John Kerry

Mr. KERRY

Mr. KERRY. Madam President, I rise to speak on something else, but I will say very quickly, I have listened to colleagues on the other side of the aisle lamenting where we are today. It has been 11 months since a new President was inaugurated and, obviously, everybody understands this is not a mess he created. The last 8 years of the stewardship of this country, where there was never one appropriations bill vetoed in that entire time, is an extraordinary story of public negligence and even malfeasance. We are where we are. We are creating jobs. The economy is turning around. We had the least loss in the last 11 months. We are beginning to see those changes. We will ultimately have the strength in our economy to deal with this deficit. Tribute to David McKean Madam President, I rise for a different reason right now. It is a bittersweet privilege for me to speak about my friend and my counselor, David McKean, staff director of the Foreign Relations Committee, who is leaving the Senate at the end of this month to become the chief executive officer of the John F. Kennedy Library Foundation. I have enjoyed the benefit of David's advice for almost 20 years now. He will be sorely missed. My only consolation is, this son of Massachusetts will again be able to vote for me. He has been a part of my life in the Senate since 1987, when I was a freshman and he was a younger and idealistic legislative assistant. Over the years, I have drawn significantly on his knowledge and his skills. He leaves the Senate now to continue in public life, but he leaves it a little bit older but still idealistic and young at heart. When he came to our office, he had already made a mark. He had graduated magna cum laude from Harvard College and received a law degree from Duke University and a master's degree from the Fletcher School of Law and Diplomacy. He also taught English at the Waterford Kamhlaba School in Swaziland, Africa. But he was a crusading soul deeply interested in public policy, with a zeal for investigations and an instinct to hold Washington accountable. He was looking for a place to put all those interests to work in the Senate, and he found it. But he also found something more, I might add--much more--that summer of 1987. There was a young Kellogg fellow from the University of Pennsylvania working in my office at that time. Her name was Kathleen Kaye. She was extraordinarily smart and committed. David did not fail to notice those qualities and a lot more. Their marriage and their three wonderful children, who I am pleased to say are with us right now, Shaw, Christian, and Kaye, are a tribute and more to the relationship they share. David has devoted his career to public service. After 5 years of working in my office, he moved across the Capitol as chief of staff to another member of the Massachusetts delegation, Representative Joe Kennedy. He later became special counsel at the Commodity Futures Trading Commission before returning home to the Senate as deputy chief counsel at the Governmental Affairs Committee and staff director of the Permanent Subcommittee on Investigations. I failed to mention that before going to the Permanent Subcommittee, he worked with my staff early in his career in helping to develop one of the great investigative efforts in the Senate in recent memory, which was the BCCI investigation. That wound up on the cover of Time magazine and was a seminal report--one of the best reports I have seen in the 26 years I have been here. In 1999, I was lucky to entice him to come back to my office as chief of staff. It turned out to be his longest tenure in any of those public jobs so far. Earlier this year, when I became chairman of the Foreign Relations Committee, he became the staff director. David is the ultimate team builder and a magnet for great talent, so he would be the first to tell you that his success did not come single- handedly. But it is clear David played the essential role in turning 2009 into a stellar year for the committee and for its new chairman. Under his guidance, we conducted 125 hearings on topics ranging from Afghanistan to Zimbabwe. We secured passage of the Enhanced Partnership with Pakistan Act, and we won approval of legislation bringing far- reaching reform to our foreign assistance program. He has worked tirelessly with the committee members and the White House over the past year, and our record is a testament to his determination and skill. I think our committee has succeeded in going through the nominations of more people and passing them more rapidly to the floor than any other in the Senate, and I congratulate him for that effort. Somehow, during his career of service, he has found time to indulge in his passion for history and scholarship. He is the author of a highly acclaimed biography of Tommy Corcoran, the ultimate Washington insider. He also wrote a biography of Clark Clifford, which was a New York Times ``notable book of the year,'' and he is the coauthor of ``The Great Decision,'' which skillfully, and perhaps surprisingly, transformed the story behind the Supreme Court's landmark Marbury v. Madison case into what the Washington Post called ``a political thriller.'' As those of you in this body know, we are--all of us--really only as capable or competent as our staff. Over the years, I have depended on David McKean at every stage. He has been the consummate adviser-- trustworthy, loyal, unafraid of speaking up when I was about to veer off in the wrong direction--which, clearly, was very seldom indeed. Never was he more valuable to me than in the immediate aftermath of the 2004 Presidential election. Forty-eight hours after an election night-- and early morning and early afternoon--that didn't end up the way that I had hoped it might, I returned to the Senate for a vote. Back to work. I don't remember what the vote was about, but I do remember that David was there with a plan to get us through the day and the next 2 years. I will miss that wisdom and guidance. Our loss is the Kennedy Library's gain. In some ways, I think something like the Kennedy Library is the perfect place for this man who is at heart a scholar and an intellectual. But the Kennedy Library is particularly well-suited to David because it is a place Jackie Kennedy hoped would help turn history into advocacy and activism, and I have no doubt David's vision and experience will help to ensure that the legacy of President Kennedy endures to inspire future generations. Madam President, I want to close by simply saying that my colleagues and I are grateful for David's distinguished service. I will personally miss him very much. I wish him, Kathleen, and their children my very best as they return home to Massachusetts to start this next special chapter in David's career in public service. I yield the floor, and I suggest the absence of a quorum.

Mr. KERRY

Mr. KERRY. Mr. President, from the Marshall Plan to tsunami relief, America's arsenal has always been most powerful when we have marshaled not just the force of our arms but the power of our ideals. It is no secret that for 8 recent years, the United States seemed to have broken with some of our best tradition and time-honored values--and it set back our security to be so isolated in the world. I have said many times that even the most powerful Nation needs some friends on this planet. Now, 1 year into President Obama's administration, the time is right for a robust public diplomacy to advance our interests in the world and to enhance our national security. That is the conclusion of a new report from New York University's John Brademas Center for the Study of Congress. The center, well known to the Senate for its research and recommendations for new perspectives on public policies, recommends in its report that international arts and cultural exchanges be incorporated more fully into the planning strategies of U.S. policymakers. Mr. President, this is a timely and important study. I recommend it to the Senate and ask that it be printed in the Record.

Mr. KERRY

Mr. KERRY. Mr. President, I wish to congratulate Richard R. Jennings of Wilmington, MA, for the honor he received from the Smithsonian Institution at the American History Museum earlier this year. Mr. Jennings was recognized for his long service with the Railway Mail Service. The 85-year-old Mr. Jennings is one of the last survivors of one of the most important innovations in the history of mail service in the United States. Mr. Jennings was honored as part of a postal service exhibit at the American History Museum last summer. In addition to the recognition he received, the Smithsonian also recorded Mr. Jennings's memories of his years as part of the Boston-to-Albany and the Boston-to-New York ``mail by rail'' routes--part of a network that was so important to U.S. mail service before the airlines took over much of the service. The Railway Mail Service began in the mid-19th century but grew in importance as the railroads became dominant in transportation until the mid-20th century. ``Mail by rail'' was quite successful--dramatically increasing the speed of delivery of mail, especially over long distances. Mr. Jennnings and his fellow Railway Mail Service clerks were considered the elite of the Postal Service's employees. And for good reason. Their jobs were exhausting and dangerous. They were required to sort 600 pieces of mail an hour in a speeding train that could wreck-- and occasionally did. The potential for danger certainly added pressure to an already difficult job. In addition to changing our postal system, the Railway Mail Service was the source of an expression well known in the United States. Empty mail sacks and sacks filled with damaged, misaddressed or otherwise unsortable mail were referred to as ``bums.'' And before the trains would leave the stations along their routes, rail clerks would often shout ``throw the bums out.'' Mr. Jennings served this country in important ways, not only as a postman in the ``mail by rail'' network but also as a sergeant with the U.S. Army Medical Corps in Italy and North African during World War II. There, as much as with the ``mail by rail'' service, Mr. Jennings helped to ``throw the bums out.'' Mr. Jennings deserves our thanks for his unique and great service to our country. I congratulate him and his family and I share their pride in him and his important role in the history of our country's Postal Service.

