Frank Lautenberg

Mr. LAUTENBERG

Mr. LAUTENBERG. Mr. President, I rise in opposition to the proposal to means test Medicare part B premiums. Mr. President, I am not opposed in principle to asking wealthier Americans to pay more for certain Government services. At the same time, I think we have to be very, very cautious before making fundamental changes in a program as important as Medicare. And it's not something that should be done on a fast-track reconciliation bill, with little opportunity for public input or debate. Mr. President, Medicare is a universal program that can benefit each and every citizen. The universal nature of Medicare provides a broad base of beneficiaries that helps maintain the program's economic viability. By covering all eligible individuals, no matter their health risks, Medicare spreads those risks broadly, as an insurance program must do. Yet increasing the costs of Medicare to better-off individuals threatens to drive wealthier and healthier individuals away from the voluntary part B program. And, at some point, that could undermine the broad base of beneficiaries that is necessary. I am not prepared to say that the particular proposal in this bill would do so. I don't know. But it's a serious issue that deserves careful consideration before we move forward. Mr. President, beyond the need to ensure Medicare's economic viability, there's also a need to ensure that the program maintains broad support among the public and in the Congress. That's why so many Medicare supporters are concerned about turning the program into anything that resembles a welfare program. Now, Mr. President, at some point, these concerns may have to give way to the stark economic realities of upcoming demographic changes. But if we are to move toward some type of means testing, we need to do it very carefully, to ensure that the public understands, and supports the change. The stakes are too high to rush into this without preparing the way, and making sure we're doing it right. Mr. President, beyond the broad economic and political concerns involved with introducing means testing into Medicare, there are practical issues to resolve, as well. If premiums are to vary based on income, who is to evaluate a person's income, and how? Will the IRS take on the responsibility? Or will we create a whole new bureaucracy to do the job--some might call it, Son of IRS. This proposal seems to adopt the latter approach. But many believe this is duplicative and inefficient. It also raises questions about whether this new bureaucracy will adequately protect the confidentiality of senior citizens' private financial information. A related question is how we can monitor the changing incomes of beneficiaries. Take an individual who last year received a sizable salary, but who was laid off at the end of the year, and now has no income. How are we supposed to know that this person now cannot afford a higher premium? I wonder whether this type of issue has really been thought through. Mr. President, all of these issues need to be considered carefully before we rush into a proposal of this magnitude. Yet the proposal to means test premiums comes to us now at the last minute. It has not been subject to hearings. Nor has the public been involved in the debate. Mr. President, there is a more appropriate avenue for considering this kind of proposal. The bill before us calls for a commission that would study long term changes needed to sustain the Medicare system. So my suggestion would be to wait, and have the commission study the proposal and options for implementation. The commission is required to report back within a year. So this issue will not get deferred indefinitely. But we need to do this right. Mr. President, I would remind my colleagues that we do not need to means test Medicare premiums to balance the budget. Nor is it necessary to make Medicare solvent for an 10 additional years. We've accomplished those goals in the bipartisan budget agreement, and without resorting to means testing. So, Mr. President, I would suggest to my colleagues that we should act with caution when it comes to a program as important as Medicare. Means testing has potentially huge implications for the economic and political viability for the Medicare Program. And, in my view, it's not something we should be doing on a fast-track bill with little opportunity for serious review and public input.

Mr. LAUTENBERG. Mr. President, I move we reconsider and then lay that motion on the table. The motion to lay on the table was agreed to.

Mr. LAUTENBERG. Mr. President, the Senator from Delaware, the chairman of the Finance Committee, just gave us an assurance that the text here will be considered original text for the purpose of further amendment. It is acceptable on our side. This amendment, as we have heard, just to repeat for a moment, has three major elements. It includes $1.5 billion to protect low-income individuals with incomes that are up to 120 percent of poverty from having to pay additional premiums in the future. This provision is designed to bring the bill into compliance with the bipartisan budget agreement. The amendment also would change the means-tested deductible into a means-tested premium. This is in response to the broad criticism of the Finance Committee's original bill as unworkable and inequitable. However, I want to make it clear that I intend to support a motion that we are going to hear about shortly to strike the means-tested premium. Finally, the amendment includes a modest initiative to explore the concept of a means-tested deductible. This is a very limited test that would not force any seniors to pay a means-tested deductible but would allow a very small number of them to do so, rather than paying a higher premium. So we are again willing to accept this amendment.

