[Congressional Record Volume 155, Number 172 (Thursday, November 19, 2009)]
[Senate]
[Pages S11578-S11582]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          APPROPRIATIONS BILLS

  Mr. COCHRAN. Madam President, in the coming weeks and months, the 
Senate is scheduled to complete action on bills that will have a 
profound impact on Federal spending for many years to come. I rise to 
express my concerns about the manner in which new spending is being 
proposed in that legislation.
  Congress has sent 5 of the 12 annual appropriations bills to the 
President for his signature. Four other bills are in conference with 
the House. The Senate has not yet acted upon the three remaining bills 
under our jurisdiction.
  Last year, Congress completely abandoned the appropriations process. 
The year before that, only a few bills were acted upon by the Senate 
before all of the bills but one were bundled into an omnibus bill and 
sent to the President.
  Thus far this year, we have not been able to complete action on all 
12 appropriations bills, but we have made significant progress. The 
Senate has debated a stand-alone Agriculture appropriations bill and an 
Interior appropriations bill for the first time in 4 years. Ideally, 
these bills should be subjected to the scrutiny of the full Senate 
every year. This year, there have been hearings in each subcommittee, 
and the bills have been subjected to subcommittee and full committee 
markups. We have tried to get the bills to the floor individually so 
all Senators have an opportunity to offer amendments, and so we can 
avoid the necessity of grouping the bills into an omnibus bill.
  The chairman, who is the distinguished Senator from Hawaii, Mr. 
Inouye, deserves the credit for these improvements. All Senators on the 
committee have cooperated, though.
  Despite the many difficulties associated with enacting the 
appropriations bills, the process compels us to hear testimony, analyze 
programs, and consider funding needs and priorities on an annual basis. 
It is not always a smooth or easy process, but it has the benefit of 
compelling us to continually reevaluate the level of Federal 
spending. That is not the case when we create long-term or permanent 
mandatory spending programs.

  I don't mean to criticize the oversight of the authorizing 
committees. Many of them do excellent work in this regard, holding 
agencies and funding recipients accountable for their management 
decisions. But once a funding stream is made mandatory, it is difficult 
to reduce or cut off the spending or to use the leverage of future 
funding to motivate more efficient management of Federal programs or 
activities.

[[Page S11579]]

