[Congressional Record Volume 155, Number 175 (Monday, November 30, 2009)]
[Senate]
[Pages S11985-S12005]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of H.R. 3590, which the clerk will 
report.
  The legislative clerk read as follows:

       A bill, (H.R. 3590), to amend the Internal Revenue Code of 
     1986 to modify the first-time home buyers credit in the case 
     of members of the Armed Forces and certain other Federal 
     employees, and for other purposes.

  Pending:

       Reid amendment No. 2786, in the nature of a substitute.

  The ACTING PRESIDENT pro tempore. The majority leader.
  Mr. REID. Mr. President, today is the beginning of one of the most 
important debates in the history of our country. Today is the beginning 
of one of the most historic times in the Senate. Our two chairmen, 
Senators Baucus and Dodd, have spent months of their lives working on 
the legislation that allows us to be where we are today. We now have 
before us a bill that saves money, saves lives, and saves Medicare. It 
is a bill, if you add in Medicare recipients, that will insure 98 
percent of the people in America.
  Mr. President, I note the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. REID. Mr. President, one of the major goals of the Patient 
Protection and Affordable Care Act is to lower Federal health care 
costs and reduce the deficit. Our bill does that. According to the 
nonpartisan Congressional Budget Office, this legislation would not add 
a penny to the Federal deficit. In fact, it will reduce the deficit 
over both the short term and the long term, over the long term by as 
much as $650 billion.
  In developing this bill with the Finance and HELP Committees, we were 
determined to ensure that the legislation not only would reduce our 
deficit and our debt but that it would do so without relying on 
additional surpluses in the Social Security trust fund. This 
legislation would increase revenues in the trust fund as workers' wages 
rise. But those revenues are supposed to be for Social Security, so we 
didn't touch a penny of them--they are all used for Social Security and 
nothing else.
  Likewise, about $70 billion in revenues over the first 10 years of 
this bill flows from premiums paid into the new long-term care 
insurance program known as the CLASS Act. Several Members came to me 
and argued that none of these funds should be used for other purposes. 
I agreed. After all, these premiums would be used to build up a fund 
that later would be used to pay benefits. So, as with Social Security, 
we didn't use any of the CLASS surpluses for other programs.
  I think it is important that as the Senate considers changing the 
legislation, we maintain our commitment to protecting Social Security 
and CLASS surpluses. In both cases, all additional revenues are 
dedicated to pay benefits. Diverting them to other purposes would not 
be fiscally responsible, and it wouldn't be fair to Social Security or 
to people who paid their CLASS premiums in good faith.
  To help ensure we remain true to this commitment, I now ask unanimous 
consent that all amendments to the pending bill be considered out of 
order unless they are consistent with the following two principles: The 
additional surplus in the Social Security trust fund generated by this 
act should be reserved for Social Security and not spent in this act in 
any other fashion; and No. 2, the net savings generated by the CLASS 
program should be reserved for the CLASS program and not spent in any 
other manner in this act.
  The ACTING PRESIDENT pro tempore. Is there objection?
  Mr. ENZI. Reserving the right to object, neither of these requests 
are the requests I was just talked to about a minute and a half ago, so 
I object.
  The ACTING PRESIDENT pro tempore. Objection is heard.
  Mr. REID. Mr. President, I think what he saw a minute and a half ago 
is essentially the same thing, but I will recite this again.
  I ask unanimous consent that no amendment be in order to the Reid 
substitute amendment 2786 or a subsequent substitute amendment and H.R.

[[Page S11986]]

3590 if the additional surplus in the Social Security trust fund 
generated by this act would be expended on other provisions of this act 
and not reserved solely for Social Security, and the net savings 
generated by the CLASS program in the underlying substitute amendment 
and any subsequent substitute amendment are reserved solely for the 
CLASS program provisions of this act.
  The ACTING PRESIDENT pro tempore. Is there objection?
  Mr. ENZI. Mr. President, in the weeks this has been sequestered 
without us being able to review it and now having something that is not 
understandable in the short period of time we have to do it here, I 
have to object.
  The ACTING PRESIDENT pro tempore. Objection is heard.
  Mr. REID. Mr. President, I am sorry my friend objected. It is not too 
difficult to comprehend that any Social Security surpluses should be 
reserved for Social Security. It is not too difficult to comprehend 
that all monies related to the CLASS Act would be reserved for paying 
benefits for that. So I am disappointed that my friends on the other 
side of the aisle are not interested in making sure Social Security 
monies are not used and/or CLASS Act monies are not used for anything 
other than those two programs.
  Mr. President, I have another unanimous consent request.
  The process for developing this legislation has been very 
transparent. In fact, the hearings held in the Finance Committee were 
done very publicly, and that is an understatement. For weeks and weeks, 
members of that committee couldn't walk out of the room without being 
questioned by the press. The press was present at most of their 
meetings. So both the HELP and Finance Committees marked up their 
legislation in public markups. Republican and Democratic members of 
both committees offered numerous amendments, all of which were 
available to the public. Republican and Democratic members voted for or 
against those amendments in a public and transparent way, and each 
committee member can be held fully accountable to their constituents 
for all of those votes.
  The merged bill before us is entirely consistent with the provisions 
produced in those public markups. The bill has been fully available on 
the Internet for about 2 weeks. So each and every American has had the 
opportunity, if they wanted, to read the text of the legislation and to 
communicate their views with their Senators.
  One of the main reasons we have gone the extra mile in ensuring a 
fully transparent process is because of the leadership of Senator 
Blanche Lincoln of Arkansas. From the very start of this debate, she 
has made clear to me that a transparent process and debate on this 
critical issue is a top priority of hers. To that end, Senator Lincoln 
said she would not allow a vote on the motion to proceed to this bill 
unless it had been available to the public for a reasonable period of 
time. She was joined by virtually everyone on this side of the aisle to 
that effect. They were right. The people did deserve a chance to see 
the bill before that vote, so we were sure to give them that chance. 
The Senator deserves credit for that, and I appreciate her standing up 
on that issue.
  She believes--and I agree--that we can do more on the transparency 
front as this bill moves forward to the next stage of this process; 
therefore, Senator Lincoln has asked me to propound on her behalf a 
unanimous consent request.
  I ask unanimous consent that no amendment be in order to the Reid 
substitute amendment No. 2786, a subsequent substitute amendment, or 
H.R. 3590 unless the text or Internet link to the text of the amendment 
is posted on the home page of the official Senate Web site of the 
Member of the Senate who is sponsoring the amendment prior to the 
amendment being called up for consideration by the Senate and the 
amendment is filed at the desk. Further, that this unanimous consent 
agreement shall be in effect for the duration of the consideration of 
H.R. 3590.

