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Medicare

Sen. Bill Nelson

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Mr. President, I wanted to call to the attention of the Senate the aftermath of having passed the health care reform bill. There was a great deal of consternation at the time, while we were deliberating, that Medicare was going to be cut. We will recall that $500 billion was cut out of Medicare over the course of a 10-year period, and the amount that was being cut was considered to be a threat to Medicare.

As a matter of fact, when we passed it, the Medicare cuts came from providers--often providers that stepped up and offered to have greater efficiencies and therefore Medicare savings over the decade. For example, the hospitals of America came forth and said that we will save $150 billion. So one of the considerations in Medicare was that we were going to have to lean out the Medicare HMO Program called Medicare Advantage.

If we will recall, back in 2003 when we passed the prescription drug bill, Medicare Advantage--the Medicare HMO--was actually given a bump up in Medicare reimbursement, some 14 percent over and above Medicare fee for service. As a result, people had the great incentive to go into a Medicare HMO because the insurance companies--the HMOs--were getting so much more per Medicare beneficiary. But the fact is, we saw, on a long, projected basis over time that it was going to be unsustainable financially for the U.S. Government to keep giving a 14-percent differential to insurance companies over what the average Medicare recipient would get in Medicare fee for service.

That was one of the reforms of the health care bill--to take that 14 percent differential and lean it down over time, but at the same time make it more efficient, make the health care benefits better by having a greater percentage of the actual delivery of that premium dollar go to health care instead of all the administrative costs and all of that of an insurance company.

I am happy to report to the Senate that the Centers for Medicaid and Medicare Services came out last week with their new results on Medicare Advantage--the Medicare HMO Program--as a result of the new health care bill.

Nationally, the premiums for seniors on Medicare Advantage have gone down 4 percent and the enrollment is up 10 percent. Now that is a significant little victory coming out of the new incentives that were put in the health care reform bill--new incentives to insurance companies to improve their Medicare Advantage; nationally, 4 percent down in premiums, but they are becoming more attractive and so the enrollment has gone up 10 percent. I am happy to tell you, in my State of Florida, where there are more Medicare Advantage enrollees than any other State--over a million--the premiums are down 26 percent and the enrollment is expected to go up almost 20 percent because of the incentives in the health care reform bill.

What in this reform bill has given new life to insurance companies to improve their Medicare coverage that would cause the premiums to come down and the enrollment to go up? Because CMS has now instituted a series of financial incentives for the insurance company. And that is, if the insurance company boosts the quality of the service to its Medicare enrollees, then it will get a bonus per Medicare enrollee. So if it is rated as a 3-star or higher, each additional star gives more of a bonus and incentive to the insurance company, responding to the fact they have increased the quality. That is a good thing. The insurance companies that are only rated 2\1/2\ stars now have the financial incentive to get to 3 stars.

What we have is a win all the way around. We have a win, clearly, for the enrollees, who are the Medicare beneficiaries, because they are getting better quality and their premiums have gone down in Florida by 26 percent. We have a second win for the insurance company, because now the higher quality it achieves, it is getting reimbursed from Medicare all the more as a reward for having a higher quality plan. The third win is to the U.S. taxpayer. It lowers the overall amount the U.S. taxpayer is going to have to pay as a result of the greater efficiencies in the Medicare Program. I wanted to come and share with the Senate this win-win-win--triple win--as a result of our having passed the health care reform bill a couple of years ago.

Mr. President, I yield the floor, and I suggest the absence of a quorum.

The clerk will call the roll.

The legislative clerk proceeded to call the roll.

Sen. Mary L. Landrieu

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

Without objection, it is so ordered.

Sen. Mary L. Landrieu

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Mr. President, I wanted to get here a little earlier this morning, but I was chairing a panel and was unable to do so. I know I only have 10 or 15 minutes or so before the Senator from Texas speaks, so I appreciate the opportunity to say a few words about our disaster recovery and the debate going on between the House and the Senate about that.

Yesterday, the House was unable to find the votes to pass the continuing resolution, and one of the issues of debate is how and when to fund our disasters. I know there are a lot of people following this debate, so I want to bring everyone up to date on a couple of recent developments.

First, the Chamber of Commerce has submitted a letter to us, strongly objecting to the House using the Advanced Technology Vehicle Manufacturing Loan Program as an offset to fund disasters.

Mr. President, I ask unanimous consent to have printed in the Record the letter from the U.S. Chamber of Commerce.

There being no objection, the material was ordered to be printed in the Record, as follows:

To the Members of the United States Senate: The U.S. Chamber of Commerce, the world's largest business federation representing the interests of more than three million businesses and organizations of every size, sector, and region, strongly supports disaster relief funding to assist victims of natural disasters. The Chamber is also a vocal proponent of fiscal responsibility and recognizes that Congress must make difficult but necessary choices among competing priorities. As Congress sets spending priorities, the Chamber wishes to highlight a few important facts about the Advanced Technology Vehicle Manufacturing (ATVM) loan program. First, the program was authorized in the Energy Independence and Security Act of 2007, which was supported by both Republicans and Democrats as an important step in reducing America's dependence on oil from unstable regimes. Second, ATVM loans, which will be repaid with interest, incentivize automakers and suppliers to build more fuel-efficient advanced technology vehicles in the U.S., providing new opportunities for American workers in a sector of the economy that is critical to the nation's recovery. Third, the fact that the Department of Energy has yet to use the funds Congress appropriated for the program is not the fault of industry; numerous loan applicants have been in the queue for years, waiting for the Administration to complete its due diligence. Again, while the Chamber understands the importance of reducing America's unacceptable debt and believes that all programs must be on the table, the Chamber urges you to bear in mind the facts about the ATVM loan program, which promotes manufacturing in the U.S. and is an important component of America's energy security. Sincerely, R. Bruce Josten.

