John Cornyn

Mr. CORNYN

Mr. CORNYN. Madam President, I want to talk about the breathtaking audacity of this bill, in a takeover of yet another important sector of our economy, at a time when our economy is in recession--and the President was wondering at his job summit just on Thursday, how come the private sector seems to be on the sidelines when they should be back in the game creating jobs. This bill is exactly one of the reasons for that outcome. This bill is chock-full of avenues that lead to more and more Washington control over our health care system and our economy. The amendment of the Senator from Arkansas would give Washington control over how much money health care executives would make. But we know as a practical matter, in terms of limiting executive compensation, section 162(m) has been a disaster. Actually, in the past, when Congress has attempted to do this, it has exacerbated the problem by encouraging companies to come up with different ways of compensating their executives that would not be subject to those limitations. This is ineffective in accomplishing the goal the Senator claims she wants. This amendment also adds to the complexity--it adds mud to the already muddy waters--by imposing complex limitations on just one industry, as has been described. I listened this morning--amazed--when there were offers to include other organizations such as AARP, which has reaped hundreds of billions of dollars of income from insurance sales, and executives at Walmart in the Senator's home State, who are also involved in the health care industry. Of course, those were rejected. Our favorite game around here is to try to demonize certain parts of the private sector and, of course, if the private sector is not involved in creating jobs, all that leaves is the government. In health care, all that will do--once there is no private health insurance available because of draconian mandates, taxes, and limitations on compensation--is eventually leave the government as a single-payer provider of health care in this country. I suspect that may be the ultimate goal. We already know the Reid bill will force millions of seniors to purchase so-called Medicare gap products which, by coincidence, are sold by AARP. We have heard Senators come to the floor and quote AARP as if it was holy writ, and somehow they represent all seniors. We know they have a blatant conflict of interest in supporting this bill, particularly as to stripping out Medicare Advantage benefits so they can sell more of our seniors Medigap coverage, which Medicare Advantage eliminates the need for. We also know this bill provides more power to Washington and is taking it away from individuals in other ways by limiting individuals to only four different options for what kinds of health coverage they can get. There is no room for innovation or flexibility. We know, ultimately, that drives up the cost for people who have insurance now-- their health insurance premiums. We ought at least be as good to the American people as we are to ourselves as Members of Congress. We have almost 300 different health care plan options under the Federal employees health care benefits. Why should the American people accept less choices when it comes to their health care than Members of Congress? They should not. These health insurance market reforms are designed to give Washington more power. More and more studies have said new controls by Washington will do nothing but drive up the cost of insurance. The Congressional Budget Office said they will go up by $2,100 for American families. A new study came out yesterday saying that, in Texas, premiums would go up for 61 percent of individuals purchasing their insurance in the individual market. The President of the United States said his goal for health care reform was to lower the cost of health insurance for the average American family by $2,500. By that test, this bill fails to deliver on the President's promise. Then there is, of course, the expansion of other government programs that, while they promise coverage, limit access to care by the way they are structured. This bill purports to give 94 percent of the American people health care coverage but does so by putting 15 million more Americans on the Medicaid Program. Of the 31 million newly insured under the Reid bill, the only choice of 15 million would be Medicaid. Of course, we know Medicaid--for example, in Dallas, TX, only 38 percent of doctors will see a new Medicaid patient because reimbursement rates are so low that a doctor cannot see Medicaid patients and leave his or her door open to see other patients. We, in essence, condemn low-income persons to a health care gulag, where they are offered coverage but have no access to health care. For 60 million Americans, Medicaid would be their only choice. The $120 billion cuts to Medicare Advantage that we talked about earlier gives more power to Washington and takes it away from the individual. By cutting the private part of Medicare under Medicare Advantage, it would result in seniors having no choice but Medicare fee for service. Medicare fee for service compensates doctors at about 80 percent of what private insurance does. That is why, in Texas, 42 percent of the doctors will not see a new Medicare patient under the Medicare fee-for-service payment formula. Frankly, it pays so low that they cannot afford to see new Medicare patients. That means, again, this fraud is perpetrated on the American people-- our seniors--saying we are going to keep our promise to them by providing coverage by effectively denying access to care because the reimbursement rates are so low. This bill gives the government more power over people, and it takes it away from individuals in a number of other ways. While advocates describe it as a way to create competition and choice, the reality is it would drive out competition from the market and ultimately become the only choice for millions of American people. The so-called public option, which sounds relatively innocuous until people realize the effect of that, and the pay-or-play mandate on small businesses, which kills jobs, creates a rational decisionmaking process, and employers that will drop employees from the current private coverage, only to be left on a government-run plan, the so-called government option, which will end up, in the end, being anything but optional--denying power to the individual to make their own decisions in consultation with their doctor and family, and giving Washington more power over their lives. There are good reasons the vast majority of Americans don't trust Washington with running our health care system--an issue that so intimately affects all 300 million of us in America. We know Washington has a lousy record at managing spending. We have a $12 trillion national debt and, before the end of this month, the administration and the majority leader will come to Members of Congress and say: Would you please lift the statutory debt limit because we maxed out our credit card and we need to lift the statutory debt limit. Our entitlement programs are out of control, with Medicare running an unfunded liability of $38 trillion. The majority wants to take $\1/2\ trillion from Medicare and use it not to fix Medicare but to create a new entitlement program. Washington running health care means the personal health care decisions will be impacted by lobbyists and special interests rather than the interests of the American people. That is the reason the insurance industry has been supportive of health care up until now. There is $450 billion in tax dollars that will flow directly to the insurance industry under this bill in the form of tax credits. The hospital associations cut a deal so they would not be subject to the axe of the so-called ``independent'' Medicare advisory board. Everyone has heard about the deal that the pharmaceutical industry cut, in which it would result in them running ads supporting Members of Congress who support this bill because they want to protect their special deal cut behind closed doors. We heard Senator McCain talk about the special deal cut in this bill for Medicare Advantage beneficiaries in Florida--another special political deal in order to secure a vote to support this bad deal--but it left out seniors in Pennsylvania and California. I believe if there is any special deal to be cut, every senior who is a beneficiary under Medicare Advantage ought to have the same deal, not any more of these behind-closed-doors special deals in order to secure votes.

Mr. CORNYN

Mr. CORNYN. If the Senator will yield for a response, $6.8 billion would cut not just into the muscle but into the bone and deny a lot of elderly people, particularly in rural areas, access to care entirely.

Mr. CORNYN. Mr. President, I think as the American people are listening to the debate we are having on health care reform, they are being asked to accept some pretty implausible claims. One claim is that we can take $\1/2\ trillion out of Medicare and it would not have any impact on the delivery of services to Medicare beneficiaries--$\1/2\ trillion. I think the biggest mistake about the way this bill is paid for, with the huge tax increases and huge cuts in Medicare, is the proposal to take $\1/2\ trillion out of Medicare, including $40 billion out of home health care, in order to pay for a brandnew entitlement program, when we already know Medicare itself is on a fiscally unsustainable path. I want to talk primarily about another aspect of these cuts, and that is the 11 million seniors, including 532,000 Texans, who will lose benefits under their Medicare Advantage Program because these are not inconsequential cuts in their benefits. They are serious. I want to talk about some real human beings, some real Texans, who are going to be affected in a negative way by these cuts. First of all, I think it is absolutely critical for the American people to understand that Medicare itself does not provide complete coverage to seniors. That is why so many seniors end up buying supplemental insurance coverage--Medigap coverage, as it is sometimes called--in order to get their bills paid for. Medicare only pays, on average, about 80 percent to providers of what private health insurance does. That is the reason, without additional compensation, many doctors will not see a new Medicare patient. They simply cannot do it and keep their doors open to their other patients. The truth is, Medicare Advantage was created to fix some of the flaws with Medicare fee for service to give seniors more affordable and better coordinated health care. None of us are standing up saying the proposed bill is all bad because some of the positive developments in the bill call for greater coordination of health care. On balance, it makes things worse than it does better because of these cuts in things such as Medicare Advantage. The President of the United States has said providing Americans with a choice of quality, affordable health care was a guiding principle for him. I agree with that statement of principle. Medicare Advantage was created for that very purpose because, as I said, Medicare itself does not always work well for patients. Where I live in Austin, TX, which is Travis County, the last time I saw a report, only 17 percent of physicians will see a new Medicare patient because Medicare reimbursement rates are so low. Those problems are avoided in large part by Medicare Advantage because it pays physicians and providers better than Medicare fee for service. According to the American Medical Association's 2008 national health insurance report card, Medicare--not private health insurance--but Medicare had the highest percentage and the largest number of denied medical claims. In fact, Medicare denied 10 times more medical claims than private health insurers. That is another reason why seniors deserve a choice between Medicare and private plans that will offer them better benefits. As I mentioned, today, 11 million Americans made that choice of better benefits and better care coordination through the Medicare Advantage Program. The proposed bill, the Reid bill, will take away those choices and the benefits of those 11 million seniors by cutting about $120 billion from the program. Many of our friends across the aisle will say we can cut $120 billion out of Medicare Advantage, and it will have no impact on delivery of services. But the Director of the Congressional Budget Office disagrees with them, who says their additional benefits will be cut roughly in half. We need to set the record straight on these so-called overpayments allegedly going to insurance company profits. It is simply a false statement. It is not true. Our colleagues know the so-called overpayments to Medicare Advantage plans do not go into those plans. They go to seniors in the form of additional benefits. That is because, under Federal law, 75 percent of additional payments to Medicare Advantage plans are used to provide seniors with additional benefits-- benefits which they would not get under Medicare fee for service, benefits such as chronic care management, hearing aids, eyeglasses, and the like. The other 25 percent of any extra payments is returned to the Federal Government. Let's be clear. Cuts to Medicare Advantage would be taking away seniors' health care benefits for those 11 million seniors. As I mentioned, \1/2\ million Texans are on Medicare Advantage, and the Reid bill would cut their benefits by well over half. You do not have to take my word for it. Listen to what the CBO Director, Dr. Elmendorf, said when Senator Crapo asked him during a Finance Committee hearing. He said: So approximately half of the additional benefit would be lost to those current Medicare Advantage policy holders? Director Elmendorf: For those who would be enrolled otherwise under current law, yes. Nearly one out of every four seniors in Texas would lose about $122 a month in health care benefits to create a new $2.5 trillion entitlement that their grandchildren will ultimately have to end up paying for. And $122 a month may not sound like a lot for people inside the beltway, but a couple from my hometown of San Antonio recently wrote to me: Please vote to leave our Medicare Advantage plans alone. We can't afford anything else as our portfolio was wiped out in the stock market collapse last year. My wife and I have had to go back to work, and we are in our seventies. Yet this bill would impose another $122-per-month cut in their benefits. Another constituent of mine from Conroe, TX, wrote: Please do what you can to protect the Medicare Advantage plans. I'm on one and it has been beneficial to me. It has saved me an enormous amount of money and given me the benefits I've needed. Some groups that support these cuts to Medicare Advantage have a conflict of interest, to say the least, because the benefits under traditional fee for service, as I mentioned, for Medicare is about 80 percent of what private insurance will pay. In order to get coverage, in order to pay the bills, many seniors have had to buy additional insurance coverage. For 11 million seniors, Medicare Advantage provides those benefits. For many seniors, former employers sometimes provide wraparound plans. For retired military, TRICARE provides a wraparound plan. For many low-income seniors, Medicaid helps with cost sharing and premiums. For many other seniors, they purchase a standalone Medigap policy. We heard from our friends across the aisle about AARP's endorsement of the Medicare cuts in the Reid bill. If it sounds odd that a seniors' advocacy group would support taking nearly $\1/2\ trillion from an already near bankrupt program, it should. The fact is, as the Washington Post noted on October 27: . . . But not advertised in this lobbying campaign have been [AARP's] substantial earnings from insurance royalty and the potential benefits that could come its way from many of the reform proposals . . . Democratic proposals to slash reimbursements for another program, called Medicare Advantage, are widely expected to drive up demand for private Medigap policies, like the ones offered by AARP, according to health care experts, legislative aides, and documents. So AARP, the so-called seniors' advocacy group, is advocating for a cut in benefits to 11 million beneficiaries of Medicare Advantage. The suggestion is one reason they would do so is because they will profit from this bill because these seniors will, if they can afford it, have to go out and buy Medigap coverage from, lo and behold, entities such as AARP. The fact is, Medicare Advantage allows private plans to innovate better and provides better coordinated care for seniors. Groups such as the Kelsey-Seybold Clinic in Houston, TX, which is basically not seeing Medicare fee-for-service patients but is seeing Medicare Advantage patients because they can afford to coordinate care, the kinds of things we know they ought to be doing to provide better care, but they cannot afford to do it on the fee-for-service Medicare. We have had the Medicare Program around for more than 40 years. The fact is, government bureaucrats are still trying to get the complex reimbursement formulas right. We know, as the distinguished chairman of the Finance Committee has said, that under the fee-for-service program, which is part of what needs to be reformed in this health care bill, Medicare pays for volume and not value. Some of the positive things which I have complimented the bill on is, it includes some small steps to change our current pay-for-volume program to a pay-for-value approach through various delivery system reform demonstration programs. The irony is, Medicare did not think of these delivery system reforms; rather, Washington is finally catching up on what private sector innovators have been doing for years. We heard the distinguished Senator from Minnesota talk about the Mayo Clinic. The Mayo Clinic has been doing that. I mentioned Kelsey-Seybold in Texas. But private sector innovators have been doing this through the Medicare Advantage Program already. The delivery system reforms in the Reid bill would allow Medicare to experiment with different approaches to changing physician incentives, such as accountable care organizations or physician quality reporting initiatives. Will they work? I happen to think they will. We do know private sector innovators have already figured out how to change physician incentives in the sorts of ways we ought to be doing more of and not punishing by cutting Medicare Advantage. One Medicare Advantage plan, HealthSpring, serves 20,000 seniors in my State. They have been a leader for changing incentives for physicians to focus on quality rather than quantity. I met with their leadership and heard how they have done it. What they told me is they have a collaborative partnership with their physicians. They call it Partnership for Quality. Physicians are accountable for both cost and quality based on an evidence-based set of quality measures. The results are a win-win: better quality care leading to healthier seniors and physicians who succeed in meeting evidence-based quality standards and ultimately lower health care costs, which I thought was supposed to be one of the goals of health care reform. Participating physicians were paid financial incentives for meeting their goal, but as a result of coordination of care and evidence-based quality standards, they actually ended up charging less and patients experienced better results too. Members needed fewer hospitalizations and emergency room visits. Preventive measures increased mammograms by 80 percent, diabetic foot exams by 360 percent, and flu vaccinations by 246 percent. I have heard about HealthSpring's success from a couple in Farmers Branch, TX, who recently wrote to me. They said: We had a Medicare supplemental policy for several years until they priced themselves out of the market. We are now with a Medicare Advantage plan called HealthSpring. We have been very happy with this plan and the way they are saving us money. Please do not change or eliminate this program. Let me tell you about one other Texas company called WellMed. While the Reid bill would finally give Medicare the ability to experiment with medical homes and care coordination, a San Antonio-based company, a Medicare Advantage company called WellMed, has been using a medical home model to coordinate patient care and emphasize prevention for nearly 20 years. To quote from an article last month in ``Inside San Antonio:'' The health care delivery model at WellMed puts the patient at the center of a team directed by a primary care physician. The team may include a nurse, health coach, hospitalist, social service worker and physician assistant. According to WellMed CEO Dr. George Rapier, ``We really do have to bring back the old-time primary care doctor who cared for you, who was concerned about you, who was part of your family, and you were part of their family. It's a primary care physician who knows all about you. So if you need a specialist, they know the best specialist to send you to. If you need to go in the hospital, they make sure you get the appropriate care in the hospital. They are your coordinator of care. And that's really the concept of a medical home.'' There is no question in my mind that the model has been saving lives in my State. Here is a story about one Texan whose life was saved by physicians caring for him at WellMed: For years, Crohn's disease weakened-- We will call him Ed-- Ed's immune system and left him susceptible to infections. One morning in 2001, he lacked energy to even get out of bed. His breathing became labored. He developed a cough that sounded ``wet.'' His worried wife called his primary care physician at WellMed, Dr. Marlene Sanchez, who wanted Ed hospitalized immediately so she could order a nuclear scan of his lungs. He protested. ``She told me that if he refused to go, I should call 911 and have the paramedics come get him,'' [his wife] Annette recalled. ``He heard Dr. Sanchez talking to me, the urgency in her voice, and that convinced him to go.'' The scan confirmed Dr. Sanchez's suspicions: A potentially fatal blood clot had traveled from Ed's leg to his lungs. He was successfully treated and recovered. [Ed and his wife] recently celebrated Ed's 74th birthday. Annette credits Dr. Sanchez for saving Ed's life and for acting as a catalyst that keeps him thriving in their golden years. ``We have seen an abundance of doctors, from the cancer doctors to the dermatologist, gastroenterologist, the blood doctor, the heart specialist--Ed has gone through it all . . . and they've all been coordinated by his primary care doctor. I've been to other doctors outside WellMed and you don't get the feeling that they are communicating like this.'' Well, many Texas seniors currently enjoy these extra benefits under Medicare Advantage, such as--another benefit--the Silver Sneakers program, the Nation's leading exercise program for older Americans. This past year, one of the Silver Sneakers members personally visited my office to deliver testimonials from other Silver Sneakers members. One Texan said: At my age I need a program to strengthen me all over but primarily to help me with my balance and coordination. I need these skills to keep me from falling and breaking my bones. Another participant in the Silver Sneakers program said: I am 66, have been in the Silver Sneakers program a year. Prior to that I led a sedentary life, which included many health problems. I had hypertension, high cholesterol, chronic bladder condition, and mild depression. Since coming to classes and utilizing the weights and cardio machines, my life has improved immensely. My blood pressure has dropped, my cholesterol has been lowered, my chronic bladder condition has improved and I just feel better all around. I am no longer depressed because I look better and look forward to going to class and visiting with my friends. These cuts in Medicare Advantage are going to have a direct impact on the benefits my constituents in Texas are benefiting from--the 532,000 Texans who are currently on Medicare Advantage--and what they are asking me--which I can't answer--is why in the world would we want to cut Medicare Advantage, which actually works, as opposed to Medicare fee for service, which does not work well? Why would we take a fiscally unsustainable program, such as Medicare, which is going insolvent in 2017, and use that to create a $2.5 trillion new entitlement program? My constituents, the seniors who have paid into Medicare all these years, are saying: It is not fair to take the money we have paid into Medicare and use it to create yet another entitlement program and not to fix Medicare itself. So I believe we need to fix Medicare's nearly $38 trillion in unfunded liabilities. We need to fix the improper payment rate of roughly 1 out of every 10 Medicare dollars which results in somewhere on the order of a minimum of $60 billion of fraudulent payments each year. We need to put it on a fiscally sustainable path, rather than taking $\1/2\ trillion from Medicare for another ill-conceived Washington health care takeover. I don't believe my constituents believe you can take $\1/2\ trillion out of these programs, just as they do not believe you can take more than $100 billion out of Medicare Advantage, and it will have no impact on their benefits. They don't buy it. They don't believe it, and I don't either. Mr. President, I yield the floor.

