Jon Kyl

Mr. KYL

Mr. KYL. First of all, you would get one-third of all the money you collected up to $150,000. That is $50,000. Then you would get one- fourth of everything beyond that; is that correct?

Mr. KYL. Is my colleague aware that the average malpractice award in this country today is $4.3 million? Does that sound about right?

Mr. KYL. In fact, over half of all the awards are over $1 million. As a poor trial lawyer, for every one of these cases--we are not talking about cases per year and this is per case, you can try 20, 30, 40, 50 cases a year--so for each case, if the average award is $4.3 million, I am only going to keep $1.1 million. Is that fair; that the trial lawyer should only get $1.1 million for every one of these cases? Of course, the clients I am recovering the money for don't get that money. That money goes into my pocket.

Mr. KYL. Exactly so. Under the amendment of my colleague, at least the plaintiff, on whose behalf the lawsuit was brought, would get a fair amount of recovery, unlike today, when there are no caps, and we frequently find the person who was injured gets a very small percentage after the lawyer gets his chunk, the expert witnesses, other court costs, and so on. Maybe I should not defend my lawyer friends. Maybe the Senator is right. This is a way to attack costs. It is certainly not unfair to the trial lawyers and actually would benefit the people who do deserve to get some recovery in these cases where, in fact, they have been injured.

Mr. KYL. The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning). Further, if present and voting, the Senator from Kentucky (Mr. Bunning) would have voted ``nay.''

Mr. KYL. The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning). Further, if present and voting, the Senator from Kentucky (Mr. Bunning) would have voted ``yea.''

Mr. KYL

Mr. KYL. The following Senators are necessarily absent: the Senator from Kentucky (Mr. Bunning), the Senator from Oklahoma (Mr. Inhofe), and the Senator from South Carolina (Mr. Graham). Further, if present and voting, the Senator from Kentucky (Mr. Bunning) would have voted ``yea.''

Mr. KYL. The following Senators are necessarily absent: the Senator from Kentucky (Mr. Bunning), the Senator from Oklahoma (Mr. Inhofe), and the Senator from South Carolina (Mr. Graham). Further, if present and voting, the Senator from Kentucky (Mr. Bunning) would have voted ``yea.''

