Jay Rockefeller

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Will the Senator yield for a question?

Mr. ROCKEFELLER. I yield the floor.

Mr. ROCKEFELLER. The comments of the Senator from New Mexico were kind of incidental?

Mr. ROCKEFELLER. Mr. President, if the Senator will yield, ordinarily one goes back and forth between the two sides, and are we planning to do something different today?

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am today introducing, with the cosponsorship of my good friend from Wyoming, Al Simpson, chairman of the Senate Committee on Veterans' Affairs, legislation that involves a matter related to the Uniformed Services Employment and Reemployment Rights Act of 1994 [USERRA], Public Law 103-353. This landmark rewrite of a 1940's law, which provides employment protections to returning servicemembers, was derived from legislation reported by the House and Senate Veterans' Affairs Committees. There was one issue, however, related to USERRA which falls under the jurisdiction of the Finance Committee, a committee on which Al Simpson and I also serve. It was not possible to get this issue resolved last year before final passage of the USERRA legislation, and the bill we are introducing today would accomplish that goal. Mr. President, the matter in question relates to provisions in USERRA which address a returning servicemember's rights to participate in the employer's pension plan and, more specifically, to the relationship between USERRA and the Internal Revenue Code. Under USERRA, it is possible that a pension plan, by seeking to comply with USERRA, could have to make payments on behalf of now returned servicemembers that could cause the plan to go out of compliance with the Internal Revenue Code [IRC] because of the total amount of payments made by the plan in a given year. Obviously, this is a result that is not intended and which should be avoided. The appropriate remedy--an amendment to the Internal Revenue Code--is in the jurisdiction of the Finance Committee, and thus the matter must be resolved in legislation developed by that committee. Mr. President, so as to allow time for an amendment to the IRC to be considered, USERRA provides a 2-year period before compliance with the pension provisions in the new law would be required. As I noted during Senate debate last September on the final compromise of the USERRA legislation, it was my intention, which I communicated at the time to Senator Moynihan in his then-role as chairman of the Finance Committee, to take the lead in the Finance Committee in proposing the appropriate amendment to the Internal Revenue Code as part of the first appropriate tax bill. I also indicated to Senator Moynihan that, should such an amendment not be in law as the 2-year window provided in USERRA nears its end, I would work to amend USERRA so as to provide for a further delay in the effective date of the pension provisions. Mr. President, our introduction of this bill today is the initial step in seeking to fulfill the pledges made last fall. I look forward to working with Senator Simpson and all the members of the Finance Committee on this legislation. Mr. President, I ask unanimous consent that the text of the bill we are introducing be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. One of the things, I would say to my good friend from the State of Massachusetts, we heard this constantly during the health care debate was, ``You can lose your right to pick out your own doctor.'' But now what is it that the budget resolution and the whole course of events is doing for senior citizens in Medicare? We are talking about managed care, more and more managed care for Medicare. And so all of the sudden my colleagues on the other side of the aisle are saying, this terrible fee-for-service system which we have for Medicare, and it is only for Medicare, only they have a fee-for-service system, so we have to move to managed care. And what happens then, of course, is they do not have the chance to choose their own doctor. But if they want to choose their own doctor, then let them pay more.