Mr. KERRY

Mr. KERRY. Mr. President, anyone who has served in our Armed Forces or who has had a loved one in uniform understands just how difficult the holiday season can be--separated from husbands, wives, fathers, mothers, daughters, and sons. It can be the loneliest time of the year. Dick and Christine Moody understand that better than most, and since 2003 they have worked tirelessly to make the holidays a little cheerier for the men and women who keep America safe. They have done it with Operation Troop Support, the organization they founded 6 years ago as a way to say thank to those serving in the military. Since its founding, Operation Troop Support has sent more than 25,000 care packages to men and women in the military abroad. These packages are sent throughout the year, but during the holidays extra care is taken to see that the season is a little brighter for the troops. And it is for that reason that during this holiday season, I would like to recognize and commend Dick and Christine Moody for their efforts-- efforts that have earned them national recognition and the accolades of the National Military Family Association, the Employer Support to the Guard and Reserve, ESGR, and numerous State and local officials. I also want to recognize the hundreds of volunteers who have contributed their time, energy and money to Operation Troop Support. The support the North Shore community has given the organization has been inspiring. Volunteers have spent countless hours boxing the care packages, and they have donated thousands of dollars to ship the packages to ensure that each soldier, marine, airman and sailor receives something during the holiday season. I had the opportunity to meet with many of the Operation Troop Support volunteers while attending a St. Patricks Day luncheon hosted by the organization last year. During the luncheon, I spoke with a soldier, Thomas Lanzoni, who had recently returned from Iraq. Inspired by the volunteers of Operation Troop Support, Sergeant Lanzoni walked across the Commonwealth of Massachusetts to raise money and awareness for the Moodys's organization. Dick and Christine Moody understand the special burden placed on military families. Dick spent 23 years in the Air Force and retired as a lieutenant colonel. Additionally, the Moodys have a son and a daughter who have served abroad in the Air Force. The military has long been a part of their life. Consequently, Operation Troop Support not only supports the troops in the field but also hosts family support group meetings for the loved ones of servicemembers deployed or about to be deployed overseas. I salute the Moodys and Operation Troop Support for their service and dedication to our country. Their gestures of gratitude have reached thousands of servicemembers, reminding each of them that we support them and their families while they are deployed and when they return.

Mr. KERRY

Mr. KERRY. Madam President, I was necessarily absent for the vote on the motion to table the Hutchison motion to commit to the health care bill, H.R. 3590. If I were able to attend today's session, I would have voted to table the Hutchison motion to commit.

Mr. KERRY

Mr. KERRY. Mr. President, today I am introducing the Taxpayer Responsibility, Accountability and Consistency Act of 2009 which will provide a level playing field to America's workers to ensure they are afforded protections already in the law, such as workers' compensation, Social Security, Medicare, payment of overtime, unemployment compensation, and the minimum wage. This legislation is cosponsored by Senators Durbin, Harkin, Schumer, Brown, Menendez, and Kirk. Under current law, employers are required to take certain actions on behalf of their employees including withholding income taxes, paying Social Security and Medicare taxes, paying for unemployment insurance, and providing a safe and nondiscriminatory workplace. Employers are not required to undertake these obligations for independent contractors. When workers are misclassified, businesses that play by the rules lose business to competitors that do not play by the rules and workers lose valuable rights and protections. The Internal Revenue Service, IRS, currently uses a common law test to determine whether a worker is an employee or independent contractor. Unfortunately, a loophole exists which allows a business to escape liability for misclassifying employees as independent contractors. Furthermore, there is statutory prohibition on the IRS providing guidance through regulation on employee classification. Federal and State revenue is lost when businesses misclassify their workers as independent contractors. A study estimated that, between 1996 and 2004, $34.7 billion of Federal tax revenues went uncollected due to the misclassification of workers and the tax loopholes that allow it. Recent GAO and Treasury Inspector General reports have cited misclassification as posing significant concerns for workers, their employers, and government revenue. A study commissioned by the U.S. Department of Labor in 2000 found that up to 30 percent of firms misclassify their employees as independent contractors. State studies also show that misclassification is on the rise. In Massachusetts, the rate of misclassification has grown from 8.4 percent in 1995 through 1997 to a rate of 13.4 percent in 2001 through 2003. Misclassification is more rampant than studies indicate. Studies cannot adequately capture the ``underground economy,'' where workers are paid off the books, often in cash. Unreported cash is one aspect of this problem and it is difficult for the IRS to discover because employers have no record of pay. States have been leading the way in documenting and recovering taxes related to the misclassification of workers. In the Commonwealth of Massachusetts, Governor Deval Patrick has tackled this issue head on and created an interagency task force on the underground economy and employee misclassification. The purpose of the task force is to gather information and assess current enforcement resources in an effort to improve current enforcement methods. The Federal Government needs to follow the lead of the States by addressing the current safe harbor. The determination of whether an employer-employee relationship exists for federal tax purposes is made under a common-law test that has been incorporated into specific provisions of the Internal Revenue Code or is required to be used pursuant to Treasury regulations. In 1987, based on an examination of cases and rulings, the Internal Revenue Service developed a list of 20 factors for determining whether an employer-employee relationship exists. The IRS recognizes that there may be relevant factors in addition to the 20 factors. Most recently, the IRS has structured its inquiry into three groupings: behavioral control, financial control, and the relationship of the worker and firm. Section 530 of the Revenue Act of 1978 generally allows taxpayers to treat a worker as not being an employee for employment tax purposes, regardless of the worker's actual status under the common law test, unless the taxpayer has no reasonable basis for such treatment or fails to meet certain requirements. Section 530 is commonly referred to as a ``safe harbor.'' This provision was initially enacted for a year to give Congress time to resolve these complex issues. In 1982, the safe harbor provision was made permanent. The Taxpayer Responsibility, Accountability and Consistency Act of 2009 would address the current loophole by requiring information reporting and making changes to the safe harbor. It would require businesses that pay any amount greater than $600 during the year to corporate providers of property and services to file an information report with each provider and with the IRS. A similar provision has been proposed by both Presidents Obama and Bush. This provision will ensure that contractor income is accurately reported in order to prevent fraudulent underpayment of taxes. The Taxpayer Responsibility, Accountability and Consistency Act of 2009 revises the safe harbor and makes it part of the Internal Revenue Code of 1986. The safe harbor would continue to be available to employers for purposes of shielding them from liability, but it will be narrowed to reduce abuses and to ensure they had a genuinely reasonable basis for not treating such individual as an employee. Under the Taxpayer Responsibility, Accountability and Consistency Act of 2009, an employer shall be treated as having a reasonable basis for treating an individual as an independent contractor only if the decision was based on a written determination by the IRS to the taxpayer addressing the employment status of such individual or another individual holding a substantially similar position with the taxpayer, or a concluded employment tax examination by the IRS. The current safe harbor would continue to apply to services rendered up to one year after the date of enactment; after that, the new safe harbor would apply to services rendered more than one year after the date of enactment. I urge my colleagues to cosponsor the Taxpayer Responsibility, Accountability and Consistency Act of 2009 which will provide valuable protections to workers who are erroneously misclassified and help combat the underground economy.