Mr. LAUTENBERG. I yield time to the Senator from Massachusetts for 1 minute because this debate is just about over.

Mr. LAUTENBERG. I yield myself 3 minutes. Mr. President, a significant part of the discussion has been why it is that we do not, to use the expression, bite the bullet, get it going, set the program into place so that over the years this will work its way into the system and we will have done better by Medicare. Well, Mr. President, I was the senior Democratic negotiator in developing the budget resolution, and we shook hands and we came to the consensus, and this bill before the Senate, part of the reconciliation package, now is supposed to put into place, as I understand it, the things that we agreed to in the extensive meetings that we had, including participants from the White House and the House of Representatives, as well. Having gotten that into place, suddenly now we are approached with something that I describe and Senator Kerry from Massachusetts before described as coming in from nowhere, coming in from outer space. I say coming in from left field. Suddenly, we had a new proposition to consider whether or not we will say to those who are anticipating that their coverage would fall into place at age 65, well, no, we have a new kind of novel idea. We are going to extend it to age 67 and we want to get it into place now. Mr. President, in the development of this bill, this big booklet I am holding, there is a chapter on commissions, and we say that the commission shall meet and within 12 months after their appointment--it is a 15-person commission, bipartisan in character, with 3 appointees by the President--we say in 1 year we will have a report, we will have recommendations. It is not going to be done in a half hour or half day on the floor of the Senate. We are going to take good time and thoroughly review it. We will debate it, as our leader said just now, debate it, have hearings, review it, make sure we are all certain about what we want to do. But, no, suddenly that is too slow. We want, in reality, to take 20 or 30 years to develop it, but it has to be done today to kick it off. I think that is part of the absurdity of this, Mr. President. I look at this legislation, and I am wondering what happened between the Finance Committee's final deliberation and this moment here. We talk about the purpose of this. The purpose of this is purportedly to present more solvency to the Medicare Program. There is only one problem: The program will perhaps be more solvent, but more individuals will be insolvent. That will be the outcome. There is nothing more worrisome today--and I see it in conversations, social, business and otherwise--than any other time that I ever remember, people saying, ``I hope I don't lose my health insurance if my company closes down.'' I understand that even now in separation agreements in marital disputes that a part of the responsibility that is being asked of the income earner is, ``I want to be provided,'' says the person being left, ``with health insurance. I need to protect myself. I can't be there with the children and be exposed to a sickness or an accident.'' People worry about that all the time. People who have saved all their lives so they would have a little nest egg for retirement are saying, ``Wow, you see what it costs to be in the hospital these days, see what it costs to have an operation. It costs so much I would be bankrupt if I had to go through one of those things.'' We are dealing with a very sensitive issue, a very complicated issue. I hope, Mr. President, that all of our friends on the floor of the Senate will give this a chance for the commission to get to work to review it and not introduce this new--I will call it--extraneous subject, and I am not defining it in terms of the budget process but in terms of the place that it holds. I hope we will work, Mr. President, not to permit the waiver of the budget agreement.

Mr. LAUTENBERG. Mr. President, we have taken a quick look. I would say from our standpoint we think this is a pretty good amendment. I say to the Senator from Rhode Island and the Senator from West Virginia, we think it is a pretty good amendment. Apparently there is some question yet to be resolved.

Mr. LAUTENBERG. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. LAUTENBERG. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendment No. 455 (Purpose: To conform the Energy Title to the Bipartisan Budget Agreement)

Mr. LAUTENBERG. Senator Durbin wants 10 minutes.

Mr. LAUTENBERG

Mr. LAUTENBERG. If we have just had a unanimous-consent agreement to leave here at 12:30, how does one accommodate an hour's worth of time?

