds of cuts and continue to remain available to the Medicare patients who depend on home health care. Even the National Association for Home Care & Hospice said that in a few short years, Medicare will be paying home health agencies less than it costs to even provide the services. We are talking about less than the gas in the cars and the salaries of the folks who drive around. We are not talking about profit. We are talking just about keeping doors open. As I think about the patients in Wyoming whom I have taken care of over the years who have benefited from home health services, who have been able to receive care from nurses, therapists, home care aides and allow them to stay at home, to be more independent--not totally independent but more independent--I think anything that cuts into this is not good for America.

Mr. BARRASSO. Madam President, you know as well as I that the President promised the American seniors that if they liked the care they had, they could keep it. Nothing could be further from the truth. Looking through this bill we are debating, there is an incredible amount of cuts to Medicare, which is a program seniors rely upon for their health care: $120 billion of cuts to Medicare Advantage. One in four people in America who depend on Medicare for their health care--11 million Americans--are on Medicare Advantage. The reason they chose it is because it is an advantage. It helps with coordinated care and preventive care. Having practiced medicine for 25 years, I know the people at home get it. That is why they chose that program. It also cuts $135 billion from hospitals and $115 billion from nursing homes. I want to focus a little bit on the $42 billion cut from our home health agencies. I don't know how anybody on the other side of the aisle can say with a straight face that the legislation before us doesn't cut Medicare and doesn't hurt our seniors because it does. I will tell you, having taken care of people in hospitals, the services that are provided through home health care is what helps get people out of the hospital sooner, gets them home faster, gets them out of nursing homes, and helps keep down their costs. These services include skilled nursing care, physical therapy, occupational therapy, speech and language therapy, and medical social services. I have a letter from the director of home health services of Wyoming, the Home Health Care Alliance. I ask unanimous consent that it be printed in the Record.

Mr. BARRASSO. Madam President, how much time remains?

Mr. BARRASSO. It has been a privilege to take care of patients in Wyoming for the last 25 years. This bill is going to hurt them. It is going to hurt the future of care. It is going to hurt the future of Medicare in America. You cannot take $464 billion away from Medicare, a program on which the seniors of this country depend, and say it will not affect their care. It will affect them in the hospitals, it will affect them in the doctors' offices, it will affect them in the home, it will affect them in the final days of their lives in the hospices. That is what I hear about across Wyoming. I have not met doctors who support this--not at all. I have not met very many patients who support it, and they are also told by others: We don't want this. The townhall meetings have been overwhelming in opposition. This is a bill that will be bad for our small businesses and bad for people who want to get insurance. It will be bad for people who have insurance because they know their premiums are going to go up. It will be bad for people who pay taxes because those are going to go up. But specifically for home health care, this will be awful. It will affect small communities--in all of the small communities of America, not just in Wyoming. I can't imagine anyone in a small community being for this.

Mr. BARRASSO. This proposal is going to hurt patients in a lot of ways. It is going to hurt patients psychologically. They are in a hospital when they want to be at home. It is going to hurt patients in terms of their health. The better place to be is at home, as long as somebody is coming around to check on them. That is why for so many reasons, doctors have for decades said: Try to help patients get home as quickly as they can. That is the best place for them to heal. We have heard from the Senator from Georgia a remarkable story about pennies on the dollar, the effectiveness of this program. It is good for folks, and it is good for the whole health care of our Nation if we have people healing at home, not in the hospital.

Mr. BARRASSO. I agree with the Senator. It is astonishing that the Senator from Montana would read a national organization's letter instead of one from his home State. In Wyoming, we have 43 different home health care agencies, and some of them are in communities that don't even have hospitals. Therapists drive long distances. We have colleagues from rural States here, and Montana is certainly one of them. Those home health care agencies know they are not even going to get paid enough from Medicare to put gas in the car to drive out to the ranches and the farms where people are who are staying at home, trying to stay out of the hospitals and nursing homes. We have home health agencies throughout the States, and they drive tens of thousands of miles every year, with therapists and nurses and home care aides going out to help people stay at home and therefore give them dignity and allow them to keep down the cost of care for everybody.

Mr. BARRASSO. I will yield to the Senator from Arizona.

Mr. BARRASSO. Well, as the Senator from Arizona knows, I have treated patients in Wyoming, families in Wyoming, for 25 years. The story in the New York Times has a wonderful picture of Bertha Milliard, a 94- year-old lady, who is very similar to many of the patients I have taken care of in families in Wyoming who depend on this care. There is a picture of Bertha dealing with her nurse. Bertha greets the nurse who has come to check her condition and review the medications she takes for chronic pain, for heart failure, and for stroke. Ms. Milliard says those visits have been highly effective, she says, in keeping her out of the hospital. That is the whole idea: Keep them out of the hospital so they can lower the cost of care. But the home care that she receives could be altered, according to the front page of the New York Times, under the legislation passed by the House and pending on the Senate floor today. The legislation would reduce Medicare spending on home health services, which is a lifeline for homebound Medicare beneficiaries which keeps them out of hospitals as well as out of nursing homes. So there you have it. What could be better for our seniors than to have the dignity of being in their own homes, to have someone coming into their homes to help them, to make their lives better, and that is going to include skilled nursing care, physical therapy, occupational therapy, sometimes speech and language therapy, and different medical and social services? That is where the care ought to be given, in the home. That is what we want for our seniors: the dignity at home, opportunities at home, to stay in their surroundings. That is what we want for not just all seniors such as Bertha, we want that for our Nation because that will help keep down the cost of care. This bill does the exact opposite. That is why we have to have this amendment that says don't cut Medicare for our seniors and certainly not to start a whole new program. In the Wall Street Journal today is an editorial by the dean of Johns Hopkins Medical Center, a wonderful, world class center: ``Health Reform Could Harm Medicaid Patients.'' So we are taking the money from Medicare, hurting Medicare patients, and they are using it in a way that is actually going to make it worse for patients on Medicaid, as they have dumped 15 million people into this program that is absolutely broken.