Mr. ROCKEFELLER. Mr. President, I cannot help but note for the Presiding Officer in the chair, in the last week even, the bipartisanship which has reigned on this floor. The Presiding Officer, the distinguished Senator from Washington, and this Senator and other Senators from both sides of the aisle worked together to craft a product liability tort reform bill which was slim, disciplined, and effective. People said it could not be done. It was done. Last night the Senator from Massachusetts, Senator Kennedy, this Senator, Senator Chafee from Rhode Island, Senator Dole, and Senator Packwood--there was quite a flap about a very important but not necessarily attention-grabbing subject called Medicare Select; whether it was to be expanded from the present 14 States to 50, for how long, and who would decide and all of this. And this Senator objected to its being taken further, so there was a climate of momentary controversy. But then both sides came together and worked out a bipartisan compromise which was passed. And that was very heartening. It was important; heartening. Now we are at a very different stage and it is saddening to me, but it is terribly real because I do think it has come to where we define what these two different parties that sit in this Chamber stand for. Mr. President, I will be offering tomorrow, an amendment on Medicare and long-term care to the Republican-sponsored Senate budget resolution. The amendment will take $100 billion in funds reserved for tax cuts for the wealthy and put that money back into vital health care programs. The Senate Republicans have proposed the single largest Medicare cut in the history of the program, $256 billion over 7 years. The House Republicans have proposed an even larger cut, $288 billion over 7 years. House Republicans need to cut Medicare more because they have an even larger tax break for the wealthy that they have to pay for. The House tax cut totals $345 billion. Money reserved for the Senate tax break totals $170 billion. These Medicare cuts would not be necessary--would not be necessary-- if Republicans did not need to pay for their tax cuts. The Contract With America tax cut would provide a $20,000 tax break to the wealthiest 1 percent of the population. The amendment I will offer tomorrow, along with my colleague from New Jersey, who will join me in that, and the Senator from Massachusetts, Senator Kennedy, will take $100 billion out of the $170 billion the Republicans have reserved for tax cuts for upper-income Americans and shift it to Medicare and Medicaid--very simple. It is a simple amendment. What is it about? It is about setting priorities. It says we are not going to balance the budget by whacking health benefits that seniors depend upon. It says we are not going to increase what seniors have to pay out of their own pockets ad nauseam for health care so we can put more money into the pockets of the rich. It is simple-- clear. The difference between the two parties. The Republicans have argued--will argue that the $170 billion they have reserved for tax cuts is their special dividend, their own pot of gold. I find that a particularly offensive statement. It is not their money to spend. It is the money of the taxpayers. They want to spend taxpayer money on more breaks for the rich. Democrats, through this amendment and other Democratic amendments that will be offered later on in the process, say let us keep our priorities straight. We have already committed those dollars to the Medicare Program. Instead of worrying about the effects of such tremendous Medicare cuts on seniors, I was significantly struck by what Bill Kristol, who speaks for the Republican Party, had to say earlier this week. And what he basically said was that since--not what he ``basically said,'' what he said--that since the elderly tend to vote for Democrats, it just was not a constituency that the Republicans needed to worry about. Again, straightforward and simple. And, again, the difference between the two parties. Frankly, I find that statement cynical and dangerous but not surprising from the same person who advised the Republicans last year to oppose, sight unseen, any health care proposal that came from this side of the aisle. We have heard a lot of talk over the past few months from the Republicans about the solvency of the Medicare trust fund. Republicans are desperately, in this Senator's judgment, trying to disguise their huge Medicare cuts as a way to save the Medicare Program from bankruptcy. We have heard a lot about that. They plan to cut $256 billion, by hiking Medicare premiums and beneficiary cost sharing and cutting reimbursement rates to hospitals and doctors. It is a very interesting phenomenon. I just got off two radio talk shows this morning where people were phoning in questions to me. I had five hospital administrators from two States call me. I only represent one State. They were all [[Page S6875]] scared to death about what was being proposed here because they said the only way to do that would be to shut down services. In some cases they talked about increasing prices, which of course would exclude some, laying off people and the rest. All of them talked about closing the emergency room. The Republicans say they are going to improve trust fund solvency. Yet there is nothing in this Senate budget resolution that would guarantee even one more additional year of solvency. Over the past 2 weeks we have heard health experts, health economists, physicians, and hospital representatives testify before the Finance Committee about the consequences of putting the Medicare Program in a budget straitjacket. Dr. June O'Neill, the new Republican-appointed head of the Congressional Budget Office--why do I say that? Traditionally it has been a bipartisan appointment. This year it was not a bipartisan appointment, it was a Republican appointment. I resent that. I think it is dangerous for the country, not because she is a Republican but because it is not bipartisan. Anyway, Dr. June O'Neill, the new Republican-appointed head of the Congressional Budget Office said that quality will suffer. That is what Bob Reischauer also said before her: Quality will suffer. She said seniors will have to pay more to maintain the current quality of their