Prohibiting Federal Funding of Planned Parenthood Federation of America--Motion to Proceed

Floor Speech

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Mr. WYDEN. Mr. President, 50 years ago today, President Lyndon Johnson signed into law the Social Security Act amendments that created Medicare and Medicaid. Our country slammed the door on the days when far too many older people languished in poverty without the financial security that comes from affordable, high-quality health care. It was a day when sick, older people were warehoused on poor farms and in almshouses. Just picture that. On the edge of town we had older people, literally without a shred of dignity, in what came to be known as almshouses. But Lyndon Johnson and others said that had to be changed, and five decades ago it did. Today, more than 100 million Americans have access to high-quality health care thanks to Medicare and Medicaid.

We can measure the remarkable success of these programs in so many ways, but in my judgment, one of the most important and most appealing aspects of Medicare and Medicaid is their ability to grow, their ability to change, and their ability to evolve to meet the needs of our country. The reality is that Medicare in 2015 is very different from Medicare in 1965. Medicare in 1965 was about something like a broken ankle. If it was a serious break, you would be in the hospital--Part A. If it was not a particularly serious break, you would go to the doctor--that was Part B. That was Medicare circa 1965. Today, Medicare is about chronic illness, it is about cancer, it is about diabetes, it is about stroke, and it is about heart disease.

You put Alzheimer's in, and that is well more than 90 percent of the Medicare Program. So it is a very different Medicare Program today than it was in 1965.

One of the aspects of Medicare and Medicaid I find so appealing is they have shown a certain ability, a sense of creativity, to always evolve with the times.

What I would like to do is take a few minutes to describe how I think Medicare and Medicaid are going to change in the next 50 years because I think there are some remarkable developments ahead. I see my wonderful colleague from the Senate Committee on Finance. She has been very involved in a number of these changes that have been so exciting in Medicare and Medicaid.

What I am going to do this afternoon is just take a few minutes to talk about four or five trends that I think
are going to be led by these two programs that have done so much for seniors and vulnerable people in our country.

The first is, I believe Medicare and Medicaid are going to lead a revolution in caring for vulnerable people at home. Our health care programs are going to give seniors more of what they want, which is to secure treatment at home where they are more comfortable. I think people are going to be amazed to see that seniors will get more of what they want, which is treatment at home--in Michigan, in Oregon, in Nebraska--and we now have hard information that it will be less expensive for older people to get what they want.

In the Affordable Care Act, I was able to author a provision with our colleague, the distinguished Senator from Massachusetts, Mr. Markey, the Independence At Home Program. This program has already shown it can save more than $3,000, on average, for every patient who takes part.

So picture that. This is not an example of reducing the Medicare guarantee--these guaranteed secure benefits that older people in every part of America rely on. This is about protecting the Medicare guarantee and doing it in a way that keeps seniors happier and costs less money. That is a pretty good package by anybody's calculation.

In my home State of Oregon, the Medicaid Program also has a smart policy that tracks this focus on caring for the vulnerable at home. In effect, what Oregon Medicaid has done is allow health care providers to offer services that go beyond what many might consider the textbook definition of a medical service. It is all about keeping people healthier at home and out of the emergency room. So instead of waiting to treat broken ankles or wrists, perhaps in a hospital emergency room, after a senior falls again and again and again, what we are now doing in Oregon Medicaid is saying the staff of this program will visit the senior's home and perhaps replace the broken floorboards or the dangerous rugs that are causing the seniors to slip again and again and go to the hospital emergency room.

Think about that. You could help a little bit at home by replacing a dangerous rug or you could have somebody slip and fall again and again and again and go to the hospital emergency room. Again, replacing that dangerous rug wouldn't probably meet the clinical definition of a medical service as it was always determined in years past, but now we are seeing it as part of having older people in a position to be at home, where they are more comfortable, for less money.

The second significant development where I think Medicare and Medicaid are going to lead is on pharmaceuticals. I think the pricing of prescription drugs in the future is going to be connected in some fashion to the value of treatment. We have seen remarkable changes in pharmaceuticals. The reality is that in the last 10 years we have seen real cures for illnesses where there was a death sentence perhaps a decade ago, but the sticker prices on some of these pharmaceuticals are astronomical. For so many working-class families and seniors of modest means, they look at these prices and say this just defies common sense, and they seem to get more expensive over time. Sometimes there is a six-figure pricetag.

The reality is Medicare and Medicaid weren't set up for these kinds of costs. The experts at the Congressional Budget Office are starting to ring the alarm bell, particularly about the health of Medicare Part D. Addressing this issue is going to take a lot of vigorous debate in the Congress, but it can't be ducked any longer.

Senator Grassley and I have been working for about a year now in looking into SOVALDI, one of the hepatitis C drugs, which has had enormous ramifications for health programs--Medicare, Medicaid, and others--and we are continuing our work.

Third, in addition to pharmaceuticals and home care, I think Medicare is going to lead the revolution for open access to

health care data. Again, Senator Grassley and I have put a lot of sweat equity into the issue of data transparency in Medicare. It paid off in 2014, when the Obama administration, to its credit, opened up a massive trove of information. The wave of disclosure that began, particularly with doctors--and the Wall Street Journal reported this very extensively--must keep rolling forward.

The next step is turning open data into valuable tools and getting them into patients' hands. Health care data, packaged the right way, ought to help seniors and others choose doctors and nursing homes. It ought to help figure out which hospitals and specialists excel in certain areas, and it ought to help show exactly what you get for your dollar with various treatments or doctors.