Mr. BARRASSO

Mr. BARRASSO. Mr. President, I would say when my colleague from Wyoming and I held townhall meetings around the State of Wyoming, people have said don't cut our Medicare. Yet what I see this bill doing is cutting our Medicare and specifically, right now, there are thousands of people in Wyoming who are on a program called Medicare Advantage. There is an advantage to this program. That is why so many Americans have signed up for the program. As a matter of fact, about one in four Americans who depend upon Medicare for their health care in this country has chosen Medicare Advantage, because there are some advantages being in this program called Medicare Advantage: dental, vision, hearing, fitness. Also, as a practicing doctor for 25 years, taking care of families in Wyoming, what I saw, the reason they liked this, if they were on Medicare, is because it dealt with prevention and it actually helped coordinate care. One of the things Medicare does not do as well is coordinate care and work with prevention. We know how important prevention is in helping people keep down the cost of their care--how good it is in terms of giving people opportunities to stay healthy. That is why they call it prevention. The bill in front of us, as I see it--I ask the Senator from Wyoming--is a bill that is going to cut $120 billion from Medicare Advantage, the program the people in our State like?

Mr. BARRASSO. Mr. President, to correct something I heard on the floor today, when the senior Senator from Connecticut had some concerns about this, he said how private health plans deny claims. He said Medicare doesn't deny claims. In the United States of America, the No. 1 denier of claims for health care is Medicare. The study that is out from a full year, from March 2007 to March 2008, Medicare rejected 475,000 claims of its 6.9 million claims filed, at the rate of 6.85 percent. When you compare that to private insurance companies, the industry average for the claims that are rejected is about 4.05 percent. So Medicare rejects, by number, 10 times more than the largest private insurance company. A lot of these claims--I have followed this closely because I have been the medical director of something called the Wyoming Health Fairs, where people can get their blood tested at a low cost. It is a preventive or prevention-designed program. Yet Medicare refuses to pay for prevention. It refuses to pay for these blood tests because they are preventive as opposed to diagnosing a specific problem in a specific patient with a specific symptom. What do our seniors in America do? They turn to a program called Medicare Advantage because it gives them the advantage to choose this program. It is one of the choices they have under Medicare. At this point, 11 million Americans have chosen to participate in Medicare Advantage and receive their health care through Medicare Advantage. We are talking about seniors who depend on Medicare for their health care. The number of people signing up for Medicare Advantage has continued to increase, and now there are 11 million people--or one out of every four seniors--on Medicare in this country. They know who they are and they like the program. The reason they like the program is because they get additional services--services beyond what someone on the traditional Medicare Program receives, such as dental care, hearing care, eye care, preventive care, and coordinated care. We hear a lot about the failings of the health care system, and there are many in this country, and one of them is that care is not coordinated. People go from specialist to specialist. We need coordinated care. Medicare Advantage does a much better job at coordinating care than traditional Medicare. It is baffling to me that the plan in front of us in the Senate today is trying to eliminate Medicare Advantage to the tune of over $100 billion. When one looks at the cuts that are in this plan--it is $464 billion in Medicare cuts, $135 billion for hospitals, $42 billion for home health agencies, $15 billion for nursing homes, and $8 billion for hospice providers. But it is $120 billion for Medicare Advantage--the program that more seniors, as they learn about it, want to sign up for, because it is an advantage to them to have their health care through a program which focuses on preventive care, coordinated care, and helps them stay healthy and live longer. Yet this Senate and this bill that Senator Reid has brought to the floor is trying to completely gut that program and deny our seniors who rely upon it from receiving the care they have earned. I yield the floor.

Mr. BARRASSO. Yes.

Mr. BARRASSO. Mr. President, an article in Bloomberg yesterday said the Kaiser Family Foundation poll released this past month found that 60 percent of seniors said they would be better off if Congress did not change the health care system. We know we need to do some changes. But this massive bill, this 2,000-page bill that weighs 20 pounds, is not the right change we need. For our seniors, people who rely on Medicare for their health care, to absolutely raid $464 billion from Medicare, almost $\1/2\ trillion, there is a point where more people--the baby boomers, more and more people are added to the rolls every day. To raid this program to start a whole new government program is not the right prescription for America. It is not what our seniors want. It is not what they signed up for. It is not why they are choosing Medicare Advantage. It is because it is a choice they make and that is why we right now have 11 million Americans who are on Medicare Advantage. We have 11 million seniors-- that represents almost one-quarter of all Medicare patients in this country.