  One of the justifications often cited for creating mandatory spending 
programs is that the funding recipients need predictability to properly 
and efficiently manage programs. While there may be some truth to this, 
in itself it is not a sufficient reason to make a new program mandatory 
or to change an existing program from discretionary to mandatory.
  If increased predictability is the goal, Congress should make greater 
efforts to get the annual appropriations bills done as close to on time 
as possible and in an open and orderly fashion that allows scrutiny of 
the proposed spending.
  Failure to process the appropriations bills in this manner has the 
effect of driving interest groups to seek the predictability of long-
term mandatory funding streams. In effect, we create a situation 
whereby Congress must take proactive steps to reduce or eliminate 
spending as opposed to proactive steps to continue spending.
  As a general matter, we should be very careful about moving programs 
in that direction, in my opinion. As I look at the major legislation 
that Congress is slated to consider over the coming months, I am 
greatly concerned. Of most immediate concern is the health care bill on 
which we will soon begin debate.
  The bill reported by the Senate Finance Committee creates new 
programs with direct appropriations that should be funded or not funded 
through the annual appropriations process. There are mandatory programs 
for maternal, infant, and early childhood home visitation and for 
personal responsibility education for adulthood training. There are 
grants for school-based health centers, a demonstration program for 
emergency psychiatric care, and a demonstration program to address the 
health profession's workforce needs.
  A previously authorized childhood obesity program is directly funded 
with a mandatory appropriation. Many of these programs are funded for 
only a few years, just enough time to get funding recipients invested 
in the program, after which expectations will be overwhelming that the 
programs be continued with annual appropriations.
  As ranking member on the Labor, Health and Human Services 
Subcommittee, I might be inclined to support funding some of them, but 
beginning new programs with short-term, mandatory funding is a recipe 
for trouble. It results in hiding the long-term costs of these programs 
and provides no opportunity upfront to consider tradeoffs between the 
new programs and existing programs.
  The health care bill reported by the HELP Committee includes a new 
prevention and public health fund to support an ``expanded and 
sustained national investment in prevention and public health programs 
to improve health and help restrain the rate of growth in private and 
public sector health care costs.'' That is a quote from the bill. The 
bill appropriates $2 billion for this purpose in fiscal year 2010 alone 
and increases that amount to $10 billion by fiscal year 2014 and 
thereafter.
  This has long been a priority of the Senator from Iowa, Mr. Harkin. 
To the committee's credit, the bill provides some latitude for the 
Appropriations Committee to allocate funds among various prevention and 
wellness programs in the outyears.
  At its heart, however, this provision implies that we know today what 
the appropriate Federal investment for wellness programs will be 10 or 
20 years from now. I just don't think that is plausible. If prevention 
and wellness programs are that important, let's call up the Labor, 
Health and Human Services appropriations bill and either increase the 
size of the bill or reallocate money within the bill to support 
wellness programs. When the fiscal year 2011 appropriations process 
begins, let's analyze how those programs are working and consider, once 
again, the appropriate funding levels for the coming year.
  Beyond the health care bill, there is legislation to address global 
climate change. Here, again, we face the prospect of massive new annual 
Federal expenditures being established on a mandatory basis, 
effectively being put on autopilot right from the beginning. While 
nobody knows the value of the carbon allowances that would be auctioned 
under some climate bills, it is clear that tens of billions of dollars 
