Jon Kyl

Mr. KYL

Mr. KYL. On a new program. That is exactly correct. What the Medicare trustees were saying is, if we can effect cost savings in Medicare, and surely there are some to be had there, they should go to strengthen the Medicare Program itself and not allow it to go bankrupt, rather than it being used to create a new government program. Perhaps one of the reasons why there are different numbers from one side of the aisle to the other is that sometimes we are not talking apples to apples. We are talking apples to oranges, and perhaps both numbers are correct in their context. The Senator from Tennessee used the number $2.5 trillion when the program is fully implemented. That is a very important statement. The other side will argue it is only $1\1/ 2\ trillion for the first 10 years of the program. That is a correct statement. But it is $2.5 trillion for the first 10 years of total implementation of the program. What is the reason for the difference? For the first 4 years, money is being collected, but very few benefits are going out. The benefits start after year No. 4. So if we take the first 10 years of the program, we are collecting money to pay for it over the entire 10 years, but almost all of the benefits only occur during the last 6 years. Naturally, we have collected more money than we have paid out. But when we take the first 10 years of full implementation, it is as my colleague from Tennessee noted, a cost of $2.5 trillion. That is how sometimes we get somewhat different numbers. As long as we are clear about what we are talking about, one thing is crystal clear: Whether it is $1\1/2\ trillion or $2.5 trillion, we are talking real money. Somebody has to pay for it. If America's seniors are being asked to pay for half of it, that is not fair to America's seniors, given the commitment we have made to them. That is the point of the McCain amendment. Protect Medicare, protect America's seniors. We can do that with the simple amendment Senator McCain has which is send the bill back to committee--it would only take 1 day--and send it back here without those Medicare cuts in the bill.

Mr. KYL

Mr. KYL. The following Senator is necessarily absent: the Senator from Alabama (Mr. Sessions).

Mr. KYL

Mr. KYL. I ask unanimous consent to speak up to 20 minutes in morning business.

