Currency Exchange Rate Oversight Reform Act of 2011

Floor Speech

Madam President, before he leaves the floor, I just wanted to commend Senator Bennet for the outstanding work he is doing on the budget issue, and particularly cite the fact of the cooperation of the Senator from Colorado and the Senator from Nebraska, Mr. Johanns, which illustrates how important it is to try find some common ground. That is what I am going to be trying to do on the health care issue coming up. But I wanted to commend the Senator from Colorado for his good work.

As the Senate focuses on the budget, and certainly the American people hear the discussion about health care and particularly what is going on in the supercommittee, I want to take a few minutes to talk about how there is an opportunity to come together in a bipartisan way, particularly with older people, to show that it is possible for them to get more of the care they want, particularly care at home, for a price that is lower for taxpayers, reduced costs for the taxpaying public.

This all came to light through an extremely important hearing that was held in the Senate Finance Committee on which I serve. Chairman Baucus took the time to look at the care of those who are some of the neediest and most vulnerable in our country. They are the older people who are eligible for both Medicare and Medicaid.

In the fancy jargon of American health care, they are called the dual eligibles. But I think anybody looking at the American health care system knows that these are some of those who are most vulnerable and most harmed when they fall between the cracks in the health care system. The fact is, the ball game as it relates to Medicare--I know the Presiding Officer of the Senate has spent a lot of time on those budget issues--is all about chronic disease. That is where the Medicare dollars go. It goes into the treatment of heart and stroke and diabetes. That is where the money really goes.

Millions of those who suffer from these devastating illnesses are those folks I am speaking about, the dual-eligible people who are eligible for both Medicare and Medicaid. Millions of them are eligible for alternative services, particularly services at home. But right now, a disproportionately large number of them get their care in the most expensive kind of setting, a place where they do not want to be--the hospital and the hospital emergency room.

The fact is, all over the country--in the State of Ohio, in the State of Missouri--every single day these folks are going in ambulances to hospital emergency rooms. Often they end up having to go on a life flight, essentially in the air to these facilities. As of today, even though we have more than 9 million of these individuals who are on both Medicare and Medicaid, according to Dr. Don Berwick at the Centers for Medicare and Medicaid Services, only about 100,000 of them are being taken care of at home.

So, of course, the Congress worked on the health reform issue, and it was possible in that legislation to move to take a few thousand more, a few thousand more than the 100,000 that are now being taken.

As Chairman Baucus highlighted just a few days ago, we ought to get serious about this and do a lot more because older people, if we come up with approaches that allow them to get cared for at home, will feel better about our health care system and better about the decisions that are being made here, and taxpayers are going to save money.

Anybody who questions whether this is possible ought to look at the latest information that is coming from the Veterans' Administration. They have 250 locations--locations all around the country--for the program they use called the Home-Based Primary Care Program. The only difference between that VA program and essentially what is being done on the Medicare and Medicaid side is that the VA patients are even sicker than those who have been treated in the Medicare and Medicaid studies.

The latest information shows that caring for older veterans in the home has reduced hospital stays by 62 percent, nursing home stays by 88 percent, and cost by 24 percent. Let's just for a moment focus on that number--a cost savings of 24 percent--while the older veteran gets more of what they want, which is to be at home for the care they need rather than in these institutional settings, whether they are hospitals, hospital emergency rooms, what have you. We have new information, specific, concrete information.

So that colleagues know, those who are specialists in this area at the University of Pennsylvania who have looked particularly at the model that was recently included in the affordable care act have said that if that model was fully implemented for caring for these individuals at home, it is their judgment that it would be possible to save in the vicinity of $30 billion a year.

These are enormous sums of money, and to be able to make those savings while we say to older people in Missouri, in Oregon, and around the country: You are going to get more of what you want, which is care at home, at a price lower than the alternative--that looks like a pretty good opportunity.

As the supercommittee goes forward with its work, there are some questions about whether they need additional legislative authority to do their work. If they do, I think certainly the supercommittee, in conjunction with both the full Senate and the House, ought to give it to them. My own sense is that they probably don't need additional legislative authority, but certainly there will be support in the Senate Finance Committee, under the leadership of Senators Baucus and Hatch, both of whom have done very good work on this issue, to move legislatively, whether it is in the supercommittee or through the full Senate, legislation that would allow us to dramatically expand this program.