from such auctions would be plowed directly back into an array of 
programs administered by Federal, State, and local government agencies.
  Some of the programs have a more obvious relationship to climate 
change than others. Just to list a few, the Senate-reported bill 
directly funds clean vehicle technology, building retrofits, advanced 
energy research, nuclear worker training, coastal preservation, and 
Federal land acquisition.
  Many programs that would be funded by this bill are identical or 
similar to programs already funded in annual appropriations bills. 
Others are entirely new.
  Are we truly confident in the year 2016 it will be prudent to spend 
4.3 percent of an unknowable amount of auction revenues on 
international deforestation efforts? Are we sure that in the year 2030 
we should be spending .74 percent of auction proceeds on worker 
assistance programs?
  Congress should protect its ability to reconsider support or 
opposition to such spending annually, or at least periodically, based 
on program performance and our current national interests.
  What about funding of Federal land acquisition? I have supported some 
Federal land acquisitions in my State of Mississippi, sometimes to 
incorporate important resources into our National Park System, 
sometimes to preserve sensitive habitats by including them in our 
national wildlife refuge system or in our national forests. I have had 
other Senators request specifically that we not approve the Federal 
acquisition of a particular piece of property. This has been a 
particularly sensitive issue for our western colleagues, particularly 
in whose States Federal land ownership is already extensive. Yet in the 
climate bill, we are being asked to allocate funding to the executive 
branch on a long-term basis for unspecified Federal land acquisition 
projects, all with no apparent mechanism for congressional oversight.
  Are any Senators really comfortable with that arrangement? This is 
just one example of why Congress should consider programs on an annual 
basis through an open process rather than putting programs on autopilot 
and then struggling against the tide of entrenched interests to react 
when things do not go as expected.
  In July, the House passed an education bill, the Student Aid and 
Fiscal Responsibility Act. The bill terminates the programs that 
authorized private lenders to make federally guaranteed loans to 
students and provides that future student loans will be provided only 
through direct Federal loans from the U.S. Department of Education.
  My concern with this is that the House-passed bill establishes a 
number of new mandatory education programs and expands several existing 
programs with mandatory funding streams. The Congressional Budget 
Office estimates the House-passed bill would reduce mandatory spending 
by $87 billion over the next decade. But the House bill directly spends 
all but $8 billion of that amount on new and expanded programs. It 
directly funds a new college access and completion innovation fund. It 
establishes mandatory funding streams for school modernization, 
renovation, and repair, including a program of supplemental grants for 
States along the gulf coast. It establishes mandatory programs for 
early childhood education and for reforming community colleges and 
improving training for workforce development.
  In many cases, these are new programs. In some cases, the mandatory 
amounts are meant to supplement funding currently provided through 
annual appropriations.
  Regardless of the merits of these programs, the fact remains that we 
are faced with a debt problem of huge proportions. We have now closed 
the books on fiscal year 2009, finishing the year with a budget deficit 
of $1.4 trillion. We began fiscal year 2010 with a deficit of $176 
billion for the month of October. Our national debt has hit $12 
trillion, and soon Congress will have to act to raise the Federal debt 
ceiling again.
  President Obama's own budget, optimistic in many respects, forecasts 
that our national debt will be rising to 66 percent of the gross 
domestic product by 2013. The Congressional Budget Office forecasts 
debt reaching 87 percent

