J. Exon

Mr. EXON

Mr. EXON. Mr. President, I yield 4 minutes to the Senator from California.

Mr. EXON

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, 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, 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. EXON. Mr. President, in keeping with what we have done several times today, I ask unanimous consent at this time that the Senator from Georgia be recognized for appropriate remarks on the tragedy that faced all of us today, especially the U.S. Navy.

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. 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, 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. 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. EXON. I will be glad to yield to the Senator from Alaska on the same basis.

Mr. EXON. Mr. President, suffice it to say I still have not recovered from the shock. I find myself in one of those positions that maybe we have all found ourselves in sometimes, having some kind of a bad dream but you know it will all turn out right and you will wake up. I am asking myself, am I having a dream? Obviously, I am not. This is a terrible, terrible shock. I simply want to join the others in wishing the best to the family. Our prayers are with all of them during these very, very difficult times.

Mr. EXON. Mr. President, I ask unanimous consent that before the whip leaves that I may just say a word or two and ask a question of him. We have had a lot of shocking developments around this place, but none has shocked me more than the statement he just made. Admiral Boorda was a truly outstanding man, a great friend of mine. In fact, the last time that I saw him was just a few weeks ago. And he stopped in my office, without any notice whatsoever, and he said that ``I have nothing on my mind at all except to thank you for all the help that you have been over the years to the U.S. Navy.'' That is the kind of person he was. Do you have any details at all on this? This had to be a very sudden affair. Do you know what caused his death? Could you explain a little bit?

Mr. EXON

Mr. EXON. Mr. President, when I introduced the President's budget this morning, I indicated that there were several features of the President's budget that I wish to change and would attempt to make changes in. One of those certainly was the fact that the Veterans Affairs allocation under the President's budget was not one that those of us on this side of the aisle were satisfied with. So I thank the Senator from Missouri, who has brought up this matter. We recall during the deliberations of the Budget Committee that it was something we wished to correct also. We may have some differences of opinion on where the money should come from to do the correction. But I simply say that I think we all agree that a correction has to be made. This is one of the things I had in mind--without spelling them out-- when I said I am for the President's budget, with some changes. This is one of them. I want to say that I am offering an amendment that will precede the vote on the amendment of the Senator from Missouri, along the same lines. I am taking the money from a different source. Regardless of where the money comes from, it is something that will probably have 100 votes for to make a correction in this particular area. However, after we finish this debate, as agreed to previously, I will offer my amendment and we will vote on that first. It essentially does the same thing as the Senator from Missouri does, but it takes the money to fund it from a different source. We will not need to go into that in any great detail now. We might talk about that when I offer my amendment. I want to correct one thing before we finish debate on the amendment offered by the Senator from Missouri. We may be wrong, Mr. President, but I would simply note that we feel--I state this for the Record--if corrections are necessary by the offer of the Senator from Missouri, we will certainly cooperate in trying to offer an amendment. We feel that the amendment offered by the Senator from Missouri attempts to increase spending for veterans, which is a worthy cause. We agree with that. His amendment raises the functional category for veterans. Unfortunately, the amendment as drawn, in our view, would not increase discretionary spending, which I think the Senator from Missouri wants to do; that is, the discretionary spending limits and the appropriations caps as it affects that. So, in reality, it is our view that the Senator's amendment would merely cut income security and leave the discretionary spending levels just the same as in the President's budget. I am sure that is not his intent. I am just making that suggestion. Is that something that the Senator has agreed with? Should we correct it? If so, in fairness, we would like to give time to do it. If we are not reading this right, please tell us so. I want to call it to the Senator's attention in the interest of fairness.

Mr. EXON. I yield 1 minute to the Senator from North Dakota.

Mr. EXON. Mr. President, I ask unanimous consent that this time not be charged to either side, as we have been doing all afternoon.

Mr. EXON. Once again I say, whether it triggers or not, this is an honest chart on honest numbers that has been verified by the CBO. Are you indicating there is something tricky about these numbers?

Mr. EXON. The automatic trigger, we went through that earlier, did we not?

Mr. EXON

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. EXON. That is correct.

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

Mr. EXON. Mr. President, I think we should alert all--and I believe the managers of the bill would agree--that we, most likely, will start voting in about 5 minutes, is that right?

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.