Mr. CORNYN

Mr. CORNYN. Close.

Mr. CORNYN. Madam President, while our colleague from Illinois is still on the Senate floor, I always enjoy listening to him. He is one of the most effective advocates, and he is an outstanding lawyer. He and I frequently disagree, but I always enjoy listening to his arguments. That isn't what I came to talk about, but I am glad I happened to be here when he talked about the successful effort we have had in Texas, through medical liability reform laws, to make medical liability insurance more affordable for physicians and, as a consequence, increase the number of doctors who have moved to our State, including rural areas, which has increased the public's access to good, quality health care. We have seen, in 100 counties, where they didn't even have an OB-GYN, or obstetrician--a doctor who delivers babies--after medical liability reform, that has changed dramatically, along with a number of other high-risk specialties that have moved to these counties where they were previously afraid to go for risk of litigation and what that might mean to their future and career. This is an important topic. We will talk about it more. I appreciate the Senator raising the issue. We have a different view about it. If we can save $54 billion and still allow each of these people who were harmed by medical negligence to recover--which, in fact, they would be under the Texas cap on noneconomic damages--each of these individuals would be able to recover their lost wages, their medical bills, and they would be able to receive large amounts of money for pain and suffering--I am sure not enough to compensate them for what they have been through. But no one should understand that these individuals would somehow be precluded or that the courthouse doors would be shut to people who are victims of medical negligence. There needs to be some reasonable limitations that will help, in the end, make health care more accessible, which is what we are talking about. I want to focus briefly on the cuts to Medicare in this new, huge piece of legislation we are considering. Of course, we are told by the CBO that as a result of Medicare cuts and the huge number of tax increases this bill is ``paid for.'' In other words, assuming the assumptions that the CBO took into account, which span for a 10-year budget window and are almost never true in the end--but if you take it on faith that we are going to raise taxes by $\1/2\ trillion and cut Medicare by $\1/2\ trillion, they say this is a budget-neutral bill-- notwithstanding the fact that it spends $2.5 trillion over 10 years-- basically, what we are saying to America's seniors, those already vested in the Medicare Program, is that we are going to take $464 billion that would go into the Medicare Program and we are going to use it to create a new government entitlement program. Our record of fiscal responsibility, when it comes to entitlement programs, is lousy, to say the least. We know Medicare, Social Security, which is another entitlement program, and Medicaid have run up tens of trillions of dollars in unfunded liabilities. Most of them are riddled with fraud, waste, and abuse. The question I have, and I think many have, is why in the world would you take money out of the Medicare Program that is scheduled to go insolvent in 2017, that has tens of millions of dollars in unfunded liabilities--why would you take $\1/2\ trillion out of Medicare to create yet another entitlement program that, no doubt, will have many of the problems we see now under our current entitlement programs? It just doesn't make sense, if you are guided by the facts. Of course, our colleagues on the floor have said: We can cut $465 billion out of Medicare and, you know what, Medicare beneficiaries would not feel a thing. Well, I don't think that is possible when you cut $135 billion in hospital payments, when you cut $120 billion out of Medicare Advantage on which 11 million seniors depend, on which they depend for their health care, or when you cut $15 billion from payments to nursing homes, another $40 billion in home health care. I think one of the most effective ways of delivering low-cost health care is in people's homes. You cut $40 billion from that, and you cut $8 billion from hospice, which is where people go during their final days in their terminal illness. Some of my colleagues claim these cuts would not hurt patients, but many people, including me, disagree. As a matter of fact, to quote President Obama's own Medicare actuary, he said providers might end their participation in the program. In other words, as in Medicare now, in my State, 58 percent of doctors will see a new Medicare patient because reimbursements--payments to providers--are so low, which means that 42 percent will not see a new Medicare patient. In Travis County, Austin, TX, the last figures showed that only 17 percent of physicians in Travis County will see a new Medicare patient because reimbursement rates are so low. Yet we are going to take money from Medicare to create a new entitlement program. There is no question in my mind that providers--in the words of the Medicare actuary--might be hedging their bets. I think he is hedging his bets. He also said many will end their participation in the program and thus jeopardize access to care for beneficiaries. We have heard some of the debate earlier about when our side of the aisle made proposals to fix some of the problems with the Medicare Program--not to create a new entitlement program--by taking this amount of money, $464 billion, from it. When we tried to fix it earlier, some colleagues, including the majority leader, called those cuts immoral and cruel. To quote President Obama on the campaign trail, he was one of those who criticized Senator McCain for some of the proposals he made to try to fix the broken Medicare Program. As we have heard from a Texas Hospital Association, the Medicare cuts to hospitals simply will not work because--and this is another sort of accounting trick that in Washington, DC, and in Congress people think we can get away with and fool the American people about what is actually happening. People are a lot smarter than I think Members of Congress sometimes give them credit for. Under the Senate bill, the expanded coverage doesn't start until 2014. But the hospital cuts begin immediately. I have talked about the broken Medicare Program and, frankly, I think a lot of people would rather see us fix Medicare and Medicaid before we create yet another huge entitlement program that is riddled with fraud, that is on a fiscally unsustainable path, and one that, frankly, promises coverage but ultimately denies access to care because of unrealistically low payments to providers. We are going to make that worse if this bill passes, not better. Well, this bill also includes something else that I think the public needs to be very aware of. It uses not only budget gimmicks so that our friends who support this bill can say that it extends the life of the Medicare trust fund for a few years, the problem is it doesn't solve the fundamental imminent bankruptcy of Medicare. That is one of the reasons the bill sponsored by the distinguished majority leader creates a new, unaccountable, unelectable board of bureaucrats to make further cuts to Medicare Programs. After the Reid bill pillages Medicare for $\1/2\ trillion, as I said, to pay for a new entitlement, it creates a board of unelected, unaccountable bureaucrats, the so-called Medicare advisory board, which sounds pretty innocuous, but they have been given tremendous power--to meet budget targets--another $23 billion in the first years alone. If Congress doesn't substitute those cuts with other cuts to providers or benefits, the board's Medicare cuts would go into effect automatically. That would mean Medicare patients, physicians, hospitals, and everyone else who depends on Medicare would have no say in what happens to personal medical decisions because they would just be cut and shut down by this unelected, appointed board. The government-charted boards of experts we have in existence today are not always right. We may remember the Medicare Payment Advisory Commission, so-called MedPAC, which was created by Congress in 1997, has recommended more than $200 billion in cost cuts in the last year alone that Congress has not seen fit to order. In other words, this MedPAC board makes recommendations, and Congress is then left with the option in its wisdom to act to make those cuts. Congress has said no to the tune of $200 billion in the last year alone. Then there is another relatively notorious board of experts-- unaccountable, faceless, nameless bureaucrats--that we have learned a little bit about in the last few days: the U.S. Preventive Services Task Force. They are supposed to recommend preventive services but just recently said that women under the age of 50 do not need a mammogram to screen for breast cancer. Respected organizations, such as the American Cancer Society and the Komen Advocacy Alliance, disagree based on their own rigorous review of the latest medical evidence. As the father of two daughters, I can tell you, I do not want my wife or my daughters restricted in their access to diagnostic tests that may save their lives if their doctor recommends, in his or her best medical judgment, that they get those tests. Yet what we will have in the future, if the medical advisory board is passed, is an unelected, unaccountable board of bureaucrats that can make cuts, based on expert advice, which will ultimately limit access to diagnostic tests, including tests such as mammograms, which became very controversial. The Secretary of Health and Human Services came out immediately and said: We will never allow that to go into effect. Not even the Secretary of Health and Human Services, under this provision, could reverse the decision of this unelected, unaccounted board which may well--I would say probably will in some cases--limit a person's access to diagnostic tests and procedures that could save their life even though their personal physician, in consultation with that patient, may say: This is what you need. When you give that power to the government, not only to render expert advice but then to decide whether to pay or not to pay for a procedure, then the government-- namely, some bureaucrat in Washington, DC--is going to make the decisions based on a cost-benefit analysis. OK, on a cost analysis, we can afford, according to the decision of the U.S. Preventive Services Task Force, to lose women to breast cancer--women between the age of 40 and 49--because we don't think they need a mammogram. And on a cost-benefit analysis, they may say: Tough luck. But that is not where we should go with this legislation. Many health care providers are concerned about the Medicare Payment Advisory Commission. According to a letter from 20 medical speciality groups, they said: We are writing today to reiterate our serious concerns with several provisions that were included in the health care reform bill . . . and to let you know that if these concerns are not adequately addressed when the health care reform package is brought to the Senate floor, we will have no other choice but to oppose the bill. Included in those concerns was the ``establishment of an Independent Medicare Commission whose recommendations could become law without congressional action . . . '' According to a letter from the American Medical Association today: AMA policy specifically opposes any provision that would empower an independent commission to mandate payment cuts for physicians. . . . Further, the provision does not apply equally to all health care stakeholders, and for the first four years significant portions of the Medicare program would be walled off for savings . . . This is an example of another trade association that basically decided to cut a deal with the administration behind closed doors, and they have been prevented from some of these cuts under this Medicare Commission while physicians have not been accorded similar treatment, and they do not think it is fair. They think it is unfair, and I agree with them. This letter goes on to say: In addition, Medicare spending targets must reflect appropriate increases in volume that may be a result of policy changes, innovations that improve care, greater longevity, and unanticipated spending for such things as influenza pandemics. These are critical issues with the potential for significant adverse consequences for the program, which must be properly addressed through a transparent process that allows for notice and comment. Sounds to me as if the American Medical Association thinks this is a lousy idea, and I agree with them. Artificial budget targets that the Medicare advisory board would have to meet leave virtually no room for medical innovation. It is unbelievable what medical science in America and across the world has done to increase people's quality of life--their longevity as a result of heart disease, for example. People who would have died in the seventies are today living healthy because they are taking prescription medications to keep their cholesterol in check, and they have access to innovative surgical procedures, such as stents and other things that can not only improve their quality of life but their longevity as well. If we have the Medicare advisory board saying: We are not going to pay for some of these things, it will crush medical innovation and have a direct impact on quality of life and longevity. What if we find a cure for Alzheimer's in 2020, but because this board says: It is too expensive, we are not going to pay for it, you are out of luck. What if there are things we cannot anticipate today, which we know there will be because who ever heard of the H1N1 virus or swine flu just a year ago? Some of my colleagues have said an ``independent board,'' such as the Medicare advisory board, would insulate health care payment decisions from politics. But the very charter of the Medicare advisory board was the result of a deal cut behind closed doors with the White House, a political deal, and it has a lot of reasons why, as we can tell, I don't think it is going to work well. According to Congress Daily: Hospitals would be exempt from the [board's] ax, according to the committee staff and hospital representatives, because they already negotiated a cost-cutting agreement with [the chairman of the Finance Committee] and the White House. ``It's something that we worked out with the committee, which considered our sacrifices,'' said Richard Coorsh, spokesman for the Federation of American Hospitals. A committee aide and a spokeswoman for the American Hospital Association reiterated that hospitals received a pass-- They were protected from 4 years of cuts-- based on the $155 billion cost-cutting deal already in place. Is that the kind of politics we want to encourage behind closed doors--deals cut to protect one sector of the health care industry and sacrifice another while denying people access to health care? That is the kind of politics I would think we would want to avoid. The truth is, the Reid bill gives more control over personal health decisions to Washington, DC, where politics will always play a role in determining winners and losers when the government is in control because people are going to come to see their Members of Congress and say: Will you help us? We are your constituents. And Members of Congress are always going to try to be responsive, if they can, within the bounds of ethics to their constituents. This needs to be not a process that is dictated by politics but on the merits and on the basis of preserving the sacred doctor-patient relationship. If we really want to insulate health care from politics, we need to give more control to patients--to patients, to families, to mothers and fathers, sons and daughters--to make health care decisions in consultation with their physician, not nameless, faceless, unaccountable bureaucrats. I filed an amendment to completely strike the Medicare advisory board from the Reid bill. I urge my colleagues to support it at the appropriate time. The Medicare advisory board empowers bureaucrats to make personal medical decisions instead of patients, whose power to determine their own future, in consultation with their doctor, we ought to be preserving. The Medicare advisory board is an attempt to justify the $\1/2\ trillion pillaging of Medicare from America's seniors to create a new entitlement program. We should fix Medicare's nearly $38 trillion in unfunded liabilities, not steal from a program that is already scheduled to go insolvent in 2017. At a time of insolvent entitlement programs, record budget deficits, and unsustainable national debt, this country simply cannot afford a $2.5 trillion spending binge on an ill-conceived Washington health care takeover. I yield the floor. Mr. GREGG addressed the Chair.