Mr. KERRY

Mr. KERRY. Mr. President, today I am introducing the Taxpayer Responsibility, Accountability and Consistency Act of 2009 which will provide a level playing field to America's workers to ensure they are afforded protections already in the law, such as workers' compensation, Social Security, Medicare, payment of overtime, unemployment compensation, and the minimum wage. This legislation is cosponsored by Senators Durbin, Harkin, Schumer, Brown, Menendez, and Kirk. Under current law, employers are required to take certain actions on behalf of their employees including withholding income taxes, paying Social Security and Medicare taxes, paying for unemployment insurance, and providing a safe and nondiscriminatory workplace. Employers are not required to undertake these obligations for independent contractors. When workers are misclassified, businesses that play by the rules lose business to competitors that do not play by the rules and workers lose valuable rights and protections. The Internal Revenue Service, IRS, currently uses a common law test to determine whether a worker is an employee or independent contractor. Unfortunately, a loophole exists which allows a business to escape liability for misclassifying employees as independent contractors. Furthermore, there is statutory prohibition on the IRS providing guidance through regulation on employee classification. Federal and State revenue is lost when businesses misclassify their workers as independent contractors. A study estimated that, between 1996 and 2004, $34.7 billion of Federal tax revenues went uncollected due to the misclassification of workers and the tax loopholes that allow it. Recent GAO and Treasury Inspector General reports have cited misclassification as posing significant concerns for workers, their employers, and government revenue. A study commissioned by the U.S. Department of Labor in 2000 found that up to 30 percent of firms misclassify their employees as independent contractors. State studies also show that misclassification is on the rise. In Massachusetts, the rate of misclassification has grown from 8.4 percent in 1995 through 1997 to a rate of 13.4 percent in 2001 through 2003. Misclassification is more rampant than studies indicate. Studies cannot adequately capture the ``underground economy,'' where workers are paid off the books, often in cash. Unreported cash is one aspect of this problem and it is difficult for the IRS to discover because employers have no record of pay. States have been leading the way in documenting and recovering taxes related to the misclassification of workers. In the Commonwealth of Massachusetts, Governor Deval Patrick has tackled this issue head on and created an interagency task force on the underground economy and employee misclassification. The purpose of the task force is to gather information and assess current enforcement resources in an effort to improve current enforcement methods. The Federal Government needs to follow the lead of the States by addressing the current safe harbor. The determination of whether an employer-employee relationship exists for federal tax purposes is made under a common-law test that has been incorporated into specific provisions of the Internal Revenue Code or is required to be used pursuant to Treasury regulations. In 1987, based on an examination of cases and rulings, the Internal Revenue Service developed a list of 20 factors for determining whether an employer-employee relationship exists. The IRS recognizes that there may be relevant factors in addition to the 20 factors. Most recently, the IRS has structured its inquiry into three groupings: behavioral control, financial control, and the relationship of the worker and firm. Section 530 of the Revenue Act of 1978 generally allows taxpayers to treat a worker as not being an employee for employment tax purposes, regardless of the worker's actual status under the common law test, unless the taxpayer has no reasonable basis for such treatment or fails to meet certain requirements. Section 530 is commonly referred to as a ``safe harbor.'' This provision was initially enacted for a year to give Congress time to resolve these complex issues. In 1982, the safe harbor provision was made permanent. The Taxpayer Responsibility, Accountability and Consistency Act of 2009 would address the current loophole by requiring information reporting and making changes to the safe harbor. It would require businesses that pay any amount greater than $600 during the year to corporate providers of property and services to file an information report with each provider and with the IRS. A similar provision has been proposed by both Presidents Obama and Bush. This provision will ensure that contractor income is accurately reported in order to prevent fraudulent underpayment of taxes. The Taxpayer Responsibility, Accountability and Consistency Act of 2009 revises the safe harbor and makes it part of the Internal Revenue Code of 1986. The safe harbor would continue to be available to employers for purposes of shielding them from liability, but it will be narrowed to reduce abuses and to ensure they had a genuinely reasonable basis for not treating such individual as an employee. Under the Taxpayer Responsibility, Accountability and Consistency Act of 2009, an employer shall be treated as having a reasonable basis for treating an individual as an independent contractor only if the decision was based on a written determination by the IRS to the taxpayer addressing the employment status of such individual or another individual holding a substantially similar position with the taxpayer, or a concluded employment tax examination by the IRS. The current safe harbor would continue to apply to services rendered up to one year after the date of enactment; after that, the new safe harbor would apply to services rendered more than one year after the date of enactment. I urge my colleagues to cosponsor the Taxpayer Responsibility, Accountability and Consistency Act of 2009 which will provide valuable protections to workers who are erroneously misclassified and help combat the underground economy.

Mr. KERRY

Mr. KERRY. Mr. President, I wanted to ask the minority leader--some of us are a little bit perplexed. I know the Senate has its rules, and we try to work through them. But we also at this time of year often try to accommodate families and schedules and so forth. I am curious as to whether the minority leader might not consent to allowing us or why it is that we couldn't, since Senators are here today, schedule the vote and agree to have the vote on the 60-vote margin today rather than tomorrow morning, requiring all staff and everybody in the Senate to come in on a Saturday.

Mr. KERRY. Mr. President, if I could respond, I don't mean to assert myself in any way that is inappropriate with respect to the leader, but we all know that in the workings of the Senate, what we are doing is both complicated and serious and critical to the country. We are waiting for CBO to appropriately, consistently--as a member of the Finance Committee, we adhered to a very strict notion that we would try to find the precise modeling and cost of whatever it was we might do. It is entirely appropriate, to have a proper debate or discussion, that we know exactly what the cost is of any particular proposal. That is what we are waiting for. So the majority leader is appropriately trying to move another piece of legislation that is ripe, that is important to the country. This is just a question of courtesy to Senators and to their families and to the staff of the Senate who have been working extraordinarily hard. The question is simply, why, as a matter of convenience, we couldn't schedule a vote for today instead of being scheduled for tomorrow. We could do that by unanimous consent.

Mr. KERRY. Mr. President, I ask unanimous consent that the vote scheduled for tomorrow morning be held instead today at some convenient time within the next hours.

