[Congressional Record Volume 155, Number 153 (Wednesday, October 21, 2009)]
[Senate]
[Pages S10608-S10611]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                Medicare Physician Payment System Reform

  Mr. GRASSLEY. Mr. President, reforming the Medicare physician payment 
system is one of the most difficult issues we face in Medicare today. 
The name of the formula is the sustainable growth rate. Generally 
around here we refer to that as the SGR. It is the formula for the 
reimbursement of doctors under Medicare. It was designed in the first 
instance to control physician spending and to determine annual 
physician payment updates by means of a targeted growth rate system. 
The SGR is not the only problem with the Medicare physician payment 
system. Everyone who knows anything about physician payments and 
Medicare knows that this SGR formula is not working. It is a fee-for-
service system that rewards volume instead of quality or value. This 
means that Medicare simply pays more and more as more and more 
procedures and tests and services are provided to patients. Providers 
who offer higher quality care at a lower cost get paid less. Somehow, 
it is a backward system, a perverse system. It is one of the driving 
forces behind rising costs and overutilization of health care, 
particularly in some parts of the United States.
  In addition, the sustainable growth rate formula itself is flawed. 
The SGR is designed to determine annual physician payment updates by 
comparing actual expenditures to expenditure targets.
  The purpose of the SGR was to put a brake on runaway Medicare 
spending. The SGR was intended to reduce physician payment updates when 
spending exceeded growth targets. In recent years, Medicare physician 
spending has exceeded those SGR spending targets. That has resulted, 
naturally, in physician payments being cut. As the magnitude of these 
payment cuts has increased over time, Congress has stepped in to avert 
these scheduled cuts in reimbursement to doctors.
  In a roundabout way, the SGR has been serving its purpose. Numerous 
improvements in Medicare payments in other areas have been implemented 
over the years to offset or to pay for the various so-called doc fixes 
we have had to do and generally do them on an annual basis. Presently 
they are done on an 18-month basis, expiring December 31 this year.
  We should, in fact, be reforming physician payments. That is why I 
supported the SGR amendments offered by my colleague, the Senator from 
Texas, during the Senate Finance Committee markup that concluded 8 days 
ago. Those amendments would have provided a fully offset, positive 
physician update for the next 2 years. And if we erroneously take up a 
debate on this flawed Stabenow bill, I will have an alternative to 
offer with my good friend, the chairman of the Senate Budget Committee, 
Senator Conrad. A Conrad-Grassley amendment would be a bipartisan 
approach to this.
  Realigning incentives in the Medicare Program and paying for quality 
rather than quantity of services is, of course, an essential part of 
physician payment reform. But as fundamentally flawed as the physician 
payment system is, S. 1776, the bill before us, is just as 
fundamentally flawed. S. 1776 would add--can my colleagues believe 
this--a $\1/4\ trillion cost to the national debt. A quarter of a 
trillion, obviously, is $250 billion. But worse yet, it does not fix 
the problems we have with the physician payment system. It simply gives 
a permanent freeze to those payments. The American Association of 
Neurological Surgeons and the Congress of Neurological Surgeons oppose 
the Stabenow bill for precisely that reason, and I applaud them for 
having the courage to say so.
  My esteemed colleague, the majority leader, claims this bill has 
nothing to do with health reform. I think it has everything to do with 
health reform. He says the $247 billion cost of this bill is just 
correcting, in his words, ``payment discrepancy;'' merely, in his 
words, ``a budgetary problem,'' a problem that needs to be fixed. But I 
don't believe anybody is going to buy that argument, not even the 
Washington Post. I have here a recent editorial. They said:

       $247 billion . . . is one whopper of a discrepancy.

  S. 1776 isn't being offered to fix a budget payment discrepancy, it 
is being offered as one whopper of a backroom deal to enlist the 
support of the American Medical Association for a massive health reform 
bill that is being written behind closed doors.
  Nobody is being fooled about what is going on in this body, the most 
deliberative body in the world, the Senate.
  When President Obama spoke to a joint session of Congress last 
month--the week after we came back from our summer break--he made a 
commitment to not add one dime to the deficit now or in the future. 
Those are his words, not mine. But as this Washington Post editorial 
notes, S. 1776 would add 2.47 trillion dimes to the deficit.
  We go to chart 2 now. That would be 2.47 trillion dimes, enough to 
fill the Capitol Rotunda 23 times.
  Now we have chart 3. I wholeheartedly agree with the editorial's 
conclusion. The Post editorial said:

       A president who says that he is serious about dealing with 
     the dire fiscal picture cannot credibly begin by charging 
     this one to the national credit card . . .