Mr. KYL. Mr. President, I thank my colleagues for their courtesies. I am sure the Chair will cut me off at 5 minutes. I wish to respond to some comments made earlier relative to the amendment of the Senator from Nevada on capping attorney's fees. We have an amendment we will vote on tomorrow that caps executive compensation, effectively, and the response to that from Senator Ensign was, if we are going to do that, let's cap the attorney's fees because we can accomplish something by doing that in medical malpractice cases. We can make sure the people who were injured get more of the money coming from these awards, with less going to the attorneys. I think this would be a very salutary situation. This contingent fee system can really result in some abuses. I will cite some statistics from the Jury Verdict Research in a study done in 2005: Fifty-two percent of all awards in medical liability lawsuits exceed $1 million. Think about that. Over half of the awards in these malpractice cases exceed $1 million. The average award now weighs in at $4.7 million. That is a lot of money. Obviously, juries have felt that is what the victims in these cases needed in order to be properly compensated. The Ensign amendment would limit the amount of contingency fees in these kinds of lawsuits to no more than a third of the first $150,000 recovered and a quarter of any recovery in excess of $150,000. For example, an attorney representing a client in this average case, with a $4.7 million verdict, would still receive $1,187,500 for his or her services under the Ensign amendment. That is not a bad deal with a $4.7 million verdict. The attorney gets $1.1 million-plus and the injured party, the plaintiff, gets the remainder. I ask my colleagues, in that situation, isn't $1.1 million-plus enough compensation? We are limiting the compensation for an entire year for an executive of an insurance company to $400,000 as the amount that would be deductible to the company as a usual and ordinary business expense. Here, a lawyer has just one case, and you can have many cases in a year. He would be limited, in this particular situation, to $1.1 million. A lot of folks have been asked to sacrifice under this legislation-- hospitals, doctors, and States, by accepting more Medicaid patients under their program; seniors would face sacrifices because of the $500 billion cuts in Medicare; individuals would see their premiums rise; and small businesses would get hit. The one constituency that hasn't been asked to sacrifice anything is the trial lawyers. I don't think it is much of a sacrifice to say, when you get this kind of award--a $4 million award--for your client, your fees should not exceed a little bit over $1 million. Even Howard Dean stated: Tort reform is not in the [health care] bill because the people who wrote it did not want to take on the trial lawyers. And that is the plain and simple truth. We know that to be the case. Surely, it wouldn't be too much to ask our trial lawyer friends to limit just a little bit the contingency fees they make in these cases. There is a study that was recently conducted by the Institute for Legal Reform that found that medical liability lawsuits are being driven by the plaintiffs' bar. It cites all the advertising costs and the increase in the amount of advertising they are doing. That is where a lot of this money is going--to advertise for these lawsuits. Additionally, it showed that spending for these ads has increased dramatically in the last few years. The threat of these ``jackpot justice'' suits against doctors is one of the reasons health insurance premiums are rising faster than the rate of inflation. In fact, a PricewaterhouseCoopers study concluded that approximately 10 percent of the costs of health insurance premiums are attributed to the cost of litigation and defensive medicine. An even bigger health care cost related to the threat of frivolous lawsuits is the practice of defensive medicine. A 2005 survey in the Journal of the American Medical Association found that 93 percent of physicians reported practicing defensive medicine, costing the health care system $200 billion annually. We clearly need to reform the tort system, and not in the form of some sense of the Senate but in the way of something real. It seems to me the Ensign amendment begins that process by saying: Let's at least allow the injured plaintiffs in these cases to keep more of the award granted to them and have less of that go to the lawyers who bring the cases. Surely, it is an adequate incentive that they receive about $1 million out of a $4 million lawsuit. I thank my colleagues from New Jersey and Michigan for allowing me to speak first.

Mr. KYL

Mr. KYL. Will my colleague yield for a quick point?

Mr. KYL. The Senator was making the point that you cannot take $120 billion out of the program without hurting folks. Those on the other side of the aisle said we can do that--we can cut it by $120 billion and it still won't hurt anybody. My colleague asked the Senator from Tennessee exactly what some of the benefits were and he repeated them. I went to get the actual statistical number of how much it will actually reduce benefits in terms of actuarial value. According to the Congressional Budget Office, in the year 2019, when fully implemented, here is the statistic: The actuarial value of the reduction in benefits under Medicare Advantage is 64 percent; in dollar terms, it goes from $135 a month down to $49 a month. In other words, the very things my colleague talks about--vision care, dental, all of those things----

Mr. KYL. The last point. I want to say that I hear my colleague loudly and clearly. I hope the American people do too because you cannot call a $120 billion cut something that doesn't hurt people, and especially when the Congressional Budget Office itself says, yes, that reduces these very benefits from a value of $135 a month down to $49 a month. That is a huge cut in the value of the services they receive under Medicare Advantage. That is what we are trying to prevent by this amendment.

Mr. KYL. I had hoped to take the next half hour, but if we could do 40 minutes, equally divided, I could take 20.

Mr. KYL. Would I be able to take the first 20 minutes then?

