Jay Rockefeller

Mr. ROCKEFELLER

Mr. ROCKEFELLER. In responding to the Senator from Arizona and what I am sure is a very good-faith--I know is a very good-faith effort, if Senators Feingold, Kennedy and others are in fact cosponsors of it, one would never know by looking at the amendment because only the name of the Senator from Arizona is listed. And this is part of what I am talking about. If we are going to make serious decisions about the enormous variety of programs, we have to do this in some kind of more intelligent way. Now, the rules may preclude us from doing that because the agreement has already been made, but this is many things to many people. Mr. EXON addressed the Chair.

Mr. ROCKEFELLER. Is there any time?

Mr. ROCKEFELLER. Mr. President, I appreciate the action of the ranking member of the Budget Committee. This amendment which we have not yet--let me say first of all, it will be my hope that our side will not take a position on this, because we are simply unaware of what it is. In fact, it appears to be many, many things. It starts out with the elimination of the Market Promotion Program for agriculture, I think. It appears to be part Agriculture, part Finance, part Commerce Committee. It gets into the termination of the Advanced Light Water Reactor Program. I am thoroughly unqualified to review that. It talks about timber access roads. That is an Energy Committee matter. It talks about United States Travel and Tourism, USTTA. That is something I strongly support. Other Members may not. I suspect the Senator from Arizona does not. There is a private sector funding for certain research and development by NASA relating to aircraft performance. That is the formal title. What that means I have absolutely no idea, and I have no way of finding out in the next 2 or 3 minutes. There are many other things--the recoupment of certain Department of Defense costs for equipment sold directly by contractors to foreign countries and international organizations. So, my plea would be for all my colleagues to take this 21-page amendment, between the time now--having no position on it, as would be my recommendation to my ranking member on the Budget Committee--and the time that we vote, and Senators make up their minds as best they can. I am absolutely unable, having had this for a period of 2\1/2\ minutes, to make heads or tails of it, since it is many things and, I suspect, many things to many people. This is not, it strikes me, in terms of process, one of the Senate's finer moments.

Mr. ROCKEFELLER. I do not want to embarrass the U.S. Senate.

Mr. ROCKEFELLER. Can the Senate get a copy of your amendment now? We have nothing.

Mr. ROCKEFELLER. May I have 5 seconds?

Mr. ROCKEFELLER. Mr. President, will the Senator yield for a friendly inquiry?

