George LeMieux

Mr. LeMIEUX

Mr. LeMIEUX. Mr. President, I thank the chairman of the Senate Finance Committee for his courtesy. I appreciate the opportunity to be here. I understand, Mr. President, I have a certain allotment of time. If I can be notified when I have 2 minutes remaining, I would appreciate that.

Mr. LeMIEUX. OK. If I can be notified when I have spoken for 20 minutes.

Mr. LeMIEUX. Mr. President, I rise today to talk about this health care bill. I have spoken about it before. I feel obligated on behalf of my State of Florida to explain why I, unfortunately, will not be able to support this bill on final passage. I think, in doing so, it is important to talk about why we are here and how we got here. I am sure the American people think that in this process of debating health care over the past weeks and months, this has been a process where both sides, Republicans and Democrats, have worked together, sat in an open room and gave ideas back and forth; that there has been give-and-take and compromise so that we could come to the plan that is before us today. I am sure the American people believe that amendments were offered, that each Senator could come to the floor and offer amendments and that his and her colleagues were allowed to hear about those amendments and vote them up or down. I also believe the American people think we do not just come to this Chamber and give monologs. They probably think this room is not empty and that there are just two of my distinguished colleagues here but that we all sit here and listen to each others' arguments and decide what is best for the American people. Unfortunately, that is not the case with this bill. This bill was designed and crafted by the Democratic leadership, without the input of the colleagues from this side of the aisle. There was no give-and-take. There was no back-and-forth in a conference room with C-SPAN in the room, as the President told us he would ensure when he ran for the Office of the Presidency. And we did not have the opportunity to offer amendments to make this bill better. I know that seems hard to believe, that we would not have the ability to offer amendments to make this bill better, but I can prove it to you. I have an amendment at the desk. It is amendment No. 3225. What this amendment does is it takes a piece of legislation I filed shortly after coming to the Senate in September of this year--the legislation is called the Prevent Health Care Fraud Act of 2009. This legislation has 11 cosponsors. It has bipartisan support. What the bill does is basically three things: First, it creates the chief health care fraud prevention officer of the United States. It would be the No. 2 person at Health and Human Services. Their only job would be to ferret out health care fraud. Second, it would use and take a page from the private sector to go after fraud. There is an industry out there right now that does an excellent job of stopping fraud. That industry is about the same size as the health care industry. It is the credit card business. It is about a $2 trillion business. Health care is about a $2 trillion business. In health care and in Medicare alone, estimates are that $1 out of every $7 in Medicare is fraud. In the credit card business, it is pennies on the hundreds of dollars. How does the credit card business do it? We have all had this experience. You go to purchase something in a store, and when you leave, you get an e-mail or a phone call and your credit card company says to you: Did you really mean to purchase that good or service? Guess what. If you say no, they don't pay. The way we do things in Medicare and Medicaid is we do pay-and-chase. We pay, and then when we think there is fraud, we try to go after it. This model stops the fraud before it starts. A group here in Washington, DC, has evaluated this legislation and says that it might save as much as $20 billion a year in Medicare alone. We think there is $60 billion in fraud in Medicare--$1 out of every $7. This proposal that we put forward also would require background checks for every health care provider in America to make sure they are not a criminal. Florida, my State, unfortunately is ground zero for health care fraud. We have the worst health care fraud in America. Just this past weekend, and I sent this letter around to my colleagues--a $61 million Medicare fraud scheme out of Florida and some other States. My bill, this proposal which has bipartisan support, could save $20 billion a year. We have fashioned this bill into an amendment to this health care bill. Mr. President, I ask unanimous consent that the pending amendment be set aside to call up my amendment. It is amendment No. 3225.

Mr. LeMIEUX. Mr. President, I thank the distinguished chairman of the Finance Committee. Sure, there are things in this bill that he pointed out to go after fraud. But I would like to inform the Senate of a report that came out evaluating this new bill, the managers' amendment. I have a table which evaluates how much will be saved from the waste, fraud, and abuse provisions which are in this bill. It is $.9 billion. The proposal that I have, one group--and, again, it is not the CBO--one group has said it might save $20 billion a year. Putting aside our differences, I sure wish we could talk about my amendment today, I say to my colleague. I hope we can revisit it after this is over because we should be able to agree, and it does have bipartisan support. I wish we could amend the bill today. I hear the objection, and I will move on. I hope we can talk about this.