  The ACTING PRESIDENT pro tempore. Is there objection?
  Mr. ENZI. Mr. President, in light of some of the trust problems and 
transparency problems we have, and while it appears to lead to greater 
transparency, we can also see ways that this can limit the ability for 
the minority to offer amendments. Therefore, I object.
  The ACTING PRESIDENT pro tempore. Objection is heard.
  Mr. REID. Mr. President, this is not a good way to start this debate. 
No. 1, there is an objection to the moneys in Social Security being 
protected and, No. 2, to the moneys in the CLASS Act being protected. 
That was also objected to.
  Finally, Senator Lincoln's request, which I support 100 percent, 
indicating that amendments should be filed on a Member's Web site--that 
doesn't sound too outlandish--and filed at the desk before they are 
offered, sounds pretty fair and square to me. I am disappointed this is 
the way the debate started.
  Mr. President, there is an order before the body that there will be 
two amendments in order today. One will be offered by the Democrats and 
one will be offered by the Republicans. The one to be offered by the 
Democrats will be offered by the distinguished Senator from Maryland, 
Barbara Mikulski, who I had the good fortune of serving with in the 
House of Representatives. She and I came here together in 1986 when we 
were elected to the Senate. She is a Senator I have such great respect 
and fondness for. We have been literally together and, because of our 
seniority, I am always one step behind her. Frankly, most people are a 
step behind the Senator from Maryland. The amendment she is going to 
offer is very sound and good. She will explain it in detail. It expands 
women's health services. We had a consternation about mammograms a 
couple weeks ago, and this will put that all to rest.
  I express my deep appreciation for the leadership of the Senator from 
Maryland on this issue and on so many other issues she is involved in.
  As I have indicated, the managers of the bill on our side will be 
Senators Baucus and Dodd. We look forward to a rigorous debate. With 
the consent of my friend from Wyoming, I ask that the Senator from 
Maryland be recognized.
  Mr. ENZI. Mr. President, I was hoping I would have a chance to 
comment on the things I had to object to so I can give a more full 
explanation. I am happy to wait.
  Mr. REID. Mr. President, there is no need to cut the Senator off. I 
have indicated to my staff earlier today that there is no one easier to 
get along with in the Senate than the Senator from Wyoming. I would 
never, ever cut him off intentionally. If there is anything he wishes 
to say, he should say it. If the Senator from Maryland will withhold 
for a moment, the Senator from Wyoming wishes to speak for a brief 
period of time.
  The ACTING PRESIDENT pro tempore. The Senator from Wyoming is 
recognized.
  Mr. ENZI. Mr. President, I cannot be brief on what just happened 
here. I will let the Senator go ahead. Frankly, I am a little upset 
about what has happened--combining a couple of unanimous consent 
agreements so that part of it would be acceptable and part would not 
be, leaving out the most important one, which is that we wouldn't take 
Medicare money from Medicare, and then not having much time to 
consider, or to rewrite, or to do anything with those. I have a lot of 
comments I wish to make on that, plus a general statement on the bill, 
which fits in with what just happened. I will defer to the Senator from 
Maryland.
  The ACTING PRESIDENT pro tempore. The Senator from Maryland is 
recognized.


                Amendment No. 2791 to Amendment No. 2786

  Ms. MIKULSKI. Mr. President, I have an amendment at the desk.
  The ACTING PRESIDENT pro tempore. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Maryland (Ms. Mikulski), for herself, Mr. 
     Harkin, Mrs. Boxer, and Mr. Franken, proposes an amendment 
     numbered 2791 to amendment No. 2786.

  Ms. MIKULSKI. Mr. President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  The amendment is as follows:

[[Page S11987]]

 (Purpose: To clarify provisions relating to first dollar coverage for 
                     preventive services for women)

       On page 17, strike lines 9 through 24, and insert the 
     following: ``ance coverage shall, at a minimum provide 
     coverage for and shall not impose any cost sharing 
     requirements for--
       ``(1) evidence-based items or services that have in effect 
     a rating of `A' or `B' in the current recommendations of the 
     United States Preventive Services Task Force;
       ``(2) immunizations that have in effect a recommendation 
     from the Advisory Committee on Immunization Practices of the 
     Centers for Disease Control and Prevention with respect to 
     the individual involved; and
       ``(3) with respect to infants, children, and adolescents, 
     evidence-informed preventive care and screenings provided for 
     in the comprehensive guidelines supported by the Health 
     Resources and Services Administration.
       ``(4) with respect to women, such additional preventive 
     care and screenings not described in paragraph (1) as 
     provided for in comprehensive guidelines supported by the 
     Health Resources and Services Administration for purposes of 
     this paragraph.''.

     ``Nothing in this subsection shall be construed to prohibit a 
     plan or issuer from providing coverage for services in 
     addition to those recommended by United States Preventive 
     Services Task Force or to deny coverage for services that are 
     not recommended by such Task Force.''.

  Ms. MIKULSKI. Mr. President, before I go into the contents of my 
amendment, I thank the Senator from Wyoming for his unfailing courtesy 
to allow me to proceed to offer my amendment. I have worked with the 
Senator from Wyoming on the Health, Education, Labor and Pensions 
Committee, and have often valued his sound counsel and steady hand as 
we have moved complex legislation. His considerable experience as an 
accountant and his commitment to the stewardship of Federal funds have 
often added to the consideration of legislation. As we move forward on 
both debating and refining the health care reform bill before us, I 
look forward to working with him. Again, I thank him for his courtesy.
  I also want to acknowledge the Democratic leader and wish to support 
him for bringing something called the ``merged'' bill to the floor, 
which took the best elements of both the Finance Committee and the HELP 
Committee and brought them forth.
  I believe the overriding bill before us is an excellent bill. No. 1, 
it expands universal access to health care that will now cover over 90 
percent more Americans. It will end the punitive practices of insurance 
companies, particularly in the area of gender, age discrimination, and 
preexisting conditions. It also stabilizes and makes Medicare secure 
and, at the same time, it begins to bend the cost curve by following 
innovative practices related to quality control and prevention.
  I think the overriding bill is an excellent one. I congratulate the 
manager of the bill on the floor, the Senator from Montana, Mr. Baucus, 
chairman of the Finance Committee, for the excellent work his committee 
did, for bringing in a great bill that establishes new ideas, such as 
medical homes, emphasizing primary care and prevention, and at the same 
time accomplishing the objectives I have mentioned.
  However, as I reviewed the bill, I felt we could do more to be able 
to enhance and improve women's health care. That is what my amendment 
does. The essential aspect of my amendment is that it guarantees women 
access to lifesaving preventive services and screenings.
  This amendment eliminates one of the major barriers to accessing care 
in the area of cost and preventive services. It does it by getting rid 
of, or minimizing, high copays and high deductibles that are often 
overwhelming hurdles for women to access screening programs. We know 
that screening is important and early detection is important because it 
saves lives. But it also saves money. It does it by reducing the top 
diseases that are killing women today, or certainly impairing their 
lives.
  Today, according to the CDC, the top killers of women are cancer--
breast cancer, cervical cancer, colorectal cancer, ovarian cancer. Also 
upfront and high on the list is lung cancer which, if identified early, 
can be treated with less invasive procedures and with lower costs. 
Another top killer of women is heart and vascular disease. And then 
there are the silent killers that often go undetected, such as 
diabetes, which can result in terrible consequences, such as the loss 
of an eye, the loss of a limb, or the loss of a kidney.
  We now have screenings that are proven to detect these diseases 
early. Guaranteed access to these screenings, as I said, will save 
money and lives.
  If we look at where women are today, we find women often forgo those 
critical preventive screenings because they simply cannot afford it, or 
their insurance company won't pay for it unless it is mandated by State 
law. Many women right now don't have insurance at all--seventeen 
million women in the United States of America are uninsured--or when 
they are insured, they have to pay large out-of-pocket expenses.
  Three in five women have significant problems paying their medical 
bills. Women are more likely than men to neglect care or treatment 
because of cost. Fourteen percent of women report they delay or go 
without needed health care. Women of childbearing age incur 68 percent 
more out-of-pocket health care costs than men, simply because of the 
maternity aspect.
  Women are often faced with the punitive practices of insurance 
companies. No. 1 is gender discrimination. Women often pay more and get 
less. For many insurance companies, simply being a woman is a 
preexisting condition. Let me repeat that. For many insurance 
companies, simply being a woman is a preexisting condition. We pay more 
because of our gender, anywhere from 2 percent to over 100 percent. A 
25-year-old woman is charged up to 45 percent more than a 25-year-old 
male in the same identified health status. A 40-year-old woman is 
charged anywhere from 2 percent to 140 percent more than a 40-year-old 
man with the same health status for the same insurance policy.
  What does my amendment do? It guarantees access to those critical 
preventive services for women to combat their No. 1 killers. We will 
provide these services at minimal cost.
  The overall cost of my amendment has been scored by CBO. It says the 
cost is $1 billion. The majority leader, the Democratic leader, has 
provided opportunities to meet this cost. This amendment eliminates 
this big barrier of copayments and deductibles.
  Let's talk about the benefit package. This benefit package is based 
on HRSA recommendations. It is based also on the recommendations of 
CDC. If this amendment passes, women will have access to the same 
preventive health services as the women in Congress have. If this 
passes, again, the women of America will have access to the same 
preventive services that we women in Congress have.
  What does that mean? It means a mammogram, if your doctor says you 
need it; screening for cervical cancer, if your doctor says you need 
it; that check on diabetes, if your doctor is worried about you; and 
along with the symptoms related to menopause, there are other things, 
such as a loss of weight; and they may want to know at this juncture if 
you have diabetes. If you know that at 40, you are less likely to need 
kidney dialysis when you are 60.
  The pending bill doesn't cover key preventive services, such as 
annual screenings for women of all ages to focus on our unique health 
needs. We know that for many people--for example, there are 15 million 
people in America with diabetes, and half are women. Often pregnant 
women with diabetes don't get the proper prenatal care. Heart disease 
is one of the top two leading causes of death in women--cancer and 
heart disease. Every year, over 267,000 women die from heart attacks. 
Women are generally unaware of their heart risks.
  My amendment would, again, ensure heart disease screening for women. 
Remember that famous study that said ``take an aspirin a day to keep a 
heart attack away.'' It was done on 10,000 male medical residents, and 
not one woman was included. Thanks to a bipartisan effort, Bernadine 
Healy, NIH, and the women of the Senate, supported by the good guys of 
the Senate, were able to get that screening for women, get that 
evaluation. We know we manifest things differently than guys do. Now we 
are on our way to detection--if you can afford to have a doctor and if 
you can afford to have the screening.
  My amendment also guarantees screenings for breast cancer--yes, for

