Department of Defense Appropriations Act, 2010

Floor Speech

DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2010 -- (Senate - December 18, 2009)

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Ms. COLLINS. Mr. President, let me emphasize that it was cleared with my colleagues on the other side of the aisle.

I rise today in support of the fiscal year 2010 National Defense Appropriations Act. Let me begin by thanking the committee's distinguished chairman, Senator Inouye, and the ranking member, Senator Cochran, for their leadership in crafting this bill and for their strong commitment to our Nation's Armed Forces.

I am very proud of the work that the State of Maine does that contributes to our national defense. The appropriations bill provides vital resources that our troops need and recognizes the enormous contributions made by the State of Maine to our national security. From the Portsmouth Naval Shipyard in Kittery, to the Pratt & Whitney Plant in North Berwick, to the Bath Iron Works shipbuilders to the University of Maine's engineers, to the Maine Military Authority in Aroostook County, Mainers all over our great State are leading the way to a stronger national defense.

This legislation will provide funding for essential training, equipment, and support to our troops as they bravely and skillfully engage in national security efforts at home and abroad. This is a critical time in our nation's history and the Committee has, once again, demonstrated its strong support of our soldiers, airmen, sailors, and marines.

This legislation also will fund critical force protection and health care initiatives for our troops, while continuing development of important technologies and acquisition programs to counter existing and emerging threats.

The legislation before us includes a strong commitment to strengthening
Navy shipbuilding. Our nation needs a strong and modern naval fleet allowing us to project power globally and to respond to threats. This bill authorizes $1 billion in funding for construction of the third DDG-1000, a priority of mine. The Pentagon's decision to have Bath Iron Works, BIW, build all three of the DDG-1000s demonstrates well-deserved confidence in BIW and will help ensure a stable work load for the shipyard and more stable production costs for the Navy.

In addition, this legislation authorizes $2.2 billion for continued DDG-51 procurement and nearly $150 million for the DDG-51 modernization program. The lessons and technology developed in the design of the DDG-1000 can be incorporated into the DDG-51 program to reduce crew size and to improve capabilities.

The legislation fully funds the F-35 Joint Strike Fighter request for both the Navy and the Air Force. This aircraft, powered by the superb engines made by Pratt & Whitney, will enable our servicemen and women to continue to maintain our air superiority.

At the request of Senator Snowe and myself, the Committee provides an additional $20 million for Humvee maintenance to be performed at Maine Military Authority's, MMA, Army National Guard Readiness Sustainment Site, RSMS, located in Limestone, ME. For nearly 13 years, the Army National Guard has relied on Maine Military Authority to provide a dependable service to our Nation's war fighters. The dedicated and talented professionals at MMA have demonstrated their value to the Army and to the Nation and consistently have performed Humvee refurbishment at a lower cost than the Army's own depots. This funding would help to ensure that MMA's valued workforce and high quality product remain a national asset supporting the defense of our country.

The bill also provides $250 million for cancer research through the Defense Health Programs with $150 for the Breast Cancer Research Program, $80 million for Prostate Cancer Research program, and nearly $20 million for the Ovarian Cancer Research Program. I believe that there is simply no investment that promises greater returns for America than its investment in biomedical research. These research programs at the Department of Defense are important to our nation's efforts to treat and prevent these devastating diseases that also affect our veterans and servicemembers.

The bill provides $307 million to address the Tricare private sector shortfall in fiscal year 2010 as identified by the Department of Defense. I know Tricare funding is vital to so many Maine veterans. We must continue to support robust funding for this important program and limit increases in Tricare premiums and copayments.

I strongly support the additional $15.6 million to strengthen the Office of the Inspector General in order to keep pace with the growth in the size of the defense budget and the number of defense contractors. More vigorous oversight of defense contracts to prevent waste, fraud, and abuse of taxpayer dollars will complement the procurement reforms we approved earlier this year.

This bill also includes funding for other defense-related projects that would benefit Maine and our national security.

Funding is provided, for example, to Saco Defense in Saco, Maine, to enable the company to continue manufacturing weapons that are vital to the Armed Forces.

In addition, at my urging, the legislation appropriates $5.28 million for the University of Maine. This funding would support the development of LGX High Temperature Acoustic Wave Sensors and allow the University of Maine to continue to investigate fundamental sensor materials and design concepts as well as demonstrate functional prototypes of acoustic wave sensors that will be tested under extreme temperature environments. The funding for the University will also provide for woody biomass conversion to JP-8 fuel, which will provide affordable alternative sources for military aviation fuel.