Mr. KERRY

Mr. KERRY. Mr. President, I rise as a cosponsor for S. 428, the Freedom to Travel to Cuba Act. It is time we brought our strengths to bear--our people, our vision, our energy--to help the Cuban people shape the future direction of Cuba and to fix a policy that has manifestly failed. For America to act as the great power we are, with confidence in our values and vision, we need a Cuba policy that looks forward. The truth is, we have reached out to countries where our wounds were far deeper, and far more recent. When John McCain and I led the efforts to unfreeze our relationship with Vietnam, we said: ``let's be honest . . . the Cold War is over. All the American trade embargo is doing is keeping Vietnam poor and thus encouraging a flood of refugees.'' For nearly 20 years after the fall of Saigon, the Vietnam war took a less bloody but equally hostile form. The U.S. and Vietnam had no diplomatic relations. Vietnamese assets were frozen. Trade was embargoed. But in 1995 the United States normalized relations with Vietnam. The Cold War had ended, and we even signed a trade deal with a country where 58,000 Americans had given their lives. The results? A Vietnam that is less isolated, more market-oriented, and, yes, freer--though it has miles to go. And yet, when it comes to Cuba, a small, impoverished island 90 miles off the shores of Florida, we maintain a policy of embargo--motivated by past grievance, not present realities and future dreams. Fidel Castro has stepped aside from day-to-day government, there is a new American President, and Cuban-Americans increasingly want broad, far- reaching interaction across the Florida Straits. Times are changing, and we cannot live in the past. Forty-seven years ago, I was in my first semester of college when Soviet missiles, deployed in Cuba, threatened to set the world on fire. No one who lived through those thirteen harrowing days in October will ever forget them. Certainly, the threat from Cuba was real. It is true that we continue to disapprove of Cuba's dismal human rights record and palpable lack of freedom. And it is also true that, over 50 years, the embargo can claim some successes. For example, it can be reasonably argued that U.S. pressure contributed to Cuba's decision to cease its military adventurism in Africa and its support for the violent insurgencies that ripped apart Central America in the 1980s. But on the two most important questions, the verdict is decisive: First, did this policy fulfill its often-stated purpose of overthrowing the Castro regime? Fidel Castro outlasted nine American Presidents, from Eisenhower to Clinton, and retired only for reasons of health during the tenth. When he passed on the reins to his brother, Fidel joined Omar Bongo of Gabon and Libya's Colonel Qaddafi as one of the world's longest-serving head of states. Second, have the benefits of our policy outweighed the costs? It is hard to argue they have. The embargo has cost Cubans access to our markets, and for many years to our food and medicine--with little progress to show. But it has cost us as well. It has limited the influence of our people and our democracy. What's more, this fall's U.N. vote condemning America's embargo showed yet again: Cuba is not the only country isolated by our policy. The vote against our policy was 187 to 3. All of our major allies voted against us, and one of the two voting with us itself routinely trades with Cuba. Is it morally satisfying to sanction a government whose human rights practices we abhor and whose political system rejects many of our values? Sure. And helping Cubans to live in democracy and liberty absolutely remains a goal of American policy. But for 47 years now, we have endorsed an embargo in the name of democracy that produced no democracy! In fact, our rhetoric and policies have actually helped to consolidate the Cuban government. We have provided the Castro regime with an all-purpose--if exaggerated--excuse to draw attention away from its many shortcomings, including its shamelessly flawed economic model. For too many Cubans, our threats have legitimized Castro's outsized nationalism and repression of opponents. Our posture has played to his strengths. At the same time, we have not brought our strengths to bear--our people, our vision, our energy, our opportunities. It is time for America to act as the great power it is--with greatness built on confidence in our values and vision. Of course, the greatest cost of our policy has been borne by the Cuban people themselves. Jose Marti, Cuba's great ``Apostle'' and man of letters, once said: ``Everything that divides men, everything that classifies, separates or shuts off men, is a sin against humanity.'' More than 70 percent of Cuba's 11\1/2\ million people have lived their entire lives in this stalemate. A Cuban boy or girl of 10 when Fidel Castro drove victorious into Havana is 60 years old today. His whole life has been spent deprived of basic freedoms but also deprived--in accordance with U.S. policies except during brief periods--of interaction with America's people. We must have the courage to admit the need for a new approach. President Kennedy, who instituted sanctions against Cuba, had by mid- 1963 set in motion secret contacts aimed at normalizing relations. Ford and Carter, too, looked for ways out of the box. George H.W. Bush cooperated with Cuba on the Angola peace accord, and his administration even dangled a promise of improved ties with America. Each initiative failed for a different reason, but all were grounded in the same recognition: there must be a better way forward. Fortunately, we know there is a different strategy that can succeed. The Clinton administration worked to refocus our policy around what matters: on the Cuban people, not the Castro brothers; on the future, not the past; and on America's long-term national interests, not the political expediencies of a given moment. The Clinton administration promoted people-to-people relations ``unilaterally''--without conditions on Havana. We worked to improve bilateral cooperation on issues like migration and combating drug trafficking, which were clearly in our national interest. Family travel in both directions quickly skyrocketed. And tens of thousands of Americans from across society--church members, academics and students, medical professionals, athletes, journalists, and more--were permitted to interact with their Cuban counterparts. Those policies sent a clear and effective message to the Cuban people: the United States is not who your leaders say we are. Our problem is not now, nor has it ever been, with the Cuban people. We completely changed the dynamic: A synagogue with holes in its roof so big that birds flew around the sanctuary has been repaired with funds and materials from American supporters. Environmentalists worked together to save species and protect our shared environment. The children who received bats and balls--and moral support--from Baltimore Orioles players visiting Cuba for an exhibition game will never forget the gesture of American generosity. And guess what. Across the board, Cubans seeking a better future for their country have said that nothing energized civil society in Cuba more than contact with U.S. civil society. Even Cuba's human rights and democracy activists benefitted immeasurably from the contact. Unfortunately, the Bush administration shut down most forms of contact and dramatically reduced our interactions to a tightly regulated, government controlled trickle. They tightened licensing procedures, reduced transparency, and put government in the people's way in what amounted to a unilateral suspension of Americans' ability to help Cubans shape their future. People-to-people relations were made secretive, filtered, and for narrow objectives. That is the opposite of pro-democracy. Regrettably, that was the record of the Bush administration: an enormous step backwards. Now it's up to the Obama administration to craft a Cuba policy that moves us forward. In May 2008, Barack Obama said on the Presidential campaign trail that it was ``time for a new strategy.'' While he wasn't ready to give up the embargo as a source of leverage, he did declare at the Summit of the Americas: ``The United States seeks a new beginning with Cuba,'' and announced that he was ``prepared to have [the] Administration engage with the Cuban government on a wide range of issues.'' As promised, the Obama administration has expanded licenses for Cuban-Americans--albeit only Cuban-Americans--to travel to Cuba. Controls on family remittances, gift parcels, and certain transactions with telecommunications companies were loosened as well. Mid-level talks about immigration matters and postal relations have resumed. And we've turned off an Orwellian electronic billboard flashing political messages from our Interests Section in Havana. These are positive steps, but they are only a start. So what comes next? At a minimum, the administration should use the authorities that it has to reinvigorate people-to-people relations--to unleash the energy of the American people who want to help Cubans build their future. The policy worked in the past and enjoyed wide support in both countries. When announcing expanded family travel, the President said, ``There are no better ambassadors for freedom than Cuban-Americans.'' But I think it's also fair to say that there are excellent ambassadors for freedom among the 299 million other Americans--religious faithful, teachers and students, environmentalists, scholars, doctors and nurses, political scientists, and artists--whose challenging minds, economic success, love for democracy, and advocacy of solid American values make them proud ambassadors as well. The New York Philharmonic and its board of directors have been brilliant representatives of America on trips to North Korea, Vietnam and around the world. I don't understand why the administration recently blocked their proposed trip to Cuba. What are we afraid of? Second, as we reinvigorate people-to-people diplomacy, the administration should review the programs that the Bush administration funded generously to substitute for it. The Senate Foreign Relations Committee is already undertaking an investigation into the need to reform Radio and TV Marti--programming beamed into Cuba at a cost of $35 million a year. Many Cubans call TV Marti ``La TV que no se ve'' because it has never, in 18 years of broadcast, had a significant audience in Cuba. Report after report has documented that the Marti services are hindered by bad management, weak professional tradecraft, and serious politicization. We are looking at whether its business model--as a ``surrogate service'' exempt from many Voice of America standards and regulations--has failed, and whether the TV service should be closed entirely and radio should be integrated into the high-quality VOA services. We ought to be especially concerned that human rights activists in Cuba a key bellwether audience are unanimous in their view that the Marti brand must be repaired. Meanwhile, USAID's civil-society programs, totaling $45 million in 2008, have noble objectives, but we need to examine whether we're achieving any of them. The Bush administration changed the program's focus from supporting the Cuban people to accelerating regime change, and the fact that some of our grantees have extravagantly high overheads has raised concerns about where all the money is going. It is also fair to ask whether these programs even work. Bush's refocus on regime change made it difficult for Cubans outside declared antiregime groups to accept the informational materials or assistance offered--even if they had a burning desire for it. Our interests section used to distribute tens of thousands of books a year to Cubans across the political spectrum and the books could be seen, well-worn, in government and Communist party think tanks. Today, politicization has reduced the flow of information to many of the very same people eager to steer Cuba toward a better future. The Foreign Relations Committee has begun a review of these programs. It is in the administration's interest to take the lead in overhauling them. Finally, as I mentioned at the outset, I want to address legislation that will go even farther toward fixing our Cuba policy. S. 428, the Freedom to Travel to Cuba Act, does not lift the embargo or normalize relations. It merely stops our government from regulating or prohibiting travel to or from Cuba by U.S. citizens or legal residents, except in certain obviously inappropriate circumstances. The Freedom to Travel to Cuba Act has strong support in Congress--33 sponsors in the Senate and 180 cosponsors for similar legislation in the House. I cosponsored similar legislation in the past, and I am proud to do so again. We are talking about restoring a fundamental American right--the right to travel--that is denied to Americans nowhere else in the world. Americans who can get a visa are free to travel to Iran, Iraq, Sudan, and even North Korea, and it makes no sense to deny them the right to travel to a poor island near Florida. There is a certain irony in the fact that Americans have to apply for licenses and wait, with little or no feedback, to travel to a country that we criticize for denying its citizens the right to travel. The current ban on travel contravenes the spirit of the Universal Declaration of Human Rights' statement that ``everyone has the right to leave any country, including his own, and to return to his country.'' Free travel also makes for good policy inside Cuba. Visits from Americans would have the same positive effects as people-to-people exchanges, but on a larger scale. Visiting Europeans and Canadians have already increased the flow of information and hard currency to ordinary Cubans, with a significant impact on the country. Cuba's economic model, for sure, remains profoundly flawed, and human rights conditions remain dismal. But the hard-currency sectors of the Cuban economy have significantly altered workers' dependence on the regime, introduced material incentives that are changing economic culture, and raised expectations, if not demands, for greater improvements in the future. After years of Cuban government propaganda, Americans are even better positioned than Europeans and Canadians to be catalysts of change. We can do more if we let them. That is one reason why all of Cuba's major pro-democracy groups support free travel. Freedom House, Human Rights Watch, and other groups critical of Cuba's government agree. Studies of change in Eastern and Central Europe show a direct correlation between contact with the outside world and the peacefulness and durability of democratic transitions. This is a policy whose time has come. Numerous polls of Americans--of Cuban origin and otherwise--show strong support. Non-Cuban-Americans have long supported easing restrictions. But here is what is surprising: one recent poll found that 59 percent of Cuban-Americans-- the group most widely thought to oppose a change in policy--actually support allowing all American citizens to travel to Cuba. As the proportion of Cuban Americans who arrived after 1980 increases, support for free travel is only growing. In fact, even many Cuban emigres 65 years and older, once passionately opposed to it, now favor free travel. This is a sea change in the attitudes of Cuban-Americans, and we should not ignore it. Change is in the air--in Havana, in Washington, and in major Cuban- American communities. I don't personally hold high hopes that the transfer of power from Fidel to Raul Castro and to the next generation of hand-picked loyalists portends rapid change, but it is obvious that the Cuba of today is not the Cuba of the 60s or even the 90s, and that our policy should not be stuck in time either. Cubans are searching for models for the future, and our economic system and democratic ideals appeal to them. In September, when the Colombian rock star Juanes came to Havana, by some estimates as many as a million people came to hear the concert. From the stage, he looked out at the Cuban people and started a simple chant: Una Sola Familia Cubana. The crowd roared approval at the thought of ending the conflict between Cubans across the Florida Straits. There is a hunger out there among the Cuban people. America should capitalize on it. They want contact with their own families, and they want contact with American people and American ideas. There is no other country in the world to which we have closed our lives as long as we have to Cuba. The Berlin Wall fell 20 years ago, but the wall separating Americans and Cubans has yet to come down. We have a choice to ignore change and resist it or to mold it and channel it into a new set of policies. After 50 years of trying to isolate and destroy, it's time to try working with the Cuban people and making a new future together.

Mr. KERRY

Mr. KERRY. Mr. President, for the Committee on Foreign Relations I report favorably the following nomination lists which were printed in the Record on the dates indicated, and ask unanimous consent, to save the expense of reprinting on the Executive Calendar that these nominations lie at the Secretary's desk for the information of Senators.