Mr. KYL. Mr. President, we are discussing the Hatch motion to preserve Medicare Advantage. I wish to give a little bit of background about the Medicare Advantage Program. It was established with the goal of ensuring that beneficiaries all across the country would actually have Medicare choices. Under the program, private health plans receive government payments in order to serve Medicare beneficiaries. In addition to offering comparable coverage to Part A, which is for hospitals, and Part B, physician services, Medicare Advantage plans can also offer Part D coverage, prescription drug benefits. The central goal of the Medicare Advantage provisions was to ensure that beneficiaries across the Nation, not just those in populous areas, would have access to health plan options. Under the law, Medicare Advantage plans must provide all physician and hospital Medicare benefits. Here is the key. I hope my colleagues will think about this for a moment because this has been a little bit perhaps distorted in the conversation we have had. If a plan's costs to provide all the Medicare benefits is less than the government payment, then by law, the plan must apply the difference to provide additional benefits to the beneficiary or to reduce premiums. It seems to me that is what this whole reform was about in the first instance, to try to ensure quality care and reduce the cost of insurance to beneficiaries. But what are these extra benefits? We have heard them discussed. They include, first of all, lower cost sharing, including out-of-pocket limits on beneficiary cost sharing, as well as specific health benefits such as vision, dental care, hearing services, routine physical, cancer screenings, and so on. Plans can also offer management services, which can be particularly important to beneficiaries with chronic illnesses, and that is a protection, by the way, that does not exist in regular fee-for-service Medicare. Today, every beneficiary has health plan choices. Since 2003, the number of Medicare beneficiaries enrolled in private plans has nearly doubled from 5.3 million to 10.2 million in the year 2009, according to the Kaiser Family Foundation. So these are very popular plans and growing in popularity. Let's go back in time just a little bit to consider the history, back to 1972, because in past years my colleagues on the other side of the aisle were all for Medicare Advantage. Over the years, Congress has tried to control spending by reducing payments to private Medicare plans. One problem was, severe payment reductions resulted in the elimination of plan options. For example, in 1997, the Balanced Budget Act reduced plan payments by $74.5 billion over 10 years. What happened? Well, about three-quarters of a million beneficiaries, from 1999 to 2003, had to change plans or else lose their health plan altogether. This included not only less populous and more rural areas of the country but also areas such as Long Island, NY. Well, Congress heard from these seniors loudly and clearly. They were angry about losing their coverage. Many remember that the Medicare Modernization Act was a landmark achievement which provided seniors with prescription drug coverage, but it was necessary for another reason as well and that was to respond to the call of the seniors who wanted their private options back. So, in 2003, the Medicare Modernization Act expanded plan options to include regional PPOs and restore plan payments. It was a deliberate, bipartisan decision to increase the plan's payments so they could enter rural areas of the country and even some of the urban areas--as I mentioned, Long Island. If my colleagues don't remember, let me remind them. Former Senator Clinton from New York, for example, said that these Medicare+Choice plans--that is now what we call the Medicare Advantage plans, and I am quoting: . . . are feeling the squeeze in a system caught between rapidly exploding costs and rapidly imploding finances. While we debate the future of Medicare, we need to recognize that there are people right now in our States who depend on these plans today. The current senior Senator from Massachusetts said at the time, and I quote: I urge my colleagues to support the additional funding that is urgently needed to strengthen the Medicare+Choice program for seniors. This should be among our highest priorities in this year's Medicare debate. It was, and we did. So this is not something bad that we provided this money to these plans. We provided it so the plans could provide the benefits to seniors, particularly in areas where otherwise they wouldn't have those choices. So why has this all of a sudden become unpopular with our friends on the other side of the aisle? Well, obviously, first and foremost, they need trillions of dollars to fund their bill, so they look around for where they can get some money and decide: Well, we can get $120 billion from here; this is one way we can help pay for the new entitlements under their bill. But to them, there has to be some kind of justification to take that money, so the idea is: Well, it is not fair that the government would pay money into this program for extra benefits for seniors when that money could be spent on regular fee-for- service Medicare. Of course, that argument presupposes that government health care is always superior to the plans offered in the private market, which these seniors have made clear, by doubling the enrollment in the private plans, is not the case. As I said, they have made their preference clear. They asked us for choices, as Members of Congress enjoy. They want access to private plans and these additional benefits, and we delivered as promised. We gave them the choices, Republicans and Democrats alike. Now they need the money, so they decide this is a way to get some money to pay for their new entitlement. Our friends on the other side of the aisle have been talking about overpayments. There is no such thing as an overpayment in this program under the law. No money goes to the plans. It is not as if the insurance companies get the money from the government. The insurance companies, if their bid is under what the traditional Medicare bid is, have to return 25 percent of it to the U.S. Government and the other 75 percent, by law, must go to their beneficiaries, either in the form of lower premiums or additional benefits. So these aren't overpayments to the plans, as