Mr. LeMIEUX. I thank the chairman. I wish we could do it before we had to rush to judgment on this bill. I wish we had more time. I wish we did not have to be backed up against a wall before Christmas. I understand colleagues on the other side have a desire to get this bill done. But it is my concern with this measure and with the other measures in the bill that we could have worked together. Mr. President, I say to the chairman, I am new to the Chamber. But this is not the way businesses work. It is not the way American families work. It is not the way even State legislators work, which I have experience with in Florida. I wish we could have talked about that amendment and offered it. I wish my colleagues were here to debate it up or down. Let's talk about where we are instead. Let's talk about what this bill does and why I cannot, unfortunately, support it as a Senator from Florida. We know this bill cuts Medicare by nearly $\1/2\ trillion. We know this bill raises taxes by nearly $\1/2\ trillion. And we know it does not accomplish the fundamental goal the President put forward when we embarked on this debate about health care reform. The American people are beginning to realize and if they have not realized yet will be shocked to hear that this bill is not going to cut the cost of health care for people who have insurance already. That is the very reason this debate was embarked upon, not just access for people who do not have health care insurance but to bring the costs down. Health care has gone up 130 percent in the past 10 years. This bill will not address that. In fact, estimates show that for some folks, the cost of health care will go up. There are basically five reasons why I cannot support this measure as a Senator from Florida. I am concerned, first of all, about access and quality of care for our seniors. When you take $\1/2\ trillion out of Medicare, my fear is that it is going to diminish the quality of care for seniors in Florida. It is said on the other side that we are not going to take away benefits, that we are just going to take money away from providers. It was said on the other side that the new insurance will take care of uncompensated care, so that the cuts to hospitals and to other providers will not really hurt seniors in the end. I think that is a tremendously risky experiment. I cannot believe, at the end of the day, when we pay providers less, it is not going to affect benefits. Right now, studies show that 24 percent of seniors on Medicare trying to find primary care physicians cannot find one. I get letters from seniors in Florida who say they cannot find a doctor who will take their Medicare. We know in Medicaid it is worse. We know in Medicaid that if you are just going into the program and trying to find a physician, almost 40 percent of the physicians will not take you. In metropolitan areas for specialists, it is up to 50 percent who will not take Medicaid. I fear that if we take nearly $\1/2\ trillion out of a program that is already in financial trouble, a program that in the next 7 years is going to be in serious financial trouble and not be able to meet its obligations, that it is going to hurt seniors. I have heard this discussion about how we are prolonging the life of Medicare. The distinguished chairman just spoke about it. But when you look at what the Actuary at HHS has said about that assumption, the assumption is that we are not going to restore the 21-percent decrease in physician payments which, of course, as soon as we get back in the new year, we are going to have before us. You cannot take money out of Medicare and pay for a new program and shore up Medicare. You do not need an actuary or an evaluation or an analyst to tell you that. It is common sense. You cannot get blood from a stone. If the doctor is not in, it is not health care reform. I have received a letter, as many of my colleagues have, from an organization called 60 Plus which represents 5.5 million seniors. James Martin, the president of 60 Plus, writes: Cutting half a trillion dollars from Medicare while adding 31 million more to the health care rolls is an outrage. 60 Plus strongly supports health care reform but first we should do no harm to a system serving so many so well. . . . Make incremental changes that do not bankrupt a system already teetering on insolvency. I want to talk a minute about Medicare Advantage. There are more Floridians in Medicare Advantage than any other State. A lot has been said about this program. We have had amendments to try to stop the cuts. Mr. President, 950,000 Floridians--Medicare Advantage is a great program, and people in Florida enjoy it. Seniors enjoy it because they get more than regular care; they get eye care, hearing care, wellness, diabetic supplies, and other things that add to the quality of life of seniors and help their entire health care. These Medicare Advantage providers are actually working hard to make sure their senior customers are happy, not a concept you hear a lot about when the government is in charge. There is a fix for Florida, as has been talked about, but I wish to talk about what that fix is, as I understand it. It is an off-ramp. For the rest of the country, it is going to be somewhat of an exit. For Florida, it is an off-ramp. First of all, we don't know what will happen in conference. The Senate cuts $120 billion; the House cuts $170 billion. I don't know if the Florida fix will still be there. But in talking to experts and reading the bill myself--specifically around page 895 through about 901 of the original Reid bill--there is this grandfathering in for folks in Florida, and other areas, but part of Florida is covered. Of the 950,000 people, the experts think 150,000 to maybe as many as 250,000 will not get this grandfathering in. They are going to get the cuts to Medicare Advantage. So this is not good for them. Then, for the others, say, 700,000 people or so, every year, starting in 2013, their benefits--or the payments to the providers for benefits--are going to decline 5 percent a year. That is on pages 895 through 897. So it is an off-ramp. Every year, less payments. Every year, less benefits. I talked to one provider down in Miami that many Senators in this Chamber have visited. He runs a very successful Medicare Advantage Program. He said these cuts would be devastating. So while it might not be an exit for Florida right away, it is certainly going to be an off- ramp that one day ends up being an exit. Let's remember that many of the folks on the other side of the aisle who are proposing these cuts to Medicare Advantage didn't vote for Medicare Advantage to start with. They don't like it. They don't like the private sector being involved. They don't like these extra benefits being provided. It goes against what they philosophically believe. But I know Floridians like it. Because this bill cuts it, I can't be for it. No one can guarantee to me that in the next 10 years Medicare Advantage in Florida will be as robust as it is today. I am concerned also about the home health care payments. I am concerned about what it is going to do to the small business home health care providers in Florida. I talked to the largest provider of home health care services in Florida, and he said: We will be fine, but the small businesses--the mom and pops who do this--will go out of business. That is disconcerting in a State with 11\1/2\ percent unemployment. The second reason I can't support this bill is this is going to have a devastating effect on our State budget in Florida. We talked today to the head of the Florida health care system, the Agency for Health Care Administration, and these increases in Medicaid, raising Medicaid from 100 percent of poverty to 133 percent, are going to cost Florida an estimated $3\1/2\ billion over the next 10 years. That is $3\1/2\ billion Florida can't afford to pay. Our budget has gone from $73 billion to $66 billion in a short period of time with the economic decline. Unlike this Chamber, which spends money it doesn't have, Florida has to balance its budget. So what happens when you have less money? You have to cut programs. But when you have a Federal mandate, you can't cut that. So what do you cut? You cut education and teachers. You cut law enforcement--not good for Florida. This is a burden Florida can't afford to pay. That is why all the Governors in the country--virtually Republican and Democratic alike--including our Governor, Charlie Crist, are against this unfunded mandate. The third reason I can't support this bill is because it raises taxes--$518 billion. What happens when the drug company that makes your medicine or the medical device company that makes the lifesaving implement for you gets taxed? They are going to pass it along to you. They are going to put it right in the bill. That is the way it is going to work. That is why health care costs aren't going down for the 170 million Americans who have health insurance. In fact, for some, they are going to go up. That is not health care reform. Fourth, this is a budget-busting bill. It is not deficit neutral. Let me explain why. You will hear reports this is going to cut more than $100 billion from the deficit over the next 10 years. Only in Washington, DC, could you come to this calculation. It is funny math. We have this Congressional Budget Office, which is sort of the arbiter of all things financial here in Washington. You send them a proposal and they give you an answer. But it is not a thinking answer; it is an analytical answer, and it gets gamed. What you send them determines what you get back. They only look at a 10-year period--what it is going to cost in the next 10 years. If you bring in more money than you spend in the next 10 years, then it will cut the budget. It will cut the deficit. That is what they say back to you. So what was done in this bill in order to get something that would fulfill the President's promise to be a budget cut or at least deficit neutral? We have 10 years of taxes and 6 years of benefits. Most of the benefits don't start until 2014, yet the taxes start in 2 weeks--in January. That is akin to you going to buy a home and saying: I am going to live here for 10 years, and they say: That is great, start paying today and you can move in in 2014. It is funny math. This is a $2.5 trillion new entitlement program we can't afford. We can't afford the programs we have, let alone the programs the majority in this Chamber want. We have a $12 trillion deficit. We have $30-some trillion in unfunded entitlement deficit. We have hundreds of thousands of dollars of debt for every family in America, and no plan to pay for it. We spend more than we take in. We spent $1.4 trillion--we have a $1.4 trillion deficit this year--just the debt this year. That is more than the past 4 years combined. The American people are on to this and they are angry about it and they should be.

Mr. LeMIEUX. Fifth and finally, the reason I can't support this bill is it doesn't lower the cost of health insurance for Americans. The Congressional Budget Office has said the majority of Americans would see the same increases as they currently get under the current system. For some people, individual policies, for example, they will receive a 10- to 13-percent increase. I am going to conclude by saying this, and this will probably be the final time I will speak before we have final passage on this bill. I long for what could have been. We could have worked together. We could have had an 80-vote bill. We could have had a bill that would say insurance companies can't drop you if you are sick, insurance companies can't deny you if you have a preexisting condition, insurance companies can compete across State lines, set up an exchange, give a tax credit to the American people, put money in their pocket, let them be consumers who go out and buy health insurance and drive the cost down because the market economy would, once again, work in health care. This bill doesn't solve the problem. It perpetuates it and makes it worse. At the same time, it cuts health care for seniors and doesn't lower the cost of health insurance for most Americans. For more and more seniors, the doctor will not be in. That is not reform. For those reasons, respectfully, for that lost opportunity, I will not be able to support this bill. I yield the remainder of my time to my friend and colleague from Alaska.