health care. Dr. Reischauer disputed Republican promises headlined in the New York Times a few weeks ago that, cuts in Medicare ``will be huge but painless.'' He testified that cutting Medicare in the short run is not painless and improvements in quality will be slowed down. The president of the American Hospital Association testified that ``Americans believe deeply that Medicare is Social Security. That sentiment cuts across all age, income, geographic and gender boundaries.'' He is right. Medicare is part of the Social Security law. Those proposed spending reductions may in fact be reductions in the rate of growth and not cuts in the spending, but let us be very clear. To people who rely on Medicare for their care and for people who provide their care, the spending proposals being considered are very likely to translate into cuts, cuts in services, cuts in personnel, cuts in quality. To the people to whom we provide care, these slowdowns in the rate of spending translates into real cuts. Over the past year, during debate on the balanced budget amendment, and now on the Senate budget resolution, I have tried to get my colleagues to focus on the consequences of budget cuts. I really do believe in that. I think budget cuts simply are not done for numerical reasons. They are done for the condition of the country as a whole, and within that condition of the country of the whole are many factors to consider, and some of those are the effects on people. I come from the State of West Virginia, and I cannot do anything--nor will I ever do anything--without considering the effects on the people that I represent. To think about the people that will be directly and immediately affected by these budget actions, we need to move beyond the strictly mathematical. But for those people who like math, I have a simple addition problem for them. Millie Wolfe lives in Preston County, WV. She is 83 years old, and she lives alone. She still drives a car. She lives on her monthly Social Security check of $593 a month. She spends $175 a month on rent, $93 on her medigap policy, $8.30 cents on her heart medicine. That leaves her with a little over $300 a month to pay her phone bill, her heating bill, her electric bill, gas and maintenance for her car, to buy groceries, and any and all other living expenses. She is worried she may no longer be able to drive herself to the grocery store and to the doctor's office and might soon need help with transportation. And at 83 she has a right to begin to worry about that. But she is very, very worried and very upset about having to pay $700 to $900 more per year in Medicare costs as she would under the proposal that lies before us. She is already, Mr. President, paying $1,200 a year out of pocket for her medigap coverage and her heart medicine, not counting the $46 that is automatically deducted each month from her Social Security check for her Medicare part B premium. People who live on fixed incomes like Millie Wolfe will have to subtract what they can spend on other essential living expenses in order to pay for the increased costs of health care that will be required under this budget resolution. Millie Wolfe lives alone, but she is not alone in West Virginia. She is not alone in this country. There are 9 million seniors who live alone in this country. A lot of seniors in West Virginia live on fixed incomes. Rarely does one run into a senior in West Virginia, as the Senator from Massachusetts would know, with an income that might be more than $10,000, $12,000, $13,000 or $14,000 a year. Asking those folks to pay more than they already are paying for health care in order to save the Medicare trust fund is, frankly, offensive to me. Why? Because it directly hurts them. When you say everybody should pay more, I take you back to Millie. Mr. President, over half of the seniors in West Virginia live in rural areas. That makes them even more vulnerable to the severe consequences of the Republican budget that is before us. Rural seniors will not only have to pay more under the budget resolution, but they may wind up losing their access to health care altogether. Medicare cuts of this magnitude will severely threaten the solvency of many rural hospitals, as I have indicated, forcing many of them to close their emergency rooms, if they have them, cut back on other services, and, yes, as has happened before in West Virginia, some will shut their doors. We will hear protests by the Republicans that if we do not act right away, there will not be a Medicare Program. Mr. President, I can guarantee you that if they implement their budget plan, there really will not be a Medicare program. Benefits will disappear, quality will deteriorate, and access will be hard to obtain, or will become nonexistent for people in my State, who I will fight for. One word about Medicaid and I am finished. They are going to cut $160 billion to $190 billion out of Medicaid. You see, people do not care as much about Medicaid because they say that is for the poor, and, therefore, it does not get the attention. Well, it gets the attention from this Senator. The likely impact of the budget resolution cuts on Medicaid, will mean that 5 to 7 million kids will lose health coverage, 800,000 to 1 million elderly and disabled beneficiaries will lose coverage, and tens of millions will lose benefits. For example, all preventive and diagnostic screening services for children, home health care, and hospice services would be eliminated as well as dental care if the $190 billion were cut. There is a difference between the two parties. There was not last night. There was not within the past week as we worked out our differences. On this one, our differences are going to be very hard to work out because there are fundamental priorities and principles at stake here. I do not intend to be shy in defense of the people I represent from the State of West Virginia. They work hard. They have had few breaks, and they need help where help is justified. I, along, I suspect, with many colleagues from this side of the aisle, and I expect none from the other side of the aisle, are going to do everything we can to help them. I regard this as a moral issue. I thank the Chair, and I yield the floor. Mr. KENNEDY addressed the Chair.