Mr. CORNYN

Mr. CORNYN. Mr. President, I want to talk principally about the Medicare cuts in this bill and make sure that people understand the context in which this takes place and what it means in terms of benefits for seniors. There has been a lot of parsing of language here in a way that I think can perhaps obscure the real impact of these proposals. First, let me say there is broad agreement that our health care system needs reform. But I thought the purpose of that reform was to lower costs and make it more affordable--not raise premiums, raise taxes, and cut Medicare benefits. Again, I say to our friends across the aisle, no one wants the status quo. But it is clear that our friends across the aisle are not interested in any proposals from this side of the aisle, as demonstrated by the party-line votes in the HELP Committee and the Finance Committee, and the product coming from the House of Representatives. This is simply too important to do on a purely partisan basis. Yet that seems to be the intention of the majority. The American people want us to get this right because they understand this impacts 17 percent of our economy, and it affects all 300 million of us. This is important to them. As they have watched these debates and proposals, as they have learned more about them, it is no mystery why public opinion for these proposals has dropped like a rock. Again, it has dropped like a rock. First of all, on cost, they realize that the proposals as made have masked the true cost of this bill, and there was celebration when the bill came in under $900 billion. Forget the fact it doesn't actually go into effect until 4 years into the 10-year budget window, so it was only 6 years of implementation; and never mind that it didn't include reversing the 23-percent cut in physician payments that go into effect at the first part of next year, unless Congress acts. That was left out intentionally to make this look cheaper than it is. The Senate Budget Committee has pointed out that this bill, when fully implemented, would cost the American people $2.5 trillion. I have constituents who asked me: Do you know what a trillion dollars is? They say: I don't know. We used to talk about a million dollars being a lot of money, and then a billion dollars. Now we are into the trillions-- hence, the bumper sticker ``don't tell Congress what comes after a trillion,'' for fear we will spend it. This bill, written by the majority leader behind closed doors, increases taxes by nearly $\1/2\ trillion on American families and small businesses during the worst recession we have had since the Great Depression. Unemployment is 10.2 percent, and it is perhaps headed higher. This bill proposes to make it harder on businesses to retain employees, or perhaps maybe someday hire employees and bring down that unemployment rate. This is a job-killing bill. That is why the American people, the more they learn about it, like it less and less. I predict that the longer this debate goes on, the more they learn about it, the less they will find to like about the bill for that and many other reasons. This bill also, according to the CBO, increases health insurance premiums by $2,100 for American families purchasing insurance on their own. If you are fortunate and you have large group coverage, it is a little better. But for the millions who are not, it increases the cost of their insurance by $2,100 a year. I want to focus primarily on the cuts in Medicare. When our colleagues celebrate the fact that this comes back budget neutral, let me explain that mystery. That means you have raised taxes so much and cut Medicare benefits so much, you can claim it is budget neutral. I daresay that is not cause for celebration. In order to create a $2.5 trillion new entitlement program--and that is what this is, at a time when the unfunded liabilities of our current entitlement programs go somewhere into the $40 trillion to $60 trillion range--this bill actually cuts $465 billion in payments from Medicare. These cuts include $135 billion to hospitals; $120 billion from 11 million seniors on Medicare Advantage, including a half million--or to be more precise, 523,000 Texans who depend on Medicare Advantage will see a cut in benefits because of this proposal if it passes. Mr. President, $15 billion will be cut from nursing homes, $40 billion will be cut from home health agencies and $8 billion from hospice care. You can try to parse those words and say we really are not cutting Medicare, but we are cutting Medicare Advantage. Indeed, the Obama administration's own Actuary at the Center for Medicare and Medicaid Services said Medicare cuts of this size would hurt seniors' access to care for several reasons. First, let me start with Medicare Advantage. Medicare Advantage provides benefits over and above Medicare fee for service. But I think we need to understand that with regard to Medicare fee for service in my State, the last time I checked, 42 percent of physicians will not see a new Medicare patient because the payment rate is too low for the doctors to be able to break even or maybe perhaps earn a small profit. Again, 42 percent of Medicare patients are denied access to a doctor in my State because Medicare payments are so low. What we did a few years ago was pass the Medicare Advantage Program, which was created to give seniors choice. In other words, there has been so much celebration of the public option or the government-run plan. We have a government-run plan now--Medicare fee for service, which has, depending on where you read, somewhere between an 8- to 12- percent faulty payment rate. In other words, it pays somewhere around 7.8 to 12.4 percent of bills it does not owe to people who do not deserve it, diverting that money away from payment for beneficiaries. We decided a few years ago to give Medicare beneficiaries a choice-- something I thought we all were for--a choice that provided better care coordination and better benefits. Today, 11 million seniors, including the 532,000 I mentioned in Texas, have chosen Medicare Advantage. But this bill, if passed in its current form, will take away health care benefits from those 11 million seniors on Medicare Advantage by cutting $118 billion from the program. During the Finance Committee markup, the Congressional Budget Office acknowledged that Medicare Advantage cuts would mean fewer services, such as dental or vision. Senator Mike Crapo asked this question: So approximately half of the additional benefit would be lost to those current Medicare Advantage policyholders? Congressional Budget Office Director Doug Elmendorf said: For those who would be enrolled otherwise under current law, yes. So approximately half the additional benefit would be lost to those current Medicare Advantage policyholders. What happened to the President's promise that if you like what you have now, you can keep it? This is another example of a promise that breaks under this bill, in addition to the $2,100-per-family premium increase for those who buy their insurance on the individual market. Despite the fact that this bill cuts $465 billion from the Medicare Program, it also fails to deal with draconian cuts that will go into effect in January, unless Congress acts, which will further ensure that seniors will be less likely to see a doctor in 2012. We all know this is sometimes called the doc fix, but this is basically a misguided decision Congress made back in the late nineties to cut provider benefits, thinking that they could do so and it would not have any impact on access to care. But what it has done is while on one hand Congress can stand here and say: Yes, we kept our promise to seniors by providing Medicare coverage, seniors are finding it harder and harder to find a physician who will actually see them because of those low reimbursement rates. This bill does nothing to cut the 23-percent cut in those benefits in 2012 which will have an extremely negative impact on seniors' ability to see a doctor. We know the majority leader tried, on a standalone bill, to address this issue earlier. But it was not paid for. On a bipartisan basis, Senators in this body rejected sending a bill for $200 billion more to our children. We said we need to be responsible and pay for the bill. Then the President said health care reform would be paid for by dealing with waste, fraud, and abuse in Medicare. But that is not what this bill does. The Congressional Budget Office said the Reid bill only saves $5.9 billion from reducing waste, fraud, and abuse--$5.9 billion in a bill which over a full 10 years of implementation will cost the American taxpayers $2.5 trillion. Instead of cutting Medicare, we should be addressing this problem. We know it is a serious problem. The Obama administration found that there was at least $47 billion in Medicare fraud, and that is a conservative estimate. According to Harvard professor Malcolm Sparrow, Medicare fraud may consume as much as 15 to 20 percent of the $454 billion Medicare budget. That means the amount lost to fraud each year in Medicare alone is $70 billion to $90 billion. As I mentioned, improper payment rates, depending on where you look, range anywhere from 7.8 percent of all Medicare payments paid improperly to as much as 12.4 percent, depending on where you look. Defrauding Medicare has become so lucrative that even the Mafia and other organized criminals are getting into the act. According to the Associated Press last month, members of a Russian-Armenian crime ring in Los Angeles were indicted for bilking Medicare of more than $20 million, and a week after the FBI issued search warrants for a Medicare fraud investigation in Miami, the body of a potential witness was found in the backseat of a car, riddled with bullets. Earlier this year, I introduced a bill which I hope our colleagues on the other side of the aisle will look at as a way to change the paradigm in terms of the way we address this problem of Medicare fraud. Rather than the pay-and-pursue model, we would have a model which would actually detect potential fraud on the front end by certifying payees and otherwise making sure that money is spent properly. We need to implement commonsense solutions such as this to fix fraud in Medicare before we simply cut in half or cut $\1/2\ trillion out of benefits in provider benefits to create a new entitlement. We all understand Medicare is in miserable shape financially-- miserable shape. If nothing is done, Medicare will go broke in 2017, according to the Medicare trustees. The Medicare part of entitlement problems has unfunded liabilities--promises Washington made but cannot keep and does not know how to pay for, nearly $38 trillion. Mr. President, $38 trillion is more than three times the current national debt of $12 trillion, and $38 trillion translated into the burden on every American family means that each American family owes $322,000-- more than most American families' homes are worth. The bottom line is, it is simply irresponsible, without fixing Medicare, without fixing the fraud and the waste--which I know the Presiding Officer is as concerned about as I am--and without dealing with the fact that Medicare promises coverage but denies access because of low payments, to pillage nearly $\1/2\ trillion from the bankrupt Medicare program to create a new budget-busting entitlement program. There had been some talk on the floor about earlier attempts to reduce the rate of growth of Medicare. Interestingly, back in 2005, when there were some proposals to do just that--but, frankly, the numbers paled in comparison: about $10 billion in cuts compared to $500 billion in cuts--the majority leader called those cuts immoral. I have a long list of comments made by our friends across the aisle which stand in stark contrast to the comments they are making today. Frankly, we need to do something about the insolvency of Medicare. Even if we did not do anything else, that would be a great benefit to the seniors to whom we promised health coverage but who are currently denied coverage because of the problems I talked about. I know the distinguished chairman of the Finance Committee talked about the sterling endorsements that come from a variety of Washington- based advocacy groups. One of them is the AARP, the American Association of Retired Persons. Mr. President, I ask unanimous consent to have printed in the Record an article about AARP dated October 27 at the conclusion of my comments.

Mr. CORNYN. Mr. President, what this article demonstrates is that one reason AARP might be opposed to maintaining Medicare Advantage and be for the cuts in benefits to current Medicare Advantage beneficiaries is because that group and its subsidiaries collected more than $650 million in royalties and other fees last year from the sale of insurance policies, some of which are designed to fill that gap between Medicare fee for service and what it actually costs to get to see a doctor. It is a conflict of interest for this association. Frankly, I don't think its endorsement is worth the paper it is written on, just like other associations that, contrary to the best interests of their members, have made a deal that is bad for the American consumer. The American consumers know it. They know a bad deal when they see it--a deal that includes increased premiums, higher taxes, and cuts in Medicare. Frankly, I think those people with such glaring conflicts of interest should not be in the position of trying to endorse something that is basically going to enrich them to the detriment of the American people. I plan to offer amendments about this bill's provisions as currently proposed to cut $\1/2\ trillion from the Medicare Program. My first amendment would make Medicare play by the same financial solvency rules as private insurers. We hear our friends on the other side of the aisle talk about insurance companies. I have no doubt that their desire is, frankly, to do away with private sector involvement in the health coverage field, which leaves, of course, only the Federal Government--ultimately a single-payer system making decisions out of Washington, DC, that affect the health care delivery of 300 million people--a bad idea. My first amendment would make Medicare play by the same financial solvency rules as private insurers. Because private insurers are owned by their shareholders and have fiduciary responsibilities, they could not do business the way Medicare does. They could not tolerate high fraud, waste, and abuse rates. They could not function based on the same risk-based capitalization that private insurance companies do. My amendment would ensure that before we pillage $\1/2\ trillion from the Medicare Program to pay for yet another unsustainable entitlement program, the Medicare Program should be able to meet the same solvency and risk-based capitalization requirements private insurance plans meet. My second amendment will be to strike the unelected, unaccountable board of bureaucrats known as the Medicare advisory board. We have heard this Medicare advisory board extolled, but this is the same kind of unelected, unaccountable board that we saw just a couple of weeks ago issued a new order or recommendation on mammograms based on cost-benefit, which would have condemned some women between the age of 40 and 49, denied them access to a mammogram and, frankly, condemned them to an early, premature death because of breast cancer. When you put all the power to determine the coverage and also payment in an unelected, unaccountable board, such as the Medicare advisory board, then, frankly, you are going to get more of that rationing and that same sort of cost-benefit analysis which is going to consign too many Americans to a premature death because, frankly, the Federal Government doesn't care and is not going to see them get access to care. After the Reid bill pillages $465 billion from the Medicare Program to create a new entitlement, it sets up this new Medicare advisory board, an unaccountable board of bureaucrats, to find more ways to cut billions of dollars from Medicare. Unsurprisingly, patients, providers, and even Congress don't always agree with experts, including the ones we have in place today. According to the Wall Street Journal, the Medicare Payment Advisory Commission, created by Congress in 1997, has recommended more than $200 billion in cuts in the last year alone, which lawmakers--that means Congress--has ignored. Artificial and arbitrary budget targets leave little room for innovation as well. What if we were to find a cure for Alzheimer's in 2020 but because it would be too expensive, the Medicare advisory board would say the Federal Government is not going to pay for it? Some have said this independent board would be a way to insulate Medicare payment decisions from politics. But the very creation of the Board was the result of a political deal with the White House that insulated hospitals from future cuts. I wish to close by saying I hope my colleagues will reconsider and vote for the McCain amendment, which will reverse the pillaging of $\1/ 2\ trillion from the Medicare Program to create a new entitlement program. We should fix Medicare's unfunded liabilities of nearly $38 trillion and not steal from Medicare to create another unsustainable entitlement program that will, of course, have to be paid for by our children and grandchildren on top of all the other debt we are piling on them. At a time of insolvent entitlement programs, record budget deficits, and unsustainable national debt, this country simply cannot afford to spend $2.5 trillion on an ill-conceived Washington health care takeover. I yield the floor. Exhibit 1 [From the Washington Post, Oct. 27, 2009] AARP: Reform Advocate and Insurance Salesman (By Dan Eggen) The nation's preeminent seniors group, AARP, has put the weight of its 40 million members behind healthcare reform, saying many of the proposals will lower costs and increase the quality of care for older Americans. But not advertised in this lobbying campaign have been the group's substantial earnings from insurance royalties and the potential benefits that could come its way from many of the reform proposals. The group and its subsidiaries collected more than $650 million in royalties and other fees last year from the sale of insurance policies, credit cards and other products that carry the AARP name, accounting for the majority of its $1.14 billion in revenue, according to federal tax records. It does not directly sell insurance policies but lends its name to plans in exchange for a tax-exempt cut of the premiums. The organization, formerly known as the American Association of Retired Persons, also heavily markets the policies on its Web site, in mailings to its members and through ubiquitous advertising targeted at seniors. The group's dual role as an insurance reformer and a broker has come under increasing scrutiny in recent weeks from congressional Republicans, who accuse it of having a conflict of interest in taking sides in the fierce debate over health insurance. Three House Republicans sent a letter to AARP on Monday complaining that the group was putting its ``political self-interests'' ahead of seniors. GOP lawmakers point to AARP's thriving business in marketing branded Medigap policies, which provide supplemental coverage for standard Medicare plans available to the elderly. Democratic proposals to slash reimbursements for another program, called Medicare Advantage, are widely expected to drive up demand for private Medigap policies like the ones offered by AARP, according to health-care experts, legislative aides and documents. Republicans also question the high salaries and other perks given to some top AARP executives, who would not be subject to limits on insurance executives' pay included in the Senate Finance Committee's health reform package. Former AARP chief executive William Novelli received more than $1 million in compensation last year. ``We are witnessing a disturbing trend of handouts to special interests like AARP,'' said House Republican spokesman Matt Lloyd, referring to Democratic negotiations over health reform. ``In return, AARP is lobbying for a government-run health-care bill that will pad their own executives' pockets at the expense of its own members and other vulnerable seniors.'' AARP officials strongly dispute such allegations, arguing that the group's heavy reliance on brand royalties allows it to offer members a wide range of benefits--from lobbying for seniors in Washington to discount travel packages and financial advice. The organization notes that even though it offers a Medicare Advantage plan, it has long advocated curbing waste in that federal program. ``We're a consumer advocacy organization; we're not an insurance firm,'' said David Certner, AARP's director of legislative policy. ``That drives everything we do. It's got to be good for our members, or we don't endorse it.'' Added AARP spokesman Jim Dau: ``We spend far more time at odds with private insurers than not.'' AARP's ties to the insurance business date to its founding by former educator Ethel Percy Andrus, who started a group to help retired schoolteachers find health insurance in the years before Medicare; the effort led to the creation of AARP in 1958. Now, the group relies more than ever on payments from auto, health and life insurers, according to financial statements. From 2007 to 2008, AARP royalties from insurance plans, credit cards and other branded products shot up 31 percent-- from less than $500 million to $652 million--making such fees the primary source of revenue for the group last year, the records show. AARP's annual financial report shows that 63 percent of that, or about $400 million, came from the nation's largest health insurance carrier, UnitedHealth Group, which underwrites four major AARP Medigap policies. Other carriers with AARP-branded plans include Aetna Life Insurance, Genworth Life Insurance and Delta Dental. AARP is also a major powerhouse in Washington, spending more than $37 million on lobbying since January 2008. The organization's close ties with insurers have long attracted criticism from politicians of both parties. During the health-care debate of the early 1990s, then-Sen. Alan Simpson (R-Wyo.) held hearings lambasting the group's business operations. Some Democrats criticized the group for supporting the Bush administration's expensive Medicare prescription-drug legislation in 2003. Earlier this year, AARP and UnitedHealth said they were halting the sale of ``limited benefit'' health insurance policies after complaints from Sen. Charles E. Grassley (R- Iowa) that the plans were marketed in a misleading way. Dean A. Zerbe, a former Grassley senior counsel who is now national managing director at the corporate tax firm Alliant Group, argues that AARP's involvement in the sale of insurance plans ``really hurts their credibility.'' ``Either you're a voice for the elderly or you're an insurance company; choose one,'' Zerbe said. ``They put themselves forward in the public arena as nonbiased observers, but they're very swayed by business interests.'' Republicans renewed their attacks on AARP this year after the group emerged as a vigorous defender of many of the reforms under consideration by the Democrat-controlled Congress. Nancy LeaMond, an AARP executive vice president, appeared at a press conference Friday alongside House Speaker Nancy Pelosi (D-Calif.) to announce a new proposal for plugging gaps in coverage of Medicare prescription benefits. Rep. Dave Reichert (R-Wash.), who has asked AARP to provide him with more details about its insurance-related businesses, said he believes the group is ``misleading'' its members about the alleged benefits of Democratic reforms. ``Right now there's a feeling among seniors that AARP may not be entirely forthcoming,'' he said. AARP launched a ``fact check'' section on its Web site this year to counter GOP criticisms of reform, including the discredited ``death panels'' claim, and argues that wringing savings out of Medicare and closing gaps in prescription coverage will help older Americans. Several top AARP officials also said they have no idea whether the group might gain insurance business as a result of the proposed reforms. ``We wouldn't know it, and we wouldn't really care,'' Certner said. ``The advocacy is what drives what we do here, and not the other way around.''