I know the Senator from Minnesota cares a great deal about seniors and these issues. Just a little bit of history. As I sat in the Senate Finance Committee a few days ago listening to how we ought to have some more pilot projects and some demonstrations and some studies, I thought about the days when I was codirector of the Oregon Gray Panthers, about three decades ago. I had a full head of hair and rugged good looks and all of that kind of thing. We were talking then in much the same way I heard the discussion going in the Senate Finance Committee--about demonstrations and pilots and the like. To a very good person at the Center for Medicare and Medicaid Services, Melanie Bella, and in conversations later with Chairman Baucus and Senator Hatch, I basically said: We have to change this because if we don't, my prediction is that 10 years or so from now, they will be back in the Senate Finance Committee having pretty much the same discussion. They will be talking about a few pilot projects, demonstrations, and a few more studies, and by that time, the number of those who are eligible for both Medicare and Medicaid will be lot more than the 9 million who are eligible today. It will be many times that, and we will have wasted many billions of dollars more. So now is the time to do it.

I would like to close simply by picking up on a point Senator Bennet made about trying to find common ground. This question of independence at home has strong bipartisan support. In the other body, the principal sponsor, Congressman Ed Markey, worked with Chris Smith of New Jersey, Michael Burgess of Texas--two very strong conservatives--over the years, and in the Senate, I have been honored to have Senator Chambliss, Senator Burr, and a number of other colleagues on both sides of the aisle say that this makes sense both for older people and for taxpayers.

In the next few days, Senators are going to hear from about 100 health care groups around the country making the case for the Congress--starting with the supercommittee, going through our work in the Senate and the House--to get serious about dramatically expanding, massively expanding the number of older people who are cared for at home, where they want to be, which will result in savings to the taxpayers at the same time.

This is something that should not be allowed to be delayed or put off any further. After decades of talking about how it makes sense and studying it and having some pilot projects and some demonstration projects, I think it is time when doctors come to the Senate President's office and patients come to the Senate President's office and say: I am very concerned about these cuts. I am convinced it is going to reduce access. The providers say: I am not going to be able to serve the same number of people. Older people, we know, are calling our office saying they are frightened about how it is going to affect them.

It is time for us to be able to come together in the Senate in the kind of spirit Senator Bennet was talking about, Democrats and Republicans, to say: Look, here is something that works. We know it works; it was proven by Chairman Baucus's recent hearing. We now know, based on the VA's important new study with respect to how you can care for older people at home, that we have an opportunity to significantly expand care for older people at home and generate significant budget savings. It will be bipartisan. It is something that ought to be picked up by the supercommittee. It ought to be picked up by the full Senate and the full House, and we need to do it now.

If we don't do this now and if it is put off again, after Chairman Baucus's important hearings to once again open the door to major reform, as sure as night follows the day, Congresses 5, 10 years from now will be debating the same thing. I don't think that is right.

Holding down health care costs doesn't have to mean benefit cuts or cuts to reimbursements. We have a chance, with this Independence at Home Program, to secure for older people more of the care they need in the comfort of their own homes, and employers are actually rewarded with shared savings for delivering the kind of quality care they have always wanted to provide. These ideas, by the way, are voluntary. No older person, no senior citizen is required to participate in it.

We are going to get around to every Senator's office the findings of this new VA study. It comes from 250 locations in each State and DC. There are cost savings of 24 percent, hospital stay reductions of 62 percent, and nursing home stay reductions of 88 percent. These are documented savings for older people who are even sicker than those who would be served by programs outside the VA.

This is the time. We have talked about it long enough. If the government needs additional legislative authority, it will be possible to give that through the supercommittee. I urge all of my colleagues on both sides of the aisle, Democrats and Republicans, to pick up on the strong bipartisan support that exists for independence-at-home services, particularly for those who are eligible for Medicare and Medicaid. They are the most vulnerable in our society. Those individuals and the programs they rely on, paid for by taxpayers, deserve better. We now have the opportunity to ensure they get it.

I ask unanimous consent to have printed in the Record ``Independence at Home: Better Health Care at Lower Cost.''

There being no objection, the material was ordered to be printed in the RECORD

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