Mr. LAUTENBERG. Mr. President, if I might just add a note here for all of our colleagues who are interested in amendments, or talking on the bill. Time is flying and we will be finished at about 7:30 tonight, I think it is, with no more time left. And then should any amendments be offered, they will be offered without debate or discussion and just voted upon. So I say to all of our colleagues within earshot, or through the staff, if you have amendments, you better get them here because pretty soon the time will have expired and you won't have an opportunity to do so. I thank the Chair.

Mr. LAUTENBERG

Mr. LAUTENBERG. Mr. President, we have one amendment that is still being considered. Otherwise, I ask unanimous consent that it be in order to send 25 amendments to the desk on behalf of my Democratic colleagues, that the amendments be considered as read and laid aside to be voted on in sequence.

Mr. LAUTENBERG. Again, the first amendment on that list, Mr. President, is the Lautenberg amendment. Mr. CONRAD addressed the Chair.

Mr. LAUTENBERG. May we finish this up?

Mr. LAUTENBERG. Legal.

Mr. LAUTENBERG. I look forward to that.

Mr. LAUTENBERG. Mr. President, I can't let this moment pass without commending----

Mr. LAUTENBERG. Yes, of course. I would be happy to yield to the chairman of the Finance Committee. But I expect to regain the floor. Amendment No. 502

Mr. LAUTENBERG. Mr. President, I want to commend our friend and colleague from North Dakota for being aware of what is potentially taking place here. Mr. President, this is a small example of the kind of document that you might have that has all kinds of bad goodies in here. One of the things that you have to do around here is to make certain that everybody is on the alert to the fact that some things get into these bills without being discussed, without being formally introduced. It has a way of sneaking in there. There is an osmosis process in which they fall down from the sky and get in there. This is one that is really kind of sky-high. I express very serious concerns about the provision in this bill, that it will allow, as the Senator from North Dakota said, in this case Texas, but any State--to have private companies determine the eligibility for low-income benefits like Medicaid, WIC and food stamps. Mr. President, this is a budget reconciliation bill, not a Government management reform bill. In my view, the privatization provision does not belong in fast-track legislation--fast track, that means to get it through here as quickly as you can--that is designed primarily to implement the budget resolution. This provision has no real impact on the deficit except to potentially make it worse in the years ahead, and it would represent a significant policy change with broad-ranging implications. I also note that this provision is outside of the bipartisan budget agreement. It was never discussed at any one of the negotiating sessions because I personally sat there at every one of them, and it never appeared in any early drafts of the budget agreement. This provision raises some very important policy questions. For example, will these private companies have an incentive, as the Senator from North Dakota pointed out in his chart, to exclude people that they would rather not carry from low-income programs. Will they receive bonuses for doing so? Will they feel inclined to do so in order to win other State government contracts? Now, Mr. President, I kind of grew up, if I can say, in the computer business, and we have seen some of the finest companies in the world make mistakes. We have seen it here with the FAA contract, a fairly complicated piece of business, and it was pointed out that it was Unisys and EDS and names that are very well known in the computer field. Mistakes are made and sometimes these things run way over the original cost estimate, as demonstrated in the example we saw, so we cannot afford to put all of our citizens subject to what might go awry here and spend $2 billion to take care of an arrangement, whatever that arrangement is. Ask every citizen here whether they would feel like kicking into this thing, and I am sure that given a proper questionnaire they would say, ``Heck, no.'' This is not for us and no State ought to be so privileged as to get that kind of an advantage. Mr. President, the Department of Health and Human Services reports that there may be 3 million children eligible for Medicaid who are not enrolled in the program. It is a serious problem and I feel could even get worse under a privatization program. If private companies are put in charge of enrolling more children for Medicaid, would they really conduct aggressive outreach programs to enroll children, to encourage people to bring them in even if it meant that the State's Medicaid costs would go up? I would not bet on it. I want to be clear. I am not necessarily opposed to privatization of some Government services. However, it must be considered very carefully, especially when the lives of vulnerable Americans are at stake. This proposal really breaks new ground. For the first time, private interests would be handed complete power to make benefit decisions that are of critical importance to people with low incomes. It is like turning our military over to private hands and letting them design what conflicts we are going to get involved with. The fact is that much of the allure of privatization is to save money, and there is a place for that. For example, Congress has to decide to have private companies operate some of its cafeterias and do some of its cleaning, and perhaps that translates into more savings and better service for congressional employees. But Congress has wisely limited the roll of private companies in many functions of Government. Private companies are not allowed to operate our military installations, nor do we have private companies administer our Social Security system. We draw the line at some point. I am concerned that privatizing decisions about benefits for low- income individuals may go over this line. At least, at the very least, it needs careful and thorough study. Yet, I understand that the Finance Committee has not reviewed the details of the Texas waiver, has never seen the full proposal, and since the Senator from North Dakota is also a member of the Finance Committee and talks about the secret nature of this agreement, that further confirms what the rest of us who are not on the Finance Committee might not know and that is that it has never had appropriate scrutiny, never had appropriate review.