Mr. KERRY

Mr. KERRY. Madam President, I might pick up, if I may, on this issue of premiums. First, let me say it is astonishing to me how we are continuing here to have a debate about mythology and not reality. We keep trying to bring it back to reality. Our friends on the other side of the aisle, for better or worse, seem to be content to continue to try to scare America's seniors and to try to frighten people about this legislation overall. I was listening to the debate about premiums, whether premiums are going to go up or premiums are going to go down. Let me share with people who are listening, particularly seniors, who I hope will not be scared by the false assertions that have been made; let me tell you about the experience in the Commonwealth of Massachusetts where we passed landmark health care reform 3 years ago. Since implementing this plan in which we require--we require--every single citizen in the State to buy insurance, and employers are penalized if they do not provide insurance, the fact is that today in Massachusetts, the plan is working. The companies like it and the citizens like it because they have the coverage. In fact, coverage by companies, corporations, has gone up since we put it in place. There are more companies that now participate and find that it works for them than before. But most important, 432,000 people now have gained quality, affordable health care coverage where they didn't have it before. We have the lowest uninsured numbers in the United States of America and we are proud of that. In Massachusetts, 97.3 percent of our citizens--more than we are attempting to cover under the legislation we want to pass here--97.3 percent of our citizens are covered and have health insurance. Equally important, the newly insured have enrolled in all types of private and public coverage. There are 18 percent who are in the State's Medicaid; 40 percent are in something called Commonwealth Care, which is administered by the Commonwealth, the new subsidized plan; 33 percent are in employer-based coverage; and 9 percent are in a nongroup purchase plan. Let me say to the Senate, health reform has improved access in the Commonwealth of Massachusetts. There are fewer insured individuals who report cost as a barrier to being able to get care. In the last year, most Massachusetts residents--88 percent--had at least one visit to a doctor and 78 percent had a preventive care visit. A recent State survey found that 92 percent of individuals reported having a primary care provider in our State. As coverage has increased, the number of uninsured individuals going to hospitals for free care has declined. So we have reduced the number of people who sort of unfairly require everybody else to pay for their coverage when they go to a hospital and the hospital covers them, and it is paid for unevenly by the people who have coverage and by the corporations that have to make up the difference. That has gone down now. Now the free care has gone down because the people have a program, they have a plan, and they can go in and get the care that is afforded to them. Here is what is important--and I say this to my friend who is managing for the Republicans right now--the average premiums in the individual market fell dramatically in Massachusetts--falling from $8,537 at the end of 2006 to $5,143 in mid-2009. In other words, premiums, which we have been arguing about, in the individual market, fell by 40 percent, while the rest of the Nation saw a 14-percent increase. Which would you rather have, a program where you spread the risk more fairly, where you lower the premiums and you provide quality care for people who don't have coverage today or continue the status quo, where you get thrown off your insurance by a company that just wants to take the profit and doesn't care about the fact that you got sick; that cuts you off after you have paid your premiums because they find a little catchphrase in the clauses of the contract and they tell you: Sorry, you are not covered when you are sick, or you can't even get covered because you have a preexisting condition when you walk in and you try to get the coverage. I think the case is so clear it is almost unbelievable to me that we are here arguing about this at this point. But even more ridiculous is the following: The very same people who are coming to the floor right now and telling us not to slow the growth of Medicare, which is all that we are doing. We are not cutting any benefits. I hope every senior in America hears this. It is time to end these scare tactics. There is no cut in benefits. Every benefit currently under the law will continue to be given to the seniors of this country, and that is an obligation we have. But listen to what the people who are coming to tell you that there are cuts in your benefits used to say. I say used to say because it was when they had a Republican President and they were running the Senate. The fact is, back in June 2009, because of a report on the long-term budget outlook, we know, point-blank, that if we don't cut, if we don't do something to reduce the rate of growth in Medicare, by 2080, the Federal Government is going to spend almost as much a share of the economy on just its two major health programs as it spent on all its programs in every branch of government in recent years. The Medicare provisions in this bill take the necessary steps to try to reform the delivery system through value-based purchasing initiatives, through bundled payments. A bundled payment is when you give a hospital or a delivery provider a sort of global budget, if you will. You give them a big amount of money and you say: This is what we are giving you, and you have to manage with that amount of money, instead of paying them for every single time somebody comes in to do something. When you give them that global budget, that so-called bundled budget, it encourages the executives to do what they haven't done today, which is find the ways to deliver the same quality of care but to deliver it more effectively and more efficiently. We provide the creation of an innovation center to test new payments, to have comparative effectiveness research. Doesn't that make sense? We want to know if what they are doing in Wyoming or what they are doing in Colorado or some other part of the country makes as much sense as what they are doing in Kentucky or Massachusetts or West Virginia somewhere. By looking at the comparative effectiveness, we will all learn and become more effective and more efficient at delivering services. Thanks to the distinguished Senator from West Virginia, we create an independent Medicare advisory board, which will have a profound impact on forcing the Congress to make decisions we have avoided for far too long. Our colleagues who are here today saying: Don't do this. Don't be smart about Medicare. That is effectively what they are saying because that is what we are doing. We are trying to be smart about Medicare. We are not cutting any benefits. But they are coming here and telling you we are cutting benefits, even though in June of 1995, June 28, Senator Grassley from Iowa came to the floor and said: We propose slower growth of Medicare. Medicare would otherwise be bankrupt. On June 29, 1995 Senator John Kyl said: We do heed the warning of the Medicare board of trustees and limit growth to more sustainable levels to prevent Medicare from going bankrupt in 2002. Medicare, we think, is not going to go bankrupt until 2017. Thanks to what is in this bill, we actually extend the life of Medicare another 4, definitely, and hopefully 5 years. But here is what Senator Kyl said: Preventing Medicare from going bankrupt is what is necessary to make sure seniors do not lose their benefits altogether as a result of bankruptcy in 7 years. On June 29, 1995, Senator Hatch said: It is important to start the structural reforms which are necessary to make Medicare solvent in the long term. That is exactly what we are doing. That is precisely what we are doing, and we should have the support of Senator Kyl and Senator Grassley and Senator Hatch. On October 17, 1995, Senator Kyl said: We also know that it is necessary to prevent the Medicare program from going broke. The Republican budget will slow the growth in Medicare because the Medicare trustees have warned us that without doing so the system will go broke. I think that it is totally irresponsible for any organization in America to be scaring America's senior citizens. I am quoting Senator John Kyl: ``. . . irresponsible for any organization . . . to be scaring America's seniors.'' Yet here is the Republican Party scaring America's seniors. I wish to talk about what this legislation does and doesn't do because every claim that is being made is simply without foundation. This amendment is basically an amendment designed to try to gut this bill and what it does is condition any spending increases or tax reductions in the bill on certification that all costs in the bill are offset, without counting changes in Medicare or Social Security. That is a gimmick. It is a game. It is calculated to prevent us from taking the positive changes we make and using those positive changes in an effective way to do even more that is positive. I wish to be very specific about more that is positive, but I want to, first, go through each of the claims made by the other side. First of all, they claim the Medicare payroll taxes are used in this bill to pay for non-Medicare benefits. They say this bill raises the Medicare payroll tax so we pay for non-Medicare benefits. Well, it is not true. It is true the payroll tax goes up for an individual with an income over $200,000 and for a married couple with an income over $250,000. But let's set the record straight. By law--and nothing in this bill changes that law--all Medicare payroll taxes are used to improve the solvency of the Medicare Program. This bill does not change that practice, notwithstanding anything they try to say, and it certainly doesn't divert Medicare payroll taxes to another program. Even the CMS actuary has certified that because of the Medicare provisions contained in this bill, the solvency of the Medicare Part A hospital insurance trust fund will be improved by 5 years. So what they are saying with respect to that is simply not true. They also claim Medicare cuts are used to pay for coverage expansion. This statement actually ignores the benefits seniors receive from this bill. I think it also is important to remind people how the Medicare financing system works. I just talked about the Medicare solvency in the Part A Program. The Part A Program is paid through payroll tax. The Part B Program and the prescription drug program is paid through a combination of general revenue contributions and enrollee premiums. About 25 percent of the total program cost is paid through the premium, and 75 percent is paid by the general revenues. Part D financing works exactly the same way. This bill reduces Medicare spending by a total of $463 billion. It doesn't reduce the benefits, but it reduces the spending over the next 10 years. Do you know what that does? That lowers the out-of-pocket premiums beneficiaries pay for Medicare physician services and prescription drug coverages. In effect--and this has already been certified by CBO--we lower the premiums for seniors. That is the benefit. The opponents claim the Medicare cuts to providers are going to result in decreased access. Well, it is interesting that the very same people who brought us the so-called death panels, which never existed, are at it again with respect to access. They want to scare you. They want to say you are not going to get access to a doctor or access to your medical care, and they claim Medicare benefits could be harmed by the bill. Yet, even as they say that, AARP, the people who represent 40 million retired Americans, says: No, no, no, that is not true. Our people are protected. The American Medical Association says: No, no, no, that is not true. The folks we care about are protected. This bill fully protects guaranteed Medicare benefits for seniors. It will keep Medicare from going broke in 7 years, it extends the life of the Medicare trust fund, it reduces prescription drug costs for seniors, it ensures seniors can keep their own doctors next year by blocking a 21-percent pay cut for physicians, it creates new prevention and wellness benefits in Medicare, and it keeps seniors in their own homes and not in nursing homes.