has been represented. As I said, 75 percent of the additional payments must be used to provide seniors with extra benefits, which could include lowering premiums, including chronic care management, and so on. The other 25 percent is returned to the government, so there is no overpayment. Some on the other side argue that they are protecting guaranteed benefits. Well, this is semantics. Nobody is going after the benefits Medicare has traditionally supplied. What we are pointing out and what this amendment would prevent from happening is, the benefits under Medicare Advantage would not be cut, and there is no question--nobody can deny--that those benefits would be cut. In fact, according to the CBO, by the year 2019, they will have been cut by 64 percent, a huge-- almost $90--over $90 in actuarial value. So my point is, seniors, of course, would like to keep what they have. What about this promise if you like what you have, you get to keep it. Sorry. Not if you are on Medicare Advantage. As I said, according to the Congressional Budget Office, the legislation would cut benefits from $135 a month actuarial value to $49 actuarial value. That is a real cut. It may not sound like much to some people, but to our seniors, it is a huge hit. They are asking what happened to this promise to let them keep what they have. There is an interesting memo by James Capretta and Robert Book, who write for the Heritage Foundation, on the Medicare Advantage cuts, and here is what they say: Reform should mean more patient choice and health plan accountability. But these current proposals would lead in the opposite direction--toward a system of less choice, less accountability, and eventually lower-quality health care. That is what the Hatch motion is attempting to prevent, to preserve these benefits for seniors. I have gotten tons of calls, about 500 calls just in the last several days, opposing cuts to Medicare Advantage. I haven't, by the way, received a single call from a senior citizen asking us to make these cuts. I have been reading from these letters. I have read about a dozen of these letters. Let me read a few from constituents who tell us the real effect these cuts would have on them. Bear in mind, in my State we have about 329,000 seniors who are enrolled in Medicare Advantage plans. One constituent from Phoenix says: For the past month I have heard a lot about proposed Medicare cuts. Finally, after years of being self-employed and being able to afford only high deductible insurance, I am now in Medicare and have a Medicare Advantage plan. Please tell me you are not cutting Medicare Advantage. Have a heart. Leave Medicare and Medicare Advantage alone. We are trying. A constituent from Peoria, AZ, says: I oppose cuts to Medicare Advantage. I have two family members receiving health care under this program. The care has consistently been outstanding due to the efforts of our case manager in coordinating patient care between providers and patients. We have a voice in determining type and scope of our care. Please do not cut Medicare Advantage! Here is a note from a constituent from Apache Junction: I have heard reports that if passed, the new government health care plan would do away with or cut Medicare Advantage. If so, it would nearly double my health care costs with my present health care provider. I do not want any legislation passed that would take away the Medicare Advantage option for seniors. Another constituent from Peoria: President Obama has said we can keep the insurance we have if we like it, but has said he wants to cut or eliminate Medicare Advantage. What happens to the millions of people who have Medicare Advantage? These are all seniors, many of whom cannot afford to pay more. Why should so many seniors have to sacrifice in order to help pay for universal coverage? Why do we not hear more debate on this issue? Well, to my constituent from Peoria, that is what this debate is all about. We are trying to prevent these cuts. Here is a constituent from Prescott Valley: I have Medicare Advantage. My husband wants to retire from his job where he has excellent health coverage for some serious health concerns. So long as he has good medical coverage, he does well. Should Medicare Advantage be cut, his health would necessarily suffer after his retirement. We cannot afford higher supplemental coverage. I don't want to lose my husband. I have spent many a sleepless night wondering how to keep my husband healthy once he retires. I have several friends currently undergoing chemotherapy and they are wondering if their health would be in jeopardy if Medicare Advantage were cut. Are we not worth saving? Clearly, there are many who want to spend our money on their own priorities. God bless you, sir, for advocating on our behalf! These are real concerns from real people. They don't want us to cut Medicare Advantage. The final point I wish to make is one of our colleagues was saying: Well, there are bad Medicare Advantage plans and good Medicare Advantage plans. How do we know which ones are good and bad? It turns out the senior Senator from Florida devised a formula which protects a lot of folks in his State, especially in Broward County, Miami Dade County, and Palm Beach but doesn't protect very many other folks. Maybe this is the definition of good versus bad. There are a few that are protected in Colorado, Maryland, Mississippi, Oklahoma, and Texas. In my State of Arizona, with a lot of retirees, very few are exempted from the cuts. This is not going to go over well--to exempt only a few in certain key areas, and none of the others. Again, what happened to the promise that everyone gets to keep what they have? My bottom line in supporting the Hatch amendment is that we should not punish seniors who signed up to have the choice of Medicare Advantage. There are better ways to reform health care. We have talked about those ways. Our senior citizens have paid into the program. They have asked us for this program. Democrats and Republicans have supported it in the past. Now, simply because somehow or other we have to scrape up money for the new entitlements in this legislation, we are going to attack the very program all of us have supported in the past. It is unfair, it is not right, and we need to defeat those cuts in Medicare, and that is why the Hatch motion to preserve Medicare Advantage should be supported by my colleagues.