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, Republican rhetoric is that working families will be helped, but I question if this will be true for real families in West Virginia. This Republican package seeks to cut Medicaid funding by a whopping $187 billion over 7 years. But people deserve to understand what such harsh cuts mean. Medicaid covers poor children, pregnant women, the disabled, and low-income seniors who need nursing home care. What happens to these people and their families when we slash Medicaid funding? Coming from West Virginia, when I think of a family, I think about the children, parents, and grandparents. What happens to parents struggling to balance raising children and caring for aging parents? If a working family gets a new child tax credit but loses Medicaid nursing home coverage for an aging parent, what is the overall effect on that family? The child tax credit is $500 a year for some families lucky enough to qualify, but the loss of Medicaid nursing home coverage will cost those same families $16,000 to $30,000 a year. For example, Julie Sayres of Charleston, WV cared for her mother who suffers with Alzheimer's disease as long as she could at home. But as her mother's illness got worse, she had to move to a local nursing home where Julie can visit her daily. Julie may get a partial child tax credit of $500 under this package, but if she cannot get Medicaid coverage for her mother in the nursing home when her mother's meager savings are exhausted, Julie and her family will be much, much worse off. That child tax credit will not cover even a month of nursing home care for her mother. This is real story about a family hurt, not helped by this package. In my State of West Virginia, over 21 percent of our residents rely on Medicaid, and I worry about what will happen to them and the health care system in my State as it tries to absorb more than $4 billion in cuts--West Virginia simply cannot afford this. A headline from the Charleston Daily Mail last week reads: ``[Medicaid] Cuts May Affect Infant Mortality.'' This catches one's attention. It demands closer scrutiny and careful thought. The article reports: With the help of Medicaid-funded programs, West Virginia's infant mortality death rate decreased from 18.4 deaths per 1,000 in 1975 to 6.2 deaths per 1,000 in 1994, better than the national rate of 8.0 deaths per 1,000 births. Medicaid has greatly increased poor women's opportunities to get medical care, said Phil Edwards, the administrative assistant for the Bureau of Public Health's Division of Women's Services. ``By making them eligible, they go in for prenatal care earlier than they would otherwise,'' he said. ``Every dollar you spend on this side in prevention, you save four on the other side where you don't have to treat an at- risk patient,'' Diane Kopcial of the state maternal and child health office said. Mr. President, I believe this article should make us all stop and think before we impose such cuts in Medicaid. Do we really want to jeopardize nursing home care for seniors? Do we really want to slide backward on infant mortality? I do not want to go backward. I understand that Medicaid needs reform and our amendment recognizes that there are responsible ways to reduce the rate of growth in Medicaid spending. But we should not throw seniors out of nursing homes, deny poor mothers access to prenatal care and possibly return to times when our infant mortality rate rivals some Third World countries, or turn our backs on the disabled. We should think about the real families in West Virginia and cross this country who depend on Medicaid for basic, vital health care. Mr. President, I ask unanimous consent that the full article from the Charleston Daily Mail, be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I thank the distinguished Senator from Florida, and I certainly support his motion to commit. Mr. President, what happens to parents who are struggling to try to balance the raising of children and, at the same time, caring for aging parents under the Republican proposal? If a working family gets a new child tax credit but loses Medicaid nursing home coverage for an aging parent, what is the overall effect on that family? The child tax credit is $500 for some families. Not in West Virginia where two-thirds of our families would not get it. Let us say for some families it is $500 a year, but the loss of Medicaid nursing home coverage in West Virginia would cost from $25,000 to $35,000 per family, because that is what a nursing home costs if you have to pay it yourself. An example, Julie Sayers of Charleston, WV, cares for her mother who, as the Senator from Maryland was talking about, suffers from Alzheimer's disease, and she cared for her as long as she could at home, as children want to do, but when it came to the point that she could not care any longer, she had to take her mother to a nursing home. Julie in this case gets a partial child tax credit, much less than $500 under the Republican package, but she cannot get Medicaid coverage for her mother in the nursing home. So what good is it, the child tax credit? What damage does the Medicaid cut do--$182 billion, $187 billion for a tax break for the wealthy. Julie and her family are going to be a lot worse off under the Republican proposal, not better off, but worse off, and this is a real person caring for a real mother with Alzheimer's in West Virginia today. Mr. President, I understand Medicaid needs reform, and Senator Graham recognizes that there are responsible ways to reduce the rate of growth in Medicaid spending, but we really should not get down to the business of throwing seniors out of nursing homes. We really should not do that. That, in my judgment, is what the Republican amendment does.

Mr. ROCKEFELLER. Mr. President, I am going to be on the floor again today because the Republican rhetoric is not matching the reality and the Republican rhetoric is that the children's tax credit will help families. In reality, too many families will be excluded from this credit because it is not refundable. In fact, over 20 million children will not receive the full benefit. And these children are in families earning less than $30,000, families that need tax relief the most to make ends meet on a tight family budget. To add insult to injury, not only do Republicans deny the credit to such hard working, low-wage families, Republicans are paying for it by imposing a tax increase on them with a $43 billion cut from the earned income tax credit [EITC]. The Republican leadership continues to claim that their tax package helps middle-class American families. And this sounds good, but I want to know how they define the middle class? In my State of West Virginia, we believe that parents who go to work every day, and struggle to raise their children are middle class, admirable, and deserving of support and encouragement. Over 65 percent of our taxpayers are working hard but earn less-less than--$30,000. For such families they will lose, not gain under this bill. West Virginians have a basic sense of fairness and common sense. They will know that this package and its claim of middle class tax relief are false when they fill out their tax forms in April 1997. Just 2 years ago, these working families were promised tax relief. Now Republicans are reneging on that deal and raising taxes on families earning less than $30,000. For families with two or more children, their taxes will go up an average $483. For families with one child, taxes will go up an average of $410. This will hit over 77,000 families with children in my State of West Virginia alone. But such numbers can be numbing. Let us get beyond the rhetoric, and look at real families. A real family, like the Helmick family of New Milton, West Virginia, will be worse off, not better. The Helmick family has 6 children, ranging in age from 15 to 4. Mr. Helmick works full-time as a truck driver for a local construction company, and Mrs. Helmick is a full- time homemaker. In the past, they have used their EITC to buy baby furniture and to buy a used truck so Mr. Helmick has reliable transportation to get to work. Mr. Helmick will not get to claim the full tax credit for his children, and he will lose EITC benefits under the Republican plan. This is a real working family that will be hurt, not helped. And families like the Helmicks who can not claim the child credit and are hurt by the cuts in EITC, probably will not be claiming capital gains tax breaks either. For them, this package does little more than renew their cynicism since it reneges on promises made just 2 years ago when we told families to play by rules, go to work instead of welfare and we will offset your payroll taxes so that you do not have to raise your children in poverty. I feel badly for 65 percent of families in West Virginia who will be hurt rather than helped by the Republican tax proposal. I thank the distinguished Senator from New Jersey.