[[Page S11988]]

mammograms. We don't mandate that you have a mammogram at age 40. What 
we say is discuss this with your doctor. But if your doctor says you 
need one, you are going to get one.
  Studies have found mammogram screening decreases breast cancer among 
women by over 40 percent. Regular Pap smears reduce cervical cancer by 
40 percent. This year, over 4,000 women will die of cervical cancer.
  My amendment does focus on women's health needs. Keeping a woman 
healthy not only impacts her own life but that of her family. It 
impacts her ability to care for her child or an aging parent.
  Early detection saves money by treating diseases early. Screening 
tests for breast and cervical cancer cost about $150, but the treating 
of advanced breast cancer is over $10,000 and can even go much higher. 
The treating of early stages of cervical cancer is $13,000 and can go 
much higher.
  My amendment also leaves the decision of which preventive services a 
patient will use between the doctor and the patient. The health reform 
debate is focused on what you should have when. We agree. Decisions 
should be made in doctors' offices, not in the office of a Member of 
Congress or the office of an insurance executive. The decision about 
what is medically appropriate and medically necessary is between a 
woman and her doctor.
  The authors of the bill have done a very good job in protecting women 
in many areas. This actually refines and improves this particular 
issue. That is why I support the overall health reform bill providing 
universal access to health care for over 90 percent of the American 
people, ending those punitive practices of the insurance companies, 
stabilizing and strengthening Medicare, and improving quality in public 
health by using innovation and preventive services and quality. We can 
pass a health reform bill.
  I conclude by saying that we will end the confusion about what is 
needed in the area of preventive health services for women when our 
coverage is often skimpy and spartan. We want to make sure what we do 
enables us to have access to these comprehensive services.
  I hope this amendment is adopted unanimously. I believe good people 
on both sides of the aisle will believe in its underlying premise: that 
early detection and screening save lives and save money.
  Often those things unique to women have not been included in health 
care reform. Today we guarantee it and we assure it and we make it 
affordable by dealing with copayments and deductibles in a way CBO 
believes is fiscally achievable. In the long run, I think by doing this 
it will mean a lot to families, and it will mean a lot to the Federal 
budget.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Montana.
  Mr. BAUCUS. Mr. President, before I give a statement on the bill, I 
wish to compliment the Senator from Maryland for standing up for and 
essentially helping the health care of women. As she has pointed out, 
women are discriminated against today in America in various ways. Her 
amendment addresses some of that discrimination. I very much appreciate 
that. I know all women in the country do. I do, too. I have a mom. I 
have sisters. I have women in my family, and I very much care.
  I don't know if she made this point, but about 80 percent of health 
care decisions made for families are made by women. It is all the more 
important women are not discriminated against, partly because they make 
so many decisions that affect health care for Americans, but second, 
women themselves are often discriminated against. Some States have 
gender ratings which discriminate against women. In other States a 
preexisting condition is a factor that discriminates against women.
  I thank the Senator from Maryland. She has hit the nail on the head. 
It is another reason this health care reform is going to mean so much 
for so many Americans. I personally very much thank the Senator from 
Maryland.
  In the Presidential campaign of 1912, Theodore Roosevelt's platform 
said:

       We pledge ourselves to work unceasingly in State and Nation 
     for . . . the protection of home life against the hazards of 
     sickness . . . through the adoption of a system of social 
     insurance adapted to American use.

  Today, nearly a century later, we are closer than ever to enacting 
meaningful health care reform.
  As in Teddy Roosevelt's time, we seek protection against the hazards 
of sickness. Of necessity we seek a system uniquely adapted to American 
use. And recognizing the daunting task still ahead of us, we pledge 
ourselves to work unceasingly to get the job done.
  In the years since Teddy Roosevelt, some of our Nation's greatest 
leaders signed up for this job. But at the same time, we have never 
faced a greater need to get the job done than we do today.
  Why is that? Basically because health care costs are skyrocketing out 
of control. Every day American businesses are forced to cut benefits 
for their workers. Why? To remain competitive in the global 
marketplace. Every 30 seconds another American files for medical 
bankruptcy. Just think of that. Every 30 seconds another American files 
for medical bankruptcy. Every year, about 1.5 million families lose 
their homes because of health care costs. Our system is in crisis.
  We have a historic need and we have a historic opportunity. We have 
an opportunity to enact groundbreaking reform that will finally rein in 
the growth of health care costs and help bring financial stability back 
to American families and businesses.
  Unfortunately, there are some who stand in the way. Unfortunately, 
there are some who are spreading misinformation about how health care 
reform will work. On this very floor I have heard arguments that health 
care reform is about the government trying to take over health care. 
That is false.
  The truth is, health care reform is about allowing patients and 
doctors to take back control of health care. We need to allow patients 
and their doctors together to take back control from the big insurance 
companies.
  Our plan would not increase the government's commitment to health 
care. But don't just take my word for it. The nonpartisan Congressional 
Budget Office says:

       [D]uring the decade following the 10-year budget window, 
     the increases and decreases in the federal budgetary 
     commitment to health care stemming from this legislation 
     would roughly balance out, so that there would be no 
     significant change in that commitment.