Sen. Mary L. Landrieu

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Mr. President, it is the position of the Democrats--and some Republicans have taken this position--that this is not the right way to go about funding disasters, by requiring offsets. It is not necessary, it has hardly been done in the past--it has been, but it is not routine--and it is not recommended for a number of reasons I have tried to explain on the floor. But adding to that debate now is the Chamber of Commerce saying that is not the right offset to use if you are going to insist on finding one.

Secondly, I want to push back on the argument the House position will provide enough funding to get us through the next couple of weeks. That is only partially correct, and I want to be very clear. When people say, well, we can go ahead and pass the 2.65 they have in for 2012, which is an extension of last year's number, and then the extra billion they put in for 2011, and that will sort of get us by the next couple of weeks, let me be clear: It will get FEMA by. It will fill up the disaster relief fund, which is running on fumes today. We are now down to $227 million in the fund, the lowest balance in recent memory. It will provide a small amount of money relative to the core budget--$226 million. But I want to be clear: There is no money in the House approach for agriculture, there is no money in the House approach for community development block grants--zero--and there is no money for the economic development grants that chambers of commerce all over the country, in areas and counties that have been hard hit, use to help their communities and their businesses get back.

I just left a small business hearing, and the fact is, after a disaster, whether it is in North Carolina or California or Florida or Louisiana--and this is very sad, particularly in these economic times--about 70 percent of small businesses never make it back. So at a time when we are trying to create jobs in America, help Americans get back to work and strengthen their businesses, the House wants to pass a continuing resolution with zero money for these economic development grants that chambers of commerce and other conservative organizations, as well as nonpolitical organizations, believe are very effective.

So, please, if you are going to vote for the House position, don't go home and pat yourself on the back and say you took care of disaster victims. You might have filled up the FEMA fund temporarily, but you have not left here doing the job I think we need to do.

The third point I want to push back on--and I know my time is limited--is this comment last night by several Members of the House that we have offset disaster relief before. Yes, we have, but not, to my knowledge, in the immediate aftermath of the storms. As these things have gone on over years--for instance, 4 years after Katrina we were trying to find money to rebuild one of our big military bases that collapsed, so we funded that through Defense and we found an offset. But that wasn't within the first couple of weeks of Katrina. That was after 4 years, and we couldn't find the money and we really wanted to find it. So there are ways you can offset sometimes in the distant future.

I am going to remind people that after Katrina, in the first 3 weeks, the Federal Government funded $66 billion without an offset. After the collapse of the Twin Towers, we funded $40 billion, and sent that to New York after the collapse of the Twin Towers. After 2004, which was a very terrible year for Florida, this Congress sent $2 billion within a few weeks of four hurricanes hitting Florida. Had we not done that, that State would be in a very serious economic downturn now. It never could have recovered from four hurricanes in 1 year. They didn't hit Louisiana, they didn't hit Texas, they didn't hit Alabama. All four of them hit Florida. Did we bellyache about it? Did anyone say: Let's run up to Washington and find a $2 billion program that is not working and cut it out so we can go help the people in Florida? Absolutely not. We sent the money to Florida, and I know they were grateful for it. That might be one of the reasons Senator Rubio--who was not in the Senate then but now is--has voted for this position, because he knows. He remembers.

I don't know what the House is going to do, and I most certainly don't think we need to shut the government down over this debate, but it is a very important debate to be having. I am proud to be leading the effort, along with many Democrats and some Republicans who are saying, in the aftermath of a year that was one of the worst on record, we do not need to find the offsets now.

I hope the House will stand strong and beat back that position, because it is not right today, it is not going to be right tomorrow, and it is not right for the future.

I just hope we can prevail.

Later on, when we are looking to figure out how to pay for all this, we have time over the next year or year and a half or 2 or 3 or even 4 years as we work on moving our deficit down. All of this is going to have to be paid eventually. But I believe very strongly that we must not think it is OK to get into a pattern of, when disaster strikes, instead of opening shelters, instead of giving people immediate relief, the first thing the leadership of this country does is run to Washington and try to gut several other programs overnight or quickly or without thought before we can fund disasters. That is not the way we should operate.

I thank the Chair for being very considerate and giving me this extra time. I thank my colleagues; I know others want to speak. Again, we have a whole document here, which I have shown before, of projects in all of our States that have been absolutely shut down because we have run out of money. The only programs that are being funded are real emergencies on the east coast. Everything else in Missouri, Louisiana, California, and Texas has been shut down to fund what is happening on the east coast. This is no way to run a railroad. Let's get disaster relief now.

I hope the House will reconsider their position. I thank the chamber of commerce for coming out strongly to remove that offset. Again, let's see if we can find some money for USDA--Agriculture--community development block grants, and economic development block grants. If they insist on doing it 6 weeks at a time, which I don't agree with, at least put in a little more money for these other programs so we do not shut down, and we will come back here in 6 weeks or 8 weeks and figure it out.

I thank the Chair, and I yield the floor.