Mr. KYL. Mr. President, the Community Living Assistance and Services and Supports Act, known as the CLASS act, is a new, government-run, government-funded program for longterm care, intended to compete with long-term care plans provided by private insurers. One of the oft-repeated arguments we have heard in favor of the CLASS act is that it would reduce budget deficits between 2010-2019. First, when has a government program ever reduced budget deficits? Second, the Congressional Budget Office tells us that this program will actually add to future Federal budget deficits. The CBO writes: ``The program would add to future federal budget deficits in large and growing fashion.'' Why would it do this? The program offers returns that payments made into the system cannot cover--just like a Ponzi scheme, as Senator Conrad said. Participants would have to pay into the system for five years before they start collecting benefits. Under the Senate proposal, only active workers could enroll in the program. So this would not be a program that would not benefit seniors or the currently disabled. So, if a worker began making payments in 2011, he or she could not collect benefits until 2016. So, for a time, the program would generate surplus receipts for the government while Americans are paying in and not collecting benefits. But eventually, we will reach a point when payments made into this program cannot sustain promised benefits. As the CBO tells us, the program would ``lead to net outlays when benefits exceed premiums.'' (By the third decade of program operation-- 2030-2039--CBO assumes that CLASS begins to generate net increases in Federal outlays. The net increase in Federal outlays is estimated to be ``on the order of tens of billions of dollars for each (succeeding) ten-year period.'' CBO notes that the increase in net Federal outlays which will begin to occur after 2029 results despite the requirement that premiums be set to ensure the program's solvency over 75 years. The solvency requirement counts interest income paid to the program's trust fund as available to pay future benefits. However, CBO notes that those interest payments are an intra-governmental transfer within the Federal budget. Thus, CBO notes that from a budget scorekeeping perspective, the CLASS program would inevitably add to future deficits (on a cash basis) by more than it reduces deficits in the near term, even though the premiums would be set to ensure solvency of the program. The administration's chief health actuary said the CLASS Act would result in ``a net federal cost in the longer term.'' Bottom line, this program is not sustainable outside the 10-year window. That is why the Washington Post called it, ``a gimmick . . . designed to pretend that healthcare is fully paid for.'' The Post goes on: Money that flows in during the 10-year budget window will flow back out again. These are not `savings' that can honestly be counted on the balance sheet of reform.

