J. Exon

Mr. EXON

Mr. EXON. Mr. President, I move to reconsider the vote.

Mr. EXON. Go ahead.

Mr. EXON. Let me respond to the Senator from my perspective, and I cannot speak for the majority. We are now considering the Abraham amendment. We will vote on that. If this unanimous consent request is agreed to--and if I agree to it, I must say--immediately following that, we would be up for consideration of an amendment from the Democratic side. I have indicated to my friend from California that she would be first up with her amendment. So I will simply say, after the vote, you would, as far as I am concerned, be recognized to offer your amendment. If it is possible-- obviously it is not between now and the scheduled vote at 8:30--I would certainly recommend to Chairman Domenici that we proceed with the order which would allow you to follow the vote.

Mr. EXON. Mr. President, I understand at this time we are trying to reach a unanimous consent agreement to have a vote at 8:30. Is that the Senator's understanding?

Mr. EXON. Mr. President, we have had a good debate. I believe that both the Senator from Michigan and the Senator from West Virginia are prepared to yield back the remainder of the time, and that would allow us to continue to go back to the Republican side for the next amendment. I believe that amendment will be offered by the Senator from Michigan. As I understand it, it is on the same subject that we have discussed quite thoroughly. Maybe we can cut back on the use of some of this time. I would simply like to emphasize that while it may generally not be understood in the Senate, it is not a disgrace to not use the whole hour on each side on all of these amendments. It is perfectly acceptable and it is certainly respectable to yield back time so that we can move ahead on amendments. Depending on what happens, as you know, we temporarily set aside, in agreement with the chairman of the committee, so that we could move ahead. We are not going to have any votes before 8 o'clock. I would simply suggest that if the two managers of the measure before us are ready to yield back this time and set the amendment offered by the Senator from West Virginia up for a vote when agreed to by the managers of the bill, then we could move to the amendment of the Senator from Michigan and start debating that. Mr. ABRAHAM addressed the Chair.

Mr. EXON. Mr. President, now that all time has been yielded, I ask unanimous consent to lay aside temporarily the Rockefeller amendment and proceed with the next amendment that I understand under the agreement would be the one to be offered by the Senator from Michigan.