Mr. LeMIEUX

Mr. LeMIEUX. Mr. President, I am new to this Chamber, and as I have sat here today and listened to my distinguished colleagues speak about this bill, watching some of my other colleagues on television in my office this evening, I can't help but think how fortunate I am to be here, to be a part of this process. It makes me think back also to the Founders who put together this great constitutional system of democracy that we have in this country, with the three branches of government, and here in the Senate, the sober and reflective legislative body that thinks through the great issues of the day to make sure we get them right for the American people. In listening to this great debate, I wonder what they would think about what we are doing here. Putting aside the substance, what would they think of the procedure? Because I am new to this Chamber, I think I still have fresh eyes as to what is normal as compared to perhaps what is a little bit departed from normal. Would they think it was within their intentions as the Founders that we would be coming here to vote at 1 o'clock in the morning? Would they think it would be within their intention of how things would work in the Senate that we would get an amendment to the bill that is 400 pages long, we would get it yesterday and would have just a little time to consider it before we try to vote on it? Would it be what they intended, that we would press this vote up against Christmas, and we would try to get it done quickly while most of the people in our country are off with their families and preparing for the holidays? Would that be what they intended, the process of this great deliberative body, arguably, it is often said, the greatest debating institution in the world? Is that the way they would want us to achieve policy that is going to affect one-sixth of our economy? I don't think so. In fact, I don't think the American people think so either. That is why they are so bewildered as to what we are doing here in the Senate and why we are, as my friend and colleague from Louisiana said, rushing to judgment; why we must get this done before Christmas. If it is such a good bill, why do we have to get it done so quickly? If it is such a good bill, why can't we take some more time to evaluate it? If it is such a good bill, why can't we offer more amendments to it? So I am sure the American people, if they are home watching this--and they are probably watching Sunday night football--but if they are watching this, they would say: Of course, my Senator from Florida or the Senators from the other States can now offer amendments to try to improve the bill. But that is not the case because the leader of the Democratic Party, the majority leader, has done something called filling the tree. Now, look, I am new here, too, so this is all new to me, but it is a process by which no other amendments are allowed. So if we want to change the bill, if we have ideas to improve it, that is not allowed. Is that what the American people want from us? Is that what our Founders intended? I don't think so. So we have this new amendment. It is 400-some pages long. I guess it is the amendment to fix the problems that were in the bill, or at least to get 60 votes. And what do we know about this amendment? What does it do, for example, to Medicare cuts? We know the previous bill before the Senate cut nearly $\1/2\ trillion out of health care for seniors. What does this amendment do? Well, it still cuts health care for seniors. It actually cuts a little bit more, but it is still around that same number: $\1/2\ trillion. We know also that it raises taxes. Does it raise taxes $\1/2\ trillion as the previous measure did? Yes, it does. In fact, it raises taxes a little more. Now it is $518 billion. Well, what about the question that is the most pressing on the minds of most Americans, the very reason we are here, according to the President of the United States, which is to impact the cost of health insurance for most Americans. What does it do about that? Does the amendment do something about that? We know the underlying bill does nothing to impact the cost of health insurance for most Americans. We are here about to change one-sixth of the U.S. economy, and this bill does nothing to impact the cost of health insurance for folks who already have health insurance in this country. That is not me saying it; that is the Congressional Budget Office. If you are one of the 170 million Americans who already have health insurance, this bill is not going to lower your costs. In fact, for some Americans, it is going to increase your costs over the next 10 years. Well, does this amendment fix it? No. So we are still in the same situation--cutting $\1/2\ trillion out of health care for seniors, raising taxes by $\1/2\ trillion, with nothing in it for most Americans in terms of the cost of their health insurance. How is this going to affect the American people? Well, if you have Medicare, if you are a senior who has been paying into it, it is going to affect you. My friends on the other side of the aisle will say: Look, the nearly $\1/2\ trillion that we are going to take out of Medicare is just waste, fraud, and abuse. We will get that money out. Well, the Congressional Budget Office says the measures that are in the bill will take out $1\1/2\ billion worth of waste, fraud, and abuse, not $500 billion. So where is the rest going to come from? It is going to be decreased benefits. It is going to be decreased access to doctors. We know right now in Medicare, nearly 24 percent of medical health care providers--your doctors, for example--will not take Medicare anymore, 24 percent, one in four of them. In Medicaid it is 40 percent. What is going to happen when you reduce the amount of money you are paying into Medicare? You are going to reduce the amount of money that is being paid to providers, which means providers are not going to see their patients. If the doctor is not in, it is not health care reform. This really impacts my State of Florida. We have the highest number of seniors per capita, 3 million seniors, on Medicare, and they are going to be impacted. I wish to read from a letter that was sent to me by Mr. Richard Mullaney. I received it at the end of November. It says: Dear Senator LeMieux. I thought you might like to see this letter I received from my cardiologist. It attaches that letter from the Palm Beach Cardiovascular Clinic in Jupiter, FL, down in southeast Florida. I ask unanimous consent that this letter be printed in the Record.

Mr. LeMIEUX. Mr. President, it is an open letter to patients, and it is signed by some seven doctors who are in this cardiovascular clinic practice. I will read portions of it. It says: Drastic reduction in fees are going to seriously hamper our ability to continue to see you, our patients, as we do today. We feel the need to warn you that these reductions will translate into much longer waiting periods for you to schedule an appointment or a procedure with your doctor, longer telephone response times to you, and not having the convenience of in-office Nuclear and Echo diagnostic testing available to you. The letter goes on to say: With these cuts we may not be able to provide some of the services that patients have come to depend on and in the long run, if the current policies are not changed, it may force us to close our doors. So these are doctors, real doctors, and this is a letter from their real patient saying: If these cuts to reimbursements to doctors and providers aren't addressed, then we are going to have an inability for doctors to perform health care. Those are real-world problems that are going to occur if this bill is passed. So this is no great shakes for seniors. This isn't health care improvement for seniors. Those that we already have on a government entitlement program, those who have already paid into the program are going to have a cut in their benefits. That is exactly what the Chief Actuary, we found out last week from the Center for Medicare and Medicaid Services, said. He said it is plausible, even probable, that there will be shortages for Medicare and Medicaid beneficiaries because there is not going to be doctors who are available to see them. Let's talk about the taxes: $518 billion in tax increases. What is that going to do to the cost of health care? We are going to tax medicine. We are going to tax lifesaving devices. Those taxes, of course, will be passed along to you, the consumer. So for you, your cost of health care will go up, taxes on health insurance of almost $60 billion; taxes on medical devices, $19 billion; taxes on medicine, $22 billion. If you don't have health insurance now and you don't get it, you will be taxed. If you are a small business and you don't provide health insurance to your employees, you will be taxed. I had a telephone townhall meeting this week, and I talked to a gentleman from central Florida who had been laid off from his job at a restaurant. He said to me: The reason I got laid off is because the restaurant couldn't afford the health care benefits. So when health care benefits went up, the restaurant raised its prices for its food, people stopped coming to the restaurant, and the restaurant went out of business. Then there wasn't health care for any of the employees. You can't get blood from a stone. While the benefits of this plan as laid out by my Democratic colleagues may sound great--33 million more Americans who are going to have some kind of health insurance--you have to look at the details. How are you going to pay for it, and what is the effect going to be? When you raid nearly $\1/2\ trillion out of Medicare, you are going to decline the quality of health care for our seniors. When you raise taxes by $\1/2\ trillion, you are going to pass those costs along to consumers who already have health insurance, and their prices are going to go up. You are going to pass them along to small businesses that would not be able to afford them, that will let people go. We have 11.5 percent unemployment in Florida. When small businesses can't afford this, they are going to let people go or, like that restaurant, close their doors. That is not good for a country that is fighting through the worst recession since the Great Depression. Now we find out there are a bunch of special deals in this bill. We find out that the Senator from Nebraska has been able to get a special fix for his State. See, another thing this bill does is it puts a big unfunded mandate on the States. What do I mean by that? An unfunded mandate is a requirement that the States must fulfill that they don't get paid for. This time it comes in the form of Medicaid, which is health care for the poor. Medicaid, under this proposal, is going to be increased. We are going to put 15 million more Americans into Medicaid. If you think Medicare recipients are having a tough time finding a doctor, in Medicaid, 40 percent of health care providers will not take it; 50 percent of specialists will not take it. Now we are going to put 15 million more Americans into it. What it does to the States, in a State such as Florida, it is going to cost us in 10 years nearly $1 billion to accept this unfunded mandate. The Senator from Nebraska apparently got a fix for this so his State would not have to pay the $1 billion. Well, Florida would like that same fix. If it is good for Nebraska, it is good for Florida. I am sure Iowa would like that fix as well. I am sure all the States would. So I ask unanimous consent that the pending amendment be set aside and it be in order to offer an amendment to extend to the State of Florida the same benefits that provide 100 percent Federal funding to the State of Nebraska for their expanded Medicaid Program.