  This quote is highlighted out of that same editorial.
  The Office of Management and Budget and the Treasury Department 
announced that the fiscal year 2009 deficit hit a record of $1.4 
trillion. According to the Government Accountability Office, public 
debt is projected by the year 2019 to surpass the record that was set 
in 1946, 1 year after the end of World War II. That debt was 
attributable to the war, which was the war to save the world for 
democracies because of the dictatorial governments of Italy, Germany, 
and Japan, as we recall from history.
  There is no doubt that fixing the flawed physician payment system is 
something that must be addressed. But the problem--this problem--with 
the physician payments is one of the biggest problems in health care 
that needs fixing. But at a time when the budget deficit has reached an 
alltime high of $1.4 trillion, this situation demands fiscal 
discipline.
  As the Washington Post has correctly pointed out, S. 1776 is, indeed, 
a test of the President's pledge to pay for health care reform.
  Repealing the SGR without any offsets, as S. 1776 would do, is a 
flagrant attempt to try and hide the true cost of comprehensive health 
care reform.
  Let me suggest to the American people that bill, comprehensive health 
care reform--at least the one that came out of the Senate Finance 
Committee--is thick, at 1,502 pages that we all are committed to 
reading before it goes to the floor. That bill, of course,

[[Page S10609]]

will not go to the floor because now it is being merged in secrecy with 
the Senate HELP Committee bill, and so it may come out thicker. Who 
knows. We are talking about a great deal of cost connected with that 
and the SGR fix being connected with that as well.
  We have in the Senate Finance Committee bill, that was reported out, 
significant payment system reform. That bill takes savings of almost 
$\1/2\ trillion to fund a new entitlement program outside Medicare. The 
priority for Medicare savings should be fixing Medicare problems, and 
the physician payment issue and the SGR is the biggest payment system 
problem in Medicare today. It should get fixed in health care reform 
with those Medicare savings.
  I must, therefore, object not to fixing the SGR and improving the 
system for physician payments--which clearly must be done--but to this 
very flawed bill. It is only a permanent payment freeze. It does not 
fix the problem. It is not paid for. It should be a part of health care 
reform. It adds $\1/4\ trillion to the deficit. It is one whopper of a 
discrepancy. It is not credible.
  I urge my colleagues to oppose cloture on this train wreck of a bill.
  I yield the floor and, since I do not see any of my colleagues 
waiting to speak, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Begich). The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. LEAHY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LEAHY. Mr. President, today, the Senate will finally consider the 
nomination of Roberto A. Lange to the District of South Dakota. It has 
been 3 weeks since Mr. Lange's nomination was unanimously reported by 
the Judiciary Committee to the Senate. It should not take 3 weeks to 
confirm a consensus nominee. I will be interested to hear from Senate 
Republicans who have stalled this confirmation for the last 3 weeks why 
they did so.
  There are 10 other judicial nominations reported favorably by the 
Judiciary Committee to the Senate that remain pending without consent 
from Senate Republicans to proceed to their consideration. These are 10 
other judicial nominations on the Senate Executive Calendar awaiting 
action and being stalled by Republican holds. All 10 were reported 
favorably by the Senate Judiciary Committee. Two were reported in June 
and have been waiting for more than 4 months for Senate consideration. 
These are things that we have always done by voice vote when there is 
no controversy.
  It is not only a dark mark on the Senate for holding us up from doing 
our work, but it means that the nominees have their lives on hold. They 
have been given this nomination, and everything has to come to a stop. 
They know they are going to be confirmed. They know that whenever the 