Mr. President, I want to comment further on the health care bill currently before the Senate. I have talked about my concerns previously regarding the impact on premiums, my belief that the bill will actually cause many middle-income Americans to pay more for health insurance. I have also talked about my concerns about the impact on our small businesses.

I want to talk about a couple of other issues that are particularly important to the State of Maine. The first is the impact of the nearly $500 billion in Medicare cuts on Maine's home health, hospital, and other health care providers, including our nursing homes.

I am concerned that the bill before us is financed, in large measure, through these enormous cuts in the Medicare Program--a program that already has long-term financing problems. According to the CMS Actuary, these proposed deep cuts will threaten Medicare's fiscal stability and push one in five hospitals, nursing homes, and home health care providers into the red. Many of these providers, I fear, would simply stop taking Medicare patients, which would jeopardize care for millions of seniors.

I want to make clear that I do believe there are savings that can be found in the Medicare Program. For example, far too much is lost each year to fraudulent claims. That is an area where we need to crack down. As we put in place the health care reforms that have widespread support on both sides of the aisle, we could also achieve real breakthroughs that would improve the quality of care while lowering costs. But that is not what we are talking about in the underlying bill. Instead, we are talking about essentially across-the-board cuts, deep cuts, cuts that are going to hurt some of the most vulnerable people in our country--our seniors and our disabled citizens.

This became even more clear to me as a result of a conversation I had this past week with Peter Chalke, the CEO of Central Maine Health Care. He runs not only the tertiary hospital in Lewiston, ME, but also rural hospitals in western Maine, in Rumford and in Bridgton, as well as a smaller hospital in Brunswick, ME. So you can see from that description, if you are familiar with the State of Maine, that the hospital network he covers makes a huge difference in the lives of so many Mainers. Here is what he told me. He first pointed out that Maine is one of the oldest States in the country. So we have a substantial Medicare population.

Despite being recognized nationally for providing high-quality care, Maine's hospitals currently receive the second lowest Medicare reimbursement in the country relative to their costs. There is no fat to cut in the reimbursements of hospitals in the State of Maine. They have very high quality, some of the highest quality in the Nation, according to health care experts, and according to Medicare itself. Yet they get the second lowest reimbursements.

The CEO of this hospital network put it bluntly to me. He said passage of this bill in its current form would be disastrous for the State of Maine. He said the bill would saddle Maine's hospitals with some $800 million in Medicare cuts over the next decade, with very little upside benefit from expanded coverage since about 90 percent of Maine residents are covered by some type of insurance policy today.

We also have a large Medicaid population in our State, which led him to another concern. Mr. Chalke told me that a further expansion of the Medicaid Program is simply not sustainable, since Maine has repeatedly demonstrated its inability to pay for the current Medicaid Program.

In Maine, that program is known as MaineCare. It pays Central Maine Health Care just 60 percent of its allowable costs. Moreover, MaineCare will owe Central Maine Health Care more than $50 million by the end of the year.

The failure on the part of Medicare and Medicaid to pay their full share, to pay the amount that it actually costs to provide the care, simply results in cost shifting to private payers. In Maine, this cost shifting means that individuals who have private insurance cover 130 percent or more of hospital costs. That should not be a surprise to us. If both Medicare and Medicaid are not paying at a sufficient level to truly cover the cost of care, what happens? The cost gets shifted to private insured patients. This big gap is one reason Maine's insurance rates are the fourth highest in the Nation.

This is an untenable situation. The CEO told me that if Congress passes
this bill, Maine's hospitals and physicians will be forced to expand cost shifting, further increasing the pressures on private insurance markets, further making that cost an extraordinary burden on middle-income families.

Medicare, which is so critically important to our Nation's seniors, should not be used as a piggy bank for new spending programs when the revenues are needed to shore up the current program. I know my colleague from Tennessee has been talking about that issue for a long time. I joined him in a letter that said if there are savings to be found in Medicare, let's use those savings to shore up Medicare. We all know that Medicare is not financially sustainable. So what are we doing? We are cutting nearly $500 billion out of a program that does not have sufficient funds to deal with the influx of the baby boom generation, much less with the costs it is now incurring. It is fiscally irresponsible to raid Medicare to pay for a new entitlement program.

Mr. McCONNELL. Will the Senator from Maine yield for a question?

Ms. COLLINS. I will be happy to yield.

Mr. McCONNELL. I think I heard some of our colleagues say these Draconian Medicare cuts would actually lead to the closure of some rural hospitals. I am wondering if the Senator from Maine thinks that may even be possible given the magnitude of these Medicare cuts we are hearing complaints about all across America.