Mr. LeMIEUX. For the folks who are watching at home, the reason my distinguished colleague from Iowa objected to this is because this deal would not go through if they provide it for every State. So some States are going to get it better and some States are going to get less, and that is not fair. But that is the process that has put this bill together, to cobble together 60 votes. So at the end of the day--may I ask how much time I have remaining?

Mr. LeMIEUX. At the end of the day, I have 15 seconds left. I will be back to the floor to speak about this again. But this is not a good bill for America, and that is why my colleagues on this side of the aisle have been debating and showing our objections so the American people can understand. I yield the floor.

Mr. LeMIEUX

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

Mr. LeMIEUX. Mr. President, while we have been here discussing health care, the clock has been ticking on our national debt. Just in the first 2 months of this fiscal year, we have accumulated $296 billion in debt. We took in revenues of $268 billion, and we spent $565 billion. We spent double what we took in just in the first 2 months of the fiscal year. I know you are new to this Chamber, Mr. President, as am I. I have only been here 90 days, but I have been here long enough to know this system is broken. It doesn't work. Neither this body nor the body across the Capitol has an ability to make ends meet. We continue to spend money we do not have. We spend the money of our children and our grandchildren. Right now we have a $12 trillion debt. It took us 167 years in this country just to amass a $1 trillion debt in 1982. Now we are at $12 trillion. Every family in this country is now responsible for $100,000 of debt. Where are we getting this money? We are borrowing it from countries such as China, and it is hurting our standing in the world. Central banks that hold American currency are shedding those dollars because they no longer believe our country is a good investment. I worry about our children and our grandchildren. I have three sons, as you know, Max, Taylor and Chase--they are 6, 4 and 2--and we have a baby on the way in March. I am very worried that my children will not be able to experience the American dream like you and I have; to be able to be in the Senate, to be able to achieve all of our goals, whether in public service or in private. I do not believe America is going to be the same place for them, that it is going to hold the same opportunities because I believe this debt is going to strangle us. If this body and the body across the Capitol don't figure out we need to start making ends meet and stop spending the dollars of future generations, this country will not be the leader of the world. It will not have the promise we have all enjoyed. I rise today to speak about S.J. Res. 22, which I filed yesterday. It is a constitutional amendment that requires the Congress to balance its budget and also gives to the President of the United States a line-item veto so he, like most of the Governors in this country, can strike out inappropriate budget items, these earmarks that you hear about. Senator McCain spoke this weekend about $2.5 million to the University of Nebraska to study operations and medical procedures in space. We cannot afford that program under any circumstance, and we certainly can't afford programs like that when we are $12 trillion in debt. These dollar numbers are so big they are hard to comprehend. What does $1 trillion mean? What does $1 billion mean? In Washington we throw these amounts around, and we do not even comprehend them. I know for the American people at home it is hard to get their minds around how much money this is. I have said this on the Senate floor before, and I am going to keep saying it so people understand that every dollar we spend is a choice. One million dollars laid edge to edge on the ground would cover two football fields. One billion dollars laid edge to edge on the ground would cover the city of Key West, FL, 3.7 square miles. And $1 trillion would cover the State of Rhode Island--twice. If you stacked them on the ground going up into the sky, it would be 600 miles of one-dollar bills. Every dollar is a choice, and these numbers are out of control. Just this past Saturday we voted on a spending bill, a spending bill that had a 12-percent increase and $40 billion more than last year. I want to give the American people the sense of what you could do with this kind of money, what good you could do or, better yet, you could give it back to the American people and they could decide what good they could do with those dollars for their families. With $100 billion, we could give every Floridian a $5,000 tax cut. With $200 billion we could pay the salary of every teacher for a year. With $300 billion we could pay first-year tuition at a university of their choice for every kid who is in K-12. With $400 billion, we could build high-speed rail for 10,000 miles. We could connect Key West to Anchorage and back. Every dollar is a choice. We are spending money out of control. Similar to those who have come before me, I will sound the alarm because we still haven't done anything about this problem. There are good measures out there. Senator Gregg from New Hampshire has a measure, along with Senator Conrad, to put together a commission. I support that. Senator Sessions has a measure to bring caps back. Up until about 2002, we actually were making headway against the budget. Then those caps expired and spending went out of control. I support all those efforts. I support any effort to bring spending under control. This body doesn't have any leadership on spending. Look at what we spend. We don't look at the revenues coming in the door. I served as chief of staff to a Governor in Florida. When the budget started to go bad in 2007, I was on the phone monthly with the person who determined our receipts. I knew in Florida we could only spend as much money as we had. This institution does not work that way. No one even checks to see what kind of money we are bringing in. We just spend. I wish to talk to the American people about articles in the Wall Street Journal of today. This is not a Democratic problem or a Republican problem. This is a problem of this institution. The article is titled ``The Audacity of Debt.'' I wish to read one paragraph. I ask unanimous consent that the full article be printed in the Record.

Mr. LeMIEUX. Reading from the Wall Street Journal: Democrats ridiculed Mr. Bush as ``the most fiscally irresponsible President in history,'' but then they saw him and raised. They took an $800 billion deficit and made it $1.4 trillion in 2009 and perhaps that high again in 2010. In 10 months they have approved more than $1 trillion in spending that has saved union public jobs but has done little to assist private job creation. Still to come is this multitrillion-dollar health care bill and another $100 billion to $200 billion ``jobs'' bill. We can't afford the programs we have, let alone the programs we want. I filed this joint resolution to have a balanced budget. I filed the joint resolution to give the President the line-item veto like Governors do. I know I am tilting at windmills. I know there are very few people in this Chamber or the Chamber down the hall who have the courage to do this. They are part of the process. They go along and get along. But I am fresh enough to still remember how things work in the real world. We have to change things. Our children are not going to have this great country. I am so afraid that one of my kids is going to come to me when they are 18 or 22 and say: Dad, I am going to go to another country to make my living. I am going to go to Ireland or Chile or India because I have a better opportunity there to succeed. I can't pay 60 percent in taxes. I can't assume what will then be a $23 or $30 billion debt. We are not even talking about all the entitlements we haven't paid for. We are not talking about all the money we have raided out of Medicare and Social Security in order to pay for current expenses. Some people say those obligations are more than $60 trillion, numbers we can't even comprehend. I filed this resolution. I will send a letter to every Governor asking them to adopt it in advance of the Congress taking it up. A constitutional amendment requires two-thirds of both Chambers and three-quarters of the States. They can act first. They can send letters and resolutions from their legislators to this legislative body and say: Get your act under control. It affects them too. This new health care bill is going to send an unfunded mandate to the States and increase Medicaid from 100 percent of poverty to 133 percent. They will have to pay that bill. It is going to cost Florida in 10 years almost $1 billion. Right now, in Florida, the No. 1 expenditure in our budget is Medicaid. Because we balance our budget, that means we take money away from teachers and education. That means we take money away from law enforcement. It is out of control. I am here to say the siren is sounding. The ship is going to hit the iceberg. We can't make just incremental change because then we will just hit the side of the iceberg. We have to make substantial change. The people in this body have to have the courage to do it. We can't just go along and get along as we have before. We cannot be tone deaf. The American people are onto us. They understand we are spending money we don't have. I will not stand by and let this great country fall into decline without at least arguing and pushing as strenuously as I can for a solution. I am willing to work with men and women of good will on both sides of the aisle to solve the problem. I am new here. I might not have all the answers. I probably don't. But I will surely work hard. I know this is one solution. If every State can have a balanced budget amendment and 43 States can have a line-item veto, why can't this body? I have filed this resolution. I look forward to talking about it more. I hope this body will take it seriously. I see my friend from Massachusetts is here. He also is new to this body, although he spent many years working here. We have to do things differently. We throw around billions and trillions like it is just nickles and dimes in our pockets. It is not. Every dollar is a choice. It is a choice to make. If we don't make the right choice, it will be a choice our children and grandchildren will suffer under. I yield the floor.