Mr. KYL

Mr. KYL. Mr. President, I rise to talk about the health care legislation because in a few minutes the official debate in the Senate will commence. The American people will have before them the full panoply of arguments both for and against the legislation. They will make their judgment about whether we are in fact carrying out their will. According to public opinion surveys, the will of the American people is that this bill should not pass. According to a relatively new Rasmussen poll, by an 18-point margin, Americans say this bill should not pass. By 56 to 38, they oppose it. In terms of people in the middle, the independents or other voters not identified with either political party, the percentage of people who oppose the legislation is even greater. More than 3 to 1, Independents oppose this legislation. The majority believes it will both increase their costs and decrease the quality of health care. It is for these reasons that I indicated before--and I will say it again--I don't think this bill can be fixed. In fact, I don't think the majority will allow it to be fixed. That is why, along with my Republican colleagues, I believe we should start over and attack the problems that face our country in a more realistic way, in a step-by-step approach, first to win back the confidence of the people and then to provide elements of relief to each of the problems we face, rather than trying to tackle the entire health care system, the government programs, the private programs, the insurance, the physicians, the hospitals, trying to do it all in one giant bill that results in massive government takeover, over $1 trillion--in fact, $2.5 trillion--in expenditures, massive new debt, more taxes, higher insurance premiums, all of which will result in, ultimately, the rationing of health care which is, to me, the most dangerous part of this entire exercise. Somehow or other, we could probably pay the expense of this. Somehow or other we will survive. But we won't survive the life-and-death decisions that are made every day by patients, doctors, and families, if the government begins intruding between the patient and the physician, begins making decisions about what kind of health care we can have, what kind of health care the government will allow payment for and the like. Those become life-and-death decisions. That is why Americans feel so strongly and personally about this debate and about the decisions we are about to be making here. Let me address something the distinguished majority leader said a moment ago, and then I wish to talk a bit about Medicare as one of the aspects of this insurance debate. The majority leader said that Republicans have had a seat at the table. I am on one of the two major committees, the Finance Committee. I think one amendment was adopted. It was an amendment offered by a Republican and a Democrat on the committee. There were well over 100 amendments that Republicans offered that were all shot down, defeated, largely on party-line votes. I say to my distinguished friend from Nevada that maybe we have a seat at the table but it is a little like the kids table at Thanksgiving dinner where you are told to mind your manners and keep the noise down. That is the way Republicans feel about our role at the table in fashioning this legislation. The majority leader himself would acknowledge that after the two committees in the Senate acted, he went behind the closed doors of his office and, along with representatives from the White House and a couple of other Democratic Senators, no Republicans at all, legislation was developed in his office that he then presented here on the Senate floor just before the Thanksgiving recess. That is how the legislation got developed. It was without Republican participation. We will have a chance to amend this bill. Maybe he will prove me wrong. Maybe he will demonstrate that we can fix this bill. I do, with all deference, disagree with his comment that the motivation of Republicans is to do nothing. Of course, he frequently says doing nothing is not an option. Nobody is arguing about doing nothing. Republicans have presented some very good ideas to do something, to do a lot of somethings. Our ideas have been rejected. Let's don't get into false debate about doing something or nothing and the only alternative is the bill that is on the Senate floor. There are alternatives, and I will discuss one group of alternatives we have presented in a moment. There will be a good test to see whether in fact we can amend this bill or if my prediction that there is no way to fix it will turn out to be true. That has to do, first and foremost, with what this bill does to Medicare, the program we have developed for seniors. Let me go over some of the Medicare cuts in this bill and then ask my Democratic colleagues if they are willing to join Republicans in restoring these provisions of Medicare--in other words, in striking these cuts--if they are willing to join Republicans in that effort. Then maybe the majority leader is right. Maybe we can fix this bill. If they are not willing to do that, then I resubmit that this bill can't be fixed, and it can't because our Democratic friends won't allow it to be fixed. Here are the ways this bill cuts Medicare benefits for seniors: $137.5 billion is cut from hospitals that treat seniors; $120 billion is cut from Medicare Advantage. I will return to Medicare Advantage in a moment. That is the private insurance company that somewhere around a quarter to a third of seniors take advantage of. Well over a third of the seniors in Arizona, approaching 40 percent of Arizona seniors, participate in the Medicare Program, the benefits of which are substantially cut. Continuing, $14.6 billion is cut from nursing homes; $42.1 billion from home health care, $7.7 billion from hospice care. That is a total of $464.6 billion in Medicare cuts. Seniors know we can't make these kind of cuts without jeopardizing the care they receive. That is the concern I have. We are not talking about cuts in the abstract. We are talking about delay and denial of care for American citizens. These folks wonder how it is fair or justifiable to cut the health care that has been promised to them in order to pay for some kind of new government entitlement. I receive letters and phone calls every day. I have quoted from many of these letters. Many of them have to do with the proposed cuts in Medicare, in particular to Medicare Advantage. I mentioned the percentage. In numbers, it is about 329,000 Arizonans--329,000 Arizonans--a third of a million who enjoy Medicare Advantage plans. That is over 37 percent of overall Medicare beneficiaries in my State of Arizona. They know $120 billion in Medicare Advantage cuts will hit our State and, specifically, their coverage very hard. They worry that under the Reid bill, they will lose the low deductibles and the low copayments they enjoy under Medicare Advantage and many of the other benefits I mentioned a moment ago. They worry about losing the choices they have, which is one of the nice things about the Medicare Advantage plan, and the extra benefits, including things such as eyeglasses, hearing aids, dental benefits, preventative screening, free flu shots, home care for chronic illnesses, prescription drug management tools, wellness programs, medical equipment, and access to physical fitness programs. These and many more are the kinds of benefits that are included in the Medicare Advantage Program, and they will lose many of these benefits under the legislation that is before us right now. I think they have a right to be concerned about losing these benefits. If there is any doubt about this, incidentally, the Congressional Budget Office, which is a nonpartisan entity which serves both Democrats and Republicans here--it calls it straight; sometimes they give answers we do not like, but they provide the analysis of the costs and benefits--and the Congressional Budget Office has confirmed that under the Democrats' bill, Medicare Advantage beneficiaries will lose, and they will lose big. In fact, they will lose more than half their extra benefits under Medicare Advantage. Well, my senior citizen constituents do not like that, and they have let me know about that. Let me share a couple letters--just excerpts from letters from two of my constituents. The first is from Surprise, AZ: My mother is on Medicare Advantage, and I don't know what she would do without it. The poor and middle class are already hurting much more than government officials realize. We are on fixed incomes, and have already cut back to bare minimum. What happened to ``government for the people, by the people?'' Another constituent from Gold Canyon, AZ, writes: I have been on Medicare for 11 years and have been subscribing to a Medicare Advantage plan for the past 6 years. It has been excellent, and has provided substantial savings for us. Now we understand that the government is dropping its support of the plan. Please try to stop this. It is very important to many senior citizens in Arizona. These constituents of mine, these senior citizens, know Medicare cuts will hurt seniors' care, and those who try to suggest otherwise are simply wrong. The Congressional Budget Office, as I have said, has confirmed it. One of the newspapers on Capitol Hill, Politico, recently provided a helpful summary of an actuarial report on the Democrats' health care plan, prepared by the Centers for Medicare and Medicaid Services. That is CMS. That is the outfit out of the Department of Health and Human Services that actually runs Medicare. According to page 8 of the report, as Politico summarizes, the Democrats' bill: . . . reduces Medicare payments to hospitals and nursing homes over time, based on productivity targets. The idea is that by paying institutions less money, they will be forced to become more productive. But it's doubtful that many institutions can hit those targets, which could force them to withdraw from Medicare. We hear it all the time: physicians dropping or not taking any new Medicare patients; entities that are no longer going to be able to serve Medicare patients because they are not getting paid enough by the government for them to even break even. This report I am quoting from--the CMS report--according to Politico, says that by 2014, Medicare Advantage enrollment will plunge 64 percent--we are not talking about just a few folks--from 13.2 million down to 4.7 million because of the ``less generous benefit packages.'' One of the reasons this is being done is because those on the left do not like private competition for the government program, Medicare. What I think they fail to appreciate is what my constituents have appreciated, which is this private alternative to regular Medicare provides additional benefits, additional health protections. If they are willing to pay a little bit more for those benefits, why shouldn't they be allowed to take advantage of those benefits? No. Those on the left say: We don't want any private insurance companies competing to get Medicare patients. We want that to be strictly a government program. Well, if folks like it, why shouldn't they be allowed to keep it? Remember what the President said: If you like your insurance company, you get to keep it. No, that is not true, according to this. Medicare Advantage enrollment will plunge from 13.2 million to 4.7 million because of the ``less generous benefit packages.'' So I guess it is not true: If you like it, you get to keep it. The Washington Post--a newspaper here in Washington--wrote an article about the Center for Medicare and Medicaid Services report, the same one I have been quoting here, and the headline was ``Bill Would Reduce Senior Care.'' Well, that says it in a nutshell. The story goes on to tell us: ``A plan to slash . . . Medicare spending--one of the biggest sources of funding for President Obama's proposed overhaul of the nation's healthcare system--would sharply reduce benefits for some senior citizens.'' ``Would sharply reduce benefits.'' So the Medicare cuts, as proposed by the majority, do, in fact, jeopardize seniors' benefits. The majority leader says we can amend the bill, and that is hypothetically correct, of course. Let's see how many of our Democratic colleagues are willing to join Republicans in striking these Medicare cuts, the cuts I have just now been referring to. If we do not do that, then I will repeat what I have said before, which is that we should start over because it is clear this bill is not going to be fixed and starting over would mean taking some of the Republican suggestions. Let me talk about one of these suggestions. My colleague from Florida was talking about the sorry state of real estate in his State of Florida, and I could have added my State of Arizona as well. I agree with much of what he had to say about that. But he also noted, with regard to health care, there is a subsidy in what those of us with private insurance pay because of the care that is given to others who cannot always pay for all of it. That is true. I would add, there is also a subsidy for what we pay in insurance premiums because of the government programs, such as Medicare and Medicaid, which, likewise, do not pay for all the benefits they provide. In fact, they only pay doctors and hospitals somewhere in the neighborhood of 70 to 80 percent of their cost, and we have to make up the difference in that in the private insurance premiums we pay. So increasing insurance premiums is, to a large degree, the fault of the U.S. Government, not the insurance companies. The Democrats say the answer is yet another government program, and they even have a government insurance program in the legislation they have introduced. Their other answer is to write insurance policies. They actually specify in the bill what policies have to include. These are called government mandates. What is the effect of these proposals? Is this the right way to go or is there a better idea? Again, the Congressional Budget Office, which the distinguished minority leader referred to a moment ago, in its most recent report said--and it said the same thing to the Finance Committee--the premiums for private insurance under this Democratic legislation will, what, go up. The average family is going to pay more in insurance premiums under this legislation, not less. What was the whole idea here? The whole idea of health care reform was to reduce the cost of health care, to reduce our insurance premiums. They are skyrocketing. My colleagues on the other side of the aisle say: Small businesses cannot afford to buy insurance for their employees; my constituents cannot afford their health insurance premiums, which are increasing in price. All that is true. They are increasing. So what should we be doing? We should be lowering them, not raising them. This legislation, according to the Congressional Budget Office, increases insurance premiums. What about the Republican alternative, the alternative that was presented in the House of Representatives by the House Republicans? That alternative, according to the Congressional Budget Office, reduces average insurance premiums by $5,000 a year. So on the one hand, you have the Democratic proposal, which increases insurance premiums; on the other hand, you have the Republican proposal, which decreases premiums. There is a study by a private consulting firm, Oliver Wyman, which breaks this down by State. The reason I am excited about this Republican idea is the average family in Arizona would see its premiums go down annually by over $7,400. So think about that. On the one hand, you have insurance premiums going up, under the Democratic legislation; under the other, you have insurance premiums going down, on average, somewhere in the neighborhood of anywhere from $3,300 to, in my State, up to $7,400. I think the average is somewhere between $3,000 and $5,000. The point is, you can cut insurance premiums with better ideas coming from Republicans, and I just ask my colleagues: Why wouldn't you do that as opposed to the complicated, costly, government-run kind of program you are trying to institute under this legislation, which, according to CBO, would raise insurance premiums? That is why the American people, by a significant margin, say: Do not pass this bill, why they appreciate it would raise their costs, it would reduce the quality of their health care, and why, therefore, my colleagues and I are going to try our best to persuade our Democratic colleagues to amend the bill. But if at the end of the day they are not willing to buy some of these good Republican ideas and instead insist on pushing right ahead with their legislation, at the end of the day, we will have to say: We are sorry, it does not appear this bill is going to be fixed and, therefore, we are going to follow the wishes of the American people and see to it that it does not pass. I suggest the absence of a quorum.