[[Page S11580]]

of GDP in 2020 and increasing thereafter to even more alarming levels.
  Given this set of facts, is it responsible to enact a bill that is 
expected to produce--not guaranteed to produce but expected to 
produce--a savings of $87 billion in mandatory spending but then in the 
same legislation spends all but $8 billion of that anticipated savings 
on new programs or expansions of existing programs that could just as 
well be achieved through the annual appropriations process?
  Is it responsible to advance a climate bill that spends tens of 
billions of dollars on new mandatory programs and to allocate funding 
among those programs for decades into the future when we have no 
ability to judge whether those programs are needed or effective or what 
different programs might be necessary depending on how climate 
legislation would affect our economy, our workforce, and our 
environment?
  Can we afford to enact a health care bill that is long on new costly 
mandatory programs but short on cost savings that we all know must be 
found within our health care system?
  Certainly, there are situations where mandatory funding is an 
appropriate mechanism to deliver government services. In cases where 
our goal is to provide a service to a certain group of eligible people, 
regardless of how many people may be eligible in a given year, a 
mandatory appropriation may be the most efficient means of achieving 
that goal.
  Given our Nation's fiscal situation, however, it seems to me we 
should strongly favor a procedure that requires Congress to consider 
programmatic spending every year. This is the very principle stated in 
paragraph 13 of rule XXVI of the Standing Rules of the Senate. This is 
not a question of which committee has the power over the purse. It is a 
question of whether Congress will maintain the power over the purse and 
deliberately exercise it.