Mr. KERRY. I thank the distinguished leader and the Chair. So the opponents of health care reform are simply not telling you that the program is about to be insolvent because private insurance companies and some of the providers are, in fact, using the money basically to get rich off the Medicare dollar. We ought to be clear about the impact of these policies. Even with the Medicare changes we have made--I hope Medicare beneficiaries hear this--even with the Medicare changes in the bill, overall provider payments are still going to go up. They are not cut. They are going up. We are simply slowing the rate of growth, and that is something everybody on the other side has said they want to do. Wall Street analysts also have suggested that many providers, including hospitals, are going to be ``net winners.'' That is a quote, ``net winners.'' Under our bill, they estimate hospital profitability will increase with reform because more and more hospital patients will have private insurance that they do not have today and the hospitals today are out of pocket because they take care of these people but they do not have the insurance. Just as in Massachusetts, where the premiums went down and where the expenses for free care went down, that is precisely what the impact will be here. We have a choice. We can do nothing, which is basically what our colleagues have proposed. The status quo means Medicare is going to be broke in approximately 7 years. It means seniors are going to pay higher and higher premiums and cost sharing due to wasteful overpayments to providers. It means that each year billions of Medicare dollars are going to continue to be wasted, lining the pockets of the private insurance companies that kick people off indiscriminately or tell them they don't have the coverage when they finally get sick and need the coverage. The status quo means seniors are going to continue to pay for their prescription drugs. The fact is, this is the time for responsible action. This bill strengthens the Medicare Program, it reduces premium costs for seniors, it restores Medicare's financial integrity, and it fortifies Medicare and protects Medicare benefits for America's seniors. Let me point to another thing they keep saying. They keep saying this bill cuts billions of dollars from the Medicare Advantage Program, hurting the 11 million seniors who are enrolled in those programs today. I know that is exactly what they have said--this bill cuts Medicare Advantage and hurts those millions of seniors. Wrong, not true, scare tactic, same old procedure, trying to distort and provide fear. Nothing could be further from the truth. This bill cuts down on overpayments, not benefits. What taxpayer in America should knowingly be paying an additional amount for a service, more than the service is worth and more than we pay in the regular program?

Mr. KERRY. I want to finish the thought. If we can yield on your time at the end, I will be happy to do that, but I want to make the points. It is the overpayments to insurers that actually threaten Medicare's future. That is what increases the costs for seniors. In 2009, MedPAC, the independent commission that advises us on issues affecting Medicare, estimates that Medicare is going to pay approximately $12 billion more for beneficiaries enrolled in private Medicare Advantage plans than if they were in the traditional Medicare. These are overpayments, according to MedPAC and according to folks in the medical profession. They exist because private insurers, under Medicare Advantage, are overpaid by about 14 percent, on average. I might add, coincidentally, in 2008, when the Senator from Arizona was the nominee for President, one of his top aides, Mr. Douglas Holtz- Eakin, said--I think it was in an article in USA TODAY--that Medicare Advantage plans should ``compete on a level playing field'' with traditional Medicare. The changes in this bill will help to reduce these overpayments, and they bring us closer to that level playing field that was suggested last year. My friends on the other side of the aisle also say that reducing the government subsidies to private medical plans is going to increase the costs for seniors. Again, this statement is fiction. The overpayments private insurance companies receive under the current law to deliver Medicare benefits have increased the costs for seniors today. They, in fact, result in a $90 increase in premiums to every married couple enrolled in Medicare. As we go forward, I hope it is the truth and facts that will prevail here, not the fiction we keep hearing to scare seniors. Americans ought to take note that the Minority do not come to the floor of the Senate and show us how we could fix Medicare's problems more effectively. The minority does not support changes that serve seniors better. Instead, they just embrace the status quo. Everyone in America knows the status quo is unacceptable. We cannot afford it. Medicare will go bankrupt within the next 10 years. I ask my colleagues, then where are we going to be? This is the time for responsible action, and every step we have offered offers that kind of responsible action without reducing care. Opponents of health reform won't rest. They are using myths and misinformation to distort the truth and wrongly suggest that Medicare will be harmed. After a lifetime of hard work, don't seniors deserve better? The Patient Protection and Affordable Care Act clearly strengthens the Medicare program. The bill reduces premium costs for seniors, improves Medicare's financial integrity and delivers immediate benefits for seniors like lower prescription drug costs and free preventive services. In short, health care reform will fortify Medicare and protect Medicare benefits for America's seniors.I would like to take the next few minutes to separate the facts from the fiction. My friends on the other side of the aisle say that health reform will cut Medicare benefits for seniors. And once again, this statement is false. Health reform will increase the number of Medicare benefits that seniors are entitled to under law. Nothing in this bill will take away or reduce guaranteed Medicare benefits. In fact, the legislation increases coverage of preventive services at no additional costs to seniors. That means, when seniors visit a doctor for a colonoscopy, mammography, or other preventive screen, they won't pay the co-pay required under current law. Encouraging more preventive care is one of the best ways we can save lives and lower health care costs. That's why, under this bill, seniors will receive even better preventive benefits than they receive today. My friends on the other side of the aisle say that under health reform, government bureaucrats will dictate personal health care decisions. This statement is completely false. Health care decisions about providers and treatments are some of the most personal decisions many people make. Under current law, doctors and patients decide which treatments Medicare patients need. The same is true under this bill. Health reform will keep these decisions between health care providers and patients. And with improved payment policies, this bill also ensures Medicare providers get the resources they need to continue providing quality care to their patients. My colleagues on the other side of the aisle say that reducing fraud, waste and abuse in Medicare will not save a significant amount of money. To the contrary, waste, fraud and abuse cost the health care system billions of dollars every year. Improving Medicare's financial integrity is one of the first steps we can take to save the program. According to independent analysis from the Congressional Budget Office, under this bill, enhanced oversight, like requiring background checks and screening for providers, will save Medicare dollars. Targeting waste, fraud and abuse in Medicare will protect American taxpayers and help extend the life of the program. My friends on the other side of the aisle claim that health care reform will not lower costs for seniors but drive costs higher. The truth is that seniors will see immediate savings in prescription drug costs under health care reform. This legislation will save seniors money in the Medicare prescription drug coverage program by providing more coverage and lowering the costs of brand-name prescription drugs. In 2010, seniors will receive an additional $500 of coverage before they have to begin paying out of their own pocket in the coverage gap or ``doughnut hole'' in the Medicare Prescription Drug Benefit. Also beginning in 2010, the price of brand-name drugs and biologics will be cut in half for the seniors who have to pay for prescriptions out of their own pocket when they hit the ``doughnut hole'' between initial and catastrophic coverage. Those on the other side of the aisle say that we are not doing enough to protect home health care. The fact is that this bill includes provisions I introduced to make home and community-based services more widely available in Medicaid. Despite advancements in home and community-based services, seniors have few affordable and accessible options in choosing a health care setting today. Seniors deserve more options, rather than just nursing homes. For seniors eligible for both Medicare and Medicaid and who prefer home or community-based services, this bill provides valuable support. We have heard repeatedly from my friends on the other side of the aisle that leading advocacy groups do not support the Senate health care bill. Nothing could be further from the truth. The country's leading advocacy groups for seniors rights are helping stop the scare tactics and clear up the facts. Voices like AARP and the American Medical Association support the responsible Medicare reform in this bill. On November 18th, AARP said: The new Senate bill makes improvements to the Medicare program by creating a new annual wellness benefit, providing free preventive benefits, and--most notably for AARP--members reducing drug costs for seniors who fall into the dreaded Medicare doughnut hole, a costly gap in prescription drug coverage. On November 20th, the American Medical Association said: [We are] working to put the scare tactics to bed once and for all and inform patients about the benefits of health reform. On November 16th, the Federation of American Hospitals said Hospitals always will stand by senior citizens. And on November 16th, the Catholic Health Association of the United States said: The possibility that hospitals might pull out of Medicare [is] very, very unfounded. Catholic hospitals would never give up on Medicare patients. The minority today is arguing the exact opposite of what they have said previously. In the late 1990s, Republicans and Democrats joined together to fight for America's seniors, advocating Congress take the advice of experts who said the solvency of Medicare was in trouble. Today, some are using scare tactics, falsely claiming that the Patient Protection and Affordable Care Act will impose ``cuts to Medicare'' that hurt seniors. In truth, this bill protects the guaranteed Medicare benefits our seniors deserve. I urge my colleagues to stop spreading the misinformation and false claims about this bill that are intended only to scare seniors. Instead, I urge you to work with us on this legislation which delivers health care to an additional 31 million Americans and strengthens and preserves Medicare for the 45 million beneficiaries who rely on the program.