  That is right, health care reform will not increase the Federal 
Government's budgetary commitment to health care.
  I have also heard it argued that health care reform will increase the 
budget deficit. That, too, is false--plainly, patently false.
  The bipartisan Congressional Budget Office says our plan would reduce 
the Federal deficit by $130 billion within the first 10 years--reduce 
the deficit in the first 10 years. That trend would continue, the CBO 
says, over the next decade. During the next decade, CBO says our bill 
would reduce the deficit roughly $450 billion. That is nearly one-half 
trillion dollars in deficit reduction, according to the Congressional 
Budget Office, in the second 10 years.
  I have also heard it argued that health care reform will raise taxes. 
That, too, is false. In fact, health care reform will provide billions 
of dollars in tax relief to help American families and small businesses 
afford quality health insurance--tax cuts.
  The Joint Tax Committee--again bipartisan and which serves both the 
House and the Senate--tells us, for example, that our bill would 
provide $40 billion in the tax cuts in the year 2017 alone--$40 billion 
in tax cuts in the year 2017. The average affected taxpayer will get a 
tax cut of nearly $450. The average affected taxpayer with an income 
under $75,000 in 2017 will get a tax cut of more than $1,300.

  Let me repeat that. The average affected taxpayer with income under 
$75,000 in 2017 will get a tax cut of more than $1,300. They will also 
get a tax cut in earlier years, but it ramps up to that amount in 2017.
  In the same vein, I have heard claims that health care reform will 
result in an increase in higher costs for Americans. That, too, is 
false.
  Health care reform will not result in higher costs for Americans. 
Health care reform is fundamentally about lowering health care costs 
and making quality health care affordable for all Americans. Lowering 
costs is what health care reform is designed to do, lowering costs; and 
it will achieve this objective. How? In many ways.

[[Page S11989]]

  First, health care reform will end abusive practices by insurance 
companies. Reform will stop insurance companies from denying coverage 
or hiking up rates for those with a preexisting condition. We stop that 
in this legislation. That will lower costs. Reform will stop insurance 
companies from dropping coverage or reducing benefits for those who get 
sick.
  Those reforms protect consumers, and they will protect Americans and 
reduce premium costs for Americans who are sick. These reforms will 
also help lower costs for small businesses and their employees. Right 
now, if one employee in a small business gets sick--just one--insurance 
companies can double the premiums they charge the whole business. I 
know that is true. I have heard that time and time again from small 
business owners in Montana. That is just because one employee gets 
sick, the insurance companies jack up premiums, double the premiums 
they otherwise would charge the whole business. That is just wrong. We 
stop that in this legislation.
  How else do we lower costs in this bill? Health care reform will 
provide billions of dollars in tax credits and reform will limit out-
of-pocket costs such as copayments that insurance companies are able to 
charge. We limit them. This will also help to ensure Americans can 
afford their total health care costs and not just their premiums.
  That is very important. Premiums and out-of-pocket costs are both 
addressed by this bill. It limits growth in premiums and also limits 
growth in out-of-pocket costs. So total cost--premiums plus out-of-
pocket costs--for Americans will be lower under this legislation than 
otherwise would be.
  Third, health care reform will work to repeal the hidden tax of more 
than $1,000 in increased premiums that American families pay each year 
in order to cover the cost of caring for the uninsured.
  Today, millions of Americans without health insurance are too often 
forced to turn to emergency rooms to get the care they need, and then 
health care providers shift the cost of that care to other Americans 
with health insurance. People with insurance, therefore, pay higher 
premiums. By providing quality, affordable health insurance to millions 
more Americans, health care reform will reduce this hidden tax and 
reduce premiums for all Americans--$1,000 per year per family due to 
uncompensated care. That is that hidden tax. This bill will virtually 
stop that hidden tax, stop that additional $1,000 that goes to average 
family premiums.
  How else do we reduce health care costs? By providing affordable 
health care to more Americans which will increase the number of 
Americans in the insurance market. Why? What is so good about that?
  One reason is more people will have health insurance. But also it 
will spread the risk of paying for an accident or disease more broadly. 
Spreading the risk more broadly should lower premium rates for 
everybody. It is a basic tenet of insurance.
  Fifth, health care reform will reduce costs by cutting administrative 
redtape. That is no small item. Today, insurance companies spend a lot 
of time and money finding ways to discriminate against people. They 
spend time and money to find ways to drop coverage, and insurance 
companies pass those administrative costs on to all Americans in the 
form of higher premiums. The figure I heard is about 18 percent of 
American health care dollars is administrative costs. This legislation 
would dramatically reduce that percentage to a much lower number. We 
don't know to exactly what level yet but a much lower level. About 18 
percent of total health care dollars go to pay administrative costs. 
That is not the case in other countries. They pay 4 to 5 percent in 
other countries. We have to get that down in America, and health care 
reform will significantly achieve that result.
  Health care reform will outlaw this discrimination, and also reform 
will eliminate those administrative costs that go along with it. 
Furthermore, health care costs will work to streamline administrative 
procedures across the board by requiring standard enrollment forms and 
marketing material through insurance exchanges. That, too, will help 
streamline procedures. That, too, will help reduce administrative costs 
for providing for standard enrollment forms and also standard marketing 
materials through insurance exchanges. That is going to lower 
administrative costs and make it much easier for a person to shop and 
know which policy is best for him or her. With the other reforms we are 
making competition is more on the basis of price not just underwriting, 
a fancy term for denying because of a preexisting condition and putting 
in all those extra escape clauses insurance companies often provide in 
small print. In a letter released today, the Congressional Budget 
Office said:

       Compared with plans that would be available in the nongroup 
     market--

  And they are referring there to the individual market--

     under current law, nongroup policies under the proposal would 
     have lower administrative costs.

  Let me say that again. Compared with plans that would be available in 
individual markets--individuals seeking insurance--under current law, 
individual policies under the proposal would have lower administrative 
costs.
  Lower, not higher. Lower.
  Six--another way to reduce costs. Health care reform creates 
insurance exchanges where consumers can easily shop and compare plans 
to find the right coverage. Exchanges will make it easier for Americans 
to choose the most efficient plans, and that will reduce their costs 
and put pressure on insurance companies to offer lower cost, higher 
quality plans.
  Seven--still another way this bill reduces costs. Small business 
insurance exchanges will allow small companies to pool together to 
spread their risk and increase their buying power. More pooling 
available for small business insurance exchanges--this will allow small 
businesses to negotiate lower rates and provide more quality insurance 
plans with lower premiums to their employees.
  Eight. Health care reform will strengthen oversight and enforcement 
measures to cut down on fraud, waste, and abuse in the health care 
system. Fraud, waste, and abuse are estimated to cost our health care 
system more than $60 billion every year. This bill will help reform our 
system to reduce fraud, waste, and abuse, which eats up way too many 
health care dollars.
  Nine. Health care reform will move the focus of our system toward 
efficiency and value with payment incentives that reward quality care--
not quantity and volume but reward quality care, reward outcomes. Over 
the long run, paying doctors and other health care providers for 
quality instead of quantity will reduce health care costs.
  Ten. Health care reform will lower costs by working to change the 
focus of our health care system from treating sickness to promoting 
wellness. The big problem we have today is that we treat sickness. We 
don't spend enough time promoting wellness. Reform will make critical 
investments in policies that promote healthy living and help prevent 
costly chronic conditions that drive up costs throughout the system.
  These are just 10 examples of how health care reform will reduce 
health care costs and lower premiums for American consumers. There are 
many more, but these are those 10, as I said. On the other hand, 
without reform; that is, without passing this legislation, costs are 
guaranteed to continue to skyrocket out of control.
  Since Congress failed to enact health care reform in the 1990s, 
health care premiums have risen eight times faster than wages. Consider 
that. Since the last time we attempted to pass health care reform--and 
failed--in the 1990s, health care premiums have risen eight times 
faster than wages. And if we don't reform our health care system now, 
premiums will increase 84 percent in the next 7 years. And that is just 
premiums. What about out-of-pocket costs? Those, too, will increase at 
a rate much faster than wage increases.
  Today, health care coverage costs the average American family more 
than $13,000 a year, according to the Kaiser Family Foundation. If 
current trends continue without reform, the average family plan will 
cost more than $30,000 a year in the next 10 years. That is up from 
$13,000 today to $30,000 10 years from now. And businesses could see 
their health care costs double in that same time. Without reform, our 
Nation's long-term fiscal picture is almost certainly unsustainable.