Mr. KYL

Mr. KYL. Mr. President, I wonder if I may interrupt to ask, when the Senator said this is not the approach, the approach taken by the Democratic leader, among other things, because of the cost of it--my colleague from Arizona is here, and I think no one takes second place in this body to him in carefully looking at the cost of every bill we have on this floor. He frequently proposes amendments to reduce the cost of the bills. I wonder if my colleague from Arizona agrees with my colleague from Utah and is aware of the respected columnist David Broder who wrote in today's Washington Post--actually, it is for publication tomorrow--a column, the title of which is ``A Budget Buster in the Making.''

Mr. KYL. Mr. President, if I can interrupt my colleague and compliment him on the phrase ``arrogance.'' Maybe ``hubris'' is another word. To think we are smart enough in Washington to figure out what is best for 300 million Americans is truly arrogant. A question posed by my colleague from Arizona a moment ago: Do they really think they can whiz this by the American people with regard to it not adding to the deficit, for example? Good question. I want to get back to that Broder piece my colleague from Arizona quoted. There is actually a survey that answers that question. It turns out the American people are pretty smart about this. The question in this Quinnipiac poll read: President Obama has pledged that health insurance reform will not add to our Federal budget deficit over the next decade. Do you think that President Obama will be able to keep his promise? Or do you think that any health care plan that Congress passes and President Obama signs will add to the Federal budget deficit? Answer: Less than one-fifth of the voters, 19 percent to be exact, think he will keep his word. Nine out of 10 Republicans, 8 out of 10 independents said that whatever passes will add to the torrent of red ink and by a margin of 4 to 3 even Democrats agreed that this is likely. That is why, Broder says at the end: By a 16 point margin the majority of this poll said that they oppose the legislation moving through Congress. So while it is true they are rather arrogantly trying to contend there will not be any big budget deficit from this, the reality is the American people have broken the code they will. One of two things will happen. My colleague from Arizona put his finger right on it. Either we will make cuts in Medicare, for example, that we have never had the political ability to make in the past, in which case our seniors will be hurt, or else, as David Broder said, this bill will truly be a budget buster. Neither of those results are very sanguine outcomes to an attempt to transform or reform our health care.