Mr. EXON. Mr. President, I yield myself such time as may be necessary. I wish to make a few comments about the situation here at hand. I want to take people to Nebraska, which is a very typical State in the Midwest part of our great country. It is very typical from the standpoint of being a substantial rural State with lots of rural, small communities and is also typical of the Great Plains States and some of the other States of the Union. Mr. President, I rise in support of the amendment of my colleague from West Virginia. I am a cosponsor of that amendment. The Medicare reductions in this budget are too large and are not required to balance the budget and extend the life of the Medicare hospital insurance trust fund through at least the year 2005. I am particularly concerned about the deep and disproportionate cuts that will be borne by hospitals, particularly rural hospitals. The Senate Budget Committee said its $170 billion in reductions and spending growth would include a $123 billion reduction in Medicare part A. This will threaten the quality and the financial viability of hospitals, particularly the rural and inner-city hospitals. Previous Republican budgets slowed the rate of growth in hospital payments, but under this year's plan the Congress may need to adopt policies that would actually reduce payments, not simply reduce the rate of increase in these payments. Under any definition, that represents a true cut in spending. So we will not have to get into all that argument that we continually get into about what is a cut. What I am talking about is it appears to me from some of the other information that I will furnish the Senate during these remarks that what we are threatened with is a real cut. That means less dollars, less dollars and cents than last year, and by any definition that is a cut. I recently received a letter from Harlan Heald that I will read. Harlan Heald is an acquaintance of many, many years way back to the time when I was Governor of Nebraska, and if there is a Mr. Rural Hospital in Nebraska, it is Mr. Heald. Mr. Heald is President of the Nebraska Association of Hospital and Health Systems. They are not a political organization. They are an organization that devotes time, talent and effort to represent the people who provide hospital services in rural Nebraska primarily. According to Mr. Heald's analysis, a reduction of $50 billion would have a devastating impact on Nebraska hospitals. Mr. Heald writes, and I quote: Sixty-five rural hospitals would lose $69.1 million over 7 years and 12 large rural hospitals would lose $100 million. Thirty out of Nebraska's 65 small rural hospitals would lose money in providing care. Mr. President, I will ask unanimous consent that the full text of Mr. Heald's letter be placed in the Record at the conclusion of my remarks, after I read that letter, because there are so many interesting factual and true statements in it, not from a political standpoint but from what the Republican effort and the Republican bill will do to rural Nebraska. If it is going to do something to rural Nebraska, it is going to do it to rural North Dakota and rural South Dakota and rural Kansas, and rural Oklahoma, and every rural State in the United States of America. These are the consequences of the $50 billion reduction over 7 years. What would be the impact then of a $123 billion reduction over 6 years that we are now faced with? A loss of this magnitude in a State where Medicare patients account for 60 to 70 percent of hospital admissions clearly threatens the health care system on which all of us depend. Several hospitals in my State are teetering on the brink of insolvency while we are here talking about the bankruptcy of Medicare. This latest Republican proposal will very likely drive them over the edge. Mr. President, I wish to read from the letter that I have just referenced. This letter is dated May 14, 1996, addressed to me. Dear Senator Exon: I have reviewed a summary of the current fiscal year 1997 House and Senate Budget Committee proposal with respect to the Medicare Program. On behalf of the 94 acute care hospitals in Nebraska, I wish to call your attention to a very serious potential problem. While it appears that the overall Medicare budget reductions of $158 billion are roughly the same as those in the last Republican proposal in January, the budget committees have significantly altered the allocation of reductions within the program, reducing part A spending by $123 billion versus the $77.5 billion proposed in January. We have been told on numerous occasions that the reductions are not cuts-- This is not in the letter. I just want to add here, how many times have we heard that here? Back to the letter. but are reductions in the rate of spending over a 6-year period. The current budget resolution includes lower budget reductions in part B of Medicare, while the reductions in part A have been significantly increased since the January proposal. The larger Medicare Part A reductions in the current proposal means hospitals will experience actual reductions in payments--not merely a reduction in the rate of payment increase. We are talking about real cuts here. I am away from the letter. We are talking about real cuts here, when every time we talk about cuts, people stand up and say, Oh, only in Washington, DC, is an increase a cut. I have always said we must legislate to real needs, what the costs are going to be. Another editorial comment before I go on with reading this letter from an expert on the subject in Nebraska, and that, Mr. President, is simply this: I am convinced that the reductions in the amount for real needs that the Republicans have been espousing are below the projected costs and rises in health care over the next 6 years. Putting that another way, what I am saying is that the Republicans have been saying, ``Oh, well, this is not a cut, this is just a slowing down of the growth.'' Time and time again that has been used on the floor of the U.S. Senate. Mr. Heald brings us back to reality by saying what I indicated when I first started talking on this subject, that these cuts are not simply a reduction in the growth. They are cuts, dollars and cents, below what hospitals have received before. Back to the letter: Although I have not received enough detail to permit me to make an analysis of the impact of the proposed reduction in Medicaid Part A spending, I do have information from an earlier proposal last fall that looked at Part A reductions of about $50 billion out of the total reductions over a seven-year period. Although it is a ``crude'' approximation, the impact on Nebraska hospitals looks like this: Sixty-five small rural hospitals would lose an aggregate of $69.1 million during the seven-year period of 1996 to 2002. Twelve large rural hospitals would lose a total of $100.4 million, and 11 metropolitan (Lincoln and Omaha) hospitals would lose $337.4 million, during the seven-year period. Note--In 1994, 30 hospitals out of Nebraska's 65 small rural hospitals lost money providing care. Let me repeat that: In 1994, 30 hospitals out of Nebraska's 65 small rural hospitals lost money providing care. Again, this is based on a Part A reduction of about $50 billion over a 7-year period. I hate to think what these numbers might resemble under the current proposal with Medicare Part A targeted for a $123 billion hit. Reimbursement reductions of this magnitude in a state with a disproportionate share of the elderly population, a state in which Medicare patients account for 60 to 70 percent of hospital admissions, clearly threatens the health care system upon which all of us depend. Medicare needs to be fixed. There is an opportunity for Congress to change Medicare, but the change must be driven by sound health care policy, not budgetary or political imperatives. The proposed Medicare reductions would crush Nebraska hospitals. As always, Nebraska hospitals look to your leadership. Mr. President, I also would like to read a letter from the following groups: The American Association of Eye and Ear Hospitals, the American Hospital Association, the American Osteopathic Healthcare Association, the Association of American Medical Colleges, Catholic Health Association, Federation of American Health Systems, InterHealth, National Association of Children's Hospitals, National Association of Public Hospitals and Health Systems, and Premier. This letter is dated May 10, and it is addressed by those organizations I just read, to the Honorable William Roth, chairman, Committee on Finance. Dear Chairman Roth: The undersigned organizations representing hospitals and health care systems have reviewed the Fiscal Year 1997 House and Senate Budget Committee proposal, particularly with respect to Medicare and Medicaid programs. While it appears that the overall Medicare budget reductions of $167 billion are roughly the same as those in the Republican offer in January, the Budget Committees have significantly changed the allocation of reductions within the program. The letter goes on and essentially makes the same exact points made by the letter that I read, by Harlan Heald. So the professionals know what is going on. We know what is going on here. I must continue to make the point that Nebraska is not unique in this. But if you have a hospital, because of the aging population in rural areas of America in toto, where 60 to 70 percent, and some places higher, have their beds dedicated to people who are eligible and receive Medicare, and for many of them that is the only health care system available to them, and you compare that with a hospital, for example in Lincoln or Omaha or other more metropolitan areas that have their patients coming in only about 20 to 25 percent seniors, you quickly understand that what we are doing here is socking it right between the eyes of the rural hospitals in the United States of America. Mr. President, I ask unanimous consent both of the letters I have referenced be printed in the Record.