[[Page S11990]]

  As Peter Orszag said when he was Director of the Congressional Budget 
Office:

       Rising health care costs represent the single most 
     important factor influencing the Federal Government's long-
     term fiscal balance.

  He was right. Without reform, instead of working to reduce our 
national deficit and stabilize the Federal budget, we will see total 
health care spending nearly double to encompass one-fifth of our gross 
domestic product in less than 10 years. And the Congressional Budget 
Office projects entitlement spending will double by the year 2050.
  Without reform, millions of uninsured Americans will continue to 
suffer. A Harvard study found that every year in America, lack of 
health care coverage leads to about 45,000 deaths. People without 
health insurance have a 40-percent higher risk of death than those with 
private health insurance. You have a 40-percent higher chance of death 
if you don't have health insurance compared with those who do. That is 
46 million Americans at risk today because they do not have health 
insurance. A recent Johns Hopkins study found that children without 
insurance have a 60-percent higher risk of death than those with 
private health insurance--a 60-percent higher risk of death than those 
with private health insurance.
  Another recent Harvard study found that the risk of dying from car 
accidents and other traumatic injuries is 80 percent higher for those 
without insurance--80 percent higher. The risk of dying from car 
accidents and other traumatic injuries is 80 percent higher if you 
don't have health insurance. In the greatest country on Earth, no 
American should die simply because they do not have health insurance.
  So, Mr. President, we are at a crossroads in history. We have a 
historic opportunity to enact meaningful health care reform that will 
work to stabilize our economy and provide quality, affordable health 
care coverage for millions of Americans. We are not the first to be 
here, but we have come further than ever before.
  We laid the groundwork in the Finance Committee and the HELP 
Committee. We held many hearings and countless hours of meetings on 
health care reform. Each committee crafted meaningful legislation and 
held exhaustive markups where we incorporated amendments from both 
sides of the aisle. We produced balanced, meaningful legislation, and I 
am proud--I am very proud--of the work both committees accomplished. 
Now we have one health care plan before us in the Senate, two basic 
bills merged together. We have an opportunity to debate that plan and 
offer amendments to make it even better. Then we will be called upon to 
vote.
  The health care of our Nation is depending on us. The health care of 
our economy is depending on us. History itself is depending on us to 
answer the call. I am confident we will. I am confident we will at long 
last answer the call of history. I am confident we will soon enact 
meaningful health care reform that will lower costs and bring quality, 
affordable coverage to millions of Americans.
  The ACTING PRESIDENT pro tempore. The Senator from Wyoming.
  Mr. ENZI. Mr. President, as I mentioned earlier following the 
unanimous consent requests the leader made--who then introduced Senator 
Mikulski so that she could do her amendment, which kept me from 
commenting on the unanimous consent requests he made--I have to say I 
think those unanimous consent requests would have to be put in the 
category of a stunt. Unanimous consent usually means the two leaders 
have gotten together and negotiated some kind of agreement that we 
would abide by during this time. There was no agreement on this. Yet 
they went ahead and did the unanimous consent request solely so they 
could get the objection.
  Nobody here, I am sure, wants to use Social Security money for 
anything except Social Security. So the real key to the stunt was the 
second one, which is the net savings generated by the CLASS program. 
That is a long-term care program that wound up in the Health, 
Education, Labor, and Pensions Committee bill.
  The flaw with that particular amendment was that it collected money 
for 10 years without spending any and then it wound up with a huge 
liability. So we put in a little provision that it had to be 
actuarially sound because, quite frankly, it is not very good 
accounting to collect $70 billion in exchange for a $2 billion--excuse 
me, $2 trillion--I get the b's and the t's mixed up here, because we 
are talking about real money here--a $2 trillion bill. That is how much 
we are going to have to pay out over the next 10 years to cover the $70 
billion we accept in payments for this new kind of insurance that would 
be provided. That kind of insurance is provided--it is provided in the 
private sector--but for considerably more than what they were providing 
for in the CLASS Act.
  So that was to bring a little more attention to it, and I want to 
bring a little more attention to it because I want people to take a 
closer look at the way that winds up. It is a good idea that is not 
paid for, and it is not paid for in such a way that it winds up, once 
again, adding to the deficit but in some cagey ways.
  As for having the amendments posted on the Web site before they are 
given, I hope the initial version is posted on the Web site by 
everybody before they do it. But one of the things that happens on this 
floor is that occasionally a good idea can be built on by somebody from 
the other side or even somebody from your own party, and when that 
happens you can modify the amendment. I am not sure that agreement 
wouldn't have prohibited any modifications to amendments, which is kind 
of what we ran into in the Finance Committee when we were trying to do 
amendments.
  So good ideas--they need a lot more work. And to just throw those out 
at the beginning and to have about 1\1/2\ minutes' notice that they are 
going to be thrown out--I just don't think that is the right way to go 
about this whole process.
  I have been working on the Nation's broken health care system ever 
since I entered the Senate more than 12 years ago, and I had high hopes 
this would be the year the Democrats and the Republicans of the Senate 
would work together to provide health insurance to every American. I 
urged my colleagues to start with a blank piece of paper and develop a 
bipartisan bill that up to 80 Members of the Senate could support.
  Unfortunately, the majority leadership had other ambitions, because 
the bill being debated today is a testament to a partisan ideological 
vision. It appears that the drafters of this bill took to heart the 
sentiments expressed by the Speaker of the House, who earlier this year 
said, ``We won the election, we write the bills.'' And for a number of 
weeks, the majority leader closed his door and wrote this bill on his 
own terms without any input from many of his colleagues or anybody on 
this side of the aisle.
  This is a deeply flawed bill that fails to address the real needs of 
the American people. Americans overwhelmingly want reforms that will 
help lower their health care costs. Instead, this bill will spend $2.4 
trillion when it is fully implemented and contains numerous provisions 
that will actually drive up the costs millions of Americans pay for 
their health care.
  It is important to understand how we got here. At the beginning of 
this process, the majority staff of the HELP Committee decided they 
were going to draft a partisan bill based on the reforms that had 
recently been adopted in Massachusetts. Republicans were shut out of 
the process during the drafting of the HELP Committee bill. Rather than 
working to resolve the difficult issues, the drafters of the bill 
included over 200 separate instances where the bill gave the Secretary 
of Health and Human Services the authority to make important decisions 
about the types of health care plans millions of Americans can receive. 
Rather than confronting and debating these important policies--getting 
to the details, and the devil is always in the details--the majority 
empowered unelected government bureaucrats to make decisions that will 
affect the health care of every single American.
  As a result of this partisan process, we were forced to file hundreds 
of amendments. The chairman and other Democratic members of the 
committee have repeatedly commented on the numerous amendments accepted 
by the majority during the markup. At the