Mr. LeMIEUX

Mr. LeMIEUX. I thank my colleague from Tennessee. I didn't have the honor to be a Governor but I got to sit in the office next door to be the Governor's Chief of Staff. We had these issues of trying to balance budgets because, unlike the Federal Government which is out of control, States actually have to balance their budgets. Receipts have to meet expenditures. When your Medicaid budget grows and grows and grows--and in Florida, $18 billion is what we pay in Medicaid. It is the largest expenditure in the Florida State budget. When it grows and grows and grows, what happens? You have to cut education. You have to cut public service programs that do things such as law enforcement, correctional facilities that hold prisoners. You hurt the other main functions of government if you keep adding in Medicaid. I wish to highlight a point my colleague from Tennessee made. It occurred to me when I was going through the Chief Actuary's report we received last Friday from the Center for Medicaid and Medicare Services that this plan the Democrats have put forward is the expansion of Medicaid. Let's be honest. This is Medicaid for the masses. Thirty- three million people supposedly are going to be covered by this plan if it is implemented. How do those numbers add up? Eighteen million are Medicaid, 20 million go into this new exchange, and then we lose 5 million because their employer drops them because they can go into the exchange. So what are the majority of the people who are going to go under this new health care reform going to get? They are going to get the worst health care system in America, called Medicaid, a system where doctors won't participate. If the doctor is not in, it is not health care reform. This is not all it is cracked up to be. I did a little back-of-the- envelope math: $2\1/2\ trillion to put 18 million people into Medicaid. We could give all of those people $166,000 each, put it into an account and say: Here, fund your health care for the next 10 years or we could create this huge government program that expands a program that most doctors won't accept. My colleague Dr. Barrasso has it right. Forty percent of the doctors won't take Medicaid, and 50 percent of the specialists. How is this health care reform? I know my colleagues here have a lot of experience on this issue. I see my colleague from Mississippi and it looks as though he has a great chart and is going to talk about increased Medicaid spending, so I am sure he has something great to say to us.

Mr. LeMIEUX

Mr. LeMIEUX. Mr. President, I am here to speak about this omnibus spending bill we will vote on today. It is more proof that Washington is out of control in its spending and that the leadership on the other side of the aisle is wanting to spend our children's money. This is a $445 billion bill. I know my colleague from Arizona will talk about the 5,000 earmarks in this bill costing $3.9 billion. It is a 12-percent spending increase over last year, $46.7 billion more than the bloated budget we passed in 2009, a 33-percent increase in State- Foreign Operations, a 24-percent increase in Transportation and HUD. These are unsustainable. We have a $12 trillion debt, a debt our children and our grandchildren will have to pay. Here we are again with a 12-percent increase, and in a bill that is full of earmarks--earmarks such as $700,000 for a shrimp fishing project in Maryland, $30,000 for the Woodstock Film Festival youth initiative. I am sure these are great programs, but when we have $12.001 trillion in debt, we can't afford these programs. Mr. President, 2009 has been a record-setting year for debt. We had a $1.4 trillion budget deficit. Now in 2010, even though we are new in the year, we are already running a $296 billion budget deficit. In October and November, we took in $268 billion in tax revenues. That is a hard number to find around here because most people don't look at the money we take in. They can just spend whatever they want to. We took in $268 billion, but we spent $565 billion. This is not how families make their decisions around their kitchen tables, where they have to make ends meet. This is not even how the States do it, where they have balanced budget amendments. The spending in Washington is out of control, and the Members of this body should not vote for this omnibus spending bill. Mr. President, I yield back the remainder of my time to my colleague from Arizona.