Mr. CORNYN

Mr. CORNYN. I express my gratitude to the Senator from Tennessee for leading this important discussion on Medicaid. If I can pull back for a moment, I think it is important because this is such a complex subject, as we can see from this 2,074-page bill. We need to define our terms. Medicaid, obviously, is a program for low-income people, shared by our State and Federal Governments. Medicare is for seniors, paid for entirely by the Federal trust fund, $38 trillion in unfunded federal liabilities to two entitlement programs, both of which are in terrible financial shape. Rather than make this better, this bill makes it worse. I will describe very quickly how in my State of Texas. I have watched on C-SPAN and on the floor Senators come here and say tonight we are having merely a procedural vote on whether to proceed to the debate. I thought we had been having a debate about health care reform for the last year or so. I point out that under the Senate rules, we will not be able to change one period, one comma, one sentence, one part of this bill unless we can get 60 votes to do so. So the increase in premiums, the taxes on small businesses and the middle class, the cuts in Medicare, this expansion of Medicaid--all of these are a fait accompli unless 60 Senators vote to change it. That is under the rules of the Senate. It is not true, in my humble opinion, that people can come in here and say: We are going to vote yes to proceed tonight at 8 o'clock, but it doesn't make any difference, the debate is just beginning. Not so. I again thank the Senator from Tennessee for raising this concern. Both of our Tennessee colleagues have been in the forefront of discussing this issue. I think this is shameful. The expansion of Medicaid in this bill to cover 60 million Americans is shameful. It consigns people to a health care gulag which they cannot get out of, where they get bad outcomes in terms of their health care, where they cannot find doctors who will treat them at the low rates paid for by Medicaid, and it bankrupts our States. The Medicaid officials in Texas have told me, after their preliminary review of this 2,074-page bill, it will cost Texas taxpayers, in addition to their Federal liability, $20 billion over the next 10 years. Our friends who have been Governors have told us, as Governors and as State legislators, they have to make terribly hard choices. But when the Federal Government imposes an unfunded mandate on the States to pick up $20 billion over the next 10 years, what does that do to our ability to do other things, such as law enforcement, higher education, and the like? It shoves those to the side because the Federal Government is going to jam this down the States' throats--another unfunded mandate--and it disrupts those States, as the Senator says, that are operating on balanced budgets. They do not have the luxury of printing money like the Federal Government.

Mr. CORNYN. The Senator is correct. It is a 32-percent increase in fees and tuition, and that is in California alone, which is bankrupt already. This is the direct result of the irresponsibility coming out of Washington, DC, forcing more costs on them. I know there are other colleagues who want to talk about this topic, and I want to have this continued conversation. I think this is a good format for parsing what is in this bill. Let me mention one anecdote in Dallas, TX. If you are a Medicaid recipient, or a low-income child or beneficiary in Dallas, TX, only 38.6 percent of the doctors will see a new Medicaid patient--38.6 percent. In other words, 61 percent will have restricted access to Medicaid because, as the Senator from Tennessee and the Senator from Wyoming pointed out, it only pays about 72 percent of what a private insurance policy would cover. Mr. President, 85 percent of Americans have private insurance, and they pretty much like what they have. They think it costs too much, and we agree. We want to help them bring down that cost. But we have these safety net programs which, frankly, do a lousy job. They promise coverage, but they deny access because of low reimbursement rates. Let me give an anecdote of what this means to 6-year-old Ruth Guerra in Dallas, TX. I took this article from the Dallas Morning News, dated June 3. It says: When Ruth Guerra, 6, tries to write, holding the pencil puts just enough pressure on her left pinky to make it bleed. With her condition, if she falls down while playing or a classmate accidentally brushes against her, she bleeds. Last week [her mother] Sandra Ramirez . . . took time off from her hourly job at the Dollar General after another one of Ruth's bleeding episodes. Unfortunately, because she qualifies for Medicaid--and while people in Washington say: Isn't it great; we are going to give 60 million people Medicaid--what it means for Ruth Guerra is that she has to wait 6 months to get an appointment with a doctor who will actually see her. That is what I mean when I say this bill consigns 60 million people to a health care gulag they cannot get out of. I agree with the Senator from Tennessee. We need to provide the American people with choices that Members of Congress have, among an array of choices. What this does with the mandates, with the force- feeding Medicaid on people such as Ruth Guerra and on the States, along with the huge budget deficits that are going to come from it is shameful.

Mr. CORNYN

Mr. CORNYN. Mr. President, I want to speak about the decision announced last Friday by the Attorney General to bring Khalid Shaikh Mohammed and other 9/11 coconspirators to the United States from Guantanamo Bay to stand trial in the Southern District of New York. Of course, Khalid Shaikh Mohammed is the self-described mastermind of the 9/11 tragedy where 3,000 Americans were killed. This is a terrible--a terrible--decision by the Attorney General and by the administration for any number of reasons, but I would like to explain why I believe this decision should be reconsidered by the Attorney General and the President of the United States--because of the risk at which it puts Americans and because this provides Khalid Shaikh Mohammed, a self-described superterrorist--this gives him everything he could have ever wanted, which is a platform to spew his hate-filled ideology and one in which he can recruit other like-minded individuals all around the world who may be watching. One of the things I am always amazed by in our great country is how short our memory is. Of course, we are a nation at war after 9/11. But this is a war unlike any other this Nation has ever fought. We are at war with a murderous ideology, with ruthless killers who wear no uniforms and use civilians as human shields. Treating these war crimes like ordinary criminal events and trying these killers in an article III or a Federal court under the Constitution is simply reverting to a pre-9/11 mentality. What do I mean by that? Mr. President, you will recall that the 9/11 Commission investigated the causes of what happened on September 11, 2001. One of the things they identified was the wall separating the sharing of intelligence which was shared among the intelligence community, and what information was developed during a criminal investigation had to be kept separate from ordinary intelligence collected by our military and our intelligence community. One of the things the 9/11 Commission unanimously said was that we needed to tear down that wall and share information, as we can consistent with the law, in order to protect the American people. Simply put, the trial of the 9/11 coconspirators, not in a military commission at Guantanamo Bay but in a Federal district court in Manhattan, one of the most populous portions of our country, is simply forgetting the lessons we should have learned on 9/11, which the 9/11 Commission so eloquently laid out for us and demonstrated. But let's focus on who Khalid Shaikh Mohammed is, lest we have forgotten. According to the 9/11 Commission Report: KSM [Khalid Shaikh Mohammed] describes a grandiose original plan: a total of ten aircraft to be hijacked, 9 of which would crash into targets on both coasts. They included those eventually hit on September 11 plus: CIA and FBI headquarters, nuclear power plants, and the tallest buildings in California and the State of Washington. Further quoting the report: KSM [Khalid Shaikh Mohammed] himself was to land the 10th plane at a U.S. airport and--after killing all adult male passengers on board and alerting the media--delivering a speech excoriating U.S. support for Israel, the Philippines, and repressive governments in the Arab world. The 9/11 Commission report concluded: This is theater, a spectacle of destruction with KSM [Khalid Shaikh Mohammed] as the self-cast star--the superterrorist. This is whom the Attorney General announced we will be bringing from Guantanamo Bay to a court in Manhattan to try as a common criminal. But he is anything but a common criminal. He is guilty of nothing less than war crimes against innocent Americans. According to this decision, the Attorney General is going to be providing him the forum he can use in order to proclaim himself as the ``superterrorist'' and in order to attract like-minded ideologues to his sick and twisted ideas of jihad. A criminal trial only gives Khalid Shaikh Mohammed the platform he has sought for years: a platform to expound his hatred to his would-be followers around the world. The second reason this is a bad idea is because our civilian courts and procedures are ill-suited for terrorism trials because we cannot put judges in charge of national security. I have high regard for the men and women who serve on our judicial benches around the country. I myself was a judge for 13 years in Texas. But our experience with terrorist trials shows that civilian courts are an inappropriate forum for a trial of war crimes. As a result of information--this is one example why--as a result of information disclosed during the trials related to the East Africa Embassy bombings, Osama bin Laden became aware of cell phone intercepts, which prompted his organization to discontinue cell phone conversations. Because of the evidence disclosed in the trial, they simply realized they were being eavesdropped on and quit using cell phones, denying us that intelligence. During the trial of Ramzi Yousef, the mastermind of the 1993 World Trade bombing, terrorists became aware of a communications link that provided enormously valuable intelligence to U.S. officials. This link, too, was shut down after the disclosure in that trial. Then there was the trial of Sheik Omar Abdel Rahman, the Blind Sheik. A secret list of unindicted coconspirators in the prosecution wound up in the hands of Osama bin Laden in Sudan. During the trial of Zacarias Moussaoui, the 20th hijacker, prosecutors inadvertently leaked sensitive material to defense counsel. Here is what the judge had to say about that case, which she characterized as ``like a circus.'' She said: [Lawyers] are talking about the contents of sealed hearings [to the media], if I see any more [of] what I think are inappropriate leaks, I'm going to ask the FBI to start an investigation. But that trial never even made it to a jury. Moussaoui's lawyers tied the court up in knots so he could use the trial as a platform to air his anti-American tirades. The only reason the trial ultimately ended was because at the last minute Moussaoui decided to plead guilty. That plea relieved the government of the choice between allowing a fishing expedition into its intelligence files or dismissing the charges altogether. One thing we can see with great confidence is that the trial of Khalid Shaikh Mohammed in a Federal district court in Manhattan will become the same kind of media circus times 10. It will give Khalid Shaikh Mohammed a platform to inspire his fellow terrorists. Prosecutors will be forced to reveal U.S. intelligence on Khalid Shaikh Mohammed, the methods and sources for acquiring that information, and his relationships with fellow al-Qaida operatives around the world. That information will allow al-Qaida to develop more effective plots and to alert operatives whose cover is blown. This information will enable al-Qaida to detect our means of intelligence gathering and to push forward into areas we know nothing about. Congress has made clear that U.S. civilian courts are not the appropriate venue to bring terrorists to justice. That is why we passed, in 2006, the Military Commissions Act. The military commissions were specifically designed to prevent sensitive disclosures and to protect classified information and sensitive sources and methods. Of course, we know from our work on these military commissions that they have a long history in our Republic--dating back from the Revolutionary War, to the Civil War, and to World War II--and they are an appropriate forum for Khalid Shaikh Mohammed and other terrorists. As a matter of fact, the Attorney General made the baffling decision to try some of the worst of the worst--a superterrorist such as Khalid Shaikh Mohammed--in a Federal district court in Manhattan and to leave other terrorists for trial in Guantanamo Bay before military commissions. And I say, if Guantanamo Bay and military commissions are good enough for these other terrorists in the opinion of the Attorney General, they ought to be good enough for terrorists such as Khalid Shaikh Mohammed and his fellow 9/11 coconspirators. Khalid Shaikh Mohammed and other terrorists, simply put, should not be brought to the United States. They should not be granted the same rights and privileges as American criminal defendants. They should stay at Guantanamo Bay and be prosecuted through the military commissions established by Congress under the terms circumscribed by the U.S. Supreme Court. I ask my colleagues to remember that on July 19, 2007, we had a vote on this sense-of-the-Senate resolution: It is the sense of the Senate that detainees housed at Guantanamo Bay, Cuba, including senior members of al-Qaida, should not be released into American society, nor should they be transferred stateside into facilities in American communities and neighborhoods. That sense-of-the-Senate resolution passed 94 to 3. Rarely do we see such unanimous, bipartisan opposition for the very acts the Attorney General announced last Friday, and it is with good reasons, some of which I have had the opportunity to discuss today. But there are other reasons that I will look for opportunities to come back and talk about to my colleagues. I would ask the President of the United States to overrule the decision of his Attorney General because it is ill-advised. It will make America a more dangerous place, and it will allow terrorists such as Khalid Shaikh Mohammed--it will provide them the platform to spew their hateful ideology and encourage others to join them in killing innocent Americans and other individuals. Mr. President, I yield the floor.