Mr. KYL. The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning). Further, if present and voting, the Senator from Kentucky (Mr. Bunning) would have voted ``yea.''

Mr. KYL. The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning). Further, if present and voting, the Senator from Kentucky (Mr. Bunning) would have voted ``yea.''

Mr. KYL. The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning). Further, if present and voting, the Senator from Kentucky (Mr. Bunning) would have voted ``yea.''

Mr. KYL. The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning). Further, if present and voting, the Senator from Kentucky (Mr. Bunning) would have voted ``yea.''

Mr. KYL

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

Mr. KYL. Mr. President, to continue our debate on the McCain amendment to ensure Medicare benefits for our seniors are not cut, as would happen under this legislation, I wanted to talk a little bit about the commitments we have made to our seniors and what exactly would happen under the legislation that is before us. As we all know, seniors have paid into the Medicare Program, and that is with the expectation that they will get the benefits that have been promised to them. The question is, Why would we, at this point, reduce the benefits that have been promised to them, especially if the purpose is not to enhance the financial viability of Medicare, which everyone knows is going broke but, rather, to use that money to establish a new entitlement program? Let me break down the list of cuts seniors would face under this legislation: $137.5 billion would be cut from hospitals that treat seniors, $120 billion from the Medicare Advantage plan. By the way, that Medicare Advantage plan serves almost 40 percent of the Arizona seniors on Medicare. It cuts $14.6 billion from nursing homes, $42.1 billion from home health care, and $7.7 billion from hospice care. These are deep cuts, and you cannot avoid jeopardizing the health care seniors now have under Medicare by making these deep cuts. That is why the Chief Actuary at the Centers for Medicare and Medicaid Services--we use the initials CMS--believes these cuts would cause some providers to end their participation in Medicare, which, of course, would further threaten seniors' access to care. There would not be as many providers to whom they could go for their services. Our friends on the other side of the aisle say part of this is an intention to eliminate waste, fraud, and abuse. Of course, we have known for many years that there is waste, fraud, and abuse in Medicare, but actually doing something about the problem and recognizing it are two different things. If it were easy to wring hundreds of billions of dollars of savings from Medicare by just pointing to waste, fraud, and abuse, we would have done it a long time ago. Certainly the President would, during his first year in office, want to do that, given the fact we are spending a lot of money and he is trying to find sources of revenue for the various spending programs he has proposed. If it were that easy to do, it would have been done before now. Moreover, Medicare faces a $38 trillion, 75-year unfunded liability. That is almost incomprehensible. Most of us believe that whatever savings we could achieve in Medicare, to the extent you could eliminate waste, fraud, and abuse, for example, you should do that to help make Medicare solvent. Next I want to talk about what seniors are telling us. They believe, according to public opinion surveys--and I have talked to enough of them to know this is true--that these Medicare cuts are going to jeopardize their health care. They are troubled in particular by this $120 billion proposed cut to Medicare Advantage. It has been called the crown jewel of Medicare. It is the private insurance addition to Medicare in which many are able to participate in programs they would never have been able to afford otherwise. It gives them this choice to supplement Medicare to provide all kinds of benefits such as dental, vision, hearing, physical fitness programs, and other things, as I said, that they could not get otherwise. One in four of the beneficiaries in Arizona, as I said, signs up for this program--more than 329,000 seniors. They like the low deductibles and copayments in Medicare Advantage. But the Congressional Budget Office has bad news for the seniors who like this program and who like the extra benefits they have under Medicare Advantage because, as the Congressional Budget Office notes, it would cut benefits on average by 64 percent over the next 10 years, from an actuarial value of $135 to $49 a month. Think about that. The actuarial value of the benefits the average Medicare Advantage participant has is worth $135 a month today. It would be cut in this bill to $49 a month. That is a 64-percent cut, according to the Congressional Budget Office. When we say we are not cutting benefits seniors currently receive, that is not true. This legislation would do that. I have been sharing letters from constituents who have expressed concerns to me. Let me share three more letters today. One recently arrived from Joseph and Mary-Lou Dopak of Sun City West, in Arizona, of course. They wrote