Mr. KERRY. Will the Senator yield----

Mr. KERRY. I was ready to yield on your time.

Mr. KERRY. Reserving the right----

Mr. KERRY. I reserve the right to object. I want to find out if we can have a moment to have a discussion, I ask my colleague.

Mr. KERRY. Mr. President, thank you very much, and I thank Senator Baucus for the time. My friend from Oklahoma asked how many patients I take care of in terms of Medicare. I must say that is not the essential ingredient of being able to exercise common sense and to make some judgments about this issue. I could turn to him and ask, how many buses has he driven, but he votes on transportation policy; how many wars has he fought in, but he sends people to Afghanistan; how many courtrooms has he practiced in and tried a case in, but he is willing to limit attorney's fees. That is not the measure here. The measure is, what does the policy do? Let me be very clear. The Medicare Advantage Program was put in place. It is a private plan that is run by the insurance companies. We put them in place, and they grew, in 2003, and gained the name ``Medicare Advantage'' because they were going to be run more efficiently and at lower cost. Originally, we were paying about 95 percent to the repayment, but that has angled up now to the point where MedPAC itself--not AARP. This is not AARP. This is MedPAC. Here is the MedPAC report. MedPAC says: Currently, Medicare pays Medicare Advantage plans 14 percent more than it would spend for similar beneficiaries in [the Medicare program], pays a subsidy of $3.26 for each dollar of enhanced benefits. . . . So the Medicare folks are subsidizing additional payments to a program that is paying more than is regularly paid, and it goes straight to the insurance company. It does not make sense for tax dollars to be spent that way. Finally, let me just say, the Senator referenced Massachusetts. Let me read a quote from the Massachusetts Taxpayers Foundation. It is the most conservative--it is constantly protecting the expenditure of tax dollars. Everyone in the State looks to it on issues of tax policy, expenditures. Here is what it says about our plan in Massachusetts: [T]he cost to taxpayers of achieving near universal coverage has been relatively modest and well within initial projections of how much the state would have to spend to implement reform, in part because many of the newly insured have enrolled in employer-sponsored plans at no public expense. That is what happens. The final comment I make to him: We are blessed to have five physicians in my immediate family--my daughter, my son-in-law, her father-in-law, and two nieces--and every single one of them would overwhelmingly disagree with the comments made by the Senator from Oklahoma. They hope we will pass this legislation, as do millions of other doctors.

Mr. KERRY

Mr. KERRY. Mr. President, just one moment?

Mr. KERRY. Mr. President, I just was notified--I wish to respond to a few of the things here. The Senator from Arkansas has the pending amendment. My amendment is apparently not quite ready to be called up. What I want to do, if I can make a couple comments so the conversation doesn't stay where it is, prior to the Senator from Arkansas and then I will yield and then I would like to be able to come back after that with my amendment. I wish to say to our colleagues on the other side of the aisle, I have listened carefully, obviously, for a number of days now. I notice most of them have, indeed, disappeared--as the Senator from Montana suggested. It is pretty hard to have a legitimate debate in the Senate when people speak and then leave the floor and we can't actually test the things that have been said. One of the things that was said a moment ago by the Senator from Utah was, you cannot find any doctors who support this plan. Can you find doctors who oppose it? Absolutely. I will give him that. But don't come to the floor of the Senate and suggest there are not huge numbers of doctors across the country who are desperately waiting for the Senate to pass health care reform and, in fact, this plan. In fact, the AMA-- this is what the AMA says. They represent tens of thousands of doctors across the country, and they said: [We are] working to put the scare tactics to bed once and for all and inform patients about the benefits of health reform. We have heard an incredible amount of scare tactics, Senator after Senator standing there, jumping up, pounding out one sort of misstatement or one distortion or another. The bottom line is, they have stood there for the last hour or so, claiming they are standing there to protect seniors. It is ironic, when one Senator, the Senator from Arizona, who said yesterday and sort of repeated it today--this is what he said yesterday: I will eagerly look forward to hearing from the authors of this legislation as to how they can possibly add $\1/2\ trillion in cuts without impacting existing Medicare programs negatively and eventually lead to rationing of health care. . . . That is the Senator from Arizona today. Only a year ago, when he was running for President of the United States, this is what the Senator proposed: "John McCain would pay for his health plan with major reductions to Medicare and Medicaid,'' a top aid said, ``in a move that independent analysts estimate could result in cuts of $1.13 trillion in 10 years to the government programs.'' Consistency, obviously, has never constrained anybody in politics. We know that. But to stand there, over the last half hour or 45 minutes, and say: Seniors are going to get hurt and seniors don't support this and we are here to protect seniors--just a few days ago the organization that represents 40 million seniors in America, it is the largest single representative group of seniors in our country--we all know it, it is called AARP. It is the American Association of Retired Persons. It represents people from 50 years old on up. There are a total of about 90 million of those in the United States of America, so they represent about half the seniors in America. Their interest, day to day, is making sure those seniors' interests are not hurt by what we do here in Washington. Here is what they said, on November 20: Opponents of health reform won't rest. [They are] using myths and misinformation to distort the truth and wrongly suggest that Medicare will be harmed. After a lifetime of hard work, don't seniors deserve better? This is what AARP said a few days before that, on November 18: The new Senate bill makes improvements to the Medicare program by creating a new annual wellness benefit, providing free preventive benefits and--most notably for AARP members-- reducing drug costs for seniors who fall into the dreaded Medicare doughnut hole, a costly gap in prescription coverage. The Federation of American Hospitals said the following: Hospitals always will stand by senior citizens. They have no intention of pulling out the support that exists today. The American Medical Association: [We are] working to put the scare tactics to bed once and for all and inform patients about the benefits of health reform. The Catholic Health Association of the United States: The possibility that hospitals might pull out of Medicare [is] very, very unfounded. Catholic hospitals would never give up on Medicare patients. So everything we have just heard continues the scare tactics, trying to gin anger in America that is unfounded, based on the basics of this bill. Let me call attention--this is the report this year in March that came out from Medicare--it is about Medicare payment policy. It is a report to us, the Congress, by MedPAC. As we all know, MedPAC is the entity that oversees the administration of Medicare, and its concern is maintaining the viability of Medicare, making sure Medicare patients are not hurt by a particular program. What is in this bill--that Senator Baucus and those of us on the Finance committee put in the bill--is precisely what MedPAC told us we should do and could do without harming seniors. Let me share, specifically, what they said we should do: The recommendation is that Congress should eliminate the market basket increase for 2010 and advance the planned reductions for coding adjustments in 2011 to 2010 so that payments in 2010 are reduced by 5.5 percent to 1990 levels. They suggested that. They did it because they know it will make the program sounder and it will allow them to make payments in other areas of Medicare that wind up taking care of Medicare beneficiaries more effectively. They said: The Congress should direct the Secretary [of health and human services] to rebase rates for home health care services to reflect the average cost of providing care. That is precisely what we do here. But the other side jumps up, and they will take any change, anything that reflects a shift from one place to another--they will exploit shamelessly in an effort to scare seniors and pretend it is somehow going to affect them. What is interesting--and America ought to take note of this--they keep coming to the floor and they keep opposing what is here. They keep wanting to strip something out. They keep wanting to send the bill back so that ends this process altogether. But they do not come to the floor of the Senate and show us how we could fix it more effectively and, in fact, serve seniors better, rather than just embracing the status quo. Everyone in America knows the status quo is unacceptable. We cannot afford it. Medicare will go bankrupt within the next 10 years, and then where are we going to be? This is the time for responsible action, and every step we have offered offers that kind of responsible action without reducing care. I will make one last comment and I will yield to the Senator from Arkansas and then come back and talk about further ways in which this, in fact, serves seniors and others more effectively. But as they have talked, for the last moments they have been talking about home care cuts. I have an amendment that shortly we will talk about that will prohibit any reduction in home care, that will guarantee we are clear that we are prohibiting any reduction in home care. But I have long been an advocate for better home care, more home care capacity. In the Finance Committee, I offered amendments to sustain that home care quality. Nobody worked harder than our late colleague Senator Ted Kennedy, with whom I worked for years on this, to try to extend home health care, protect home health care patients and augment home health care. Here is what the people who represent home health care in America have to say. This is from the National Association for Home Care & Hospice, a letter they sent to Senator Baucus. It was a letter they sent yesterday. The National Association for Home Care & Hospice supports making health care available to all Americans. We believe that every-one must be willing to sacrifice to make this happen. [The National Association for Home Care & Hospice] has agreed to do its part by reducing costs and payments in a manner that makes the Medicare home care program more efficient and less susceptible to abuse. We are grateful for the opportunity to make these improvements and at the same time protect the thousands of ethical providers who are participating in this important program. We are pleased to have the opportunity to work with your staff to make this happen. For all these reasons, [the National Association for Home Care & Hospice] supports the provisions of your health care reform legislation as they relate to home health care. We look forward to working with you and your staff . . . Thank you for [the] important work [you are doing]. Who better to speak to the concerns of home health care? The folks who have continually been distorting this debate and who continue to try to scare people, or an association whose sole existence, whose payroll every day is put to the use of protecting the folks they represent in home care? I think the answer is self-evident to anybody who wants to listen to common sense.