Mr. KYL. Absolutely.

Mr. KYL. If my colleague will yield, Broder, in his column as to this estimate of budget deficit, he says it depends upon two big gambles. Will future Congresses actually impose the assumed $420 billion cuts to Medicare, Medicaid and other Federal health care programs? They never have.

Mr. KYL. Mr. President, I see our other colleague from Utah here. I know that during Finance Committee deliberations, he was directly involved in one of the conversations about the drug costs and also has been working on his own ideas for alternative approaches to some of these problems. I will ask a question and then if my colleague from Utah, Senator Hatch, may like to comment further, we would invite that. Is it the case that the Joint Committee on Taxation, which reported to the Finance Committee, and the Congressional Budget Office both said that not only would the increased taxes on the pharmaceutical industry, the medical device industry, and the insurance industry be passed on to consumers in the form of higher premiums but that overall under the legislation that is before us, for the average family as compared to what prices are today, insurance premiums would actually go up and this was one of the two major reasons, the other being mandated benefits?

Mr. KYL. Mr. President, I went back to my office and got the exact pages our doctor colleague has just been talking about--page 1,189 and page 1,190 of the actual bill. My colleague from Arizona asked the question--this entity, this U.S. Preventive Services Task Force; the entity that made the recommendations with regard to mammograms is it possible their recommendations could be used to deny coverage or reduce payments or deny payments? Well, here is the exact language, if my colleagues would like to hear it. The Secretary of HHS is, of course, the person who implements this. It is not the task force. The task force makes the recommendations, and then the Secretary of HHS issues the regulations. Quoting: Notwithstanding any other provision of this title, effective beginning on January 1, 2010,-- That is just a couple months from now-- if the Secretary determines appropriate, the Secretary may-- (1) modify-- (A) the coverage of any preventive service described . . . to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. . . . So there you have modifying the coverage. Then, secondly, as my colleague was just reading: (2) provide that no payment shall be made under this title for a preventive service described in subparagraph (A) of such section that has not received a grade of A, B, C, or I by such Task Force. In other words, they make the recommendation, and they say this does not meet our standards, so she can say, therefore, we are not going to pay for it. That is taking the recommendations of this task force and translating it into the rationing of health care. This is how rationing begins.

Mr. KYL. The following Senator is necessarily absent: the Senator from Ohio (Mr. Voinovich).