[[Page S11991]]

same time, they ignored the reality that most of these amendments were 
merely technical corrections which were necessary because the 
underlying bill was hastily written and filled with numerous drafting 
errors. Unfortunately, nearly all of the accepted Republican amendments 
merely tinkered around the edges. Almost all of the substantive 
alternative-idea amendments suffered the failing fate of the party-line 
vote. In 12 days of markup at HELP, we had 45 rollcall votes on 
Republican-sponsored amendments and only 2 prevailed.
  After the markup, the majority refused to release a final copy of the 
bill for over 2 months, denying the American people the chance to see 
what they had done. Once we finally got a copy of the bill, we learned 
that majority staff had unilaterally made numerous changes to the bill, 
in some cases undoing agreements that had been worked out by Members on 
issues such as prevention and wellness.
  While this was happening, there were also ongoing bipartisan 
negotiations, led by Senator Max Baucus. And I have to congratulate him 
for the process he started and got people involved in and for his 
persistence and the amount of time he put into it. This dwindled down 
to a Gang of 6. The Gang of 6 discussions were not an honest attempt to 
try to develop a bipartisan health care bill that would offer real 
solutions to the problems that face our health care system.
  Ultimately, these negotiations failed to produce a bipartisan bill. I 
do not believe the failure was due to a lack of effort on the part of 
the participants but, rather, we were unsuccessful because the 
Democratic leadership chose to impose arbitrary and unrealistic time 
deadlines on the process that we commented on. The deadline slipped a 
few times, moved up a week, and then became finalized. The decision was 
made that it was more important to move fast than it was to get it 
right, and the decision ultimately doomed our efforts.
  This, in turn, led to another partisan markup where the Finance 
Committee rejected most GOP health reform ideas. Proposals such as 
medical liability reform were rejected on jurisdictional grounds, while 
the chairman unilaterally included Democratic provisions that were 
clearly within the jurisdiction of other committees. Republican 
amendments were voted on and then unilaterally changed at the eleventh 
hour--actually, 1:30 in the morning--by amendments offered by the 
chairman.
  The two bills were then merged, merged in secret, with no input from 
the many Republicans who want to enact a bipartisan health bill. We now 
have a 2,074-page bill that reflects many of the worst provisions from 
both the HELP and the Finance Committee bills.
  We did not need to end up here today with Republicans opposing a 
partisan health care reform bill. The Senate should develop legislation 
that will impact one-sixth of our Nation's economy and affect the 
health of every American.
  The former chairman of the Senate Finance Committee, Daniel Patrick 
Moynihan, a Democrat from New York, once provided the following 
perspective on how the Senate should consider major policy changes. He 
said:

       Never pass major legislation that affects most Americans 
     without real bipartisan support. It opens the doors to all 
     kinds of political trouble.

  Chairman Moynihan noted that absent such bipartisan support, the 
party that didn't vote for it would feel free to take shots at the 
resulting program whenever things go wrong and a large segment of the 
public would never accept it unless it was an overwhelming success. 
Chairman Moynihan understood a partisan legislative process guarantees 
that any glitches that occur in implementing the bill would provide 
ammunition for future attacks; thereby, further undermining public 
support of the new policies. There will, unfortunately, be plenty of 
glitches if this bill is ever enacted.
  The Reid bill will impose $493 billion in new taxes, and many of them 
go into effect immediately. At same time, most Americans will not see 
any insurance reforms or other potential benefits from this bill until 
at least 2014. That leads to some interesting accounting.
  The Reid bill will kill jobs and cut wages. The Congressional Budget 
Office has told us the employer mandates in this bill will likely 
result in lower wages and higher unemployment. These job and wage cuts 
would hit low-income workers, women, and minorities the hardest. It is 
hard to believe that with unemployment at a generational high, 
Democrats would even consider putting more jobs on the chopping block. 
The Reid bill mandates that Washington bureaucrats ration care. The 
bill lays the groundwork for a government takeover of health care, 
giving Washington bureaucrats the power to prevent patients from seeing 
the doctor they choose and obtaining new and innovative medical 
therapies.
  I think that is attested to by the first amendment we have, the 
amendment by the Senator from Maryland, because her amendment preempts 
the provision in the bill that allows the U.S. Preventive Services Task 
Force to determine what preventive services should be covered. This 
amendment recognizes the problems associated with government 
bureaucrats determining what benefits should be covered. The majority 
realized it had a political problem when the U.S. Preventive Services 
Task Force said that women aged less than 50 years old should not have 
annual breast screening exams. This amendment doesn't do anything to 
protect patients who might be denied access to preventive tests in the 
future, such as prostate exams, colonoscopies, Pap smears, and so on, 
if bureaucrats decide to deny access.
  This bill also shows how this will never be a truly science-based 
process. Bureaucrats will always have to respond to political pressure 
for powerful constituencies.
  I guess we are part of the powerful constituencies. If we decide 
something should or should not be in there, that eliminates the 
science-based part of it.
  I understand what they are trying to do. In the HELP Committee, when 
we were doing the markup, we did numerous amendments around this 
clinical effectiveness research, to see what it was supposed to 
eliminate from the health care for the person, separating them from 
their doctor by making these science-based decisions.
  We did a series of amendments and found there, evidently, are a lot 
of things they are hoping will be precluded from people being able to 
get. I invite people to take a look at those amendments. We may have to 
try those again to see exactly where this process is going. I 
appreciate the Senator from Maryland making an attempt to solve a part 
of the problem, but I am having a little trouble with the reading of 
the amendment itself. At any rate, enough of that.
  The Reid bill spends millions--billions. There is that word again. 
The Reid bill spends billions of taxpayer dollars on new pork-barrel 
spending. The bill would build new sidewalks, jungle gyms, and farmers' 
markets and creates a $15 billion slush fund for additional pork-barrel 
projects, a real deviation from what the Appropriations Committee has 
ever allowed.
  This bill also fails to achieve the commonsense goals Republicans and 
Democrats share. This bill even breaks many of the promises President 
Obama has made about health care reform. President Obama repeatedly 
called for a health care bill that will reduce costs. This bill will 
actually drive up health care costs for millions of Americans as a 
result of new mandates and taxes. President Obama has also said that if 
Americans like the insurance they have, they can keep it. Under the 
bill, millions of Americans will lose their employer-provided health 
insurance.
  President Obama promised not to raise taxes on individuals earning 
less than $250,000 per year. The bill would impose several new taxes on 
people who make considerably less than $250,000 a year.
  President Obama said the health care reform would not increase the 
deficit. This bill will not increase the deficit only if you believe 
certain things. This bill will not increase the deficit if you believe 
Medicare payments to physicians will be cut by 40 percent over the next 
decade. I don't think anybody believes that.
  The bill would reduce the deficit only if you believe Medicare 
payments to other providers will be slashed to levels that endanger 
patients' ability to get the care they need. No one believes that.

[[Page S11992]]