Mr. CORNYN

Mr. CORNYN. Mr. President, I rise today to voice my support for National Adoption Month and the efforts of those individuals who play a role in foster care and the adoption process. According to the U.S. Department of Health and Human Services, approximately 51,000 children are adopted in the United States of America each year. This is an encouraging figure and a strong testament to the efficacy of child welfare workers and foster care families around the country. However, this month also provides us with an opportunity to look at the more sobering side of this issue. Currently, more than 130,000 children await adoption in the United States. This figure represents children who do not yet know the safety and security of loving parents or a home to call their own. This is a dilemma about which we must raise awareness and for which we must find solutions. As a father myself, I can speak for the sacrifices that most parents willingly make for the well-being of their children. I therefore deeply admire and respect those who make these sacrifices for children who are not their own by birth by providing foster homes or by seeking to adopt. Many adoptive parents have fought their way through significant obstacles in the legal process in order to adopt, and all have taken risks and made sacrifices in their own lives to create a family where none has been before. The theme of this year's effort to raise awareness about the adoption of children and youth from foster care, ``You don't have to be perfect to be a perfect parent,'' should help serve as a reminder that, although many would-be adoptive parents feel unequal to the job, they have a great deal to offer these children. There are many ways to adopt, whether through the public foster care system, domestic adoption through private agencies within the United States, or intercountry adoption, to name a few, and numerous adoption agencies and workers stand ready to assist in the process. As a Senator, I have seen the statistics of those children for whom no home was made, for whom no parent stepped up to the hard but rewarding job of parenting, and while there are encouraging exceptions, figures make it very clear that society has found no replacement for a stable home and loving parents. Thus, it is both for the sake of these children and for the welfare of our Nation that I encourage adoption as a way to enhance one's own life and the society in which we all live. As I have said in the past, the act of adoption itself represents the value that Americans place on the worth of each human life, and it is throughout this particular month of the year that we take time to reaffirm this sacrificial and rewarding act.

Mr. CORNYN

Mr. CORNYN. Mr. President, I was watching television this morning, and I was contemplating the challenge that confronts our country, this economy, and the American people when it comes to jobs, seeing that more and more people, unfortunately--even though the stock market appears to be coming back some and people's 401(k)s are perhaps no longer ``201(k)s'' or ``101(k)s,'' but still unemployment continues to creep up and up. Even the administration estimates that unemployment will exceed 10 percent in the near future. It occurred to me that there are a number of things that we are doing here in Congress that actually, rather than encouraging job creation or facilitating job creation, are job-killing policies. Today I wish to concentrate on whether the proposed health care reforms we have seen out of the House and those that at some point will come out of the Senate when Senator Reid's bill is revealed contribute to job-killing policies coming out of Washington or whether they are growth, progrowth, and job-incentivizing policies. Yesterday we learned that 530,000 Americans filed for unemployment benefits for the first time, more than half a million Americans. So despite the fact that our economy grew in the third quarter, and the recession is over from a technical point of view, for more than half a million Americans this recession we are growing out of just got worse. It reminds me of--I think it was Ronald Reagan who said a recession is when a neighbor loses their job; a depression is when you lose your job. The fact is that a lot of Americans are hurting with roughly 9.8 percent unemployment, with people unable to make their house payments, and the foreclosure problem continues unabated. In my State, we have not been immune from the recession, but I am glad to say our economy continues to outperform other States. Instead of the 9.8 percent unemployment, we are at 8.2 percent. I never thought I would be bragging about 8.2 percent unemployment, but I am grateful it is not worse. The relative success of Texas is due to our job-friendly business environment. This is an important lesson to which I think Washington ought to pay more attention: What kind of policies emanate from Washington, just like what kind of policies emanate from Austin, which encourage job creation and which policies destroy job creation. One of the keys to our relative success is we have kept taxes relatively low. According to the Tax Foundation, 42 States have taxes higher than Texas. In other words, we are in the bottom 8 of all 50 States. We have kept our regulatory burden relatively light, meaning it does not cost businesses a lot of money to comply with redtape and a heavy regulatory burden. We are a right-to-work State, so people are not compelled to join a union in order to qualify for a job. We have adopted sensible legal tort reforms, which I think has created a predictable business environment and litigation environment. Rather than chasing people away from the litigation lottery, they are now encouraged to come, understanding what the rules of the road are and what is expected of them. That has helped. In contrast, Washington is considering delivering several job-killing proposals. For example, our national debt is projected to grow by $9 trillion over the next 10 years. We don't know whether the higher energy costs we will face in the cap-and-trade bill that has been proposed will actually pass, but if they do, it is projected to add a lot of costs to small businesses, whether they are an agricultural producer just paying for diesel fuel or those businesses that have high electricity costs, such as Texas Instruments in Dallas, TX. They have one of the highest electricity costs in the State because of the nature of their manufacturing business. If cap and trade imposes additional costs on them, it is going to kill their ability to maintain their level of business and grow their business and create more jobs. American employers don't know whether card check will become law. Of course, this is the bill that would deny the secret ballot for workers to decide whether to join a union, and we don't know whether a new era of global protectionism will reduce global trade and investment opportunities. My State of Texas loves free trade because we realize creating more markets globally for our goods and services creates more jobs in our State. Unfortunately, the message in Washington is confusing, to say the least, if not hostile, to free trade. Yesterday we got to look at more job-killing policies coming out of Washington in the form of Speaker Pelosi's health care bill which, to her credit, was revealed to the public. It was posted on the Internet. I wish Senator Reid would post his bill that he sent over to the Congressional Budget Office on the Internet so we could take a good look at it, read it for ourselves, see how this impacts our constituents and our States, and so the American people can read it and see how it will affect them. Will it drive insurance up? Will it impose more taxes? Will it cut Medicare benefits, for example, if you are a Medicare Advantage beneficiary? I give Speaker Pelosi credit. At least she put her bill on the Internet. What we have learned from this 1,900-page bill so far--and we are still scouring it to find out what its impact will be, both its intended impact and its unintended consequences. Initially, the Congressional Budget Office said the House bill, Speaker Pelosi's bill, will actually bend the cost curve up. It said: On balance, during the decade following the 10-year budget window, the bill would increase both Federal outlays for health care and the Federal budgetary commitment to health care, relative to the amounts under current law. I thought health care reform was supposed to bring costs down. We heard the President and all of us have spoken in terms of bending the cost curve. Nobody thought we would be bending the cost curve up. We thought we were unified in a bipartisan way determined to bring the costs down. But that is not what the Congressional Budget Office says the Pelosi bill does. Then we learned that this much vaunted public option would actually cost more than private insurance plans. That is what the Congressional Budget Office said. They wrote: A public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. Here, again, I assume these are unintended consequences, those we ought to be very careful about avoiding. Surely, the purpose was not to make the public option or a government-run plan more expensive than private insurance. But that is what the Congressional Budget Office believes the Pelosi bill would do. The public plan would have lower administrative costs, to be sure, because it would be subsidized by the taxpayers but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. Then when we look at job-killing provisions of these health care proposals, we have to look at the tax penalty on individuals who do not have insurance, the so-called mandate, the government directive that everybody buy insurance or pay a penalty. That would generate, according to the Congressional Budget Office, under the Pelosi bill, $33 billion in new penalties and taxes. Then there is perhaps the unkindest cut of all, and that is the so- called pay-or-play requirement for businesses which would tax employers, the very people we are looking to help us retain and create jobs, an additional $135 billion penalty. It is important to remember this so-called pay-or-play mandate is essentially a tax on workers and take-home pay. Most of the increased costs of this new mandate on employers will simply be shifted to workers in the form of lower wages. Employers may also respond by cutting jobs, particularly for low-income workers, or deciding to outsource more jobs or relying more on part-time workers. You don't have to take my word for it. Let me cite Ezekiel Emanuel. That name may sound familiar because he is the brother of chief of staff Rahm Emanuel. He writes with Victor Fuchs in the Journal of the American Medical Association: It is essential for Americans to understand that while it looks like they can have a free lunch--having someone else pay for health insurance--they cannot. The money comes from their own pockets. Harvard professor Kate Baicker has said: Workers who would lose their jobs are disproportionately likely to be high school dropouts, minority, and female. . . . Thus, among the uninsured, those with the least education face the highest risk of losing their jobs under employer mandates. We also know there are members of the administration--the Cabinet-- who are, I guess as every Cabinet does, cheerleading for the proposals of the administration which they serve. Certainly that is the case with Secretary Sebelius. The Secretary of Health and Human Services has made the claim on the agency Web site, among other places, that health care reform would be good for job creation. But I suggest that the report of Secretary Sebelius is riddled with errors and false assumptions. Independent, nonpartisan studies have shown that these proposals will actually raise premiums on people who already have insurance. So when the President says: You can keep what you have if you like it--well, you are not going to be able to keep it at the same price. You are going to end up paying a lot more for it. The Congressional Budget Office has found these ``reforms'' will also increase taxes on the middle class, as well as hurt jobs, as I have explained, and small businesses. Of course, in order to pay for it, the Senate Finance Committee bill--which I presume will be included in the Reid bill, but we have not seen it yet--will actually cut Medicare benefits for seniors in order to pay for it. I suggest it is not helpful to the cause of health care reform to release flawed reports filled with false promises. I hope the Obama administration and all of our colleagues in the Senate will try to work together on a step-by-step approach to try to address the problems that make health insurance unaffordable and to cover people who currently are not covered. I think the American people would be better served if Secretary Sebelius directed her attention instead to addressing shortages and delays in the distribution of the H1N1 vaccine. In Texas, we were promised 3.4 million doses of vaccine by October, and we have been delivered about half of that, 1.7 million, even though the peak of the swine flu, H1N1 season is upon us in the next couple of weeks. I am afraid it doesn't build a lot of confidence when this government-run health care plan or program delivers about 50 percent of what it promises. It is not a confidence builder. Going back to the health care plans, let me just say that every independent analysis of the health care bills we have seen so far, whether they are Speaker Pelosi's bill or the one that came out of Senator Dodd's committee or Senator Baucus's committee, have found that costs will actually increase, not go down, for small businesses. The Pelosi health care bill released yesterday increases taxes on small businesses. Specifically, it imposes a 5.4 percent surtax on individuals with incomes over $500,000 and families with income greater than $1 million. One may say these are rich people; they can afford it. But half of the people who will be captured are small businesses that are not big corporations. They are individuals, they are sole proprietors, they are partnerships, they are subchapter S corporations where the principal employer receives their income as a flowthrough and paid on a personal income tax return. These kinds of additional fees and taxes on small businesses and job creators have the opposite result of what I thought we were about, which is to encourage job creation and retention. All told, just the surtax in the Pelosi bill would cause small businesses to face the highest marginal tax rate in 25 years. And, of course, it also imposes the pay-or-play mandate on employers that I talked about earlier. Former Congressional Budget Office Director Peter Orszag, who now serves in the Cabinet at the Office of Management and Budget, has indicated a pay-or-play mandate will hurt workers' wages. He said: The economic evidence is overwhelming, the theory is overwhelming, that when your firm pays for your health insurance you actually pay-- The worker-- through take-home pay. The firm is not giving it to you for free. Your other wages or what [you would have earned otherwise] are reduced as a result. I don't think most workers realize that. I agree with him when he said that workers actually end up paying a higher cost. It is not absorbed by the employer, but it also ultimately results in reduced wages. The Congressional Budget Office has said: [I]f employers who did not offer insurance were required to pay a fee-- Here again talking about the pay-or-play mandate in the Pelosi bill and Senate bill-- employees' wages and other forms of compensation would generally decline by the amount of that fee from what they would otherwise have been--just as wages are generally lower (all else being equal) to offset employers' contributions toward health insurance. Again, I end with the question that I asked earlier: Is what we are doing in Washington on health care or in a variety of other areas actually killing jobs rather than encouraging and facilitating jobs? I think, unfortunately, in the examples I mentioned, we are considering job-killing policies. The American people are worried about it. That is why they want to be able to read the bills. I hope we will be able to read the Reid bill soon--the bill the majority leader has written behind closed doors--because the American people are entitled to see how it will impact them; whether they will pay higher premiums; whether they will pay more in taxes, even if they are middle-class workers; and whether, if they are a senior, their Medicare benefits are going to be cut, as I fear they will be. The Gallup Poll says the American people are understanding the consequences of this debate well. It says Americans have become more likely to say the cost their family pays for health care will get worse, not better, if these proposals pass; 76 percent say their costs would get worse or not change, only 22 percent believe their costs would be reduced by these proposals. I think this is another reason why we need to slow down, be careful, and let's read the bill. Let's show the bill to the American people, get input from our constituents so we don't engage in job-killing policies, either intentionally or inadvertently, at a time when we ought to be very gravely concerned about growing unemployment and more and more people losing their homes due to foreclosures. Certainly, we should not be doing anything which would make the matter worse rather than better. I yield the floor.