Mr. KYL

Mr. KYL. Mr. President, I rise today in my capacity as the cochairman of the Senate's National Security Working Group. It is in that capacity I recently traveled on a CODEL with the senior Senator from California. Pursuant to the requirements of the current Memorandum of Understanding on the Administrative Procedures for the U.S. Senate National Security Working Group, specifically paragraph 6, Senator Feinstein and I have filed in the Office of Senate Security a classified memorandum available to the members of the working group and their designated staffer. As my colleagues are aware, the NSWG, which is the successor of the Senate's Arms Control Observer Group, was created by the Senate to aid administrations that choose to negotiate arms control treaties. In view of the 67-vote threshold to ratify a treaty, and given the complexity and importance of the subject matter at the heart of arms control treaties, as well as the Constitution's mandate that the U.S. Senate has a role of advice and consent in treaty making, the NSWG exists to provide a forum for an expert group of Senators to have up-to-date information on ongoing treaty negotiations, and to provide the Administration with consultation from the Senate. This consultative role is important, because the Constitution entrusts the Senate with the responsibility to provide its advice along with, perhaps, its consent to a treaty. This means administrations are supposed to listen to the advice of Senators if they expect to earn the Senate's consent. The U.S. negotiating team is lead by Assistant Secretary of State Rose Gottemoeller, a highly capable administration official and a gracious host. I thank her for her time and hospitality, as well as for her service. I urge my colleagues in the NSWG to take the time to study the classified memorandum Senator Feinstein and I have drafted. The issues covered in our memorandum are significant, and, in some cases worrisome. I won't go into detail here--the memorandum is classified and for good reason. That said, I will ask to have printed four recent articles on the START follow-on treaty negotiations to the Record. These articles highlight issues that every Senator should consider. As my colleagues know, the 1991 START Agreement expires 2 weeks from today. I urge my colleagues to consider what will happen on December 6, the day after the expiration of that agreement. For the first time in 15 years, an extensive set of verification, notification, elimination and other confidence building measures will expire. The U.S. will lose a significant source of information that has allowed it to have confidence in its ability to understand Russian strategic nuclear forces; likewise, the Russian Federation will lose information about U.S. nuclear forces, almost all of which are strategic, unlike the Russian-forces, which place tremendous emphasis on tactical nuclear forces not covered by the 1991 Agreement or its successor. Yet, no one appears to know what will come next. According to the reports I will add to the Record, there is no plan for what provisions of the 1991 Agreement will be maintained after the 1991 Agreement expires on December 5. The question of what happens after the 1991 Agreement expires is important. The Russian Federation is already telling us they intend to deploy a new road mobile missile, one which, for the first time, will have multiple independent reentry vehicles. Open source reports indicate this missile will constitute 80 percent of Russian ICBM forces by 2016. This is a significant deployment. Moreover, it confirms that Russia, unlike the U.S., is modernizing its nuclear forces. How will we monitor this highly destabilizing weapon, the RS-24? According to the article I introduced from the Global Security Newswire by Elaine Grossman, we won't have the entry and exit portals at Votkinsk. That we don't have answers to these questions is alarming, more so because our negotiators must have known for months that a ``bridge'' would be necessary. Why do I say this? Simple: the Moscow Treaty took the Senate 9 months--287 days--to ratify from the date of its signature. And that was a very limited treaty--it was about two to three pages long. The START agreement of 1991 took 429 days to ratify on October 1, 1992, after it was submitted to the Senate on July 31, 1991. And by everything we have seen in the press and been briefed on in the National Security Working Group, this new treaty will be almost as complicated, and will include highly significant nuclear force reductions, that will take time for Senators to consider. In fact, the Senate has not had even one hearing on the START process yet. The administration must have understood this. Yet it spent the first half of the year negotiating a joint understanding that would allow it to show progress towards the President's goal of world without nuclear weapons. According to press reports, only now have the negotiators begun looking at the question of verification. I was shocked that there had been virtually no talk--and I know this from my conversations with members of both the Russian and U.S. delegations in Geneva--of what happens after December 5 and prior to the possible entry into force of the follow-on agreement when and if it is signed by the two executives. Mr. President, I don't say this lightly, but, this borders on malpractice. I have said repeatedly that I hope to be able to support the treaty being negotiated now. I have kept an open mind throughout this process. Yet as I learn more about what has been negotiated thus far, and the general process this treaty negotiation has taken, I grow more concerned. The paramount object of this treaty should have been to extend the verification measure of the 1991 Agreement. But, it appears that the administration's object was to lock in significant nuclear weapons cuts; they achieved that with the July joint understanding. Only recently has verification gotten the attention it deserved all along. And, now, the Russians may think they have the advantage. That may be why they returned a counter offer a little over a week ago that the U.S. was ``very disappointed about'' in the words of Under Secretary of State Ellen Tauscher. We have entered an end-game where the Russians may feel that the U.S. wants the START follow-on agreement more than they do; even though Russia needs this treaty, needs to lock the U.S. into strategic delivery vehicle reductions as Dr. Keith Payne explained in his testimony before the House Foreign Affairs Committee, only the House so far has held a hearing on START. I believe the U.S. would have been very well served with a simple 5 year extension of the 1991 Agreement, as the treaty allowed. But, now the President is preparing to head to Oslo to collect his Nobel Peace Prize, one that was apparently based on the President's endorsement of the Global Zero vision. The Russians apparently perceive that the President would be quite embarrassed if he had to pick up his Prize having failed to get a START follow-on completed. In the interest of the United States, I implore the administration not to negotiate against an artificial deadline. There are means to lock in verification and associated activities from the 1991 Agreement after it expires in 2 weeks. Mr. President, I ask unanimous consent that the four articles to which I referred be printed in the Record.

Mr. KYL

Mr. KYL. Thank you. Mr. President, we are going to focus for the next hour on perhaps one of the most pernicious aspects of Leader Reid's bill: the fact that it cuts Medicare by almost $\1/2\ trillion--almost $500 billion in Medicare cuts. There are a lot of seniors in my State of Arizona and in the States represented by my other Republican colleagues. Those seniors are scared of these cuts. It is not because of anything Republicans have said to try to scare them; they have simply become aware of what is in these bills. By ``these bills,'' I am talking about both the Senate bill offered by the majority leader and the House bill, which are the two bills that would presumably try to be reconciled in conference. Our seniors have been told that under both bills, their benefits are going to be cut by about $500 billion, and that is enough to scare them. In fact, all of America is concerned about this. A recent USA TODAY Gallup Poll shows that an overwhelming number of Americans--61 percent--oppose cutting Medicare to pay for health care reform. Yet, despite that overwhelming opposition, Democratic leaders in Congress have moved ahead with this bill to slash, as I said, nearly $\1/2\ trillion from Medicare to pay for the new health insurance programs. They are simply not listening to what Americans have to say about this. If Democratic leaders have their way, hundreds of billions of dollars will be slashed from hospitals that treat seniors, from the Medicare Advantage Program, which we will talk about in a minute, from nursing home care, home health care, and hospice care. Medicare already faces a severe challenge, including a whopping $38 trillion in unfunded liabilities and insolvency by the year 2017. That is almost incomprehensible--in just a few short years, $38 trillion in unfunded liabilities and insolvency. Obviously, seniors want us to fix that problem rather than raiding Medicare to pay for a new health care program, and they want to preserve Medicare Advantage. I receive letters from worried seniors every day about this Democratic plan to cut Medicare Advantage, which is a very popular program in Arizona. Medicare Advantage is the opportunity we have given seniors to enroll in a private insurance company to help them receive Medicare benefits. What these private insurance companies do is make a more attractive program by adding some additional benefits to the basic set of benefits that are promised under Medicare. What our seniors are telling us is, these are very important benefits to them, things such as vision care and hearing. Now that I am getting a little bit older, I can tell you that both my vision and hearing is starting to go, and I would like to have that kind of benefit. Dental benefits, preventive screenings, free flu shots, home care for chronic illnesses, prescription drug management tools, wellness programs, personal care, and durable medical equipment, all very important for seniors. By the way, physical fitness programs, one of which has a great name--it is called the SilverSneakers Program, and the seniors are very supportive of this because it keeps them physically fit which is, of course, what we should be doing. I get letters and phone calls from my constituents, and they are sharing their anxieties about losing these benefits, losing prescription drug coverage; about the overall decline in the quality of care that they understand will occur when their doctors' payments are cut, when all these other cuts under Medicare that my colleagues are going to discuss in a moment finally hit. They know it is going to impact their care. They don't like this interference from government bureaucrats, in effect, getting between them and their physicians when it comes to their health care. Let me read portions of three letters from constituents and then I will yield to my colleagues. A constituent from Surprise, AZ, writes: Dear Senator Kyl: Please fight the cuts to Medicare Advantage. I am on Social Security disability and on a fixed income. The Medicare Advantage insurance I have has literally been a lifesaver for me. I cannot afford to lose the coverage that includes prescription drugs. I need your help on this. Two Medicare beneficiaries, a husband and wife from Mesa, AZ, write: We believe that our health is our responsibility and that we have a right to make all the decisions regarding our health. We do not need permission from our government to take actions that will protect and preserve our health. We do not need a third party who has never met us and who is not acting in our best interests in making decisions about our medical care and we do not want to lose our Medicare HMOs. That is the Medicare Advantage about which I spoke. Then, a constituent from Sun City West, AZ, who incidentally is a World War II veteran, wrote a very powerful letter about how Medicare Advantage improved his life and his wife's life. He said: As a B-17 pilot I flew 50 combat missions out of England and I earned five air medals after flying B-24s on coastal submarine patrol. When we moved to Arizona to be near our children I visited a local VA hospital to find out that I had a $50 copay for each visit and I never saw a physician, just an assistant. In desperation, I purchased a Medicare supplement for my wife and myself. The cost was almost $600 per year and I only receive $833 a month on Social Security. Fortunately, here in Arizona, my wife and I were both able to sign up for MediSun, an Advantage plan, with no monthly payment and simple $10 or $20 copays. That made it possible for us to purchase a home. With the health care reform being considered, we understand that Advantage plans will be reduced or eliminated. What happened to ``if I like my insurance, I can keep it''? Well, it is a good question from my constituent. Of course, he is exactly right. When the promise was made: If you like your insurance you get to keep it, unfortunately, that is not the way this legislation works. As a result, a lot of the benefits they are currently receiving, for example, from Medicare Advantage, would be cut or eliminated. My constituents are right to be wary of cuts to their Medicare Advantage. They depend on it. They realize you can't cut $\1/2\ trillion from Medicare without adversely affecting your health care.