Republicans allow a vote, it will be virtually unanimous. It makes the 
Senate look foolish, and I wish my colleagues would allow these people 
to move quickly.
  The American Bar Association's Standing Committee on the Federal 
Judiciary reported that its peer review of the President's nomination 
of Mr. Lange resulted in the highest rating possible, a unanimous 
rating of well qualified. His nomination has the support of both home 
State Senators, Senator Johnson, a Democrat, and Senator Thune, a 
Republican, and was reported out of the Judiciary Committee by 
unanimous consent on October 1. I expect the vote on the President's 
nomination of Mr. Lange to be overwhelmingly in favor, as was the 99-0 
vote for the only other district court confirmation so far this year, 
that of Judge Viken. I will be listening intently to hear why then 
Senate Republicans--despite the support of Senator Thune, the head of 
the Republican Policy Committee and a member of the Senate Republican 
leadership--have stalled this confirmation needlessly for 3 weeks.
  This is one of the 13 judicial nominations reported favorably by the 
committee to the Senate since June to fill circuit and district court 
vacancies on Federal courts around the country. Ten of those 
nominations were reported without a single dissenting voice. This is 
unfortunately only the third of those judicial nominations to be 
considered all year.
  It is October 21. By this date in the administration of George W. 
Bush, we had confirmed eight lower court judges. By this juncture in 
the administration of Bill Clinton, we had likewise confirmed eight 
circuit and district court nominations. The Senate has confirmed just 
three circuit and district court nominees this year less than half of 
those considered by this date during President Bush's tumultuous first 
year in office and confirmed by this date during President Clinton's 
first year. This is despite the fact that President Obama sent nominees 
with bipartisan support to the Senate two months earlier than did 
President Bush. Moreover, President Clinton's term also began with the 
need to fill a Supreme Court vacancy.
  The first of these circuit and district court confirmations this year 
did not take place until September 17, months after the nomination of 
Judge Gerard Lynch had been reported out of committee with no dissent. 
Finally, after months of needless delay, the Senate confirmed Judge 
Lynch to serve on the Second Circuit by an overwhelming vote of 94 to 
3. That filled just one of the five vacancies this year on the Second 
Circuit. The Second Circuit bench remains nearly one-quarter empty with 
four vacancies on its 13-member bench.
  Judge Viken, the first of just two district court judges the Senate 
has been allowed to vote on this year, was confirmed on September 29, 
by a unanimous 99-0 vote. Today, the Senate is finally being allowed by 
Republicans to vote to confirm Roberto Lange, who was reported by the 
committee on October 1. It took 3 weeks to proceed to Mr. Lange's 
nomination despite the fact that he, like Judge Viken, had the support 
of both his home State Senators, one a respected Democratic Senator and 
the other a Republican Senator who is a member of the Republican Senate 
leadership.
  South Dakota has had its two vacancies filled this year but vacancies 
in 35 other States remain unfilled and the Senate's constitutional 
responsibilities are going unfulfilled. There was--there is--no reason 
for the Republican minority to impose these unnecessary and needless 
delays to judicial confirmations. When will Senate Republicans allow 
the Senate to consider the nominations of Judge Hamilton to the Seventh 
Circuit, Judge Davis to the Fourth Circuit, Judge Martin to the 
Eleventh Circuit, Judge Greenaway to the Third Circuit, Judge Berger to 
the Southern District of West Virginia, Judge Honeywell to the Middle 
District of Florida, Judge Nguyen to the Central District of 
California, Judge Chen to the Northern District of California, Ms. Gee 
to the Central District of California and Judge Seeborg to the Northern 
District of California?
  In a recent column, Professor Carl Tobias wrote:

       President Obama has implemented several measures that 
     should foster prompt appointments. First, he practiced 
     bipartisanship to halt the detrimental cycle of accusations, 
     countercharges and non-stop paybacks. Moreover, the White 
     House has promoted consultation by seeking advice on 
     designees from Democratic and GOP Senate members, especially 
     home state senators, before official nominations. Obama has 
     also submitted consensus nominees, who have even temperaments 
     and are very smart, ethical, diligent and independent.

  I ask unanimous consent that a copy of Professor Tobias's column be 
printed in the Record following my statement.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See Exhibit 1.)
  Mr. LEAHY. When I served as chairman of the Senate Judiciary 
Committee during President Bush's first term, I did my best to stop the 
downward spiral that had affected judicial confirmations. Throughout my 
chairmanship I made sure to treat President Bush's judicial nominees 
better than the Republicans had treated President Clinton's. During the 
17 months I chaired the Judiciary Committee during President Bush's 
first term, we confirmed 100 of his judicial nominees. At the end of 
his Presidency, although Republicans had chaired the Judiciary 
Committee for more than half his tenure, more of his judicial nominees 
were confirmed when I was the chairman than in the more than 4 years 
when Republicans were in charge.
  In spite of President Obama's efforts, however, Senate Republicans 
began

[[Page S10610]]

this year threatening to filibuster every judicial nominee of the new 
President. They have followed through by dragging out, delaying, 
obstructing and stalling the process. The result is that 10 months into 
President's Obama's first term, the Senate has confirmed only three of 
his nominations for circuit and district courts while judicial 
vacancies skyrocket around the country. The delays in considering 
judicial nominations pose a serious problem in light of the alarming 
spike in judicial vacancies on our Federal courts.
  There are now 96 vacancies on Federal circuit and district courts and 
another 24 future vacancies already announced. These vacancies are at 
near record levels. Justice should not be delayed or denied to any 
American because of overburdened courts. We can do better. The American 
people deserve better.
  Professor Tobias' observations about the Second Circuit hold true 
throughout the country and with respect to this President's efforts to 
work cooperatively with respect to judicial nominations. President 
Obama made his first judicial nomination, that of Judge David Hamilton 
to the Seventh Circuit, in March, but it has been stalled on the 
Executive calendar since early June, despite the support of the senior 
Republican in the Senate, Senator Lugar. The nomination of Judge Andre 
Davis to the Fourth Circuit was reported by the committee on June 4 by 
a vote of 16 to 3, but has yet to be considered by the Senate. The 
nomination of Judge Beverly Baldwin Martin to the Eleventh Circuit has 
the support of both of Georgia's Senators, both Republicans, and was 
reported unanimously from the committee by voice vote on September 10 
but has yet to be considered or scheduled for consideration by the 
Senate. The nomination of Joseph Greenaway to the Third Circuit has the 
support of both Pennsylvania Senators, and was reported unanimously 
from the committee by voice vote on October 1, but has yet to be 
considered or scheduled for consideration by the Senate. All of these 
nominees are well-respected judges. All will be confirmed, I believe, 
if only Republicans would consent to their consideration by the Senate. 
Instead, the President's good efforts are being snubbed and these 
nominees stalled for no good purpose.
  President Obama has been criticized by some for being too solicitous 
of Senate Republicans. As Wade Henderson, the executive director of the 
Leadership Conference on Civil Rights, said to The Washington Post 
recently: ``I commend the President's effort to change the tone in 
Washington. I recognize that he is extending an olive branch to 
Republicans on the Judiciary Committee and in the Senate overall. But 
so far, his efforts at reconciliation have been met with partisan 
hostility.'' As usual, Wade has it right. The efforts the President has 
made have not been reciprocated.
  The Senate can and must do a better job of restoring our tradition of 
regularly considering qualified, noncontroversial nominees to fill 
vacancies on the Federal bench without needless and harmful delays. 
This is a tradition followed with Republican Presidents and Democratic 
Presidents. We should not have to overcome filibusters and spend months 
seeking time agreements to consider consensus nominees.
  In addition, four nominations to be Assistant Attorneys General at 
the Department of Justice remain on the Executive calendar, three of 
them for many months. Republican Senators have also prevented us from 
moving to consider the nomination of respected Federal Judge William 
Sessions of Vermont to be Chairman of the United States Sentencing 
Commission for over 5 months, even though he was twice confirmed as a 
member of that Commission. The majority leader has been forced to file 
a cloture motion in order to end the obstruction of that nomination.
  Four out of a total of 11 divisions at the Department of Justice 
remain without Senate-confirmed Presidential nominees because of 
Republican holds and delays--the Office of Legal Counsel, the Tax 
Division, the Office of Legal Policy, and the Environment and Natural 
Resources Division. Earlier this month, with the hard work of Senator 
Cardin, we were finally able to move forward to confirm Tom Perez to 
head the Civil Rights Division at the Justice Department. His 
nomination was stalled for 4 months, despite the fact that he was 
approved 17 to 2 by the Judiciary Committee. At the last minute, Senate 
Republicans abandoned an ill-fated effort to filibuster the nomination 
and asked that the cloture vote be vitiated. He was finally confirmed 
with more than 70 votes in the Senate.
  During the 17 months I chaired the Judiciary Committee during 
President Bush's first term, we confirmed 100 of his judicial nominees 
and 185 of his executive nominees referred to the Judiciary Committee. 
And yet 10 months into President's Obama's first term, we have 
confirmed only 2 of his nominations for circuit and district courts and 
40 of the executive nominees that have come through our committee.
  I hope that, instead of withholding consents and filibustering 
President Obama's nominees, the other side of the aisle will join us in 
treating them fairly. We should not have to fight for months to 
schedule consideration of the President's judicial nominations and 
nomination for critical posts in the executive branch.
  I look forward to congratulating Mr. Lange and his family on his 
confirmation today. I commend Senator Johnson for his steadfastness in 
making sure his State is well served.