Mr. CORNYN

Mr. CORNYN. Madam President, I wish to talk about another one of those consequential issues of our day that we have been talking about a lot lately. That is health care reform. I wish to start by asking a question of my colleagues and anyone who is within the sound of my voice, and that would be: Before we create a new government-run health care plan, why don't we fix the ones we already have? Why don't we do more to fight fraud, waste, and abuse in Medicare and Medicaid? Of course, Medicare is a government-run plan for seniors. It is part of a commitment we made that people who have achieved a certain age will have health care available to them, and that is a commitment we need to keep. Medicaid, conversely, is for low-income individuals. It is a State-Federal Government share program. But like a new government plan could be dressed up in many different ways, kind of like a child on Halloween, like some calling a government plan a public option, or some talking about opt-outs, opt-ins, and triggers, once the mask comes off, what we are left with is plain and simply another government-run health care plan. When I was on the floor on Monday and talking about our current government plans, Medicare and Medicaid, I pointed out the very serious fiscal problems that both of these programs have and ones that we should attend to before we go creating another government-run plan with perhaps its own set of fiscal problems. For example, Medicare, which is health care for our seniors, has $38 trillion in unfunded liabilities and will go bankrupt in 2017 unless Congress acts sooner. Medicaid, we know, has its own share of problems. It actually reduces access to health care. It promises access on the one hand but denies that access because of unrealistically low reimbursement rates to health care providers. So many health care providers in my State, in Texas and elsewhere, simply will not accept a Medicaid patient. What good is Medicaid, what good is Medicare, if you cannot find a physician who is willing to see you? It is not much good at all. I agree with our colleague, Senator Landrieu of Louisiana, who has asked why don't we fix the two public options we have now instead of creating a new one. This afternoon I wish to talk about how we need to fix another problem with our government plans; that is, how we should do more to fight waste, fraud, and abuse. I noted earlier this week that both Medicare and Medicaid combined have, by some estimates, as much as $90 billion lost in taxpayer dollars each year, stolen from the intended beneficiaries of those two important government plans. ``60 Minutes'' ran a story on this on Sunday which included the story of a former Federal judge who discovered that someone had billed the government for two artificial limbs on his behalf, even though he still has the ones God gave him when he was born. Someone is using his name and in this instance his billing number in order to defraud the American taxpayer. We ought to be doing more to stop it. This morning in the Judiciary Committee, we discussed health care fraud. We listened to some witnesses from the Justice Department. Basically what I concluded from that hearing is there are more bad guys than there are good guys, and we are stuck with a lack of resources to deal with this. We need to change the way we approach it to prevent fraud and waste on the front end rather than on trying to chase it down on the back end. According to the Department of Health and Human Services, $32.7 billion--$32.7 billion--of Medicaid funds were consumed last year by waste, fraud, and abuse. That is about 10 percent of Medicaid's total costs, which were $333 billion. Medicare has similar problems. Medicare fraud may consume up to 15 to 20 percent of the $454 billion in the Medicare budget. According to Harvard Professor Malcolm Sparrow, that means the amount lost to fraud would be between $70 to $90 billion each year. Some of the examples of waste, fraud, and abuse should be embarrassing. For example, between 2000 and 2007, more than $90 million of claims were ordered by dead doctors. According to a report of the Senate Permanent Committee on Investigations last year, some of these dead doctors have been very productive. They have been ordering Medicare benefits for up to 10 years. This past August in Houston the FBI discovered that a doctor and his wife had defrauded health care providers of more than $31 million, one doctor and his spouse, $31 million. They claimed to have administered a number of injections and other treatments that never, in fact, occurred but they still charged the taxpayer for them and were paid because of Medicare fraud. Defrauding the Federal Government and the Federal taxpayers through their health care programs is so lucrative that Mafia figures and other criminals are getting into the act. According to the Associated Press this month, members of a Russian-Armenian crime ring in Los Angeles were indicted for bilking Medicare of more than $20 million. A week after the FBI issued search warrants related to Medicare fraud in Miami, the body of a potential witness was found in the back seat of a car, riddled with bullets. Violent criminals are moving into defrauding the government and the American taxpayer because the risks and rewards look better to them than, for example, the drug trade. According to this same AP story, a Medicare scammer could easily net $25,000 a day, while risking a relatively modest 10 years in prison if convicted on a single count. A cocaine dealer, by comparison, could take weeks to make that amount, while risking life in prison. So it is a matter of incentives, risks, and rewards. Apparently, the risk of committing Medicare and Medicaid fraud is so low and so lucrative that it has continued to grow and grow and grow. We know vulnerability in government programs also facilitates drug abuse. According to a General Accounting Office study of five States released last month, the General Accounting Office found that about 65,000 Medicaid beneficiaries in these States each visited 6 or more providers for the same type of controlled substance. Each of these 65,000 Medicaid beneficiaries visited 6 or more providers for the same type of controlled substance. These controlled substances included Valium, Ritalin, and various amphetamine derivatives. Together, these 65,000 Medicaid beneficiaries charged taxpayers $63 million to feed their habits--in just 2 years. Sometimes providers aid and abet these drug addicts. The GAO reported that a Florida physician was sentenced to life in prison after writing multiple prescriptions for controlled substances to patients who he knew were drug abusers. Tragically, five people died as a result of the drugs this doctor prescribed. We know there is a better way to deal with the fraud in the two public options or government-run plans that currently exist. We do not have to accept the 3- to 10-percent loss in taxpayer dollars because of fraud, waste, and abuse. That is 3 to 10 percent of the taxpayer dollars. Let's just compare that for a second to another industry that deals with huge amounts of money and millions of transactions: the credit card industry. According to the Center for Health Transformation, the credit card industry processes more than $2 trillion in payments ever year from 700 million credit card transactions, used at millions of vendors. Yet fraud in that industry is a fraction of what exists with Federal Government programs. It is at least 100 times higher. Then--more close to home--private health insurance companies do a much better job of fighting fraud, waste, and abuse than do government bureaucrats. I know everyone likes to bash the insurance industry, but in this area they sure beat any government plan I have seen. Fraudulent claims in the private sector are much lower. They are roughly 1.5 percent of all the claims submitted, according to a new book called ``Stop Paying the Crooks,'' edited by Jim Frogue. This is because the private sector operates with a different paradigm, a different strategy. They use a ``detect and prevent'' strategy, as opposed to the Federal Government, which will pay first and then we will chase the crooks later on. Because, as I said earlier, there are more bad guys than good guys and our efforts to combat fraud are underresourced, this ``pay first and chase the crooks down'' is not working at all. We need to change that paradigm to one that more closely follows the private sector strategy of ``detect and prevent'' rather than ``pay and chase.'' So why isn't the Federal Government doing a better job of fighting fraud? We heard testimony this morning, as I said, from representatives of the Department of Justice and the Department of Health and Human Services. I congratulated them, first of all, for their service to our country. They have had some modest successes with stepped-up investigations and prosecutions for health care fraud. I say ``modest'' because the volume of the problem, the enormity of the problem, dwarfs any of their successful efforts. Still, the administration--I will give them credit--is trying to get their hands around the problem. Regarding Medicaid, for example, the inspector general of HHS released a report in August. He said the data collected by the Medicaid Statistical Information System was not timely or accurate enough to help fight fraud, waste, and abuse. Data from the Medicaid Program takes a year and a half to be publicly available, by which time the crooks will have already gotten the money and escaped, perhaps long retired in the Caribbean. This morning, the administration told us they were going to conduct a national fraud summit. I can tell you, sometimes having a meeting is a substitute for doing something about the problem. So having a summit is fine in and of itself, but I do not have a whole lot of confidence that another meeting or summit is going to solve this problem. Instead, we need to give the Federal Government--and our law enforcement personnel, in particular--and those custodians of the Federal tax dollars better tools to be able to solve the problem. I have offered a number of pieces of legislation designed to help fight health care fraud in Medicare and Medicaid. For example, earlier this year, I introduced something I call the STOP Act, which is called the Seniors and Taxpayers Obligation Protection Act. This legislation would give Federal agencies greater tools and authority to detect waste, fraud, and abuse before they happen. The STOP Act has bipartisan sponsors, and I believe its provisions should be a part of what we do to reform our health care system. I had also offered an amendment to the bill in the Finance Committee that would have made sure we fixed the fraud already existing in Medicaid before we expanded the program. Specifically, my amendment would have said that Medicaid had to reduce its improper payment rate to 3.9 percent. That may sound like a lot, and it is still too high, but it is actually the average of improper payment rates across the Federal Government. So my suggestion in my amendment was, just be average. Yet my amendment was voted down largely along partisan lines. Fraud is not the only problem we see in government health care programs, but it is one reason I am skeptical of the so-called public option or government insurance companies or government takeovers of the rest of the health care sector that they do not currently control. It is a serious problem we ought to address rather than just creating a new plan with a similar set of problems and see 3 to 10 percent of the amount of money we spend on this new program lost to crooks and other criminals. Madam President, 61 percent of the American people, in one poll, said they believe the issues of fraud and waste in Medicare and Medicaid should be addressed before--before--we create a new government-run program. I believe we should listen to the American people. I believe we should fix the current government-run programs before we create another one. So, Madam President, I leave with a few more questions that I think must be addressed, will be addressed over the weeks and months ahead. First of all, we know Senator Reid, along with help from Democratic leadership, has merged the Finance Committee bill with another Senate committee bill behind closed doors and sent it to the Congressional Budget Office to be scored or a cost estimate provided. I would like to ask, why can't we see the bill? Why can't we see the bill? Why can't the American people see the bill so they can read it for themselves online and they can tell us how they will either be positively or negatively affected by the provisions in another thousand-page bill? Secondly, I would like to ask--and I guess we will find out sooner or later, but we do not know now--how much will it cost? Will this be another trillion-dollar-plus bill? Third, I would like to know how much this bill will raise premiums on people who already have health insurance coverage--as virtually every opinion we have heard surveying the Finance Committee bill, the HELP Committee bill, and the House committee bills has said that Federal controls on health insurance plans will actually raise premiums. So we need to know how much the Reid bill--that is going to come to the floor, that has been written behind closed doors, that we need to see posted on the Internet--we need to know how much it is going to cost. We need to know how much it is going to raise insurance premiums for people who already have health care coverage. The next question is, How much is it going to raise taxes on the middle class? I know some people around here think you can impose taxes on insurance plans, you can impose fees on medical device providers, you can do all of this, and it will be absorbed by those entities, by those companies, when expert after expert tells us what we know, what our common sense tells us; that is, those costs will be passed down to the consumer and they will be passed down to the taxpayer to pay for them, middle-class taxpayers. How much will this bill raise taxes on the middle class? Then I think the American people would like to know--and this was in the Finance Committee bill; we will find out, I assume, at some point whether the Reid bill does the same thing--there was roughly $\1/2\ trillion in cuts to Medicare. Yes, that is right. It is the same Medicare plan that is scheduled to go bankrupt by 2017. Yet the proposal is, let's take another half-trillion-dollar chunk out of this fiscally unsustainable program, with $38 trillion in unfunded liabilities. We are going to take that, we are going to cannibalize from that plan to create yet another government plan or a public option, as some like to say around here. Well, I think these are all important questions, and I wish I had the answers to them. I know constituents call my office. They write me. They e-mail me. They tell me in person: We are pretty worried about what we see coming out of Washington these days--with the spending and the debt, the responsibilities we should be meeting today, ourselves, but which we are kicking down the road and going to ask our children and grandchildren to pay for. This particular subject is one that will affect all 300 million Americans. I know they will be paying close attention, as they should, to the debate as we go forward. Madam President, I yield the floor and suggest the absence of a quorum.

Mr. CORNYN. Madam President, I ask unanimous consent to speak for up to 15 minutes.

Mr. CORNYN

Mr. CORNYN. I ask unanimous consent to speak for up to 15 minutes.

Mr. CORNYN. I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CORNYN

Mr. CORNYN. Mr. President, I listened to the majority leader, Senator Reid, talk about his melded bill, the combination of the Finance Committee bill and the HELP Committee bill that he has now completed merging behind closed doors. He said he is going to send it to the Congressional Budget Office to get a score or a cost estimate. My hope is we will all be able to see it soon. We have not been able to participate in the process since it has been a process taking place between the majority leader and presumably Senators Dodd and Baucus, the chairmen of the two committees, without Republicans being present. So we don't know what is in it, and we don't know how much it costs. Certainly those are two critical questions the American people are asking and those of us who will be required to vote on this legislation at some point would like the answers to. When will we be able to see it? When will the American people be able to see it? How much will the bill cost? Today, I wish to focus on another question: Why is it that some people in this country think another government-run health care plan is the answer? A government-run plan goes by a lot of different names. It is an attempt, in part, to obfuscate what people are trying to do. Sometimes people like to call it the public option because it sounds innocuous. Who could be against a choice, an option, if it is not mandatory? Others say they are not for a public option unless it has a trigger. Others talk about opting in, and we heard the majority leader talk about a bill he intends to introduce that provides an opt out for the States. The reality remains the same. We are talking about a brandnew entitlement program, a brandnew government-run health care program run out of Washington, DC, based on the fundamental and misguided belief that one size fits all for a nation of 300 million people. Some of my colleagues believe a government plan is gaining momentum. I appeared yesterday on a Sunday television show with Senator Schumer, the distinguished Senator from New York, who said he thought Congress was right on the cusp of a public option or government-run plan. The more the American people find out about what is meant by the public option, the less they like it. Last week, we saw the Washington Post-ABC News poll that supposedly said that support for a government-run plan was growing. In fact, support has fallen by 5 points since June. These numbers can be misleading. As the Presiding Officer knows, in politics and public opinion polling, he or she who gets to ask the questions or frame the questions, he or she who gets to decide what the sample is can have a dramatic impact on the answers given to a poll. It is absolutely the case that support for the so-called public option drops dramatically when we explain to people what it would actually do. ABC News polling director Gary Langer wrote about this dynamic in June. He noted that while 62 percent initially favored a so-called public option, that number dropped from 62 percent to 37 percent once it was explained to people that it would put many private insurers out of business because they couldn't compete with the Federal Government and the so-called government plan. In other words, support dropped when people realized they would not be able to keep what they have now--which is one of the President's promises--because many insurers would simply be driven out of business. Thus that promise President Obama has made time and time again would not be possible under the public option or government plan. Today in the Washington Post, Fred Hiatt explained why a government plan would end up breaking President Obama's promise: A government plan would work like Medicare and Medicaid--those are two government plans-- and they would, as Medicare and Medicaid do, pay providers at low rates. As a matter of fact, last week we had a vote on a bill--actually, on a cloture motion on a motion to proceed--a technical vote but one that would have taken us to a bill to basically reverse the cuts in Medicare reimbursement rates to Medicare providers. But it was not paid for. It would have added $300 billion to the national debt. So 13 Democrats joined with Republicans to defeat that. Hopefully, we will go back to the drawing board and come up with a bill that will be paid for. But the point is, any new government plan, as Fred Hiatt pointed out, would work like Medicare and Medicaid and pay providers much less than they could get under private insurers. So providers would, as they do now, make up the difference by charging private plans more for the same services. This is a so-called cost-shifting phenomenon. Then private insurance premiums--if you have private coverage now--would increase for people who have health insurance coverage now. Ultimately, some of them would be forced to drop their private insurance because it would be more expensive, not less, which is what I thought the object of this exercise was about: how to bring down costs, not how to drive them up, and the cycle would continue until all private insurers would go out of business, and all Americans would find themselves on a single-payer, government-run health care plan. So much for the option in the public option. So the fact is, the government plan would not be just a competitor; it would, in fact, act as a predator by calling the shots. Even as it takes the field, the government plan would undercut the private market and create another Washington monopoly. Some people have described the so-called public option as a Trojan horse. I have used that phrase myself. But the person who actually devised the public option said this--his name is Jacob Hacker, and he is a professor at Berkeley--he put it this way last year: Someone once said to me, ``This is a Trojan horse for single payer,'' and I said, ``Well, it's not a Trojan horse, right? It's just right there.'' Professor Hacker said: I'm telling you, we're going to get there, over time, slowly. The truth is, we should not be creating another government plan when the ones we have now are not working very well at all. As Robert Samuelson wrote in today's Washington Post: Why would a plan tied to Medicare control health [care] spending, when Medicare hasn't? He noted that from 1970 until 2007, Medicare spending had risen by 9.2 percent annually. Let me say that again. From 1970 to 2007, Medicare spending had risen by 9.2 percent annually. He says this is just one reason the so-called public option is what he called a ``mirage.'' We know there are current entitlement programs that have major unfunded liabilities. Medicare has a $38 trillion unfunded liability and will effectively go bankrupt in 2017. Yet this bill, at least the Finance Committee bill--I presume the bill coming out of Senator Reid's office will do the same--takes $500 billion from Medicare to create a new entitlement plan, a new government-run health care plan, when Medicare itself has $38 trillion in unfunded liabilities. It just does not seem to make any sense. Medicaid, which, of course, primarily helps pay health care costs for the poor, reduces access to health care in many communities because reimbursement rates are so low that many providers simply cannot take new patients. As ``60 Minutes'' reported just last night, fraud and abuse in government health care programs cost taxpayers about $90 billion a year. Does this sound like a model we want to hold out--a new government-run plan--when the ones we have now are broken and need fixing? On the Medicare fraud and abuse, according to FBI special agent Brian Waterman, Medicare fraud is a bigger problem in South Florida than the drug trade. He said: There are entire groups and entire organizations of people that are dedicated to nothing but committing fraud, finding a better way to steal from Medicare. One former Federal judge looked at his Medicare statement and found that someone had billed the government for two artificial limbs on his behalf even though he still has the ones God gave him. In other words, he did not need any artificial limbs, but somebody charged them to Medicare on his bill without his knowledge. I agree with our colleague, Senator Landrieu from Louisiana, that a government plan would just replicate the same kinds of problems we have seen in Medicare and Medicaid. As she said: Why don't we fix the two public options we have now instead of creating a [new] one? Well, supporters of a government plan say we need to have more competition and give consumers more choice. I could not agree more. But this is not--this is not--the way to do it. Competition occurs when we have more private insurance companies competing in marketplaces, which would happen under some proposals made by our side of the aisle--if we would simply create a system where individuals could buy health insurance in any State across the Nation and were not just confined to buying health insurance in their own State. Competition increases when we get more insurance carriers to enter the market, not by creating a government plan that will drive them out of it. We have proposed ways, as I have said, to increase the number of private insurance options in every State. We think if that is the goal, certainly we ought to be able to come together in a bipartisan way to accomplish that goal. But I do not know why in the world we would settle for a health care proposal that would ultimately drive people to a single-payer, government-run health care plan, would raise taxes on the middle class, raise premiums on those who have insurance now and depress the wages of those who have that health insurance now, and would cut, as I mentioned a moment ago, $500 billion from a Medicare Program that is scheduled to go bankrupt in 2017. Why would we settle for something that would make things worse instead of better for more than 100 million Americans? Why would we vote to spend $1 trillion or more on a new entitlement program without fixing the ones we have now? Well, it is not just me saying that this so-called public option with the opt-out the majority leader has now proposed--which he admits does not have 60 votes, and the one Republican, Senator Snowe, who said she would vote for the bill said she would not vote for a bill with a public option. So I am not sure why, with one Republican supporting the Finance Committee bill, they have now apparently rejected Senator Snowe's support and opted for a strictly partisan proposal coming out of Senator Reid's conference room. But I also checked, and another health care expert whom I respect shares some of my views about the dangers of the so-called public option. Secretary Mike Leavitt, who is the former Secretary of the Department of Health and Human Services, said: Advocates for a public health-care plan continue to look for a way to give political cover to moderates while advancing their goal of implementing a government-run health- care system. He said: [Ultimately,] it is designed to undercut private insurance. He said it is ``dangerous for three reasons.'' He said: One, it would be cheaper for employers to stop offering private [coverage to their employees and to] funnel their employees into the government-run plan. Employers, not employees, would get to make that choice. Secondly, he said: [A] government-run plan would use the coercive force of government to dictate the prices that [are going to be] charged by others--by doctors, nurses, and hospitals--in a way that private entities cannot. Third, he said this proposal is dangerous because a ``government-run plan would be subsidized by American taxpayers, while private plans are not.'' In other words, he says, if, in fact, States will be given a chance to opt out of the so-called public option, they would not have a chance to opt out of the tax dollars their taxpayers would spend in order to subsidize the so-called public plan. As he concludes, he says: The state ``opt-in'' is a transparently false choice. It is just another gimmick to try to find votes for an unwise policy that would increase the federal government's control over health care. We can do better. We must do better. I urge my colleagues not to take the bait on this so-called public option, whether it has an opt-out or not, because it is just another disguised way to try to end up with a single-payer, government-run health care system out of Washington, DC. Mr. President, I yield the floor.