Mr. KYL. I am happy to yield to my friend.

Mr. KYL. Mr. President, the Senator from Mississippi is exactly right. It is not just Members of the House and Members of the Senate, Republicans and Democrats and senior citizens in the State of Arizona. Here are some other third-party sources. I will just cite three: The Centers for Medicare and Medicaid Services; that is, CMS. That is the outfit that runs Medicare. They confirm that cuts will indeed compromise the services seniors now receive. The Washington Post--how about that for a third-party source-- summarizes a report in a November 13 article entitled ``Bill Would Reduce Senior Care.'' That is a fairly specific headline. It says: A plan to slash more than $500 billion from future Medicare spending, one of the biggest sources of funding for President Obama's proposed overhaul for the Nation's health care system, would sharply reduce benefits for some senior citizens and could jeopardize access to care for millions of others. Then Politico, which is a Capitol Hill newspaper, reported that, by 2014, enrollment in Medicare Advantage would drop from 13.2 million to 4.7 million because of less generous benefit packages. That is a 64- percent decrease. Looking at my colleague's chart there, Medicare Advantage, which I spoke about and which my constituents wrote to me about, the concern there is that people now enrolled--13.2 million--are going to be reduced down to 4.7 million because the reductions in the benefits are simply no longer sufficient incentive for them to enroll in that program. Of course, that is what the pro-government-run health care folks want to happen. They are all for a public company competing with private insurance companies in the market for folks, but when it comes to Medicare, they don't want the private companies that provide Medicare Advantage care competing with the government program. Under this bill, they will get their way. It is going to go from 13.2 million down to 4.7 million. That is a lot of senior citizens who will lose their Medicare Advantage coverage. I will conclude by confirming what the Senator from Mississippi said. It is not just Representatives in the House or Senators who have sworn to help protect our constituents, but it is third-party sources as well in the government and in the media that have confirmed that this bill will cut benefits. They will certainly do it for senior citizens. We will talk later about the Republican ideas. Republicans have suggested a step-by-step approach to target specific solutions to specific problems, including things such as medical liability reform; allowing Americans to purchase insurance across State lines, which would expand competition for patient business; association health plans to help reduce costs. Most of our ideas are cost-free; they won't cost a dime. They wouldn't cut Medicare or diminish the quality of care for anybody. They have been rejected by our Democratic colleagues. I hope my colleagues will agree that a place to start in this legislation is not to cut Medicare. Why would you want to cut Medicare if the whole idea here is to provide greater opportunity for affordable and quality health care for American citizens? It makes no sense to me. I yield the floor to my colleague from Idaho.

Mr. KYL. Mr. President, the answer to that is yes. The idea was that seniors were complaining about the existing program. One thing was that a lot of folks in rural areas were not receiving good, efficient, and quick care because they had to drive long distances and couldn't find a doctor to serve them and hospitals couldn't take care of them. Republicans tried to figure out, how could we incent the insurance companies to put together pools of physicians and hospitals to go into rural areas and take care of citizens who live there. The Medicare Advantage Program was one of the ways in which that was done. It has proved to be very successful.