  The bill will also reduce the deficit if you believe Congress will 
allow a massive new tax to be imposed on middle-class tax payers. I 
hope no one believes that.
  If you don't believe Congress will allow all these things to happen, 
then you can't believe this bill will reduce the deficit. President 
Obama, in his remarks to the American Medical Association this summer, 
acknowledged the need to address our out-of-control medical liability. 
Rather than addressing this issue, this partisan bill preserves the 
costly, dangerous, duplicative medical malpractice system.
  President Obama finally said no Federal dollars will go to pay for 
abortion. According to the National Right to Life and the Conference of 
Catholic Bishops, the Reid bill fails this requirement as well.
  Despite all these failures, it is still not the worst health care 
bill in Congress. The Wall Street Journal got it right when they 
described the House-passed bill as the worst bill in America. Even if 
the Senate passed the bill before us today, it would still have to go 
to conference with the House bill and any final bill would have to move 
toward several provisions in the House bill and poll after poll 
suggests that the American people are opposed to this bill, let alone 
the wild one from the House.
  If we cannot defeat this partisan bill and get back to work for the 
American people and write a bill that garners the support of both 
parties, doing it step by step so we can assure, for instance, the 
seniors that Medicare money will only be spent on Medicare--that is one 
of the pieces that ought to have been in that unanimous consent I 
started talking about. That is not going to happen, though. They are 
going to take a bunch of money out of there.
  I think this legislation fails to meaningfully address these goals 
and will stick the American people with a bill we cannot afford. I 
believe we can do better, and we owe it to the American people to do 
so.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Hagan). The Senator from Connecticut is 
recognized.
  Mr. DODD. Madam President, let me begin, if I may, by congratulating 
the majority leader and my colleague and dear friend from Montana, 
Senator Baucus, and members of the Finance Committee as well as the 
members of the HELP Committee. As I said before, I am sort of an 
accidental participant in all this, in the sense that the person who 
should be standing at this desk and at this podium as the chairman of 
the HELP Committee is, of course, our deceased colleague from 
Massachusetts. I was filling in for him during the months of his 
illness and managing the markup of the bill that produced part, half--
whatever the percentage is--of the combined legislation. All our 
colleagues know, whether you agreed or disagreed with him, he 
considered this issue to be what he called the passion of his public 
life, to make a difference for all Americans when it comes to their 
health care. So I know it is with a sense of sadness that, on the day 
on which we begin this historic debate and discussion, he is not here 
to participate--at least physically. We sense his presence, of course, 
those of us who had the privilege of serving with him for so many 
years, as Senator Baucus and I did, and worked with him on these many 
issues. Of course, our colleague from Wyoming, Senator Enzi, and 
Senator Grassley did as well over the years. I thank all members of the 
committee.
  It was a laborious undertaking. The Presiding Officer was very much a 
part of that as well, during those many hours we gathered in the Senate 
caucus room--the Russell caucus room now named the Kennedy caucus 
room--in some 23 sessions, over many hours. But that was only the 
culmination of an effort that began a long time ago.
  Actually, the business of writing this bill began months and months 
earlier. My colleague from Montana can appreciate the hours I know I 
spent in meetings in his office, late into the evening, long before a 
markup began. Long before any formal conversations and discussions, 
there was a significant reaching out to our colleagues, to try to bring 
us together and develop what we all hoped to be the case and still can 
be the case; that is, a consensus bill, a bipartisan bill on health 
care.
  I know as a matter of fact here, beginning last fall, Senator 
Kennedy, when he did have his strength, met on countless occasions with 
members of the minority to try and navigate the minefield of health 
care ideas, to see if it couldn't be possible to put together that kind 
of a consensus bill.
  I know our committee began a long process, beginning last winter, to 
try to begin, long before the markup of this summer, to draft such a 
proposal, having what they call a walk-through of legislation, going 
through the various ideas and listening.
  It was with some regret that I say this idea that the bill somehow 
being jammed down people's throats, with little or no thought given to 
other people's ideas and thoughts, is not borne out by the facts. I 
have been here for many years. I have been through many markups over 
three decades in this body on various committees. This effort was and 
still remains an effort to try to bring us together about this issue, 
which has such a massive impact on not only the individuals of our 
Nation who go through the fear every day of wondering whether the 
coverage they have will be adequate; and if they don't have that 
coverage, whether an illness or tragedy could befall them that could 
wipe out everything they have--not only today but for the rest of their 
lives.
  This journey begins. My hope is, before we have finished the task, we 
will find that common ground that we each bear responsibility to try 
and achieve.
  Before we left for the Thanksgiving holiday, the Senate held a 
landmark vote on whether we should even debate health care. I must say 
a lot of attention was given to that. There must be a lot of confusion 
in the minds of many Americans, wondering why we had to debate whether 
we could debate. The one issue this body is known for is endless 
debate. We are not limited, under our rules of the Senate, at least not 
formally limited, by how much time we can consume when we want to talk. 
The filibuster is a unique practice which only the Senate has. So we 
had to vote as to whether we could actually have a vote. We had a 
debate on whether we could have a debate on the subject matter that is 
obviously of great concern, whether you agree or disagree.
  I think all Americans agree the present system needs a lot of work. 
The vote we took simply stated that after decades of inaction, despite 
the efforts of others over the years, this time the Senate would not 
fail to deliver the change the people we represent across America want 
and need.
  We now begin that long, overdue conversation over exactly what change 
should look like in the area of health care. There are, as has been 
made clear over the past months, many different opinions on the subject 
matter, almost as many as there are Members of this body. I hope my 
fellow Senators are ready to share their thoughts, listen to the ideas 
of their colleagues and, most importantly, join together to act. The 
legislation we present for debate is designed to fix the things that 
are wrong with our system, while protecting and strengthening the 
things that are great about health care in America. As I have heard my 
colleague from Montana say on so many occasions, we are not out here to 
design or copy what goes on in Canada or Europe or Australia or New 
Zealand or any other country around the world. We are here to design an 
American health care plan, an American plan, one we are forging after 
listening to health care providers, our constituents, and others who 
have great interest in the debate and discussion and who bring very 
valuable facts to the table, as all of us, individually, even those not 
on the committee, have listened over many weeks and months--in fact, 
over many years that we have been debating this subject matter.
  Our long history of innovation and discovery--cures, vaccines, and 
treatments, discovered and produced right here in our own country, that 
have saved countless lives here and around the world--is something for 
which every American ought to be proud. Our legislation, this combined 
bill, encourages that innovation so more groundbreaking medical 
discoveries can be made in America.
  In fact, one of the debates that occurred in the HELP Committee, as 
my colleague and the Presiding Officer may recall, was on an amendment 
offered by Senator Hatch--no technical

[[Page S11993]]