Mr. ROCKEFELLER. Mr. President, under the order I believe it was 12 minutes. I was trying hoping to slip it up to 15 minutes.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I wrote the majority leader on March 21, and I said this problem is going to be coming up. We know there is a deadline. I am fully aware of that. He wrote back on April 3, and he told me, ``I agree with you that this issue deserves careful consideration, particularly if Congress intends to extend the program permanently. I know that the chairman,'' that being Senator Packwood, ``plans to hold extensive hearings at the full committee level on the Medicare Program.'' And, ``We will take a close look at Medicare Select, as we will all parts of the Medicare Program.'' What I would say to my friend from Rhode Island is that we have not done that. In the meantime, Congress mandated a study to be done, and the study is in the process of being done. The study has also already raised several questions. Other groups raised other questions about quality, about being able to buy other medigap policies. So there are a number of questions that needed to be answered. I wished to do all of this somewhat earlier, and I was given the promise that we would do this somewhat earlier. It is just that the promise was not fulfilled. I should say also that a number of questions have been raised which have somewhat changed the atmosphere in the last several months. Before the Senator came to the floor, I talked about questions which had been raised by a number of groups--pricing games, medigap availability, illusory costs, and things of that sort. The Senator from West Virginia wants to be sure.

Mr. ROCKEFELLER. Will the Senator yield?

Mr. ROCKEFELLER. What has changed, I say to the distinguished Senator from Rhode Island, is that I had correspondence with the majority leader of the Senate, a letter that I ask unanimous consent to have printed in the Record, and also the majority leader's response to this Senator.

Mr. ROCKEFELLER. The Senator from West Virginia did not say it was peculiar, but I said it was a problem as far as the Medicare extension is concerned. Whether it applies to more medigap policies is not, at the moment, of concern to me. I want to make sure that, in Medicare Select, we can. HCFA has concerns about quality and concerns about access. They are not a frivolous organization. I just think we have a chance to try to find an accommodation, hopefully in a quorum call, in which we could address some of the consumer concerns and perhaps also accommodate the Senator from Rhode Island, the majority leader, and the Senator from Oregon in the process, since I am, obviously, very well aware of where the votes are in the situation. I just want to do the best I can to build in consumer protection for a program which is young, which is actually only in 14 States, and is not at all in all 50 States.

Mr. ROCKEFELLER. If the Senator will yield, I think one could practically rewrite the Constitution in the House of Representatives by that vote in the current climate. If the Senator would further yield, he talked about standards being higher for Medicare Select than for other medigap things. I think high standards are important and I know the Senator from Rhode Island does, too. I want to see the Senator from Rhode Island and his State be able to have this program if that is what the State and the Senator wants. I think the time crisis that the Senator refers to can be handled in 60 seconds. That can be changed in 60 seconds. My point is that for 2 months I have suggested extending the program to the 14 States with the program already in effect. What I am really suggesting now is that we first look at the evaluation of the program before we open the door to all the other States. What I am really suggesting is that, if we could perhaps suggest the absence of a quorum, we could work something out on this.

Mr. ROCKEFELLER. The Senator from Rhode Island made mention of no particular problems being raised by HCFA. I think that raises, therefore, this very important point. Because, in fact, Donna Shalala has written to the Honorable Bill Archer, chairman of the Committee on Ways and Means, on March 7 of this year. And one paragraph says: The case study portion of the Medicare Select evaluation has already raised a number of questions about the Medicare Select demonstration. That is from HCFA. As managed care options under Medicare are expanded, we want to ensure that our beneficiaries are guaranteed choice and appropriate consumer protections. That is precisely what the Senator from West Virginia was asking for. Donna Shalala goes on: In addition, many of the select plans consist solely of discounting arrangements to hospitals. The Senator from West Virginia mentioned that at the beginning. Donna Shalala goes on: We would be concerned if the discounting arrangements under Medicare Select were to be expanded to Medicare supplementary insurance part B services. Discounting arrangements, particularly for part B services, may spur providers to compensate for lost revenues through increased service volume. Consequently, we are concerned that such an expansion would lead to increased utilization of part B services rather than contribute to the efficiency of the part B program through managed care. Then she says: We would, therefore, oppose such a change. There is honest and open debate on this matter. I am still willing to talk with the Senator from Rhode Island. I think we can work something out. Again, I, unfortunately, can count the votes, but the Senator would like to have some consumer protection in this, and I think the Secretary of HHS would, too. I think, frankly, George Mitchell, in his bill, had open enrollment and major insurance reforms, and the Senator from Rhode Island knows that well. The Mitchell bill, in fact, did not propose to make Medicare Select permanent in the absence of coordinated open enrollment. So I think there is room to work something out here, Mr. President, because I think everybody is talking with good will on both sides on this matter. Mr. CHAFEE addressed the Chair.