Mr. LeMIEUX

Mr. LeMIEUX. Mr. President, it is always good to follow my colleague from Ohio. I rise to speak about the health care bill. I, specifically, wish to speak about this new report we have received from the Office of the Actuary from the Centers for Medicare & Medicaid Services. This report, unfortunately, confirms many of the problems we already knew. This report comes from an independent actuary who works in the very agencies that have to implement our Federal health care programs. This actuary has reviewed the proposal before us, the proposal that is intended to be health care reform. The review and report of this actuary shows significant problems with this proposal and why we must start over and take a step-by-step approach. I had the opportunity to read this report this afternoon in my office, word for word, and go through it line by line. I hope all my colleagues do on both sides of the aisle. There are many troubling things this report shines light upon. First, the proposal we are debating increases the cost of health care. For Americans who are at home and might be watching this to see various Senators on the floor of this great body, they think the reason we are here is to reduce the cost of health care and to promote more access. Those are the two big goals. That is what the President told us. We are going to lower the cost of health care. This report shows, national health care expenditures are going to go up from 16 percent of the gross domestic product to 20 percent. The chief actuary says, on page 4 of this report, we are going to spend $234 billion more on health care over the next 10 years. We are going to spend more on health care. We are not going to reduce costs. We are going to increase costs. Moreover, the Federal Government, in its provision of health care, is going to spend $366 billion more in health care provisions. We are told this proposal is budget neutral or it actually creates less of a deficit. It cuts the deficit of the Federal budget. But as has been revealed this week--and this is just gimmickry--the taxes start before the benefits. For 4 years, we pay the taxes and the benefits don't start until 2014. So 4 years of penalties without any benefits. This is similar to if you were to go buy a home and you went to buy the home and you said: We are going to live here for the next 10 years, and the real estate agent said to you: That is fine. You are just going to pay for the first 4 years, but you don't get to move in until 2014. For families sitting around the kitchen tables, that is not how they balance their budgets. But that is this strange world that Washington is, that you can set up this budget gimmickry in order to get it to so- called budget neutrality. The actuary of CMS recognizes that. He says, on page 2, most of the coverage provisions would be in effect for only 6 of the 10 years of the budget period. The cost estimates shown in this memorandum do not represent a full 10-year cost of the proposed legislation. It is not budget neutral. It is just a gimmick. The second problem the actuary points to is, it jeopardizes access to care for seniors. My colleagues have been saying this for the past couple weeks. You can't take $\1/2\ trillion out of Medicare and have it not hurt the provision of health care for seniors. This plan is going to gut Medicare as we know it. It severely cuts funding for Medicare. In this report, it goes through all the cuts to Medicare Advantage, to home health, to hospice. The actuary goes through all these cuts. What does the actuary conclude is going to be the result? Our friends on the other side of the aisle say this is not going to cut Medicare; it is going to save Medicare. How do you take $\1/2\ trillion out and save Medicare? The actuary understands it. He knows that doctors who provide services under Medicare for seniors or for the poor under Medicaid aren't going to take these reimbursements anymore. They will not see people and provide health care. So it is not health care reform if the doctor will not see you. Right now, in this country 24 percent of doctors aren't taking Medicare; 40 percent are not taking Medicaid. The actuary says providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and might end their participation in the program, possibly jeopardizing access to care for beneficiaries. The second reason we are doing health care reform, access to care, is going to be hurt for seniors by this bill. That is on page 9, for those who are following at home. By the way, we are going to put this report on our Web site at lemieux.senate.gov. If you want to read it, you can read all the details. The next thing the actuary discovers as a problem with this bill is that for the 170 to 180 million Americans who have health insurance, your premiums are going to go up, not down. We are not going to bend the cost curve down. Health care will be more expensive, more expensive than if we were to do nothing and not implement this bill at all. The chief actuary says premiums for the government-run plan, for example, would be 4 percent higher than for private insurers. So we don't achieve that goal. What is going to happen when we put all this burden on businesses? Because we know that under this program we are going to penalize businesses if they don't provide health insurance. We are going to penalize individuals if they don't provide health insurance. So what are small businesses going to do who are hardly making it now? In Florida, we have 11 percent unemployment. Our small businesses are suffering. The actuary says on page 7, some small employers would be inclined to terminate their existing coverage. So they will drop their health insurance. You are an employee in a small business, they drop your health insurance. Now you must go buy the Federal program, where you will be subsidized. What does that mean? It means every man and woman will be paying taxes to help pay for health care insurance, taxes we can't afford, spending we can't afford, not in a world where we have a $12 trillion budget deficit. We are just pushing the cost off on our children and grandchildren. That is when this deficit is going to come home to roost. The actuary also says the excise tax on high cost employer-sponsored health insurance is going to cause employers to scale back coverage. So if you have one of the better health care plans, the Cadillac plans, your employer will not be incentivized to give you less coverage, less benefits, less access. Is that what we thought reform was supposed to be? Now we also know from the actuary we are going to raise taxes in this bill. As my friend, the Senator from Arizona, was saying, we are going to tax device makers. We are going to tax pharmaceutical companies, the implements and devices and medicines that save our lives. We know there is $64 billion in penalties in this bill. The actuary says, on page 5, if you are a small business or you are an individual and you don't provide the insurance, you are going to be taxed, penalized, $64 billion in penalties. The actuary says: We anticipate that such fees would generally be passed to health consumers-- These are the taxes on the devices and the drugs-- in the form of higher prices and higher insurance premiums. I also wish to address one point before concluding. My friends on the other side have been saying there are not going to be any cuts to benefits because we will run a more efficient system. There is going to be less fraud and abuse and waste. We all want that. That makes a lot of sense. But the actuary, in evaluating this--and he talks about it on page 12--finds that the cuts and the reductions are negligible. In fact, he can't even sufficiently provide evidence to know what the estimates of savings might be; at best, $2.3 billion for all the efficiency and savings. Remember, this is a $2.5 trillion program. There is $2.3 billion in savings, like 1 percent. So it is not the efficiency that is going to make up the cuts; it is going to be a cut in benefits to seniors. It will be higher insurance premiums for Americans. That is not health care reform. It is why the Wall Street Journal called this bill the worst bill ever. In talking about this new proposal to expand Medicare and drop the age for Medicare, this morning the Wall Street Journal corrected itself and said that is even worse than the worst bill ever. Similar to the Presiding Officer, I am new to this Chamber. I have been here about 90 days. It is a great honor to serve in the Senate, representing 18 million people from Florida, but it is also a little bit frustrating. The way the Senate works is not the real world. It is not like moms and dads who sit around the kitchen table and try to figure out how to make ends meet and they can only spend as much money as they take in. That is not how we work in this institution. We don't work in a reasonable way. My colleague from Utah will speak in a minute. He was on the floor the other night talking eloquently about how, when you do real reform, you get 80 Senators to vote on a proposal. If this bill passes, 60 Democrats will vote for it, 40 Republicans will not. If just one Democrat would feel their conscience and not vote for this bill, we could start over. We could work together in a bipartisan way and help those 45 million Americans who don't have health insurance. But we wouldn't do it by robbing from Medicare. We wouldn't do it by raising taxes. We wouldn't do it by creating a $2.5 trillion new program. I have struggled to try to figure out a way to explain to the people how bad this bill is. I know it is hard. You are sitting at home, around the kitchen table, trying to understand what Washington is up to. It is hard to understand. I have thought about cultural references and historical references, maybe even things in pop culture that I could use as an analogy to try to explain what is going on in the Senate. The only thing I can think of is the ``Wizard of Oz.'' In the ``Wizard of Oz,'' Dorothy gets thrown into the tornado in sort of an alternate reality, a place that doesn't play by the same rules. That is sort of the Congress. Dorothy and the lion and the tin man and the scarecrow are told: Follow the yellow brick road, you will get there. All your answers will be solved. Everything will be great. That is sort of like this phrase we hear around here: Make history, make history, just get it done. Pay no attention to the cuts in Medicare. Pay no attention to the Medicaid you will put on the States that can't afford it. Pay no attention to the higher taxes and the higher premiums people will have to suffer under. Similar to the scarecrow, who doesn't have a brain, it is not very thoughtful to put more expenses and more taxes on the States with Medicaid when they can't afford it. Similar to the tin man, who doesn't have a heart, it is not very thoughtful to take money out of health care for seniors. Similar to the lion, who has no courage, we don't have the courage to do what is right and work together in a bipartisan way. When you get to the end of the yellow brick road and you get to Oz, you find out there is nothing behind the curtain. This isn't health care reform. We need to start over, and we need to get it right. I yield the floor.

Mr. LeMIEUX

Mr. LeMIEUX. Mr. President, I thank the Senator from Texas. This is budget gimmickry. As the Senator from Texas said, as a former chief of staff who worked on trying to balance the budget because our constitution in Florida requires that, we try to figure out how much revenue we have and how much we can spend. If there were not enough revenues, we either had to cut spending or find a new source of revenues. We could not engage in this budget gimmickry. If I may borrow an analogy from my friend from Nebraska, this is like paying for a car for 4 years before you even get to drive it. Imagine you are going to make a substantial purchase--a house or car--and they show you the house, and they say here is your mortgage payment, and you will live in the house for 10 years, but you will start paying for it today. But you can't move in until 2014. That is what this bill does. In order to make this ``budget neutral,'' we steal $\1/2\ trillion from Medicare--health care for seniors, which seniors have paid into-- and we raise taxes, which is going to increase, not decrease, the cost of insurance. When we tax pharmaceutical companies and tax the providers of medical devices, what happens? They pass those costs right along to the citizens. Not only are we stealing from Medicare, not only are we raising taxes, which will be passed on to the citizens, now we are going to tell the States we are going to increase Medicaid. We are hearing about this secret deal that has been put together behind closed doors. My friends are in the dark, and a lot of Democrats don't know what is going on either. They are trying to figure out what the deal is. The deal will put more of a burden on the States. I know my friend from Nebraska knows this, being a former Governor. The American people need to know, when you increase Medicaid, the States pay the vast majority of that; and because they have to balance their budget, they will have to cut something else. So they are going to have to cut teachers or law enforcement. So we steal from seniors, steal from the States, raise taxes, and we don't cut the cost of health care for most Americans. I am new to this Chamber, and perhaps my friend from Idaho can help me understand this. It doesn't make a lot of sense as to how we should proceed with health care reform.