Mr. EXON. Mr. President, I move to reconsider the vote by which the amendment was rejected, and I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. EXON

Mr. EXON. I yield 3 minutes to the Senator from Minnesota.

Mr. EXON. May I suggest one other extension? Maybe we do not have to have a unanimous-consent agreement on this because we generally go with a gentlemen's agreement. Our side would offer the first amendment after the two votes; is that correct?

Mr. EXON. Mr. President, I hope the manager of the bill, the chairman of the committee, could be present because I would like to straighten some things out. We had made an earlier agreement that we would move back and forth. I thank my friend, the chairman of the committee, for being on the floor. We made an arrangement. Good-faith arrangements are something this Senator has always lived up to in 18 years in the U.S. Senate. I was to offer the next amendment. I could not do so since the Senator from Iowa was on the floor, got the floor, and was talking as in morning business for 5 minutes. It went on way beyond that. In the meantime, I have been working diligently with the chairman of the committee to try to work out the increasing number of amendments that are coming forth. We had discussed this, either off or on the floor. There were private discussions going on in good faith, I thought, with Chairman Domenici and myself, as ranking member. I went in to visit, to try to work that out and accommodate everyone. I came back out to find that the Senator from Missouri, probably unknowingly, broke the arrangement. The Senator from Nebraska had been faithfully waiting to offer the next amendment and I thought my prerogative would have been protected, as is customary in this body. I ask the chairman of the committee whether or not it is true that the Senator from Nebraska was to be next recognized to offer an amendment, under the previous agreement?

Mr. EXON. What I was hopeful of is that I would offer my amendment, we would have a vote on that, then go on to your amendments and proceed in the usual fashion. That is what I would like to have done. But it seems to me now you have used up considerable time on the time that you had. Is that right, I ask the Senator from Missouri?

Mr. EXON

Mr. EXON. Mr. President, as agreed to yesterday, at this time I send an amendment to the desk and ask for its immediate consideration.