Mr. ROCKEFELLER. The distinguished Senator from New Jersey is kind as always.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. If the Senator will yield to his incredulity and mine. I would add that under the Republican $270 billion cut, Medicare will be squeezed in its growth rate at 4.9 percent per person. Now, you go into the private market, private health insurance, that is going to grow at 7.1 percent. But they are going to hold it down to 4.9 percent for Medicare. Now, this is for your Medicare. So what is going to happen? Obviously, spending for Medicare, because you do not reduce the price of health services simply because you reduce the amount of money that you are willing to pay, to make available to pay for them, the price will continue to rise as it has in the past, but the amount of money will be much less. So what, in fact, you have guaranteed is this BELT procedure.

Mr. ROCKEFELLER. I would be happy to, although I have my third Draconian measure that I would like to mention.

Mr. ROCKEFELLER. Mr. President, this is an interesting----

Mr. ROCKEFELLER. The Senator from Massachusetts, I believe, is yielding me time.

Mr. ROCKEFELLER. Mr. President, I guess it is my general impression that the other side, the Republican party, does not want to vote on this amendment which we started hours and hours ago. We have had all kinds of delaying tactics and we had second-degree and first-degree amendments, talks about all kinds of time agreements, but not a vote, not a vote. I have not been on the floor. I have been working with our leader, but I assume that this point had been made over and over again. One of the things that I think seniors should be aware of is--which has not been talked about at all in the Republican amendment for Medicare, which cuts $270 billion out of Medicare--is something called the BELT agreement. It is not GATT, it is not NATO, it does not have forces, but it has lethal effect, absolutely lethal effect. And it is tucked away inside the Republican Medicare plan. And BELT, because I know you are anxious to find out, stands for the ``budget expenditure limit tool.'' Interesting phraseology. It is a budget gimmick that poses a very dangerous threat to our senior citizens. And when our colleagues on the other side of the aisle say we are trying to scare senior citizens, one of the things that comes back at me is, do our senior citizens even know the beginning of what they would be getting into if we ended up with the Republican amendment to cut $270 billion and other matters, for example, the BELT agreement? Now, let me tell you what the BELT agreement does. This is the Republican device that will make automatic cuts in Medicare for years to come--for years to come--automatic cuts, no legislative authority, automatic cuts. And what will the cuts be made for? They will be made for the GOP tax breaks for the wealthy. The budget gimmick is labeled, as I indicated, the ``budget expenditure limit tool.'' And it is the Republican secret plan to make automatic cuts in the traditional--now catch my words--fee-for-service Medicare Program. Now, remember what we have been hearing this afternoon at great length is that ``No, no, no, don't worry about these things called HMO's. Don't worry about that, because 90 percent of seniors are already in the fee-for-service program. Of course they'll be staying in the fee-for-service program.'' So all seniors are meant to relax when they hear that argument. But they do not understand the BELT agreement, the BELT agreement, which is the ``budget expenditure limit tool.'' And what it does is makes automatic cuts in the traditional fee-for-service Medicare Program, without any action by Congress or the President, for the next 7 years into the future. Now, how would it work to hit seniors? First of all, it would put GOP, Republican, priorities ahead of seniors' health care needs in three ways. First, the BELT--this budget limitation tool for seniors on fee-for- service Medicare, ordinary Medicare, 90 percent of seniors--it would set a fixed annual target on Medicare spending. Oh, we have not talked about that this afternoon. We have not talked about a fee or an expenditure limit on Medicare spending. I have not heard that from the other side this afternoon, because everything was geared to have seniors believe, so long as they were in the Medicare fee-for-service portion that they are now in, that life continues to be cheerful and wonderful and there is no worry. ``Don't worry about that, HMO's.'' But they did not tell us about BELT. So a fixed annual target is set on Medicare expenditures representing the amount necessary to secure the funds that Republicans need for tax cuts for the wealthy. And it becomes an absolute limit on what Medicare will contribute to seniors' health care. May I repeat that? It becomes an absolute limit, a ceiling, on what Medicare will contribute to Medicare regular enrollees, non-HMO seniors' health care. Second, if Medicare's bill exceeds this limit, the BELT, which is the budget expenditure limit tool, imposes automatic--what is my next word?--reductions, reductions, arbitrary in nature, in key Medicare spending in the following year, imposing cuts in Medicare; for example, inpatient hospital services, reductions in expenditure for inpatient hospital services, inpatient hospital services for seniors; home health services, reductions; hospice care services, reductions; diagnostic tests, reductions; physician services and outpatient hospital services, reductions, Mr. President. I am sorry, I am sorry, this is in the Republican plan. No, we have not heard about it because we did not have much time. And, no, we did not hear about it in the Finance Committee because we spent about a total of 10 minutes debating this entire thing--10 minutes per side.