Mr. LeMIEUX

Mr. LeMIEUX. Madam President, 68 years ago today, the United States was thrust into World War II following the surprise attack on Pearl Harbor. Today, we pay tribute to those who survived the attack and remember the men and women who perished. Although the attack claimed the lives of more than 2,300 Americans, it did not break the resolve of our military. Today, we are grateful for the service of those we lost in conflict as well as those who returned after fighting to keep us safe and free. I join all Floridians in honoring those who fought for our freedom on that day and throughout the ensuing campaigns in Europe and the Pacific. On this Pearl Harbor Day, I thank all World War II veterans who answered our Nation's call to serve in the cause of freedom. They are true heroes and our Nation will always remember their sacrifice.

Mr. LeMIEUX

Mr. LeMIEUX. I thank the Senator from Nevada. I don't know that there is a State that is going to be more impacted by cuts in health care for seniors than my State of Florida, with 3 million Floridians on Medicare, almost 1 million on Medicare Advantage. I think it is worth repeating what these cuts are going to mean: $137.5 billion from hospitals that treat seniors. I talked to the director of a hospital district down where I am from, down in south Florida. He said these cuts will be devastating: $120 billion from Medicare Advantage, $14.6 billion from nursing homes that treat seniors, $42 billion from health care for seniors--from home health care, and $7.7 billion from hospice care. Yesterday, our friends on the other side were trying to convince us and the American people that there are not going to be any cuts to benefits. It is not going to affect health care for seniors because they are going to pay less, but that will just get rid of the waste and the fraud and the abuse. Everyone is against waste fraud and abuse. We have a measure on this side of the aisle that actually, I think, would do something about it. We have gone through the Reid bill to find all the provisions. My staff and I have been going through it, line by line, to find all the provisions that go after waste, fraud, and abuse--and there are some, to their credit. But the Congressional Budget Office has said, in their report that came out on November 18, the provisions that go toward waste, fraud, and abuse would cut $1.5 billion and create that efficiency. But the cuts are $464 billion. So if they are going to save $1.5 billion and there is going to be $464 billion in cuts, where are the rest of the cuts going to come from? It is, as my friend, the Senator from Tennessee, said, seniors are going to get thrown under the bus. But you are not going to be able to cut $464 billion, only get $1.5 billion in savings, and not cut benefits. So seniors who want to go to the hospital are going to have their benefits cut; seniors who have home health care, their benefits are going to get cut and all the way down the line. Everyone needs to understand that at its base, this is a bill that hurts seniors. Perhaps no State is going to be impacted more than Florida, where we have this huge population of seniors. I know my friend from Nevada has a huge population of seniors in his State. We have the highest per capita number of seniors. We like to say all the rest of the seniors in the country are eventually going to move to Florida anyway. We are going to have the greatest generation--we have them there now--we are going to have more of them living in Florida, and their health care is going to get cut. This bill cuts from health care for seniors, it raises taxes, and it doesn't decrease the cost of health care for the 170 million Americans who have health insurance now. For some, it raises it. For me, a new Member to this body, it does not make any sense. But what does make sense is what my esteemed colleague from New Hampshire has done with this amendment. If you are for health care for seniors and you do not want it to be cut and if you are true to your word that we have to put the savings back into Medicare, then this bill, which says as its purpose ``to prevent Medicare from being raided for new entitlements and to use Medicare savings to save Medicare''--I cannot imagine that anyone could vote against that amendment, because if you vote against that amendment, you are voting against senior health care. I ask my colleague from New Hampshire, who has so much experience on these budget issues, if this amendment is not agreed to, what is going to happen to the Medicare program?

Mr. LeMIEUX

Mr. LeMIEUX. If I may, I will follow up on my colleagues' comments about what happened in Georgia. I walked to one of the largest home health care providers in Florida. We have a letter to the editor in the Sarasota Herald Tribune of November 16 where this person, who works for one of these home health care companies--one of the bigger ones, which aren't going to be in as much trouble--they say: Contrary to the other assertions that senior care will be unaffected by health care reform in Florida, this scenario could be devastating for older Floridians. More than 56 percent of Florida's home health agencies could be in the red as early as 2011. So we are going to take the smaller home health agencies--the mom- and-pops--in Florida, we have 1.9 million small businesses. They are not going to be able to function because we are going to take this money out. I want to make a point, also, that today in the New York Times, a good point was made that there is going to be no new insurance money coming in for home health care agencies--or very little. It is not as if there are going to be folks having this new public option or new insurance-backed program because home health care is for seniors. There is not going to be any extra money. So what is going to happen? We are going to have our moms, dads, and grandparents who are benefiting from this home health care in Florida and across this country instead of having to go to a nursing home, instead of having to go to an assisted living facility away from their home and family--they are not going to be able to go anymore. By the way, I don't believe that will save any money. I think that will increase costs because we know nursing home care is far more expensive than home health care. It is estimated that 1 day of hospital costs, for example, is 43 times as much as home health care. When you get rid of home health care, you are actually going to increase costs. I want to follow up on a comment, if I can, of my friend from New Hampshire. I am new here, and I am still understanding the ways of Washington, DC. Everybody in America needs to know this bill will not help seniors at all. This bill takes money from senior health care. If there was a legitimate and straightforward effort to actually help seniors, we would take Medicare savings and keep the money in Medicare. But, as our leader said today, we are robbing the piggy bank, taking money out of health care for seniors and putting it into this new program.

Mr. LeMIEUX. If the Senator from Arizona will allow, I want to ask one question of my friend, the medical doctor, about infections in hospitals. My understanding is that home health care is actually better for the patient, it is better for the efficacy of the treatment because a big problem we have in hospitals is that patients get staph infections and other infections. In fact, it is one of the leading causes of death in a hospital. You don't go in with this infection, you get it there. Isn't this proposal that is going to take people out of home health care and send them to hospitals going to actually hurt patients?

Mr. LeMIEUX

Mr. LeMIEUX. Mr. President, I have been reviewing the amendment of the Senator from Michigan. This is very important to the people of Florida because it deals with Medicare Advantage. Medicare Advantage is a very important program. It is not just some extra frills. It is the idea that our folks in Florida can get eye care, dental care, hearing care, diabetic supplies, preventive medicine. Last week I went down to a Medicare Advantage clinic in Miami, the Leone Center. This is a place where seniors are getting holistic health care. The intention of this amendment is to guarantee the benefits in Medicare Advantage, but I am not sure it is phrased that way. I have been reading the bill. I have been reading Title XVIII of the Social Security Act. I cannot find the phrase ``guaranteed benefit.'' I ask unanimous consent that the ``guaranteed by law'' phrase in this amendment offered by my colleague from Michigan be eliminated so that we would ensure that benefits of eye care, dental care, preventative care, diabetic supplies, all the other things that are provided in Medicare Advantage, are actually preserved. No one is objecting to lower costs. No one is objecting to a competitive situation where we have companies providing more services for less cost. We want to make sure the services are still there. I ask unanimous consent to have that phrase ``guaranteed by law'' be eliminated from the amendment.

Mr. LeMIEUX. Mr. President, regarding this amendment, I had a conversation with my colleague from Michigan. The phrasing ``guaranteed by law'' doesn't guarantee anything. This isn't going to protect the benefits of Medicare Advantage. The benefits our senior citizens enjoy, such as eye care, hearing care, and dental care, are not protected by this. You can vote for it if you want to. It sounds good, but it is gift wrapping on an empty box.