Mr. KYL. Mr. President, I ask if my colleague will yield for a quick question.

Mr. KYL. We talked a lot about the rationing of health care that is the inevitable result of these cuts in this bill; that when you reduce the amount of money you compensate hospitals, doctors, nurses, and others, they cannot provide as many services. Some leave the business altogether. As the Senator from Idaho pointed out, some businesses go out of business. So there are fewer entities providing the care. That means it takes longer for patients to obtain the care where it is available, and frequently they do not get as good of care because folks cannot take that much time to take care of them in that sense. Will my colleague please talk about his concerns about the overall problem of rationing that comes from the reductions in the benefits to providers? By the way, the Senator's chart says ``other Medicare cuts to providers.'' We use that term ``providers'' as a short-cut term. Will my colleague explain what it means to a 70-year-old woman in Idaho who is a provider and how important is that, what happens when you don't pay that provider so that provider is no longer available to take care of her?

Mr. KYL. Mr. President, I want to interrupt my colleague from Mississippi for a moment and ask him--or I think the Senator from Idaho has some experience with this as well--we have been talking about $\1/ 2\ trillion in cuts to Medicare. But we have not even talked about the biggest one yet. We have talked about cuts to Medicare Advantage, we have talked about the cuts that will be ordered by this new Medicare Commission. But I guess I would ask my colleague from Idaho, isn't it true that the biggest dollar cuts to Medicare are going to come because we are going to pay the doctors and the hospitals and the nurses a lot less money? Of course, every one of my constituents who has talked to me about it said wait a minute, if you are going to pay them a lot less money--I am having a hard time finding a doctor who will take Medicare patients. Isn't that going to result in delay of care for me and denial of care, in effect rationing of care? There will not be enough doctors and nurses to take care of me because they are not being paid enough to even keep their doors open.

Mr. KYL. Mr. President, I would say to my colleague from Florida that is exactly right. I was interested in that Congressional Research Service report, a totally nonpartisan report, which essentially makes the point if you vote to proceed to the bill, 97 percent of the time you are voting to approve the bill because they end up passing. Those of our colleagues who say they have problems with this bill, serious problems with the bill, are enablers if they vote to proceed to the debate of this bill. They are enabling those who want to pass a bad bill to do so because that is exactly what will happen. In order for them to try to fix the bill it would take 60 votes to get an amendment agreed to and that is a very tall order around here. The second part of the question, yes, this may be a little confusing, but what the majority leader has asked is that we vote on a cloture motion to proceed to a House bill that has to do with bonuses for AIG people. You say, What does that have to do with this? The answer is it has nothing to do with this. The leader ordinarily would have taken the House bill, which is the bottom half of this stack here, would have taken the House-passed health care bill and asked to proceed to that bill. If we then agree to proceed to that health care bill, he would then substitute his own version, which is the second half of the stack here, and then you would have a Senate version that we would begin to amend or act on or at least debate. I don't think the majority leader wants those on his side of the aisle to have to vote on the House-passed health care bill. It doesn't appear to be very popular out in America. In fact, by about 2 to 1 the American people say they don't want to have anything to do with that bill. So, instead, we are going to a shell bill that has nothing to do with health care and then the leader will simply shift to his substitute health care bill. As my colleague from Florida knows, once you vote to begin the debate on this bill, you have put in motion the process by which it could, and in 97 percent of the cases does, end up getting passed into law. For those colleagues who say I am not sure I like this bill but you know I will move the process along by at least going to it, the time to stop it and to say let's fix it before is the time right now, not after you get on the bill. It is too late.

Mr. KYL. The point is this: Unless they have a way to get 60 votes to get those provisions out they are in effect endorsing them by voting to proceed to the bill because they can't get them out. My colleague is exactly right.