Mr. LAUTENBERG. I would be delighted.

Mr. LAUTENBERG. Not aware. I cannot even believe it would be suggested, because that is such a dereliction of duty that I think everybody would be embarrassed if something like this took place. What do you mean? That a Secretary has no right to review the conditions under which we are spending the taxpayers' money?

Mr. LAUTENBERG. The rest of it is State funded.

Mr. LAUTENBERG. Never, not even in the years that I spent in the private sector, and I ran a pretty good-sized company with 16,000 employees when I left. It did better after I left. It now has 30,000 employees. Never have I seen it. Never, when one works with Government, have I seen this kind of an arrangement that has a peculiar odor, and it is not Chanel No. 5. The fact is that to give away Government funds in a program as sensitive as this to take care of the poor--listen, all of us have seen the abuses of private sector companies that have taken over health care and things of that nature. It just blows one's mind when you see that the president of a company that is in the health care business made $22 million in a single year and meanwhile is squeezing down because that is where the profits are going to come from, from cutting conditions. They are cutting programs that are supposed to take care of people's health. Well, do you want to have someone up there whose bonus, whose stock options, whose salary depends on making sure that they service as few people as possible, reduce expenses as much as possible when, in fact, the WIC Program is designed to take care of people who are really impoverished, people who need the nutrition that comes through the program to sustain them? So do you want to have some executive sitting at some remote place--and I liked that executive life when I was there, but it was never at the Government's expense--at Government expense. We see constant reference to cases being tried, investigations being conducted where programs were turned over to the private sector. I talk about things like jails--we have tried that in New Jersey--which were dismal failures because they could not protect the guards sufficiently in these jails because they did not hire the right kind of people. They did not provide them with the right kind of tools. The facilities were not built enough to make sure the inmates incarcerated were properly cared for. So we see this time and time again, and here we walk in and say, ``OK, here is a bunch of poor people. You take care of them. Do the best you can at the best price you can.'' What an outrage.

Mr. LAUTENBERG. Sure.

Mr. LAUTENBERG. I will tell the Senator how it strikes me. I say thank God that the Senator from North Dakota has brought this to the attention of the Senate and to the public. My friend has done a real service in doing this. The notion that an individual working for a private living, perhaps their salary dependent upon their ability to curtail services, is hardly the way you want to treat a sick patient in the hospital. That is hardly the way you want to treat a family problem. That is hardly the way you want to protect a mother who has been battered. That is hardly the way we want to do things in a society with the conscience this country has. I am delighted, again, that the Senator introduced it. I am concerned that privatization like this is not going to do the job. Before we go ahead with approval of a waiver, we ought to at least hold a hearing and review the details. Mr. President, Congress has established these safety net programs for people in our society who are truly in need, impoverished. They are designed to ease suffering, to provide nutritional assistance to help children, help struggling people get into the work force to get themselves off welfare, to do whatever they can to sustain themselves. These programs can literally mean the difference between homelessness and independence, and we ought not to rush to hand them over to a private interest at this time, perhaps never, but we sure ought not to do it in the hasty manner that this is being undertaken. We can always revisit this issue, Mr. President, without constraints of a reconciliation bill. I fully support the action being proposed by the Senator from North Dakota and commend him for it, I must tell you.