                               Exhibit 1

  Commentary: Second Circuit Appeals Court Openings Need To Be Filled

                            (By Carl Tobias)

       The country's attention was recently focused on the Senate 
     confirmation vote for U.S. Second Circuit Court of Appeals 
     Judge Sonia Sotomayor, President Barack Obama's initial 
     Supreme Court nominee and judicial appointment. This emphasis 
     was proper because the tribunal is the highest court in the 
     nation and decides appeals involving fundamental 
     constitutional rights.
       Nonetheless, the same day that Justice Sotomayor received 
     appointment, Second Circuit Judge Robert Sack assumed senior 
     status, a type of semi-retirement, thereby joining his 
     colleague, Guido Calabresi, who had previously taken senior 
     status. Moreover, on Oct. 10, Judge Barrington Parker also 
     assumed senior status. These developments mean that the 
     Second Circuit will have vacancies in four of its thirteen 
     authorized judgeships.
       Operating without nearly 25 percent of the tribunal's 
     judicial complement will frustrate expeditious, inexpensive 
     and equitable disposition of appeals. Thus, President Obama 
     should promptly nominate, and the Senate must swiftly 
     confirm, outstanding judges to all four openings.
       The numerous vacancies can erode the delivery of justice by 
     the Second Circuit, which is the court of last resort for all 
     but one percent of appeals taken from Connecticut, New York 
     and Vermont. The tribunal resolves more critical business 
     disputes than any of the 12 regional circuits and decides 
     very controversial issues relating to questions, such as free 
     speech, property rights and terrorism.
       Among the appellate courts, the Second Circuit needs more 
     time to conclude appeals than all except one, which is a 
     useful yardstick of appellate justice. The August loss of two 
     active judges and the October loss of a third will exacerbate 
     the circumstances, especially by additionally slowing the 
     resolution of cases that are essential to the country's 
     economy.
       There are several reasons why the tribunal lacks almost one 
     quarter of its members. Judge Chester Straub took senior 
     status in July 2008, and President George W. Bush nominated 
     Southern District of New York Judge Loretta Preska on Sept. 9 
     after minimally consulting New York's Democratic Senators 
     Charles Schumer and Hillary Clinton. September was too late 
     in a presidential election year for an appointment, and the 
     110th Senate adjourned without affording the nominee a 
     hearing.
       Moreover, President Obama has nominated no one for the 
     Calabresi or Sack opening, although both jurists announced 
     that they intended to take senior status last March. In 
     fairness, Judge Calabresi did not actually assume senior 
     status until late July, while Judge Sack only took senior 
     status and Justice Sotomayor was confirmed in August.
       President Obama has implemented several measures that 
     should foster prompt appointments. First, he practiced 
     bipartisanship to halt the detrimental cycle of accusations, 
     countercharges and non-stop paybacks. Moreover, the White 
     House has promoted consultation by seeking advice on 
     designees from Democratic and GOP Senate members, especially 
     home state senators, before official nominations. Obama has 
     also submitted consensus nominees, who have even temperaments 
     and are very smart, ethical, diligent and independent. The 
     Executive has worked closely with Senator Patrick Leahy (D-
     Vt.), the Judiciary Committee chair, who schedules hearings 
     and votes, and Senator Harry Reid (D-Nev.), the Majority 
     Leader, who arranges floor debates and votes, and

[[Page S10611]]

     their GOP counterparts to facilitate confirmations.
       Emblematic is the President's nomination of U.S. District 
     Judge Gerard Lynch, who served with distinction on the U.S. 
     District Court for the Southern District of New York since 
     2000. New York Democratic Senators Schumer and Kirsten 
     Gillibrand expeditiously suggested the superb trial judge to 
     Obama, who nominated Lynch on April 2. By mid-May, the panel 
     conducted Lynch's confirmation hearing, and on June 11, the 
     committee approved Lynch. In mid-September, the Senate 
     confirmed Lynch on a 94-3 vote.
       Senator Schumer's Sept. 9 announcement that he had 
     recommended District Judge Denny Chin to the White House and 
     the jurist's Oct. 6 nomination are precisely the correct 
     approaches. The New York and Connecticut senators must 
     continue suggesting excellent candidates for the three Second 
     Circuit openings which remain. Obama must swiftly consider 
     their proposals and nominate outstanding prospects. The 
     Judiciary Committee should promptly afford hearings and 
     votes, while the Majority Leader ought to expeditiously 
     schedule floor debates and votes.
       Judge Sotomayor's Supreme Court elevation, the assumption 
     of senior status by Judges Calabresi, Parker and Sack and 
     Judge Lynch's recent Senate confirmation mean there are four 
     openings in the Second Circuit's thirteen judgeships. 
     President Obama should cooperate with the Senate to quickly 
     fill the vacancies with superior judges, so that the tribunal 
     can deliver appellate justice.