Mr. ROCKEFELLER. The Senator from West Virginia would like to do that, but if I might add one more thing, that is, the Senator is right about part B, and the Senator from West Virginia just got carried away and read too much of a paragraph, which was a mistake on the part of the Senator from West Virginia. Donna Shalala, on the other hand, is referring to the Medicare Select evaluation. She is referring to the Medicare Select evaluation in this letter which she wrote back on March 7, which should have been available to all of us. Bruce Vladeck, in his testimony on February 15 in front of the House Committee on Energy and Commerce, raised a major concern with the adequacy of beneficiary protections under Medicare Select. If that is not HCFA speaking, I do not know what is. Bruce Vladeck said: There is no requirement for States to review the actual operations of the Select plans once they are approved to assure that quality and access standards are being met. He does not like that. He is worried about that, and he says: We feel strongly that beneficiaries should not have to worry about the quality and access provisions on their Medicare choices. We look forward to working with the subcommittee * * * And then Bruce Vladeck, the head of HCFA, said: Our second concern is whether Medicare Select will make any contribution to increasing the efficiency of the Medicare program. I think that goes off into another area. It is the consumer protection area, I say to my friend from Rhode Island, which concerns me the most. I might suggest the absence of a quorum in order for some conversation to go on. I suggest the absence of a quorum.

Mr. ROCKEFELLER. Mr. President, obviously, we need to work this out. The time problem is not, in fact, a constraint on those States which currently have Medicare Select because I already said I would be perfectly happy to go ahead and extend them. The question is: How can we, looking at some of these complaints about not being able to change MediGap policies, discrimination of various sorts, how can we arrive at some kind of compromise which gives consumer protection for these Medicare beneficiaries that would choose Medicare Select? How can we give them some kind of consumer protection over and above what is contemplated in the law that the Senator from Rhode Island wants to get passed right away? Would the Senator be willing to discuss those matters, if not publicly, privately?

Mr. ROCKEFELLER. Will the Senator yield?

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

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I am afraid I will have to.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I yielded the remainder of my time, so if the Senator will yield.

Mr. ROCKEFELLER. Is the Senator from Rhode Island finished?

Mr. ROCKEFELLER. Mr. President, I want to thank the Senator from Rhode Island and to say that I agree with what he said and concur in the amendment and do gladly accept it, as it were, and consider it good. What this will do, I think, is what was wanted on both sides of the aisle, which is ideally what we strive for around here and rarely achieve. I had been reluctant to see the 14 States expanded to 50; the other side of the aisle wanted to see the 50. I did not have strong feelings about the 50 until I understood more about what the study, which is going on now, will show. I also wanted to make sure that if people leave Medicare Select and want to go to another MediGap Program, that they are not precluded from being able to join another program because of preexisting conditions, which, of course, most older people have. It seems to me this is a good compromise. This would allow all 50 States to go into this, if they chose to do so. There would be a period of about a year and a half that that would take place. Some people will say the insurance industry does not want to do that because a year and a half is not enough time. There are 450,000 people in this program now, so it must be sufficiently interesting to the insurance companies. I am pleased that there will be hearings on this. That was a part of my original understanding with Senator Dole. Senator Dole, who is chairman of the Medicare Subcommittee that I am ranking member on, so to speak, he and I have agreed we will work out, along with others who want to be involved--modifications to Medicare Select if the study and the experience show that that should take place. I think that is entirely proper and fair. The GAO study itself, I think, is important because it would analyze the problems that seniors are having in switching MediGap policies. When we talk about MediGap policies, not everybody necessarily tunes in on that, but that is incredibly important. Most seniors have MediGap policies to make up for deficiencies in Medicare. These policies are very important to seniors, and that is why all of this be done properly. So, from my point of view, the compromise is a good one. It was carried out in honorable and good fashion between the Senator from Rhode Island, Senator Chafee, Senator Packwood, and, obviously, the majority leader and myself, and Senator Kennedy. I think it is a good compromise. I yield back the remainder of my time.

Mr. ROCKEFELLER. There are two points I want to make that I think are very important to those who might be listening and who might be confused at this point. One is that we went from a 5-year extension to a year-and-a-half extension. Then, as the Senator from Rhode Island pointed out, the year-and-a-half extension would then become automatic unless the Secretary of HHS had objections or found problems or whatever. That means that basically--I do not want this to be taken the wrong way--Donna Shalala who is watching this closely--I do not think destructively but constructively--18 months would pass and she would still be there. So that for some of the colleagues who might be worried that this is an automatic extension, it is not, except as the merit allows that. I think that is a matter of great comfort to me, and it is another reason why I appreciate the Senator from Rhode Island. I thank him.

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

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I do object.