Mr. EXON. If the Senator will withhold for a minute so we can talk about time here, a lot of people have asked me when we are going to vote. I simply say--and I have not had a report from the Senator yet this morning--that we have about 34 amendments that Democrats are intending to offer. We asked last night that they try and advise us, and your side advise you, what amendments we have. We are trying to complete this effort by tomorrow night. We are certainly going to have to have some discipline somewhere along the line to get that done. I would like to ask, first, about how many amendments do you see on your side, or do you know about at the present time? When we have that, we will add that to the 34 that we have here and multiply that out by the number of hours that each one of those amendments are entitled to. Then we will begin to see the difficult task we are going to have by trying to finish this by tomorrow night. The second question I want to ask to move this debate along is this. Last night, Senators on both sides suggested that we put off this debate until this morning and not have a vote before noon. I am wondering if we could possibly get an agreement that we would try and balance out time so that we could have a vote in the vicinity of noon today on this matter. Is that a feasible proposal? Does the Senator think that might move things along?

Mr. EXON. Mr. President, we are hearing repeatedly today what we heard from the Republican side of the aisle yesterday--every time it is said I intend to correct it--and that is that the President's budget is not in balance. As I said in my opening remarks yesterday, and in my opening remarks this morning, contrary to the statements that are being made from that side of the aisle, the President's budget is certified to be in balance by the Congressional Budget Office. Lest we forget what that is, the Congressional Budget Office is run and managed by a Republican appointee whom I supported to be the head of that organization. The Congressional Budget Office, whether run by a Democrat or Republican, has always been considered to be about as fair as you can get with regard to certifying numbers. I quote once again, as I did yesterday--and I will keep quoting it today every time somebody on that side of the aisle says that the President's budget is not balanced--and that is this quote from the Congressional Budget Office headed by June O'Neill. The President's budget proposes policies that the Congressional Budget Office estimates would balance the budget by the year 2002. Yet that side of the aisle keeps saying, ``It does not. It does not. It does not.'' I am not going to get into ``You said that, she said that, he said that.'' But their claims are fundamentally wrong and they do not not contribute to a legitimate debate on the budget when they keep saying, ``the President's budget doesn't balance.'' Likewise, I would say, that the Congressional Budget Office has said that the Republican budget proposal introduced by Chairman Domenici yesterday does balance. There are several things that I could pick apart on that. There are several things that I could get up and say, ``I don't agree with CBO. I think that the Republican budget does not balance in the year 2002 for this reason, for that reason, for the gimmicks that are included in their budget.'' But it seems to me that when I take that kind of an argument, I am undermining the basic context that I think is important; that is, that CBO has certified that in their best judgment and by their best estimates both the President's budget, that I have just offered, and the Republican budget offered yesterday by Chairman Domenici, have been certified to by CBO as balancing the budget by the year 2002. Now, I do not think we accomplished very much since both of the basic budgets that we are arguing about here have been certified by CBO. Last year, I repeat again, the Republicans hounded the President, hounded the Democrats and challenged the President to come forth with a budget that could be certified to as being balanced by the year 2002 by the Congressional Budget Office. Now that it has been done, as I said yesterday, they are moving the goal posts once again. I think we can have legitimate debate on what are the rights and what are the wrongs in both the President's budget and, the Republican budget. I admitted and conceded in my opening remarks this morning, that there are some parts of the President's budget that I do not agree with. I think we accomplish very little by getting up on the floor of the U.S. Senate, as Republicans did yesterday and as they are starting out to do today, to say the President's budget is not balanced. Says who? Says the Republican majority. The Republican majority is a partisan referee and therefore their claims should not be considered as authentic with regard to whose budget balances best and in what timeframe. As I say, I think there are many policy problems with the Republican budget, and I think there are policy problems with the President's budget. I suggest we could expedite the proceedings and come to more intelligent debate if we stop saying this budget does not balance and that budget does not balance, and agree, if we can, that the CBO has certified both the Republican budget and the President's