Mr. LeMIEUX

Mr. LeMIEUX. Mr. President, I rise to express my sorrow at the passing of former U.S. Senator Paula Hawkins and to pay tribute to her long life and groundbreaking career of public service. A resident of central Florida, Paula Hawkins began her political career in 1972 when she was elected to Florida's Public Services Commission where she served for two consecutive terms and worked to become a vibrant voice for consumers. Paula Hawkins aspired to continue her public service by running for higher office, first for the U.S. Senate in 1974, and then for Lieutenant Governor in 1978. Though both times she lost the race, she never gave up and never lost the desire to continue working for Floridians. Paula made history in 1980 when she became the first woman from Florida to be elected to the U.S. Senate and the first woman from Florida to be elected to Federal office. During her tenure in the Senate, Senator Hawkins became an outspoken champion for America's victimized children and brought a special focus to the problem of child abduction. Driven by the disappearance of 6- year-old Florida resident Adam Walsh, Senator Hawkins ushered passage of landmark legislation focusing on the issue of missing children. Her work would ultimately help to establish the National Center for Missing & Exploited Children. She also supported a special unit at the Federal Bureau of Investigation that would focus solely on profiling serial killers. Though I am saddened by her passing, I am honored today to serve in the same class as Senator Hawkins--a seat she held before being succeeded by former Senator Bob Graham, and my predecessor, Senator Mel Martinez. The citizens of our United States owe a debt of gratitude to this great Floridian and we shall not soon forget the work of Senator Hawkins.

Mr. LeMIEUX

Mr. LeMIEUX. Madam President, I come to the floor today to draw back the curtain a little, I hope, and to widen the lens to talk about the issue of the bill before us, not just on this particular amendment but on what it is going to mean for my constituents in Florida and for the people of this country. I had the opportunity last week to be back home in Florida, in south Florida, in Palm Beach County and Broward County and Miami-Dade County, where I talked to doctors, hospital administrators, folks who run Medicare Advantage plans, as well as everyday Floridians, specifically senior citizens. The responses I heard were nearly unanimous, and that was grave concern about the bill that is being debated on this floor and a general confusion as to why the Congress is pursuing the path that it is. The people of Florida do not understand why we are going to cut Medicare to create a new program. The people of Florida do not understand why we are going to raise taxes to create a new program. The people whom I have spoken to in Florida do not understand why we would undertake a new $2.5 trillion health care proposal if it was not going to reduce the cost of health insurance for the 170 million to 180 million Americans who have health insurance today. Why are we embarking upon this measure if it is not going to affect most everyday Floridians and everyday Americans who are struggling under the high cost of health insurance? Health insurance premiums have increased 130 percent in the past 10 years. When the President put this proposal forward and when he campaigned on it, he said his major goal was to reduce the cost of health insurance. When he addressed the Nation in a joint session of Congress on September 9, he said his plan would reduce the cost of health insurance. But we find out that for at least 32 million Americans, it will raise the cost of health insurance 10 to 13 percent. So at least half of the goal, if not most of the goal, of his plan for most Americans in this country will not be accomplished. Yet we are going to cut nearly $\1/2\ trillion out of Medicare, we are going to raise taxes by $\1/2\ trillion, and we are going to spend $2.5 trillion on this program, which was admitted to by Senator Baucus yesterday on the floor, which cannot be, under my understanding, in any way budget neutral. But I want to speak specifically about the cuts to Medicare. It cuts $192 billion, according to the Congressional Budget Office, ``to Medicare's payment rates for most services.'' I think we have to be clear here that if you cut providers, you are going to cut services. The very reason we talked about increasing doctor payments in that $\1/ 4\ trillion program was so that patients would not receive fewer services, so there would be ample doctors providing services for Medicare. It is beyond logic to argue that cutting providers will not cut services. What will happen when we cut providers, doctors, nursing homes, home health agencies, hospitals? Fewer and fewer of them will provide benefits, and fewer and fewer of them will take Medicare. The Chief Actuary of CMS believes the cuts in the bill we have before us could cause providers to end their participation in Medicare: . . . providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and might end their participation in the program. Every American understands this. If we pay less money to health care providers, they are going to offer less benefits or more and more they are not going to participate in Medicare. The Medicare Payment Advisory Commission found in June of last year that 29 percent of Medicare beneficiaries who were looking for a primary care doctor had a problem finding one to treat them. This is of grave concern to the 3 million Floridians who are on Medicare. If a doctor will not see them, what kind of health care plan is this? These seniors, our ``greatest generation,'' have paid into this program their whole life. It is illusory if they can't find a doctor who will treat them. One of my constituents, Earl Bean, from Sanford, FL, recently told CNN that he called about 15 doctors when he was trying to find health care, and he was told they were not taking new Medicare patients. So when we cut $\1/2\ trillion out of Medicare, is that going to improve health care for seniors or is it going to continue to decline health care for seniors? You can't get blood from a stone. It is going to make the situation worse. For anyone to come to this floor and say that it would not is incredible. We have in Florida the second highest Medicare population. When we cut $135 billion from hospitals and $21 billion from the disproportionate share fund, which is basically money that goes to these hospitals to provide health care for seniors and the indigent, how are they going to be able to provide that health care? I spoke to the administrator of the North Broward Hospital District and told him about this cut to the DSH funds, and he told me it would be devastating to their provision of health care. Then we are going to take a very popular program called Medicare Advantage--more than 900,000 Floridians in my State--and we are going to cut it as well. I recently visited the Leon Medical Center and their new facility in Miami Dade County where they provide state-of-the-art, first-class health care for seniors; not only normal health care but eyeglasses, hearing aids, dental care, and the constituents who go there love it. They are getting the kind of health care that you would hope your senior citizens in your family would get. The principal of the company, Ben Leon, told me they have saved $70 billion in the way they have run their system. He told me if we continue on this path with these cuts to Medicare Advantage, he will not be able to provide these good services going forward. There are some fixes to grandfather folks in, but all in all people will be cut, and all in all the program will not be as good, and it will decline the health care of seniors in Florida and across this country. We will cut $15 billion from nursing home care and $40 billion from home health agencies. I spoke to a provider of a home health agency practice in Florida. He said these cuts will put half of the home health care agency folks out of business. At a time when we have 11.2 percent unemployment in Florida, this health care bill is going to cost people their jobs, and it is going to decline the quality of health care. I am also concerned about this Medicare advisory board. This independent board of nonelected folks is going to have the power to cut Medicare by $23 billion over the next 10 years, and it will be up to this body to reinstate those cuts. These people are not elected, my constituents in Florida don't know who they are, but they are going to be responsible for the decline of their Medicare and their health care. The ``greatest generation,'' who fought to protect this country, is looking at this health care bill and wondering why. Folks with health insurance in this country--more than 170 million who are not going to see their health care costs go down but up--are wondering why. Americans who are seeing higher taxes and penalties for not buying these health insurance programs under this bill are wondering why. If we are here to reform health care--and we should be--if we are here to try to make sure the 45 million people in this country and the nearly 4 million Floridians get health insurance--and we should be-- then why don't we take a step-by-step approach? I am new to this body. My first day here was September 10, so I have not even been here 3 months. But I can tell my colleagues, the American people, if they knew what I know now and could see what I see, would be baffled by this process. There is not a give-and-take on this issue. We didn't all sit down together in a conference room and work this out to have a bipartisan bill. The Democratic leader worked on it with his colleagues but not with us. So now we have a program that cuts Medicare, that raises taxes, that doesn't decrease the cost of health care for the majority of Americans and will cost us $2.5 trillion and can't be budget-neutral, at a time when we have a $12 trillion debt, a debt that requires each of us--each family--to put $100,000 on our shoulders to be responsible for that debt, a debt where the third largest payment in our budget is for interest payments, and over the next 10 years those interest payments will go up by $500 billion, enough to pay for many of the budgets of the Federal Government----