  Every year in appropriations bills, programs are terminated, reduced, 
or expanded based on performance and the availability of resources, 
pursuant to the budget resolution. Interest groups and program 
beneficiaries are required to give us their views annually. The 
competition for available dollars is intense. But so what? Whether it 
is health care, climate change, education, or other legislation, 
Congress should be very cautious about establishing new, long-term, 
mandatory funding streams because it fundamentally weakens our ability 
to control Federal spending at a time when we greatly need to exercise 
that control.
  I hope my colleagues will keep this in mind as we proceed with the 
business before us.
  The PRESIDING OFFICER (Mr. Whitehouse). The Senator from Maryland is 
recognized.
  Mr. CARDIN. Mr. President, shortly we will have an opportunity to 
vote on moving forward and considering health care reform in this 
country. I thank the majority leader, Senator Reid, for putting 
together the bill that came out of our two committees that accomplishes 
what I think are the three goals we need to accomplish in health care 
reform. I have been asked by the people of Maryland whether I would 
support a particular bill. I told them in order for me to vote for a 
bill, it has to do three things: First, it needs to bring down the cost 
of health care in America; second, it needs to provide an affordable 
quality insurance option to every American; and, third, it must be done 
in a fiscally responsible way.
  The bill Senator Reid is bringing forward accomplishes those three 
goals. First, it brings down the cost of health care in America by 
about $1 trillion. It does it by investing in prevention and healthy 
lifestyles; by cracking down on fraud, waste, and abuse; and by 
eliminating unnecessary administrative costs in our health care system. 
That is the way we should bring down health care costs in America. That 
will improve quality but bring down costs.
  Second, this bill allows every American to have access to affordable 
health insurance and health care. The Congressional Budget Office 
estimates the bill will reduce the number of uninsured in America by 31 
million. We will be able to get 98 percent of Americans who are in this 
country legally, citizens, covered by health insurance as a result of 
this legislation.
  Third, this bill moves forward in a fiscally responsible way by not 
only staying within our budget but by actually reducing our budget 
deficit by $127 billion with no new tax burdens on middle-income 
families.
  I am particularly pleased this bill will help middle-income families 
in America. Mr. President, I know you have received letters from your 
constituents. I have received letters from my constituents that tell us 
the status quo is unacceptable for middle-income families in America.
  Let me give two examples of people who wrote to me. I got hundreds of 
letters from Marylanders telling me they cannot make it under the 
status quo. This is from Meg, from Rock Hall, MD. Rock Hall, MD, is on 
the eastern shore. She is a healthy, active 62-year-old woman. She 
plays tennis four times a week. She is not on prescription medicines 
and has never had a major medical issue.
  She wanted to change her insurance coverage. She has insurance, but 
she wanted to go to a more affordable insurance plan for her family. 
She was denied coverage. Why? Because she had received counseling 3 
years earlier due to a stressful family situation and because she had a 
slightly elevated cholesterol level. Her cholesterol has been brought 
under control taking over-the-counter medication, and she has not had 
counseling in over a year.
  She writes to me, and how do I answer that? It says:

       If I am considered high-risk, where does that leave 
     Maryland residents who have serious health conditions, are on 
     medications, or require on-going care?

  Meg is absolutely right. The bill the leader is bringing forward will 
deal with middle-income families such as Meg's by telling health 
insurance companies they cannot participate in such discriminatory 
practices, by restricting preexisting conditions. In fact, Meg doesn't 
have preexisting conditions, but they are using that to deny her full 
coverage.
  Earlier this week, Cynthia and Eric Cathcart came to us, came to this 
Capitol to tell us their stories. I must tell you, I was shocked to 
hear of their circumstance.
  Here are two individuals who are self-employed, trying to make it. 
They have two children. They are trying to get along. Eric told us he 
is basically giving up on his business and is going to have to work for 
a larger company because he can't afford health insurance. Cynthia, who 
is a piano instructor, tells us the same story. Listen to this.
  Here are a husband and wife, two children, and they cannot get an 
insurance policy to cover their whole family because of the preexisting 
condition restrictions. These are small business owners who are going 
to have to literally give up their businesses.
  Today they have two separate insurance plans: one for the husband and 
child, one for the wife and child, because that is the only way they 
can get it. They have to pay two separate deductibles because they 
couldn't get an insurance plan to cover the family. The amount of money 
they are paying for health insurance is prohibitively expensive.
  The status quo is not acceptable for the Cathcarts and should not be 
acceptable for any of us. Under the health care bill the leader is 
bringing forward, though, discriminatory practices by private insurance 
companies would be prohibited, and the Cathcarts would have the option 
of a lot of different plans they could choose from to cover their 
entire family without separate deductibles for different members of 
their family.
  That is the type of health care reform we need that will help middle-
income families in America. It will help middle-income families by 
bringing down the cost of health care. The cost of health care in 
America is growing at way too fast a rate. Ten years ago in Maryland it 
cost an average family about $6,000 for health insurance. Maybe their 
employer paid part; maybe they paid part. Today that is $12,000 a 
family. By 2016 it will be $24,000 a family if we do not take action. 
We need to help middle-income families. We need to move forward with 
health care reform.
  The average family in Maryland today is paying $1,100 per family for 
the cost of those who do not have health insurance. Those who have 
health insurance are paying for those who do not have health insurance.