Mr. KERRY. What I am aware of is that the individual who was running for President of the United States never stood up and said it was false. I don't have any quote of Senator McCain ever refuting it. All I can say is that throughout the campaign, that was the operative language. It was debated. It was never refuted. I yield the floor.

Mr. KERRY. Madam President, I will yield myself such time as I will use. There have been times during this debate that I have listened with astonishment to the minority. They agree with the diagnosis--that our health care system is in need of treatment. But they offer no remedy, no prescription, no cure. We don't need a second opinion on what the problems are with our health care system. Our country leads the world in the advancement of medical science. We have the best doctors, the best technology and the best hospitals in the world. It is no surprise to see kings and queens come to the United States for medical treatment. But for all that, the system is dysfunctional, wasteful and abusive. It rewards quantity over quality. And it delivers profits more than care. It is a system in which too many American families are just one illness or one injury away from financial ruin. I would like to thank Majority Leader Reid, Chairman Baucus, Chairman Dodd and Chairman Harkin for getting us to this important point in our long march toward a health care system that is affordable and available to all Americans. Their efforts have presented us an opportunity to cast a vote that will make life better for every single American. It isn't often that we get a chance to do that. But we have that chance now. I know the majority leader, the Senate Finance Committee, and the Health, Education, Labor, and Pensions Committees have each tirelessly worked on the provisions in this bill and have taken great care to ensure that Medicare beneficiaries will maintain access to their guaranteed benefits and will receive additional preventive benefits and expanded prescription drug coverage. The amendment offered Senator Johanns is very similar to the McCain amendment we debated over the last few days. Once again, the opponents of this bill are endorsing the status quo that leaves Medicare on the brink of going bankrupt and seniors facing higher costs. My amendment simply ensures that no beneficiary would receive a reduction in their guaranteed Medicare home health benefit. Let me remind my colleagues again what will happen if we stick with the status quo. The status quo means Medicare will be broke in approximately 8 years. The status quo means seniors will continue paying higher and higher premiums and cost-sharing due to wasteful overpayments to providers. The status quo means that each year billions of Medicare dollars will continue to be wasted on lining the pockets of private insurance companies. And the status quo means that seniors will continue struggling to pay for prescription drugs. The stakes for seniors and for the Medicare Program have never been higher. Senators have a choice: Endorse the status quo or strengthen Medicare. Regarding Medicare changes for home health providers, let me describe what is in the Senate bill. As most of my colleagues would agree, home health care is an important benefit in the Medicare Program. Today more than 3 million Medicare beneficiaries receive home health services across the country--including those with acute illnesses and injuries and those afflicted with numerous chronic conditions. Across the country, more than 9,800 home health agencies provide care to seniors in their homes. This care helps seniors get better and avoid expensive rehospitalizations. Home health providers make a real difference in improving seniors' health. We should support their efforts. While I have great respect for the services of home health providers, we also have a responsibility to protect the Medicare Program. As part of this, we must make sure Medicare is paying appropriately--and not overpaying--for Medicare services. We must also take action to root out fraud and abuse in the Medicare Program. I believe the policies in the Senate bill achieve both goals. First, the Senate bill would ``rebase'' home health payments to ensure payments reflect actual costs of providing care. These changes are based on MedPAC recommendations, which is the nonpartisan group that advises Congress on Medicare. When the current home health payments were set, seniors received an average of 31 visits per episode. Today, they only receive 22 visits. The Senate bill directs CMS to ``rebase'' payments to reflect this change. That is common sense. The Senate bill also roots out fraud in the system by revising how Medicare pays for ``outlier'' cases. Medicare provides an extra payment today for providers who treat sicker or ``outlier'' patients. Unfortunately, the GAO found that some providers were gaming the system and getting more outlier payments than they deserve. For example, GAO found that in one Florida County, providers were receiving 60 percent of all total outlier payments--even though the county had less than 1 percent of the total Medicare population. Clearly, something was going on there that needs to be changed. The Senate bill addresses this problem by placing a cap on the amount any individual provider can receive in outlier payments. In addition, it establishes a productivity adjustment for home health providers beginning in 2015. These changes ask home health providers--like all other providers--to offer more efficient and higher quality care over time. I believe the Senate policies are fair and reasonable. In making these changes, we worked closely with the home health industry to ensure these changes were reasonable and fair. On the rebasing policy, MedPAC recommended we fully implement these changes in 2011. To ensure providers could adapt to the new payment rates, the Senate bill phases- in the changes over 4 years. The home health providers support this phase-in. The outlier policy and fraud changes were actually suggested by the home health industry. The home health industry fully supports these changes. For the productivity changes, the Senate bill holds off on applying these reductions while the rebasing policy is taking effect. This will give providers extra time to adapt to the payment changes and is much less aggressive than the proposals put forth by MedPAC, the House bill and the administration, which require all of these payment changes to be implemented at the same time. Finally, the Senate bill includes special protections for rural home health providers. From 2010--2015, rural providers will receive a 3 percent extra payment each year. This payment will ensure that rural providers are protected as we reform the broader home health system. In total, the Medicare delivery reforms in the Senate bill strike a fair balance between ensuring seniors have access to care, while also rooting out inappropriate payments from the system. The opponents of these Medicare changes do not have a plan to protect seniors and strengthen the Medicare Program. They advocate doing nothing. The opponents of health reform are now claiming that Medicare beneficiaries will be harmed by this bill. And here is what AARP--for example--has said about these claims:

Mr. KERRY. I yield myself an additional couple of minutes. It improves the solvency of the Medicare program by 5 years. It puts $30 billion back into the pockets of seniors in the form of lower Medicare premiums. It makes prescription drugs more affordable. It guarantees that seniors can continue to see the doctor of their choice. It provides free wellness and prevention benefits to Medicare beneficiaries. They are busy talking about the cuts, when this actually improves what Medicare beneficiaries are going to get. They don't have wellness and prevention benefits today. It provides for them. It guarantees they will see the doctor of their choice. It actually puts $30 billion back into their pockets, and it also includes fair and appropriate changes for home health that actually protects access to health care. The truth is, the Johanns amendment is the amendment that actually would wind up hurting seniors. This amendment provides additional benefits. We all understand the importance of this. The Senate bill releases home health care payments so those payments actually reflect the real cost of providing care. We do that not in a partisan way. We do that based on the nonpartisan MedPAC commission recommendations to us of how you can improve Medicare. Our colleagues have a long way to go on the other side to begin to talk about real health care change. This bill roots out fraud from the system, revises how Medicare pays for the outlier cases; that is, the cases that treat the sicker or what we call outlier patients. Unfortunately, GAO found some providers were gaming the system and getting more outlier payments than they deserve. Do they want us to continue to overpay people, providing service that people either don't need or charging more for the service that they do need but could have gotten at a lower price? Those are the changes we make. The American people will be proud of it. Let me give an example. The GAO found that in a Florida county, providers were receiving 60 percent of all the other outlier payments, even though the county had less than 1 percent of the total Medicare population. That is absurd. What we do is fix those kinds of absurdities that make Americans so angry about the administration of their tax dollars in Washington. I believe the Senate bill addresses a number of these problems in a thoughtful way. We need to have a debate about what is in this bill and what the real impacts are and what the negative impacts are of not doing these things. Our colleagues stand for the status quo. This is going to be historic when we pass it because it is going to benefit people in so many different ways, getting rid of preexisting condition restraints, not having people kicked off insurance they thought they had but when they get sick, they find it is gone. We end that. We get 31 billion more people covered in a way that spreads the risk of being sick in a sensible way and reduces the costs for other Americans. That is common sense. I am proud of what we are doing.