budget that I have just introduced as being balanced by the year 2002. If we are going to go down that road, we are just going to be throwing stones at each other's budget without getting to the specifics of what we would like to see done. Once again, to bring that point home, I want to talk for just a moment about the Medicare part A and B trust funds that have become focal in the debate, and justifiably so. Once again, I am going to introduce for the Record and read a very short letter from June O'Neill, the Republican-appointed Director of the Congressional Budget Office. The letter is dated May 9, 1996: Congressional Budget Office, Washington, DC, May 9, 1996. Hon. J. James Exon, Ranking Minority Member, Committee on the Budget, U.S. Senate, Washington, DC. Dear Senator: At your request, the Congressional Budget Office (CBO) has examined the effects of the Administration's budgetary proposals on the Hospital Insurance (HI) trust fund. Under current law, the HI trust fund is projected to become insolvent in 2001. CBO estimates that the Administration's proposals would postpone this date to 2005. Sincerely, June E. O'Neill. Director. Mr. President, in listening to the Senator from Washington, he seems to assert that the home health care part of the budget would be safer in Medicaid part A than it would be in Medicaid part B. I find this association somewhat ironic in view of the fact there is no place in the entire Republican budget where the majority seeks to find more savings, or, placed in a better context, there is no place where reductions from real needs have been more savaged by the Republicans than in Medicare part A. Yet, the majority wants to reduce $123 billion from protected Medicare part A spending. If that is what they do to programs that they claim are safe, I hate to see what they would do to programs they dislike. What I am saying is the sound and fury from the other side with the President's shift in home health care--he is shifting it into an area that would make it safer. The President is taking and transferring this out of the part of the budget that the Republicans are savaging with cuts that would be far below real needs. Once again, I am not sure we are talking about apples and apples and apples and oranges here. Suffice it to say, I think so far the attack on the President's budget, while, once again, I say is not perfect in my eye, is not honest and straightforward. I think some of their arguments are somewhat suspect. Mr. President, one more quote, again from my remarks of yesterday, that are found on page 203 of the committee report: The Republican budget is rife with gimmicks. The tax cuts mysteriously drop off from $23 billion to $16 billion by the year 2002. The Republicans count on savings towards balancing the budget from spending cuts that they already used in the Kennedy-Kassebaum health bill. They similarly count twice the savings in housing. Without these gimmicks, the Republican budget would not be in balance. I only cite that, Mr. President, to say this Senator, too, could be charged with trying to undermine the Republican budget. The term ``gimmicks'' in the President's budget was used by my friend and colleague from Washington in remarks just concluded. This Senator used the term ``gimmicks'' yesterday explaining shortcomings that I see in the Republican budget. I do not believe that either of us should keep hounding the other side on gimmicks because the facts of the matter are, there are lots of things in the President's budget and there are lots of things in the Republican budget that could be deemed as gimmicks. Those of us who call parts of the Republican budget gimmicks and, likewise, when the Republicans call parts of the President's budget gimmicks, we are voicing an opinion. Only time will tell whether it is true or not. While I have attacked parts of the Republican budget as gimmicks, I say in the end what we should all do is recognize and realize that gimmicks or no gimmicks, the Congressional Budget Office, which we all recognize as a legitimate referee, has certified that, in their opinion, both budgets reach balance by the year 2002. And I suspect, because I respect the professionalism of the Congressional Budget Office, that they are not necessarily blind-sided by what the Senator from Nebraska calls gimmicks in the Republican proposal, or likewise, when the Republicans charge that parts of the President's budget has gimmicks in it. So, gimmicks or no gimmicks, I think we should get on with the debate by recognizing that while there is legitimate criticism in order to both of the budget proposals, I hope that we can get off the kick of saying it over and over again that the President's budget does not balance and that the Republican budget does not balance. We can say that, but I think it contributes not a great deal to the legitimate discussion, since it is a moot point. The Congressional Budget Office has said that both budgets are balanced. I think there is plenty of room for debate on changes that should be made to improve the two budgets. But let us, hopefully, agree that we are talking about two budgets that do meet balance by the year 2002, and that should not be a key part of the debate. I reserve the remainder of my time and yield the floor. Mr. GORTON addressed the Chair.