as follows: The plan to reduce our coverage and take $120 billion from Medicare Advantage is a slap in the face to all seniors. The Medicare Advantage plan works because Medicare funds are given to a private insurance company to administer the plan. We do not want our Medicare Advantage plan robbed to fund a government-operated comprehensive health insurance plan. Commonsense tells us that will not work. The President should be fixing what ails the current health care system, instead of putting everyone into a government- operated health care plan. For our President to pick on Medicare Advantage is totally unfair to those of us upon whose shoulders this country has been built. A constituent from Tucson, AZ, wrote a rather short and direct letter, and so it is easy to quote here. I am a senior citizen age 83. If I lose my Medicare Advantage coverage, I'll also lose my primary care physician of 18 years because he does not accept Medicare Direct. Senator Kyl, do not let them take away my Medicare Advantage. I get these letters every day. I have not yet had a constituent come up to me and say: Please, would you take away the Medicare Advantage Program, it is not right. Everybody has said, of course: Please preserve this important program. Finally, a constituent from Phoenix, AZ, who suffers from multiple sclerosis, describes what it means to her. I am a 57-year-old woman with multiple sclerosis, currently on Social Security Disability. I make under $14,000 a year and have been on the Secure Horizons Medicare Advantage plan for a long time now. . . . I realize it is hard for Congress to understand, but we need to keep our Medicare Advantage plans in order to have [quality] health care at a price we can afford. We need you to help protect Medicare Advantage plans for the seniors in your State. We are the ones you need to fight for and we should not have to choose between going to a doctor and getting our medication and having food on the table and a place to live. Please do your part to protect our Medicare Advantage plans and keep prices within our reach. As I said, these are the kinds of letters we get all the time. It is hard for these folks to understand, first of all, why, having paid into the plan and having taken advantage of what is a good supplement to the basic Medicare, that would be taken away from them. I think it is even harder for them to fathom that the reason it is being done is to pay for a new program rather than to keep Medicare itself solvent. I tell folks like this that I will continue to fight for her and I will continue to try to protect this program because we believe it is essential. It is why I support the McCain amendment to commit the bill back to committee. It only has to be there a day. We are not talking about a further delay here. But it addresses both of the key issues of cuts and savings. If the McCain amendment passes, it would send the bill back to the Finance Committee with instructions to remove the Medicare cuts from the bill. That is all it does. But, second, those savings would be applied to Medicare rather than to fund a new government program. Those savings could therefore address the waste, fraud, and abuse problem that has been identified by everyone. It can be used to strengthen the Medicare trust fund rather than to fund a new health care entitlement program. We believe the first thing we should do to see whether we can actually fix this bill--I have been quoted as saying that I don't think we can fix this bill. By that, I mean, with all due respect to my colleagues on the other side of the aisle, I don't think they want to make the changes I think would be necessary for the American people to begin to support this kind of legislation. Seniors are overwhelmingly opposed to the Medicare cuts. That is a fact. If my colleagues on the other side of the aisle are not willing to support the McCain amendment or something like it, I don't know how we could then say we can fix this bill. So I hope my colleagues will use this process we have to actually make amendments to the bill and not simply have a political discussion. Republicans have pointed out that there are better ways to reform the health care problems we have today than to do it on the backs of seniors. We put forth a bounty of ideas. Let me just recoup some of them. We think we could start and we could save a great deal of money by medical malpractice reform. That would bring down costs. We could allow Americans to buy lower cost insurance policies across State lines. That alone would unleash a wave of competition for patients' business. We could allow small businesses to band together to get the same purchasing power big businesses have. These ideas have essentially been ignored by the majority. Instead, we have this big government takeover of health care at a huge cost and significant reduction in quality and benefits to the American people. We don't think this is the way to go. Certainly, on behalf of my senior citizen constituents and others who are on Medicare Programs, I am going to continue to fight for them, as my colleague John McCain is, and therefore urge my colleagues to support his amendment to eliminate the Medicare cuts under this bill.