[[Page S11581]]

That is why the bill the leader is bringing forward, that will cover 98 
percent of Americans, is going to help middle-income families by 
eliminating that hidden tax of $1,100 per family in Maryland and around 
the country.
  Health care costs are growing three times faster than wages are 
growing in America. Inaction should not be an option.
  For small businesses the situation is very dire. They are spending 20 
percent more than a comparable company that does the same business that 
is larger. Just as stressful, they cannot predict what the annual 
premium increase is going to be. How can you run a business without 
knowing what your costs are going to be from 1 year to another? For the 
sake of small businesses we need to move forward with health care 
reform.
  A lot of families in Maryland depend upon Medicare; a lot of middle-
income families in Maryland depend upon Medicare. This bill will 
strengthen Medicare by dealing with the underlying costs of health 
care, by getting that under control. At the same time we protect 
Medicare for the future, we provide additional benefits for our seniors 
by starting to close the doughnut hole, getting prescription drug costs 
under control, and providing preventive care for our seniors. This 
legislation will help middle-income families by dealing with insurance 
reform and eliminating preexisting conditions. It will provide larger 
pools to offer more choice for middle-income families.
  This legislation will help workers who work for small companies. It 
will help those people in our community who have preexisting 
conditions. It will help those people in our community who are changing 
jobs. It will help those in our community who depend upon Medicare. 
This is legislation that is critically important for middle-income 
families in America.
  The status quo is unacceptable. We need to act, and we are going to 
have a chance to do that when we vote Saturday on proceeding with 
health care reform. I urge my colleagues to move forward on this vital 
legislation for America.
  I yield the floor.
  The PRESIDING OFFICER . The distinguished Senator from Utah is 
recognized.
  Mr. BENNETT. Mr. President, I enjoyed listening to my colleague from 
Maryland. He says to us repeatedly the status quo is not acceptable. I 
agree with that. I would point out to him that the bill that has been 
presented to us by the majority leader guarantees the status will 
remain ``quo'' until 2014. This bill delays implementation until 2014. 
For 4 years the status will remain ``quo'' on key provisions.
  Mr. CARDIN. Will my colleague yield on that point?
  Mr. BENNETT. I am happy to yield.
  Mr. CARDIN. Let me point out that much of the insurance reform takes 
effect immediately. The preexisting conditions are dealt with 
immediately. The larger pools for those who can't find health coverage, 
that is done and implemented immediately.
  Mr. BENNETT. I understand, but the key provisions of the bill that 
cost significant money are postponed until 2014. Why? Because unless 
you make that postponement you cannot get the score down to the point 
where it is in the majority leader's bill.
  The challenge is that the real cost of health care is substantially 
more than this bill demonstrates as it comes out of the Congressional 
Budget Office. Why? Because the Congressional Budget Office is required 
by law to give costs over a 10-year period. If this whole thing started 
at the time the bill was passed and ran for the whole 10 years, the 
cost would be so high that it could not be offset with the programs 
that have been put in the bill. So the easy way to save costs and bring 
it down below the level that is acceptable is to delay the 
implementation until 2014.
  We saw that in the Finance Committee. The Baucus bill moved the date 
of implementation from January 1, 2013, to July 1, 2013, to save money. 
Now the Reid bill moves it from July 1, 2013, to January 1, 2014, an 
entire year of additional ``savings.''
  These are not savings at all. These are simply a delay in the 
implementation and therefore a delay in the expenditures.
  I want to move to the point the Senator from Mississippi was making 
with respect to the impact of this on the national debt and the 
national deficit. The last time we had a budget from President Bush, 
the last Bush budget said the total expenditures would be $3.1 
trillion.
  President Obama's budget called for expenditures of $3.6 trillion or 
\1/2\ trillion more.
  OK, \1/2\ trillion more, you would assume, therefore, that the 
deficit that would occur would be roughly \1/2\ trillion more than the 
Bush deficit. But the last deficit of the Bush administration, before 
the financial crisis hit us, was $116 billion. That is .1 trillion of 
the $3.1 trillion. And the first deficit of the Obama administration is 
$1.4 trillion.
  You say: Wait a minute. Those numbers do not add up. The reason they 
do not add up is, we can control how much we spend, but we cannot 
control how much we take in. How much we take in is a function of the 
economy.
  Let's go back to the budget that was submitted and passed by the 
Obama administration and passed on the floor of the Senate by the 
Democratic majority. It projected $2.2 trillion in revenue, and it 
projected $2.2 trillion in entitlement spending, mandatory spending. 
That meant that everything else in government had to be borrowed. Money 
for the Defense Department had to be borrowed, the State Department, 
all of our embassies overseas, all of that money had to be borrowed. 
The money for transportation, for the Federal Aviation Administration 
had to be borrowed. The money for national parks had to be borrowed. 
The money for education had to be borrowed.
  It wasn't that the expenditures went up an extra $1\1/2\ trillion to 
get a $1.4 trillion deficit. It was that the revenues went down. Yes, 
the expenditures did go up. The expenditures under the Obama budget 
went up roughly $\1/2\ trillion from the expenditures under the Bush 
budget. But the big problem was, the revenues went down at the same 
time.
  The cautionary tale that comes out of this is, again, we can control 
how much we spend, but we cannot control how much we get in. That is a 
function of the economy. Money does not come from the budget; money 
comes from the economy. When the economy is weak, as it is now, we are 
going to have deficits, no matter how big an effort we make to try to 
avoid them, because the money simply doesn't come in.
  The reason I make that point is because, back again to the numbers 
that we realized when we were debating the budget, the money coming in 
was $2.2 trillion and the money already committed in entitlement 
benefits that the Congress did not deal with in the appropriations 
process was $2.2 trillion. What we will do, if we pass the bill the 
majority leader has introduced or will introduce, is to increase the 
amount of mandatory spending, increase the commitment of the Federal 
Government to make expenditures in the health care area that will be 
beyond the reach of the Appropriations Committee, that will be going 
out whether or not we have the money coming in to pay for them.
  I know the score out of CBO says this will save money for the Federal 
Government, but let's get into the details of what the CBO had to say 
to see how much it would save and see why it would save.
  The CBO says, about the longer term calculations with respect to this 
bill:

       These longer-term calculations assume that the provisions 
     are enacted and remain unchanged throughout the next two 
     decades, which is often not the case for major legislation.

  I think that is one of the understatements of the year. Major 
legislation does not often go unchanged for two decades. Congress will 
add goodies. Congress will delay some of the tax provisions. We see 
that every year with respect to the legislation known around here as 
the doc fix. It is in the law right now that every year we cut 
reimbursements to doctors under Medicare, and every year the Congress 
comes in and says: We won't do it this year. The doc fix comes in and 
says: We will change this earlier situation. That means any score that 
depends on our not passing a doc fix is going to be wrong. CBO says 
that. Again:

       These longer-term calculations assume that the provisions 
     are enacted and remain unchanged throughout the next two 
     decades,

[[Page S11582]]

     which is often not the case for major legislation.

  We keep hearing how the costs are going to come down. What does CBO 
have to say about that? This is the quote that has to do with what I 
was talking about with respect to expanding the Federal commitment for 
entitlement spending in health care. Quoting again from CBO:

       Under the legislation, federal outlays for health care 
     would increase during the 2010-2019 period, as would the 
     federal budgetary commitment to health care.

  The Federal budgetary commitment to health care will increase. So how 
do we get a score that says we will save money? You get the score 
because you have projected revenues that will increase. You have tax 
provisions in there that say we will get the money from this tax, we 
will get the money from that tax. Then it will be a saving to the 
Federal Government. It is not a saving to the Federal Government; it is 
a raising of Federal revenues above the commitment to spend. But as I 
pointed out in the beginning, the raising of Federal revenues is not an 
automatic thing upon which we can depend. It is dependent upon the 
economy. What happens if we make the commitment to the spending and 
then the economy is not good and the revenues do not come in at the 
level CBO is projecting? These are all assumptions CBO is making, 
feeding into the computers. The computer cannot and does not project 
any kind of economic downturn, any kind of recession, any kind of 
problem. It just says: If, if, and if, you will get this number. And 
then they plug that number in, and that number says it will be big 
enough to pay for all of this. But make no mistake, what CBO says on 
the side where we can control it, the spending side, it says it would 
increase the Federal budgetary commitment to health care.
  So once again we have entitlement spending. We have the demand for 
money going out going up on the hope that the revenues coming in will 
somehow be greater than the amount going up, and therefore we can 
project that this will save the government money.
  How accurate has CBO been in the past with respect to the spending 
side? Well, we can go back to Lyndon Johnson and Joe Califano, who 
created Medicare, and take their original projections as to how much 
Medicare would cost. I have given that speech on the floor before. The 
answer is, Medicare costs 20 times more than was projected at the time 
it was put in place. We could do the same thing with Medicaid. It is 
not quite that big, not quite 20 times. SCHIP, whatever it is. With the 
exception of Medicare Part D, which was a Republican initiative, every 
single time the Federal Government has put in a Federal program for 
medical activity and medical expenditures, the actual expenditures have 
exceeded projections, sometimes 20 times exceeding it, going back to 
Medicare. That is the spending side.
  We cannot produce that kind of money on the revenue side because we 
cannot really control the amount of revenue that comes in. The amount 
of revenue that comes in is a function of the economy.
  Once again, where are we this year? Mr. President, $2.2 trillion in 
revenue, substantially below the amount of revenue that came in in the 
Bush administration. It is not Bush's fault that there was more or 
less. It was the economy that made a downturn. And if we think in this 
body we can repeal the business cycle and see there will be no more 
downturns in the future, we are really kidding ourselves. There will be 
downturns, and there we will be, with the commitment in place, the 
increase in the Federal budgetary commitment to health care, without 
the revenue to pay for it.
  This is CBO again:

       The long-term budgetary impact could be quite different if 
     key provisions of the bill were ultimately changed or not 
     fully implemented. If those changes arose from future 
     legislation, CBO would estimate their costs when that 
     legislation was being considered by the Congress.

  In other words: We will make no attempt to guess what is going to 
happen in the future, but we can tell you that any kind of tinkering 
with this in the future is going to make all of our predictions wrong. 
That is the logical thing for them to say, it is the prudent thing for 
them to say, and it is the accurate thing for them to say.
  There are many things about this bill that I don't like. I am 
convinced it will increase premiums for those who currently have health 
insurance. There is no way it can produce the kinds of results my 
friend from Maryland talked about of covering 30 million more people 
and cutting costs for everybody in Middle America without costing a lot 
more money someplace else. One of those places is going to be either in 
your tax responsibilities or in increased premiums or in the States.
  We all know how the Governors feel about this proposal. The Governors 
have said this proposal will bankrupt us by the rolling of Medicaid 
costs onto the States--not Republican Governors, it is Democratic 
Governors who have come forward and said: We can't handle this. So 
there are lots of things about this bill I don't like.
  But I believe the score that has been put together is not an honest 
one. I am not accusing CBO of doing anything wrong. I am accusing those 
who wrote the bill of putting in provisions so that we will delay this 
implementation there, we will call for this tax here and the score that 
goes there and so on. And it ends up that when we feed all of that 
information into the computer and then say: O mighty computer, none of 
this will change, what is the number, the computer gives you a number, 
but it is a number based on assumptions that are based on smoke and 
mirrors.
  There is an old saying: Where there is smoke, there is fire. This 
bill has a lot of smoke in it, and, in my opinion, it is the American 
people who are going to get burned.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. SPECTER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________