Mr. CORNYN

Mr. CORNYN. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CORNYN. Madam President, I would like to make a few comments about the Defense authorization conference report, which we will vote on, presumably, later this afternoon. First, I wish to express my appreciation to the conferees for fighting for legislation we passed out of the Senate but which was not included in the House version of this bill. This legislation is contained in sections 575 through 589 of the conference report, and it is called the Military and Overseas Voter Empowerment Act--or the MOVE Act--and it addresses a national disgrace. Our military servicemembers, we know, put their lives on the line for us every day to protect our rights and freedoms. Yet too many of them who are deployed overseas face many stumbling blocks and hurdles as they attempt to cast their votes and participate in our national elections. In 2008, more than a quarter of the ballots requested by uniformed and overseas voters went either uncollected or uncounted--a quarter of the ballots--according to a recent survey of seven States with high military populations. Another recent study by the Heritage Foundation documented the problems during the last election cycle. They looked at 20 States with large military populations and concluded that as many as three-quarters of our troops and their family members were ``disenfranchised by their inability to request an absentee ballot'' and that as many as one-third of the ballots that were requested never reached the appropriate election officials to be counted on a timely basis. Voting has remained a challenge for our troops and their families for many reasons. One is our election laws are varied from State to State and they are very complex. We also know that multiple levels of government bureaucracy are involved--from the local level, to the State level, to the Federal level. We know election challenges and other unforeseen events can delay the finalization of ballots. We know, with the high tempo of military operations, frequent deployments for our troops and their families make it hard for them to exercise their most fundamental civil right, which is the right to vote. What this legislation does--the MOVE Act--is address several of the biggest roadblocks our troops and their families face when attempting to vote. First, the MOVE Act reduces the reliance on ``snail mail'' for correspondence between election officials and our troops. Under current election laws, many troops must, first, mail a request for an absentee ballot. Then they have to wait for the election officials to mail them the blank ballot. Then they must mail the completed ballot in time to be counted. This legislation requires election officials to create electronic blank ballots and to post them online to cut down on some of these steps. Election officials must allow the use of faxes and e-mails to expedite correspondence with our troops. Together, these reforms will reduce dependence on snail mail--until the servicemember is ready to return the completed ballot to be counted. Second, the MOVE Act will expedite the return of the completed ballot to elections officials. Under current law, each servicemember is responsible for making sure his or her ballot is postmarked and returned on time. Our legislation--this bipartisan legislation-- requires the Department of Defense to take possession of completed ballots and ensure they get to election officials on a timely basis by using express mail, if necessary. This legislation will also require election officials to give our troops at least--at least--45 days in which to return their ballots. The MOVE Act contains many other commonsense reforms that were suggested by other Senators and which will help end the effective disenfranchisement of our troops and their family members. However, one key provision of the bill we passed out of the Senate was modified in conference, and I believe all Senators should understand why and how that happened. The provision I am referring to was in the bill I introduced called the Military Voters' Equal Access to Registration Act. It too became part of the MOVE Act and was amended to the Defense authorization bill as it passed out of the Senate. This legislation was designed to provide basic voting assistance services to every servicemember and family member upon transfer to a new military installation, as well as at other significant transition points in their military careers. As part of in-processing at each base, every servicemember was to be offered an opportunity to fill out a simple form that would, first, register the servicemember or that family member to vote; it would, secondly, update existing registrations; and it would request absentee ballots for the next Federal election cycle. The Department of Defense would have then been responsible for forwarding the completed forms to the appropriate election officials. This kind of voting assistance may sound familiar because it is nearly identical to the motor voter provisions contained in the National Voter Registration Act. The logic is that military installations can and should offer the same kind of voting assistance that their local department of motor vehicles would offer to them if they lived at home stateside. This legislation makes practical sense because many of our troops and their families are transferred quickly and without much notice, and it is difficult for them to keep changing the address that local officials have on file. During the conference process, when we were working with our counterparts in the House of Representatives, this legislation was watered down, unfortunately, and was made optional for the Department of Defense to offer voting assistance to our troops and their families. I have to say, I was disappointed at this action because when our troops are given orders to deploy elsewhere, obviously, those orders are not optional and neither should the requirement of the Department of Defense when it comes to helping make sure our deployed troops' votes actually count. So it should not be optional for the Department of Defense to offer these services to the troops and their families when they arrive, as ordered, at their new post. I am particularly concerned this legislation was weakened at the specific request of the Department of Defense. Furthermore, the Department's objection was based on a misreading of the National Voter Registration Act. In fact, at our request, the Department of Defense's objections were reviewed by subject matter experts at the Department of Justice. These experts at the Department of Justice agreed with us on the clear meaning of the law and that the Department of Defense had made an error in interpreting the Senate bill. Unfortunately, by then the damage was done and House conferees deferred to the Department of Defense interpretation of this legislation and made it optional at their request. I do not think the Senate should be content to kick a field goal when we could have scored a touchdown for the men and women of our U.S. military--and we will. First, I expect the Department of Defense to implement this optional program at every applicable military installation. I will request regular updates from the Department on its implementation, as well as any explanation for delays. We will not let up until we make sure this is complied with. Secondly, I expect the Department of Defense to correct the official record and to make clear to the Members of the House and the Senate who were conferees that its objection to this legislation was based on an erroneous interpretation of the law. Third, I intend to offer amendments to other legislative vehicles to correct this watering down of this important provision--the language passed out of this Chamber unanimously--and I will continue to make sure it becomes ultimately the law of the land. The provisions of the MOVE Act that did make it through conference, I do believe, represent a clear win for our troops and their families. Many of my colleagues were instrumental in making this happen, and I thank all of them. Again, this was a bipartisan effort. However, my colleagues in the conference also included language in the Defense authorization bill which clearly does not belong in this bill and which I do not support. I refer, of course, to language addressing so-called hate crimes in the conference report. I, in a previous life, was a judge for 13 years and attorney general of my State after that. I believe very firmly in the concept of equal justice under the law, and I believe crime should not be treated differently based on the victim of that crime. I have had the privilege of working with many victims of crime and their families, and I share their determination that those who commit crimes should be delivered swift justice and be held accountable. But a fair justice system, committed to equal justice under the law, does not distinguish between crimes based on race, gender or whatever the category that is included in a particular list. A fair justice system, committed to equal justice under the law, does not criminalize thoughts or perceptions. It criminalizes behavior. In this country, a fair justice system, committed to equal justice under the law, is based on federalism, one which respects that State and local law enforcement and prosecutors are doing their jobs fairly and responsibly. Expanding hate crimes legislation should not be part of this conference report. Not withstanding this flaw in the bill, I will vote for the conference report but with this reservation. The hate crimes provision does not belong in the bill and I believe violates our national commitment to equal justice under the law. I yield the floor and suggest the absence of a quorum.

Mr. CORNYN

Mr. CORNYN. Mr. President, today I recognize a dedicated group of volunteers for their service to small business owners in Texas. The Service Corps of Retired Executives, also known simply as SCORE, is a nonprofit organization that connects new entrepreneurs with seasoned business executives for expert advice and consultation. Creating a new business enterprise can be challenging, and perhaps the most advantageous way for new entrepreneurs to seek advice is asking successful executives who have firsthand experience. SCORE provides a forum for entrepreneurs to engage experienced leaders in both one-on-one settings and group environments. SCORE offers complementary counseling services covering important topics such as business management, financing, marketing, and taxes, among many others. SCORE was created on October 5, 1964, as a mission of the Small Business Administration, SBA. Since that time, the organization has evolved into a stand-alone nonprofit group, steadily increased its volunteer base, and embraced the Internet as a tool for outreach. SCORE is approaching a significant milestone this year--45 years of service to small business owners. It is worth noting that SCORE recently documented another achievement by providing services to its 8 millionth client. Today SCORE offices can be found in 48 States and the District of Columbia. In 2008, 11,200 SCORE volunteers provided approximately 1.3 million hours of service saving business owners an estimated $167 million. In Texas, 378 SCORE volunteers provided over 63,000 hours of complimentary counseling. SCORE's remarkable success continues to be recognized by the Federal Government, and today the SBA maintains a partnership with SCORE to help entrepreneurs turn their visions into reality. I commend SCORE volunteers in Texas for sharing their time and expertise with the next generation of business owners. In so doing, SCORE volunteers are helping a new generation build their own American dream.

Mr. CORNYN

Mr. CORNYN. Mr. President, I join my colleagues in appreciation and admiration of Senator Ted Kennedy. By the time I took my seat in the Senate, Ted had already held his for nearly four decades. He had already established himself as one of the most influential members in this body's history. He had already introduced hundreds of bills that became laws and shaped thousands of others. He had already grown from youngest son to elder statesman and become an icon for millions of Americans. Before I was ever elected, I respected Ted Kennedy. And after becoming his colleague, my respect grew. I was privileged to serve with him on the Judiciary Committee and to be ranking member when he chaired our Subcommittee on Immigration, Refugees, and Border Security. We worked together closely, and that experience has made me a more effective Senator. Ted Kennedy and I often held different principles, but we shared key convictions too. We agreed that our immigration laws needed reform. We recognized that judicial philosophy mattered. We believed that providing advice and consent on appointments to the Federal bench was not merely a right of Senators but one of our most solemn responsibilities. Ted Kennedy understood the power of language. On the Senate floor, he used words of passion, calling his colleagues to embrace grand visions with great urgency. In bill negotiations, he used words with precision, understanding better than anyone how legislative language governs, and how to codify his convictions into the law of the land. Senator Kennedy and I shared an interest in the history of this body, and a special pride in those who held our seats before us. In my case, I have long admired Sam Houston, who liberated the people of Texas, served as one of our first Senators, and raised his voice against secession. In Ted's case, he looked to the great Daniel Webster, who also stood for union, and for liberty. Ted was drawn in particular to this quote by Webster: Let us develop the resources of our land, call forth its powers, build up its institutions, promote all its great interests, and see whether we also in our day and generation may not perform something worthy to be remembered. All Americans can agree that Ted Kennedy's service in the U.S. Senate is something worthy to be remembered. Sandy and I continue to keep his wife Vickie in our prayers. And we offer our condolences to all who miss him most.

Mr. CORNYN

Mr. CORNYN. Mr. President, I join my colleagues in appreciation and admiration of Senator Mel Martinez. Mel lived the first 15 years of his life under communist dictatorship in Cuba. That experience gave him a special appreciation for the blessings of liberty. As Mel's own career in public service took him from Florida to Washington, he never forgot the people living under totalitarianism in his homeland. And he never wavered in his conviction that the people of Cuba deserved the same rights as the rest of us, especially the rights to choose our leaders, worship as we please, and live in freedom. Mel distinguished himself as a lawyer in central Florida, then won elective office as mayor of Orlando, and was appointed by President Bush to serve as his first Secretary of Housing and Urban Development. Secretary Martinez helped the people of lower Manhattan rebuild after the terrorist attacks of September 11, 2001, and he worked to expand opportunities for home owners nationwide. Mel was proud that he was the first Cuban-American to ever serve in a President's Cabinet. Mel was also the first Cuban-American to serve in the U.S. Senate. In this Chamber, he raised his voice to strengthen our national defense, especially the Navy's shipbuilding program. He supported the development of America's natural resources in an environmentally responsible way. He had a heart for victims of Alzheimer's disease and their families, and supported greater Federal research funding to help find a cure. Senator Martinez and I shared a concern about waste, fraud, and abuse in Medicare and Medicaid. So earlier this year, he and I introduced legislation to do something about it. The Seniors and Taxpayers Obligation Protection Act or the STOP Act would give Federal agencies greater tools and authority to detect waste, fraud, and abuse before they happen. The STOP Act has sponsors on both sides of the aisle, and I believe its provisions should be a part of our efforts to reform our health care system. Mel served less than a full term in the Senate, but he has helped shape legislation that will govern our Nation for years to come. He and his wife Kitty are now back home in central Florida, and Sandy and I wish them both the very best.