Mr. BARRASSO. I actually heard somebody say Medicare Advantage is not Medicare. But if you turn to the Centers for Medicare Services' 2010 Official Government Handbook--we are going to go into 2010 next month. If you go to the official handbook for 2010, and the handbook is called ``Medicare And You,'' it says a Medicare Advantage plan is ``another health coverage choice you may have as part of Medicare.'' People who actually look at this choose this. They make the choice because they say this is a good deal for me. That is what Americans want. They want to get value for their money. A recent poll said, in terms of Americans, when they send money to Congress, how much of that do they get back in value? They think about 50 cents on the dollar. That is a national Gallop Poll. They have been polling on this for a long time and it is the highest number ever of what Americans think, in terms of the fact that they are getting very little value for their tax dollars. They see games being played. That is what I hear when I have telephone townhall meetings in Wyoming. They know Senator Reid's bill steals $464 billion from Medicare. They know it raids the health care program they depend upon, not to make Medicare stronger, not to make Medicare more solvent, but as my colleague from Wyoming tells me, to create a brandnew entitlement program. They are raiding Medicare to start another government program that is itself going to be insolvent. I ask my colleague from Wyoming, are you seeing what I am seeing?

Mr. BARRASSO. Mr. President, I ask my colleague from Wyoming, with whom I have the privilege of serving, I saw a large story in USA Today. This story says ``Senate Keeps Medicare Cuts in the Bill.'' What it says is: Senate Democrats closed ranks Thursday behind $460 billion in politically risky Medicare cuts at the heart of health care legislation. It goes on to say: Approval would have stripped out money to pay for expanded coverage to tens of millions of uninsured Americans. As I read this, it says the Republicans tried to keep the Medicare money for people on Medicare, but the Democrats want to take $460 billion away from seniors who depended upon Medicare and use it to start a whole new government program. Am I reading this correctly?

Mr. BARRASSO. We are taking it away from seniors and using all that money to start a new government program when we know Medicare is going to go broke by 2017.

Mr. BARRASSO. It is also no surprise when people read about this and learn about it that they would want to be on Medicare Advantage. What the Senator from Utah has said, the sponsor of this motion, is that the money that goes into this program is for the benefit of the seniors. It is for services for the seniors on Medicare. To me, this whole bill basically guts Medicare, raids Medicare to start a whole new program. Today, as the Senator from Arizona has mentioned in these articles, the Associated Press and USA Today said: Senate Democrats closed ranks Thursday behind $460 billion in politically risky Medicare cuts at the heart of health care legislation. . . . It goes on to say: Approval would have stripped out money to pay for expanding coverage to tens of millions of uninsured Americans. So they are going to take $460 billion, it says, away from our seniors who depend on it for their Medicare and start a whole new government program. The Washington Times, front-page story headline, reads: ``Democrats Win $400B in Medicare Cuts. McCain Pushed for Another Way to Pay for It.'' I look at this and say this is not fair to our seniors, not fair to the patients I have taken care of for 25 years in Wyoming, taken care of folks--taken care of folks--when grandmom breaks her hip, what we need to do for our patients. These are choices people have made. Mr. President, 11 million Americans have chosen Medicare Advantage because there is an advantage to them for the health care they get--the additional services, the coordinated care, the preventive care. Anyone who looks at this and studies it says: I want to sign up. It has been wonderful in rural areas and big cities. This has helped a lot of people in the country. It is not surprising that one out of four people in the country on Medicare have chosen Medicare Advantage, but yet what we are seeing here is Democrats want to get rid of Medicare Advantage.

Mr. BARRASSO. Just as we do. It works in preventive care and coordinated care.

Mr. BARRASSO. I agree with the Senator from Arizona that people choose to be on Medicare Advantage. Mr. President, 11 million people have chosen to be on Medicare Advantage because it is a wise choice to make because they get better benefits. They get dental care, they get the vision care, they get the hearing aids, they get the fitness thing.

Mr. BARRASSO

Mr. BARRASSO. The Senator absolutely believes we need to find a way to make sure all the citizens of this country have insurance, and there are ways to do it: allowing people to buy insurance across State lines. That doesn't take a 2,000-page bill. There are ways to do it to help get down the cost of care that give individuals incentives to buy their own insurance, giving tax breaks to those individuals. We could do things with tort reform, such as the loser pays rule. We could allow small groups to join together to have a better ability to bargain and get the cost of insurance down. So this Senator absolutely believes we need to find a way to get everyone insured. There are people who need help who don't have help, and we need to find a way to do that, but it is not this 2,000-page bill.

Mr. BARRASSO. I don't think this bill is the way to do it, which is a government takeover of the health care system.

Mr. BARRASSO. I don't have that letter with me, but everything I look at says this will gut Medicare, make it go broke sooner, and it will be bad for seniors.