Ms. COLLINS. Mr. President, the minority leader brings up a very good point. I know the Republican leader is familiar with the analysis that was done by Medicare's own Actuary that says that one out of five hospitals--and these are likely to be the small rural hospitals that are so important in our States--would be so jeopardized by these cuts that they may not survive. Another thing that will happen is that physicians are going to start turning away Medicare patients.

Mr. McCONNELL. I ask my friend from Maine, isn't that beginning to happen in some States already before we even take this additional step?

Ms. COLLINS. It is. My friend from Kentucky is exactly right. In my State, there are already severe shortages of primary care physicians, particularly in the more rural areas of the State--the northern, eastern, and western parts of the State. Their practices are full to start with. What we are asking them to do is to keep accepting new Medicare patients whose reimbursements will not cover the cost of their care. That is why in many States you see physicians limiting how many Medicare patients they will take. I know how painful that is for our physicians. After all, they became physicians to care for people. They want to ensure people have the care they need. But there is a limit to what they can do.

I share the concerns of the Senator from Kentucky that the result of this bill will be to jeopardize the very existence of rural hospitals, small nursing homes, home health care providers, which, in my State, are absolutely critical. After all, I know my colleagues from Tennessee and Kentucky have had the same experience I have had of talking to seniors who are getting home health care. They are so happy to receive health care in the privacy and the comfort and security of their own homes rather than being forced into a hospital setting or a nursing home. Yet the bill before us singles out the Medicare home health benefit for a disproportionate share of the cuts. It proposes that home health care and hospice care--hospice care, Mr. President--would be slashed by $42 billion over the next 10 years. That makes no sense whatsoever. That's $42 billion in cuts for home health care and $8 billion on top of that for hospice care.

A home health care director in my State, a nurse whom I know well, really summed it up well. First, she described the impact on Visiting Nurses of Aroostook, the county I am from in northern Maine. It had total revenues of $1.9 million last year. It estimates that it will lose $313,000 in the first year of the House bill, if that were to pass, and $237,000 under the Senate bill.

According to the director of this agency, cuts of this magnitude would cause this home health agency to consider shrinking the area served or discontinuing some services. They cannot afford to cover such a geographically huge area as Aroostook County with that kind of cut.

Here is another thing I want to share with my colleagues, because this is what this debate is really all about. What she told me is the following: It is going to be hard for our staff--and our staff is scared--but it is our patients who will pay the price if Congress makes these cuts in home care.

That is what concerns me. It is not just the impact on our rural hospitals, our dedicated physicians, our struggling nursing homes, and our valiant home health agencies. It is their patients. It is the vulnerable senior citizen who lives on a rural Maine road who may lose access to home health care. It is families who want to live in rural communities but cannot if there is not a hospital nearby. It is a nursing home that closes, forcing families to move a loved one far away from the home. Those are the real-life consequences of slashing Medicare.

I hope we will reconsider the cuts in this bill. It is so disappointing that the Senate has repeatedly rejected attempts to try to mitigate those cuts.

There are so many other problems with this bill.

I see the Republican time is about to expire. I hope as we proceed that we can also talk about the impact of the 4-year gap between when all the new taxes under this bill go into effect and when the subsidies are proposed to go into effect. $73 billion in new taxes and fees will go into effect by 2014, and some of those new taxes start in 2 weeks--2 weeks--if, in fact, this bill is passed. And I hope it will not be. For example, the bill taxes pharmaceuticals and medical devices. The bill taxes health insurance. Next year, the bill imposes a penalty for health savings accounts, which makes no sense to me.

We want people to be able to save money to help cover their deductibles.

Next year, the bill proposes to restrict flexible spending accounts--again, this makes no sense to me.

The $73 billion in new taxes and fees imposed by the bill over the next four years are going to be passed on to consumers, without a doubt. CBO says that and the Joint Committee on Taxation says that. But when do the subsidies go into effect to mitigate this upward pressure on premiums? Not until 2014. I do not see how imposing these new taxes now--before the exchanges are set up that the chief benefits of the bill are supposed to become available--makes health care more affordable.

Mr. President, the health care legislation that the Senate is currently considering would have enormous consequences for our economy and our society. It would affect every single American and 17 percent of our economy. There are many reforms that have strong, bipartisan support, that could have been the basis of our efforts here in the Senate. It has therefore been disappointing that this process has been so divisive and partisan. While I continue to believe that our health care system is in need of fundamental reform, the bill before us takes us in the wrong direction and will do more harm than good. In keeping with the Hippocratic oath of ``first of all, do no harm,'' I plan to oppose this legislation.

Mr. President, I yield the floor.

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