Mr. CORNYN

Mr. CORNYN. Mr. President, I would respond to the distinguished Senator from Tennessee, of course not. The American people are smart. They can understand that these numbers are not going to add up. As our Republican leader said this morning, this bill that was reported in the newspaper and scored by the Congressional Budget Office yesterday will never see the light of day. So this is a work in progress. We are committed, I think on a bipartisan basis, to reform our health care system. But the goal--and we need to keep our eye on the goal--is to bring down the cost and to cover people who currently are not covered. This bill, unfortunately, does not accomplish those goals. But we are going to keep working with our colleagues, if they will be open to our suggestions. But I have to tell you, as a member of the Finance Committee, virtually every suggestion Republicans made during the amendment process to this bill was voted down on a party-line basis. I came to the floor to talk about one of those amendments the Senator from Tennessee mentioned, where we asked merely that the bill--once it is reduced to legislative language and the cost is determined--be put on the Internet for 72 hours. That was voted down along a party-line vote. But I thank the Acting President pro tempore and other folks on the other side of the aisle, eight of whom have written to the majority leader saying that makes sense to them. So I hope we will build a bipartisan consensus for more transparency in the debate. I have also come to the floor to talk about how it makes no sense to cut Medicare benefits for 11 million Medicare beneficiaries who happen to be engaged in the Medicare Advantage Program in order to pay for this bill. Why would you take $\1/2\ trillion from Medicare, which is on a pathway to bankruptcy by 2017, in order to create a new government program? It can only make sense inside the beltway and if you voluntarily suspend your powers of disbelief. It does not make sense across the country. That is why it is so important to have these discussions, ask these questions, have transparency. Today I wish to ask another question: Will the health care proposals, such as the Finance Committee proposal and others, break the President's promise of not raising taxes on families making less than $250,000 a year? Unfortunately, the Finance Committee bill does, in fact, raise taxes on families making less than $250,000 a year. So the President cannot keep his promise if we pass this particular legislation. For example, this bill imposes a penalty on individuals who do not meet the Washington-imposed mandate that will be enforced by the Internal Revenue Service. The Internal Revenue Service is going to impose a penalty on you if you do not have health insurance that meets the Washington-imposed mandate. According to the Joint Tax Committee, the penalty initially included in the bill would especially hit middle-class families hard. They found that at least 71 percent of the penalty would come from people earning less than $250,000 a year. The bill also increases the penalty from 10 percent to 20 percent for Americans who use a portion of their health savings account for purposes other than qualified medical expenses. It seems to me we ought to be encouraging more people to use their health savings accounts rather than less. But as I discussed yesterday on the telephone with the CEO of Whole Foods, John Mackey, he said the health savings accounts--they call them wellness accounts, which are overwhelmingly successful and voted on every year with the satisfaction rate of some 85 percent or more by the employees of Whole Foods, headquartered in Austin, TX--will be an illegal plan under this mandate. Insurance premiums, of course, will go up in the process. This bill also raises the floor on deductions of medical expenses to 10 percent from its current level of 7.5 percent. So you will be able to deduct less of your medical expenses if you have serious health care expenses, which means your taxes will go up. If you can deduct less, your taxes will go up. The committee did, I would point out, consider an amendment that was intended to bring the bill in line with the President's promise not to raise taxes on people making less than $250,000 a year, and it was voted down along party lines. Republicans were for it and Democrats were against it. This amendment would have protected families who earn less than $250,000. But, as I say, it was voted down. In addition to imposing taxes on people the President promised not to impose taxes on, this also imposes additional so-called industry fees, which experts have said will ultimately be passed down to consumers in higher insurance costs. So instead of making insurance more affordable, this bill would actually make it less affordable and head in the wrong direction. The nonpartisan Congressional Budget Office and the Joint Tax Committee both confirmed these fees would be passed along to consumers and ultimately raise insurance premiums. So my question for today is: Will these proposed health care reforms break the President's promise not to raise taxes on those making $250,000 or less? Unfortunately, the Finance Committee proposal, which we will now apparently vote on on Tuesday of next week, does break the President's promise. But Republicans stand ready to work with our friends on the other side if they will accept some ideas on how to do this to bring down costs and to cover more people to make health coverage more affordable. But so far all those suggestions have been rejected along party-line votes. Mr. President, I yield the floor.

Mr. CORNYN

Mr. CORNYN. Mr. President, I wish to thank my colleague from Tennessee for speaking so eloquently and raising the issues that are on the minds not just of Senators who are going to have to vote on this legislation but our constituents all across America--people who will be directly affected by what we do here on health care reform. Yesterday, I came to the floor and I asked the question: Will we have a transparent debate? This morning, when I got up and checked my e- mail, I was delighted to see that eight Democratic Senators have written to the majority leader, Senator Reid, and said they wanted to have bill language posted on the Internet and a score or cost by the Congressional Budget Office at least 72 hours before we are required to vote on the bill. That is exactly what we had requested in the Finance Committee, which we lost strictly on a party-line vote, an amendment that would have made that part of the bill. So I consider that progress. I am delighted that these eight Democratic Senators have asked the majority leader for that. I think that is a minimum we should expect in terms of transparency. Today, I have a new question, and that is whether seniors will get to keep the Medicare benefits they currently have. Will seniors be able to keep the Medicare benefits they currently have? The President has made this a consistent theme, that if you like what you have, you are going to be able to keep it. He said in August that if you like your health care plan, you can keep your health care plan. It seems pretty straightforward and unambiguous. Last month, he was more specific about one part of Medicare. He said: People currently signed up for Medicare Advantage are going to have Medicare and the same level of benefits . . . These folks will be able to get Medicare just as good and provide the same benefits. Some of these programs get a little confusing, but let me explain that Medicare Advantage is a private sector competitor to Medicare fee- for-service, where you just--it basically provides people with an array of coverages, and I think Senator Alexander mentioned vision and dental care and prescription drug coverage and the like. I believe allowing seniors to keep the benefits they currently have under Medicare Advantage--and there are some 11 million of them--is a goal Republicans share with the President. So if the President is sincere when he says that Medicare--and particularly Medicare Advantage--beneficiaries can keep what they have, we would like to help him keep that promise. Medicare Advantage is working for about 11 million seniors to give them a choice with their health benefits, and half a million of those are in Texas. Half a million Medicare Advantage beneficiaries are in Texas. As we have heard, Medicare fee-for-service, which is the government- run plan, pays doctors about 20 percent less than employer-sponsored insurance for reimbursements for services. That is why in my State, about 42 percent of doctors will not see a new Medicare patient under a fee-for-service arrangement, because the fees are so low that the doctors can't provide the service at that price and still stay in business. So what happens is that 89 percent of seniors have supplemental coverage. My mother, who passed away this last spring, bought supplemental coverage to try to make up for the difference where Medicare fee-for-service left that gap. Of course, many low-income Americans depend on Medicare Advantage as their supplemental coverage. Some have claimed that Medicare Advantage provides extra payments, and they want to cut Medicare Advantage because they say it will reduce insurance company profits and not harm coverage. But under Federal law, that is simply not the case. Under Federal law, the fact is that 75 percent of those payments to Medicare Advantage over and above what Medicare fee-for-service pays go directly to better benefits for seniors, under current law. That is why we hear they get vision coverage, dental coverage, prescription drug coverage; they get better benefits because we as a Congress say 75 percent of those so-called extra payments go to provide better benefits. Unfortunately, the Finance Committee bill will take those benefits away from seniors enrolled in Medicare Advantage. In other words, if we were to call up this Finance Committee bill today and to pass it, it would violate the President's promise, that the 11 million people on Medicare Advantage would not see a cut in their benefits. There are various numbers floating around. That is why we need what Senator Alexander said: the numbers from the Congressional Budget Office. But the Finance Committee proposal cuts nearly $113 billion from the Medicare Advantage Program. Common sense tells us you can't do that without having a negative impact on Medicare Advantage for those 11 million seniors, 500,000 of them in Texas, as I said. The Congressional Budget Office agrees with that sort of intuitive or commonsense conclusion. They estimate that the Finance Committee bill will cut benefits by more than half to Medicare Advantage seniors. During the Finance Committee markup, the Congressional Budget Office Director, Dr. Doug Elmendorf, told us that approximately half of the Medicare Advantage benefits will be cut for those seniors enrolled in Medicare Advantage. So just as yesterday when my question was, will this debate be transparent, my question for today is, will seniors get to keep the Medicare benefits they currently have? I think that should be a focus. I know it will be a focus for the 11 million who are on Medicare Advantage. But for all seniors who are seeing a proposed cut of $\1/2\ trillion in Medicare in order to pay for a new government program while Medicare itself is on the brink of bankruptcy and has tens of trillions of dollars of unfunded liabilities, this is a question a lot of my constituents in Texas and a lot of seniors across the country are asking: Will seniors get to keep the Medicare benefits they currently have? That is what the President promised. We need to make sure this bill keeps that promise. In the coming days, I will come back to the floor and ask more questions about these extraordinarily complex proposals we have seen, including the bills that have come out of the HELP Committee, the Finance Committee, and out of the House of Representatives, because I think we need to break it down into smaller pieces and ask these discrete questions so the American people can judge for themselves whether these bills do what the President has promised. Mr. President, I yield the floor.

Mr. CORNYN

Mr. CORNYN. Mr. President, I join my colleague from Tennessee in discussing health care, which, as the Presiding Officer knows, has been the subject for several weeks now in the Finance Committee and across the entire country for the last few months. Currently, we are waiting for the CBO to come back to the Finance Committee and tell us what the preliminary cost estimate is of the Finance Committee bill, as voted with amendments that were passed in the Finance Committee. Soon, if we can believe the reports, the majority leader will bring to the floor a so-called merged bill from the two Senate committees--the HELP Committee and the Finance Committee--and then we will be asked to offer amendments and vote on that bill. While we are waiting for the process to unfold, I think it is very important to carefully ask the questions that the American people-- including my constituents in Texas--are asking me, questions I believe Senators should ask themselves as we debate health care reform on the Senate floor. The first question I would like to propose is: Will we have a transparent debate? The American people want transparency. I cannot tell you how many of them have contacted me from my State and elsewhere and have said: We want to read the bill language. Amazingly enough, many have cited back to me pages--references either from the House bills or the HELP Committee bill or otherwise--and said: What does this mean? I have concerns about that. The second question is: Will Congress actually listen to the concerns of our constituents once they learn more about what is in these bills? In other words, ultimately, the question is: Will we know what is in the bill before we are required to vote on it? Will we know how much it is going to cost before we vote on it, both in committee and on the floor of the Senate? If you will remember, way back in August of 2008--that seems like a long time ago, but it is almost yesterday--President Obama pledged that our debates on health care reform would be transparent. I applauded him for that at that time. He said negotiations should take place on C- SPAN, so anybody and everybody who cared about it could see it. I remember, on January 20 of this year, sitting up there near the dais when our President spoke, and he said things I agreed with, such as: ``We need greater transparency in government.'' He said: ``Transparency promotes accountability and it promotes public confidence in what we do here.'' Well, the converse is also true; secrecy breeds suspicion and ultimately promotes cynicism about what we do here. That is why this is such an important issue. Unfortunately, those Americans who have been counting on a transparent process in Washington have been disappointed so far. We have seen special deals negotiated by the White House with lobbyists which have not been disclosed to the American people, some which we have learned about and some which we may not yet know about. One is the deal with the pharmaceutical industry--holding their exposure to $80 billion under this legislation. That deal was reinforced last week by a vote in the Finance Committee. I wasn't a party to that deal. I am sure the Presiding Officer was not. I wonder how many other deals have been cut between the White House and various interest groups that we don't know about. We also learned about a deal cut with some hospitals--some but not all. A CBO score on an amendment last week had to be redone because it was $11 billion off because the CBO, the nonpartisan office charged with telling us how much this bill will cost, didn't know about this hold harmless agreement with the hospital association. We need to know of these deals because they will not necessarily be reflected in the bill language, and only the White House, presumably, and the special interest groups that cut these deals know about them. But I think it is important the American people know about them so they can evaluate whether we are appropriately doing our job. I have heard it time and time again, particularly since the passage of the stimulus bill that we got roughly at 11 o'clock on a Thursday night and were required to vote on in less than 24 hours--my constituents are saying: Is it asking too much to have you read the bill before you vote on it? I voted no on that bill for a lot of reasons, but I didn't have the time, nor I suspect did many Members of Congress have the time, to read it before we were required to vote on it. We don't set the voting schedule; the majority leader does. I think that is another reason they want us to slow down. Let's find out what is in the bill. Let's let the American people read what is in the bill. Tell us what it is going to cost, and let's have a good, old-fashioned debate about what is in the best interests of the American people. The third special deal that was disclosed had to do with Medicaid. You remember the majority leader from Nevada said: The unfunded mandate for Medicaid expansion is too much for my State to absorb. Lo and behold, a new deal was cut with new language that would give four States a better deal than they would have had in the original proposal by the chairman of the Finance Committee, Senator Baucus. One of those four States, lo and behold, happens to be the State represented by our distinguished majority leader. I think these examples reveal why transparency is so important. As the distinguished Senator from Tennessee pointed out, we are going to have this mysterious merger of the Finance Committee proposals with the Health, Education, Labor, and Pensions Committee bill behind closed doors, presumably--I heard reports it is occurring now, maybe even as we speak, in the conference room of the majority leader without any of us being present. I think it is a perilous, indeed, a dangerous way for us to do business. As the distinguished Presiding Officer knows, the first amendment offered by our side of the aisle last week in the Finance Committee was offered by the Senator from Kentucky, Mr. Bunning. His amendment would have required a 72-hour waiting period before we would vote on the Finance Committee bill. During those 72 hours, we would, hopefully, have had actual legislative text not just conceptual language available to us and available to the American people so they could read it. We would also insist, under his amendment, on a score; that is, a cost of the Congressional Budget Office telling us how much Medicare was going to be cut, how much taxes would be raised, and how the bill would be paid for. That seemed like an eminently reasonable amendment to me. But, unfortunately, a majority did not carry the day in the committee, and it failed. I hope we have another chance to come back to that issue, perhaps even as one of the first amendments as we take up this bill on the floor because I think it is incredibly important to public confidence, to accountability, to try to do something about the cynicism that has crept into the public's perception of what we are doing. That is reflected in 16 percent of respondents in a recent Rasmussen poll saying they rate Congress as either good or excellent--16 percent. We need to do better than that. We need to restore confidence in what we are doing, and I think transparency will help; otherwise, what are we left with? We are left with people wondering whether there is some reason we don't want the public to read the bill. Maybe there is a reason that they don't think the public should read the language because maybe they don't intend to read the language before they vote on it. Some have said the language is just simply too complicated; that an average person cannot understand it if they read it, and that even some Senators would not be able to understand it if they read it before they voted on it. I ask us all to take a deep breath and one step back and think about the consequences. If some staffer is the one writing the language, and Members of Congress, members of committees, Members of the Senate do not read it and it perhaps is not written in understandable language so we know what the impact will be, how does that promote public confidence? It is something that ought to give us pause, and we ought to reconsider as we reflect on what the message sends. Mr. President, I ask unanimous consent for 2 additional minutes.