Mr. KYL. Mr. President, the whole point of health care reform is to bring down costs and to make health care more affordable for American families. So why have Democratic leaders produced a health care bill loaded with provisions that will increase premiums? Independent studies from the nonpartisan Congressional Budget Office and the Joint Committee on Taxation and even a study by the chief actuary at the Department of Health and Human Services confirmed this: that the Democrats' plan will drive up premiums and overall health care spending faster than in the absence of these so-called reforms. How is this so? Let me mention five specific ways. First, new insurance mandates and new taxes on the insurance industry. New insurance requirements and new taxes on the insurance industry will force premiums to rise for many Americans, particularly the young and healthy. According to an independent analysis that studied the effect of the new insurance reforms and new taxes on the insurance industry, insurance premiums in my home State of Arizona could skyrocket by as much as $2,619 for individuals and $7,426 for families. Think of that, an increase of $7,426 for families in my State. That is outrageous. What can $7,426 buy an Arizona family? A lot of things. It could pay for a year's tuition at the University of Arizona. It could pay for a year and a half of groceries or nearly 2 years of utility bills or it could pay for 2 years' worth of gasoline. Families have a lot of expenses and a lot of ways to spend $7,426. They don't need the Federal Government intruding on them and dictating that money has to go somewhere else. Our friends on the other side of the aisle will say they could provide subsidies. In fact, the legislation will provide subsidies to help with this increased cost. But not every family will qualify, and the subsidies may not even cover the total cost of the increase. Moreover, what is the point of raising the cost of health insurance and then subsidizing a portion of the increase? You are still raising premiums. It is nonsensical to have a health care reform that makes families worse off and then gives them a government subsidy to help make up for part of the cost. Second, new mandated benefits will increase costs. Under the Reid bill, the government will require insurers to cover a broad range of new medical benefits determined by Washington, regardless of whether those benefits are actually needed by each individual patient. These additional benefits might help some patients, of course, but the government cannot provide them to everyone for free. So the cost will be shared by everyone in the insurance pool, and that means increased premiums for many Americans. In fact, the Council for Affordable Health Insurance estimates the new mandated benefits would increase the cost of basic health coverage between 20 and 50 percent. That is the second way insurance premiums are increased. Here is the third way: limits on plan types. Under this Reid bill, insurers are limited to offering a total of only four specific kinds of insurance plans. So the low-cost, high-deductible plans that currently families and individuals enjoy will be virtually eliminated. They will have to buy more expensive plans, again paying more in premiums. Whatever happened to getting to keep what you have? Just as one size do not fit all, in this case, four sizes do not fit all either. Here is the fourth way premiums increase: New taxes are imposed on groups such as medical device makers. According to the Congressional Budget Office and the Joint Committee on Taxation, a new tax on medical devices will increase premiums and increase the price of everything from wheelchairs to diabetes testing supplies, to pacemakers, and it will be paid entirely by the patients. Its cost, according to the Joint Committee on Taxation? It is $19.3 billion over 10 years. This tax will hit cutting-edge technology such as CT scanners, replacement joints, and the arterial stents that doctors use during angioplasty. This tax will clearly stifle innovation. As the Wall Street Journal editorialized: This new tax will eventually be passed through to patients, increasing healthcare costs. It will also harm innovation, taking a big bite out of the research and development that leads to medical advancements. The fifth way in which this legislation will increase costs for the insured is it actually taxes the insurance plans themselves for the first time. You buy insurance, you get taxed. The Reid bill, for the first time, directly accomplishes this. As the independent Joint Committee on Taxation told us, this new tax will increase the cost of health insurance for everyone, since insurers will pass the costs along to their patients. This tax alone could raise some Americans' premiums by $487 per year. Because this tax is indexed to regular inflation rather than to health care inflation, just as with the alternative minimum tax, it could soon start hitting middle-income families. According to former Congressional Budget Office Director Douglas Holtz-Eakin, half of all families making less than $100,000 per year could end up paying this tax. Those are five specific ways in which this bill will increase your costs, increase the premiums you pay for health insurance once this bill is in effect. We believe there are better ideas. Republicans have proposed a variety of solutions to target specific problems and, in particular, the problem of cost. I, specifically, want to conclude by mentioning the Republican health care alternative in the House of Representatives. The majority voted it down, but the truth is, it would, in fact, lower premiums for individuals, families, and small businesses. Contrast the House-passed bill which increases premiums, the Reid bill which increases premiums, but the Republican House bill which would actually decrease premiums and you will see Republicans in the Senate proposing similar ideas. According to the Congressional Budget Office, under the Republican plan, premiums would be $5,000 lower than the cheapest plan under the Pelosi bill. Small businesses, too, would see their premiums decrease by as much as 10 percent, again according to the Congressional Budget Office. Those in the small group market would also see a 10-percent decrease under the House Republican bill, again according to the nonpartisan CBO. The House Republican bill included such reforms as allowing States to sell policies across State lines. You have heard a lot of Senators on the Republican side talk about that point. That would have enabled 1,000 companies to compete nationally, and that helps to drive down the costs. Medical liability reform, a proven way to cut costs. My State of Arizona, Texas, and Missouri have all seen premiums go down because of medical malpractice reform. Health savings accounts, which put patients in charge of their own health care by allowing them to save their health care dollars to spend as they choose, this, too, would have been strengthened by the House bill, and you heard Republican Senators talk about that as a reform. There are many other ideas we have. We will be talking more about those ideas as we go forward. I wish to conclude my remarks about the Reid bill, loaded with provisions that increase insurance premiums, and to make the point that since, as I said at the beginning, the whole point of the exercise is to reduce health care premiums, the last thing we should be doing is adopting the provisions in the Reid bill, which will actually increase health care premiums. Let's keep in mind that health care reform is all about making things better for Americans, and this bill does not meet that test by a long shot.

Mr. KYL

Mr. KYL. Mr. President, I wish to compliment the Senator from Texas for sounding this warning. Being from Texas, she is undoubtedly aware of a great country-western song out right now by Brad Paisley called ``Welcome to the Future.'' I think we have seen a glimpse of the future under Obamacare here by this pronouncement of the U.S. Preventive Services Task Force recommending against the routine screening of women between ages 40 and 49 for best cancer. I want to speak for about 60 seconds about this issue to go into the actual numbers from the study to which Senator Hutchison referred. The rationale of the study is that you would need to screen 1,339 women in their fifties to save 1 life, so screening is worthwhile. But since you would need to screen 565 additional women--in other words, 1,904, to be precise--in their forties to save 1 life, screening is not worthwhile. That is the kind of cost-benefit analysis that will result in rationing, and it is precisely Senator Hutchison's point that this is how rationing begins. Welcome to the future.

Mr. KYL

Mr. KYL. Mr. President, I prematurely congratulated Senator Byrd yesterday for breaking the record of Carl Hayden, who has up to now held the record and was in the House of Representatives the day Arizona became a State. He served all the way up until I believe 1968. Senator Byrd reminded me: No, it is not until tomorrow, at whatever hour it was. I said: Well, I think you will probably make it. Of course, his response was: The Lord willing. That has been a motto of Senator Byrd throughout his career: The Lord willing. We hope the Lord is willing for many more days so the record will be even harder to break. We congratulate you.

Mr. KYL

Mr. KYL. The following Senator is necessarily absent: the Senator from Texas (Mrs. Hutchison).