Mr. EXON

Mr. EXON. I guess I was wrong on that, Mr. President. I was ready to offer an amendment. I would have gone next. Out of deference to the agreement we made, I am not offering that. So I guess the slot really would be on our side. I see nothing wrong if the Senator agrees that Senator Rockefeller will take the place of the Democratic slot I was prepared to take, and then the next amendment will be on your side. Eventually, sometime tonight, we will get back to the Exon amendment that is being temporarily set aside.

Mr. EXON. Mr. President, Senator Rockefeller is here. We are trying to move things along. He is ready to offer an amendment. We had a discussion here a few moments ago. As I understood it, the arrangement would be that there would be no more votes before 8 o'clock, and that, in the meantime, we had agreed to set aside, temporarily, the Exon amendment, which is before the body, to allow other amendments to be offered. I am pleased to see my friend from New Mexico here. Senator Rockefeller is here. I ask unanimous consent that the Exon amendment be temporarily set aside for the purpose of other people offering amendments. I simply say that, under the rules that are still in effect, it would be the Republican's turn to offer an amendment. If there is no Republican here and ready to offer an amendment, with the approval of the chairman of the committee, we could recognize Senator Rockefeller for his amendment.

Mr. EXON. Mr. President, I suggest the absence of a quorum and ask that the time be charged equally to both sides.

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

Mr. EXON. I yield as much time as is necessary to the Senator from West Virginia for the purpose of offering and explaining the amendment.

Mr. EXON

Mr. EXON. That is correct.

Mr. EXON. We will provide that amendment to you during the vote.

Mr. EXON. No. Let the Record show as the Senator from New Mexico indicated. We are going to start voting in about 5 minutes. The first vote will be a 15-minute vote, immediately following, without any intervention, by a vote on the amendment offered by the Senator from Missouri, and that will be a 10-minute vote. Mr. President, let me wind up briefly within the time I have left. I just find it a little bit odd that the Senator from New Mexico and the Senator from Missouri continue to complain that the discretionary numbers in the President's budget are too low. This has been mentioned by other Senators in debate, and I had this written down because I wanted to comment on it in closing. Mr. President, if the President's appropriated savings are steep, then the Republican appropriations savings are positively cataclysmic. That is the point. Over the 6 years of the budget, the Republican budget cuts $65 billion more from appropriations than does the President. And in the final year of the budget, 2002, the Republicans cut $13 billion more in appropriated spending in that 1 year than does the President. The Senator from Missouri knows that the Appropriations Committee will distribute those cuts--not this resolution. Indeed, neither the Republican budget, nor a Republican budget of any kind, contains program-by-program detail for appropriated accounts. The fairest comparison of appropriations in the outyears, therefore, is to compare totals of spending levels. If I need additional time to close, I take it off of the time I have on the amendment. In sum and in closing, the Republicans want to cut projected spending on the very poorest in the Nation. We want to plug some corporate loopholes that have been alluded to here and some specifics, and there are many more. We agree. We want to honor our veterans. That is the reason for this Democratic amendment. The real question is whether we want to protect the disabled kids or the corporations who are moving jobs overseas. Mr. President, I yield any remaining time that I have. I believe the Chair will confirm that we have previously agreed to the yeas and nays on the Exon amendment. I ask for the yeas and nays.

Mr. EXON

Mr. EXON. Mr. President, I yield 2 minutes to the Senator from North Dakota.

Mr. EXON. We are ready. That sequence, just to set the record straight, we would vote on the Exon amendment first and the amendment from the Senator from Missouri second. And I believe, if I remember correctly, the first vote would be a 15-minute vote, and the second vote, I believe it was stipulated by the Senator from New Mexico, is to be 10 minutes. Is that the Senator's understanding?