Mr. ROCKEFELLER. The word ``sequestration'' is the perfect word.

Mr. ROCKEFELLER. Yes.

Mr. ROCKEFELLER. That is the point, I say to my friend from Iowa. And what is absolutely incredible is I have sat here under limited time, to be able to discuss any of this, this afternoon for hours, and I have heard all of this talk about this glorious--``All those seniors in the fee-for-service Medicare Program are going to be happy. We don't do anything. They are just there. They don't have to join the HMO's. They will be in that 90 percent of happy folks that we are going to do nothing to cut their services and life will go on.'' But this BELT procedure is reserved exclusively for them, I say to the Senator from Iowa. So they are going to cap this at 4.9 percent, even though the private cost of health care costs are going to be 7.1 percent. So it is automatically guaranteed there is going to be a shortfall, at which point the sequester falls in, the BELT falls in, the reductions are made in inpatient hospital services, home health services, hospice care, diagnostic tests, physician services--that means visiting a doctor--and outpatient hospital services. That is the whole ball game in health care. There is not much else you can do. I will say, I made a mistake, because the third part of this is that under the plan, since the first-degree amendment of the Senator from Colorado wiped out the $89 billion reduction in Medicare and supplanted it with a $270 billion Republican one, what I failed to say was that, in fact, they have been at least kind enough to say that the Congress could adjust this BELT or do something with this BELT procedure, but only under a supermajority. I am not sure what a supermajority is, but it has to be at least 60 percent. It is probably closer to 66\1/3\ percent, which means that the Congress would not do it, so the BELT would be in effect. Of course, BELT threatens access to choice. It applies only to Medicare fee-for-service expenditures. It hits only seniors who want to keep their current doctors. As a result, this budget gimmick will discourage doctors from accepting fee-for-service patients, senior patients, which, for reasons which we now understand much more clearly because of what is hidden in this Republican plan since obviously their payments will be cut, the physician payments will be cut, threatening the access of seniors to doctors' offices of their choice. If there is anything you can say to a senior that will justifiably terrify that senior, it is that you are going to take that senior's doctor away. All afternoon we have been hearing that is not going to happen, but it is the current beneficiaries who are going to be hit the hardest. I just would very much like for my colleagues to understand a new concept called BELT, budget expenditure limit tool, which automatically, if costs go up too much--which, of course, they will--it automatically sequesters and then reduces virtually all health care services for seniors. Nobody in this building knows about it.

Mr. ROCKEFELLER. Virtually nobody in the Finance Committee knew about it, because we only debated the thing for about 10 minutes. Now, the Senator from Iowa and the Senator from West Virginia know about it, and perhaps some others do, too.

Mr. ROCKEFELLER. Of course, I will.

Mr. ROCKEFELLER. That is correct. The Senator is 100 percent correct.

Mr. ROCKEFELLER. The Senator is correct, but I will add a further dimension. It is another aspect in what it is that our Republican colleagues have to do, driven by this Contract With America, in order-- you see, there is a reason for this. You do not do it because you want to do it, you do it because you have to get that tax-break money.

Mr. ROCKEFELLER. That is why you have to come up with gimmicks like this which you do not talk about on the floor of the U.S. Senate, because you do not want anybody to know about it.

Mr. ROCKEFELLER. There is nothing--nothing--in the Democratic amendment which has that.