Mr. KYL

Mr. KYL. Mr. President, I ask unanimous consent that during the 30 minutes controlled by the Republicans, we be allowed to engage in a colloquy.

Mr. KYL. Mr. President, I will begin by making some comments about the amendment Senator McCain, my colleague from Arizona, has filed. This is an amendment that, as the minority leader just said, will protect America's seniors. It will disallow the Medicare cuts this bill includes. The economist Milton Friedman famously said, ``There is no such thing as a free lunch,'' and that applies to health care as well. There is no such thing as free health care. Someone has to pay. Since this bill is a $2.5 trillion bill, the first question is, Who pays? The first answer to who pays is, it is America's seniors, because about half of the cost of the bill is allegedly paid for by cuts to Medicare. Let me break down a little bit more specifically than the Republican leader did exactly what that means. This is about $500 billion in Medicare cuts as follows: $137.5 billion from hospitals who treat seniors; $120 billion from Medicare Advantage, which is the insurance program that provides benefits to seniors which will be cut more than in half as a result of this $120 billion reduction; $14.6 billion from nursing homes that treat seniors; $42.1 billion from home health care for seniors; and $7.7 billion from hospice care, one of the most cruel cuts of all. Obviously, with cut this dramatic there is no way to avoid jeopardizing the care seniors now enjoy, and seniors know this. That is why they have been writing our offices and attending townhall meetings to let us know they disapprove. I quoted from two letters constituents of mine from Arizona sent asking to please not cut their Medicare Advantage Program. This has been called the crown jewel of the Medicare system, and many of them rely on Medicare Advantage for dental care or vision care or hearing assistance they have come to rely on. They are not buying the claims that somehow or other we can make $\1/2\ trillion cuts in Medicare without somehow hurting their care. They know better than that, and they are right. The care they have been promised will be compromised to pay for this new government entitlement under the bill. Finally, many are wondering what happened to the promise that they get to keep the care they have. We all heard the President say that many times: If you like the care you have, you get to keep it. That is simply not true. There are 337,000 Arizonans who are Medicare Advantage patients. They like what they have. Yet we know, according to the Congressional Budget Office, that the benefits they have under Medicare Advantage are going to be cut by more than half. They are saying: What happened to the policy I like? I am not going to be able to keep it if this bill passes. This is why the McCain amendment must pass. If our Democratic colleagues are not willing to protect Medicare, then I cannot imagine how the bill could otherwise be made acceptable since it starts with the commitments that Congress and the President have made to our senior citizens.

Mr. KYL. Mr. President, I say to my friend from Tennessee, first of all it comes from a reading of the bill. It is very clear in the bill as to how much money is taken from Medicare. The number the Senator from Tennessee just articulated is the correct number. In addition to that, the Congressional Budget Office and the Joint Tax Committee analyzed the specific numbers. Obviously they were given the numbers in the bill, but the numbers they are using are--I just broke it down into four or five general categories. There are other divisions within that. But as I said, for notional purposes here: $137.5 billion from hospitals; $120 billion from Medicare Advantage. That number might be $118 billion; I am not precisely certain of it, but it is very close. There is $14.6 billion from nursing homes, $42.1 billion from home health, and $7.7 billion from hospice care. If any of our colleagues would like to contest these numbers, I would be happy to be corrected, but I believe those are the correct numbers.