Fourth, I believe Medicare is going to lead the debate on improving end-of-life care. All the roads with respect to end-of-life care, in my view, point toward patients having more choices and a better quality of life. In my view, we ought to make sure patients are in the driver's seat. In this regard, I was very pleased the Obama administration announced just a few days ago a real breakthrough in terms of end-of-life care. I think we have all had the debate. We certainly had that debate in the Affordable Care Act, where we heard about seniors not being given the opportunity to choose life, to choose cures, and they were going to, in effect, be receiving what amounted to death sentences.

In the Affordable Care Act, I was able to get included a provision that made it clear that is not what this debate would be all about. For the first time it would be possible for an individual who is receiving hospice care to also have the option for curative care. In other words, they would not have to sacrifice one for the other. That is very important to patients because even when patients are contemplating the prospect of hospice care, they want to know--because it is almost in our gene pool as Americans, as Nebraskans, and Oregonians--whether there may be a cure. Maybe our ingenuity will come up with a cure, and they want to have that hope. Now they are going to have it.

The result of the change is called concurrent care--the Care Choices model. For the first time patients and families will be in the driver's seat and they will not have to give up the prospect of curative care in order to get hospice. For the first time we are giving those who want treatment in hospice some real flexibility.

Next, I think Medicare is going to go further to protect Americans with catastrophic coverage. The reality is that millions of Americans who are younger than 65 are protected against the huge expense of an accident or serious illness. This is an area where I think Medicare, having led in so many areas with the kind of creative genius I have described--going to show the way on home care, pharmaceuticals, end-of-life care, and more access to data--that most advocates for seniors say Medicare has a little catching up to do. Seniors ought to have the safety of an out-of-pocket maximum in Medicare.

I know this is an area I very much look forward to talking to my colleague from Michigan about. She has been a wonderful advocate for seniors throughout all her career in public service. I think colleagues on the Committee on Finance of both political parties are going to say, if there is catastrophic protection in the private sector, it is high time we have it for seniors on Medicare. I think this is an area we will also be talking about.

I want to wrap up with one last point; that is, about Medicaid. I also believe more States are going to come around and expand their Medicaid Programs. It took nearly two decades for all 50 States to adopt Medicaid initially, so there is already a history of this unfolding over time.

When we look at the numbers, we see the proposition and the benefit of expanding Medicaid is not exactly some kind of theoretical notion. A new study shows there is a gulf opening in terms of access to health care between States that have expanded Medicaid and States that have not.

In our country, everybody should have access to medical care, regardless of their ZIP Code, but it is not only a question of what is best for the health of our people, it can often be pretty important to a State's economy. A recent study found that Kentucky and their cost of covering new Medicaid patients will be far outstripped by the other economic benefits of expanding the program. In my view, more States are likely to do the right thing by their citizens and their economies, and the gulf between those States that cover individuals on Medicaid and those that do not will narrow.

Mr. President, I am going to close on a little bit of a personal note. My background is working with older people. Years ago I was director of the Oregon Gray Panthers. It was an extraordinary honor to be able to do this. Those were the days when if a town had a lunch program for older people, it was considered a big deal. Senator Stabenow was starting her career in the Michigan Legislature, and she remembers those days. It was a big deal when a town just had a lunch program where older people could congregate. That was considered a pretty serious array of senior services because you could get a few things there where older people got lunch.

So as we have heard, now we are looking at the opportunities for extraordinary innovation.

Elizabeth Holmes was here today and had a chance to visit with several Members. She has taken the whole notion of personalized medicine--and personalized medicine where in effect an individual could order their own test, and it costs only a few dollars. The State of Arizona has already embraced it. She is talking to government officials about something that would empower patients and would make sense from a health quality standpoint and from the standpoint of cost.

She is a young, very gifted woman. I believe she is a graduate of Stanford, my alma mater. I talked yesterday to her about this. I could just see the enthusiasm for the future of health care and what she has already been able to accomplish and what she is going to be able to do in the days ahead with this new focus on personalized medicine and tests that empower patients to make their own decisions about health care. As to the sums of money that are involved for the tests, I am not sure they are even going to be able to be processed by government computers because they are too small. We are going to save too much money. So there are going to be very exciting developments ahead for Medicare and Medicaid.

The last 50 years have been an extraordinary run for these programs. It is a personal thrill for me to have been involved in the early years of these programs. Now they are essential to the well-being of more than 100 million Americans.

We take this special day to kind of savor how much progress has been made from the days when America had poorhouses and almshouses for seniors to today, where Medicare is leading the way on home care and disclosing data and looking at new approaches with respect to health tests, such as what Elizabeth Holmes has been here to visit on. We can see that with Medicare and Medicaid, their particular genius is that they are always keeping up with the times and looking to new approaches that better meet the needs of older people and do it in an affordable fashion.

I will close by way of saying that I don't think there is a single area I have talked about--I know my colleague and the Chair are members of a different political parties--or I don't think there is a single issue that I have brought up here in the last 15 or 20 minutes that Democrats and Republicans can't find common ground on. In fact, Chairman Hatch in the Finance Committee, to his credit, has said that by the end of the year he wants Democrats and Republicans on our committee to produce a bill dealing with chronic illness--which, as I suggested, is what Medicare is all about and is responsible for 90 percent of the spending. So on that hopeful note, after an incredible 50-year run, I think the next 50 years are going to be even better. In the four or five areas that I have been talking about for a few minutes, I don't think there is a one of them where Democrats and Republicans can't find common ground.

I know my colleague from Michigan is waiting to speak. I will note as I wrap up that she has really been a leader in this field, particularly in getting Democrats and Republicans together. By the way, as she begins her speech, I would note that many Americans are going to receive better mental health care services in the years ahead largely due to the work--the bipartisan work--of my colleague on these issues.

So I am happy to wrap up my comments and look forward to hearing from my colleague from Michigan.

I yield the floor.

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