  Mr. LEAHY. Mr. President, I ask unanimous consent that my further 
remarks be charged against my time in connection with this nomination.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Mr. Leahy are printed in today's Record under 
``Morning Business.'')
  Mr. LEAHY. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. SESSIONS. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SESSIONS. Mr. President, I wish to briefly make a few comments 
about the confirmation vote we will soon be having on supporting this 
nominee. I saw him, as a member of the Judiciary Committee, and we made 
inquiry of him. I liked him. He handled himself well.
  He has been a strong and ardent Democrat all his life--an active 
Democrat. He was educated, I believe, at the University of South Dakota 
and has practiced law a long time there. I think he has the ability and 
the commitment--he said he did and I believe him--not to allow his 
politics to influence his decisionmaking once he puts on that robe; 
that he will be objective and fair; that he will comply with the oath a 
judge takes to be impartial; that he will provide equal justice for the 
poor and the rich; and that he will serve the laws of the United States 
under the Constitution. So we moved him forward, and I am glad he will 
be confirmed.
  I will note that some nominees I will not be able to support, and I 
would expect some others may object as well. It is our responsibility 
to be careful and to be cautious in making decisions about judges 
because they are given a lifetime appointment. They can't be removed 
for bad decisionmaking. I believe the President has submitted two more 
nominees to the district bench. There are 74 vacancies in the Federal 
courts in America as of today. A few days ago, there were 9 nominations 
pending--this is 1 of them--and now there are 11 nominations, I 
understand, pending.
  As the President gets his machine up and running and starts 
submitting nominees, I think we will have good hearings. My view is 
that if they are qualified, it doesn't make any difference to me if 
they are an active, partisan, campaigning Democrat. That is fine. The 
question simply is, once they put on the robe and they are required to 
decide cases, can they put aside their personal feelings, backgrounds, 
emotions, and partisanship? Most judges can.
  I practiced in Alabama, where judges run on a party ticket. They run 
as Republicans and Democrats. Everybody knows which of them--very few--
carry those biases with them.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. SESSIONS. I thank the Chair, and I urge my colleagues to support 
the nomination.
  The PRESIDING OFFICER (Mr. Udall of New Mexico). The question is, 
Will the Senate advise and consent to the nomination of Roberto A. 
Lange, of South Dakota, to be United States District Judge for the 
District of South Dakota?
  Mr. SESSIONS. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The clerk will call the roll.
  The bill clerk called the roll.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 100, nays 0, as follows:

                      [Rollcall Vote No. 324 Ex.]

                               YEAS--100

     Akaka
     Alexander
     Barrasso
     Baucus
     Bayh
     Begich
     Bennet
     Bennett
     Bingaman
     Bond
     Boxer
     Brown
     Brownback
     Bunning
     Burr
     Burris
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Coburn
     Cochran
     Collins
     Conrad
     Corker
     Cornyn
     Crapo
     DeMint
     Dodd
     Dorgan
     Durbin
     Ensign
     Enzi
     Feingold
     Feinstein
     Franken
     Gillibrand
     Graham
     Grassley
     Gregg
     Hagan
     Harkin
     Hatch
     Hutchison
     Inhofe
     Inouye
     Isakson
     Johanns
     Johnson
     Kaufman
     Kerry
     Kirk
     Klobuchar
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     LeMieux
     Levin
     Lieberman
     Lincoln
     Lugar
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (NE)
     Nelson (FL)
     Pryor
     Reed
     Reid
     Risch
     Roberts
     Rockefeller
     Sanders
     Schumer
     Sessions
     Shaheen
     Shelby
     Snowe
     Specter
     Stabenow
     Tester
     Thune
     Udall (CO)
     Udall (NM)
     Vitter
     Voinovich
     Warner
     Webb
     Whitehouse
     Wicker
     Wyden
  The nomination was confirmed.
  The PRESIDING OFFICER. Under the previous order, the motion to 
reconsider is considered made and laid upon the table. The President 
will be immediately notified of the Senate's action.

                          ____________________