amendment--dealing with how to create a pathway for the Food and Drug 
Administration to approve follow-on biologics and how many years of 
exclusivity innovators should receive for their original product. We 
had a heated debate in the committee. It went on for a day or so. In a 
divided vote, the Hatch amendment was approved with bipartisan support 
for this very critical and important issue. No technical change, I 
might add, a significant part of this bill.
  Our legislation recognizes that we do best by our citizens when the 
public and private sectors work together. It has been our history in so 
many areas, not just in this area.
  Medicare, the ironclad commitment to take care of our seniors, dating 
back to 1965, when Members who preceded us in this Chamber, in a heated 
debate that went on for days, heated debate over whether we would have 
a health care program for seniors, decided not on a partisan vote but 
nearly as much, that there ought to be something called Medicare. It 
took the poorest sector of our population, the elderly, and lifted them 
out of poverty. Because we said: After their works on behalf of all of 
us, their defense of our Nation in two world wars, and their 
contribution coming out of a depression, we ought to be able to do 
better by them when it comes to their health care needs, Medicare was 
established. And despite what some critics have said, this legislation 
protects and strengthens Medicare. I hope even our friends who have 
taken to labeling government-run programs such as Medicare as socialist 
takeovers will join us in keeping this important promise to our 
seniors.
  Of course, Americans are justifiably proud of and happy with our 
workforce of dedicated health professionals, the doctors, specialists, 
primary care physicians, compassionate nurses, dedicated medical 
technicians, and family doctors all across the Nation who make a 
difference every single day in serving the people of our Nation. This 
legislation is designed to guarantee that you can get the care you need 
when you need it from the doctor you like. Meanwhile, it will help that 
physician spend less time filling out redundant paperwork and more time 
taking care of you and your family. It will help you spend less time 
fighting with your insurance company and more time getting better and 
getting back on your feet again.
  There are many things to like about our health care system in the 
United States. This legislation doesn't change them. There are many 
things that are wonderful about our health care system. I think it is 
important at the outset to acknowledge that and to understand, again, 
the quality of innovation that occurs, the compassionate work done by 
health care providers in every community. In my State, there are 31 
hospitals, all nonprofit hospitals, in the State of Connecticut. I have 
visited all of them over the years, but I have gone back recently and 
almost completed a round of going to see them all about this bill, 
sitting down with rural hospitals in northeastern Connecticut to major 
urban hospitals in Bridgeport and Hartford. I wish I could take 
everyone with me to see what everyone does. I know this is the case in 
other States where people do a remarkable job every day. If you show up 
in a hospital, they treat you. No one gets turned away. It is a 
wonderful thing about our health care system, the people who work in 
them every single day, reaching out to try and make a difference in the 
lives of these individuals, and how frustrating it is for these health 
care providers.
  I met with a group of ophthamologists in Hartford. One doctor was 
telling me how a family came to him the other night with a child that 
clearly needed a medical device and technology and knowing what a 
difference it could make for her. Yet that insurance company said: No, 
you can't do it; we don't provide that kind of coverage. The 
frustration that doctor expressed because he couldn't provide what that 
family needed. They didn't have the resources financially to pay for 
it, and they were being turned down. That child could not get that 
help. Under our bill that won't happen, if we can get this legislation 
done. Examples like that child happen every day across this great 
country of ours.
  The high cost of health care has bankrupted millions of families. The 
system, in many ways, despite its strengths, is broken in too many 
places as well. Without reform, health care will continue to eat up 
larger and larger shares of budgets--the Federal budget, State budgets, 
business budgets and, of course, family budgets. Budgets, particularly 
family and business budgets, are at breaking points. The high cost of 
health care has bankrupted millions of families, shuttered the doors of 
businesses, forced States to make impossible choices, and put 
unimaginable strain on the Federal bottom line. If we don't address the 
skyrocketing cost of health care, more and more families, more and more 
businesses could lose everything and our deficit will explode. As bad 
as it is today, it gets worse if we do nothing.
  That is the bigger picture. But the reality of our broken system can 
be captured by the tragedies that play out in American homes every 
single day. As we have discussed, tens of millions of our fellow 
citizens who don't have health insurance at all go to bed every single 
night knowing that if they wake up sick or their children wake up ill 
or in need of medical care, they might not be able to see a doctor to 
get the medical care they need. Many of these Americans don't have 
insurance because they can't get insurance, they have a preexisting 
condition, and no insurance company wants them on their rolls.
  There are even more Americans who do have insurance but can't be sure 
of anything these days when it comes to their health care. They are 
paying more and more in premiums, twice what they paid even a decade 
ago. Yet they are getting less and less and less coverage for their 
money. They lie awake at night wondering, what if I lose my job, as 
many have over these last number of weeks and months, what if I get 
sick and find out my policy doesn't cover the care I need or, even 
worse, my insurance company cancels my policy altogether. What if I run 
out of benefits and have to pay out of my pocket. These are not 
irrational fears. They are anything but irrational fears. Millions of 
our fellow citizens have them every single day, and these nightmares 
come true for far too many of our citizens. People lose their homes 
because they get sick. People die because they can't afford care.
  This does not happen to the 8 million of us who are Federal 
employees, all of us who serve in this body and the 435 who serve in 
the other body. Like all Federal employees, we have a special 
marketplace. Every year each one of us gets to choose from a long menu 
of insurance options. We sit down. We pick a plan that makes sense for 
us and our families, and we know the coverage we have chosen will be 
there when we need it. Every American should have the same opportunity 
as the people who represent them in the Halls of Congress. That is what 
our bill tries to do.
  For too long health insurance has been a seller's market. Depending 
upon where you live, you may or may not have more than one option or 
two options to choose from. Sometimes there aren't any good options at 
all. You pay whatever the insurance companies want to charge you, and 
you get whatever coverage they feel like giving you. You are covered 
only until they decide they don't want to cover you any longer. By the 
way, if you lose your job, or if you want to change your job, if you 
want to start a business, if you want to move, you could lose your 
coverage entirely.
  Our bill is designed to help you get a better deal and empowers every 
American family to pick the plan that works for them, creating a real 
marketplace, like the one Federal employees have, that members of 
congress have, with multiple insurance companies competing for your 
business and a real choice for you and your family. If you like what 
you have now, great, keep it. If you don't, you will have more and 
better options to consider. If you are one of the millions of uninsured 
Americans who has been denied coverage because of a preexisting 
condition, you will immediately have access to affordable coverage so 
that you will have insurance while this marketplace is being 
established. In that marketplace, you will finally have a chance to 
find affordable insurance that works for you and your family. No matter 
who you are or which plan you choose, you will have less expensive 
options. Insurance will be available regardless of your age or your 
health. And once you

[[Page S11994]]

have it, the insurance company won't be allowed to take it away. You 
stay covered even if you lose your job, even if you move, even if you 
get sick.

  On the day this bill is enacted, health insurance becomes a buyer's 
market, not a seller's market. That is as American as apple pie, having 
choices, good old competition out there. So little of it exists today. 
Our bill is designed to promote and create more of it. When businesses 
have to compete for your business, we all do better. Businesses do well 
and, obviously, the consumer has better choices. As other pieces of the 
legislation begin to take effect, our health care system will become 
less expensive and more responsive to the needs of the American people. 
Because American families and businesses literally can't afford more of 
the status quo, our bill makes health care more affordable.
  According to the Congressional Budget Office, if you are buying 
health insurance in the individual market under the senate bill, 
premiums may be up to 20 percent lower than equivalent coverage today. 
According to CBO, if you are buying health insurance in the individual 
market, you could see premium costs be as much as 20 percent lower than 
what they are today. If you are working for a small business, according 
to CBO, your premiums may be up to 11 percent lower than what they are 
today. And according to the Congressional Budget Office, if you work 
for a large employer, which five out of six Americans do, your premiums 
could be lowered by as much as 3 percent. In every single category--
individuals, small businesses, as well as large employers--premium 
costs come down under our bill, according to the Congressional Budget 
Office.
  Compare that to the status quo of doing nothing or defeating this 
bill. I can't speak for every State, but I suspect these numbers are 
probably pretty much true across the country. In Connecticut, in the 
year 2000, a family of four paid on average around $6 to $7,000 a year 
in health care premiums. Today that same family in my State, 9 years 
later, is paying over $12,000 for that same coverage. And if we do 
nothing in the coming days, those numbers will jump to around $24 to 
$25,000 in 7 years and as much as $35,000 in 10 years.
  Compare that with what we offer here in this bill. The CBO says we 
can actually lower premium costs in the individual market, the small 
group market, and the large group market. That is what is in this bill. 
That is why it is deserving of our support.
  Because investing in keeping people well is more cost effective than 
waiting to treat them when they get sick, this legislation puts a focus 
on prevention. Let me pay a particular tribute to Senator Tom Harkin, 
now chairman of the HELP Committee, who spent a long time on the 
prevention piece of this bill, as I know the Finance Committee did as 
well, combining efforts to encourage more effort in reducing the 
tremendous problems that are associated with four or five illnesses 
that consume about 70 or 75 percent of the health care dollar. You 
can't wipe them out altogether, but by working on prevention, dealing 
with obesity, smoking, cardiovascular problems, you can make a 
difference in those areas alone.
  I know my fellow members of the HELP Committee, we passed 
legislation--and my good friend Mike Enzi was a part of this and a 
strong supporter on the floor of this body--when for the first time in 
America history, the Food and Drug Administration can now regulate 
tobacco products. They can regulate mascara, cat food, dog food, men's 
cologne, all of those things get regulated, but tobacco did not. We 
changed that. We finally have regulation of the sale, marketing, and 
the production of tobacco products by the Food and Drug Administration. 
That is $180 billion a year in health-care related costs. Four hundred 
thousand people die every year from smoking-related products; 3,500 
young people today will start smoking in the United States; 1,000 will 
become addicted for life, 3,500 a day just in that one area. If we can 
reduce people's dependency on those products, if we can get people to 
quit, if we can stop children from starting in the first place, what a 
difference that can make for people all across the country. From 
diabetes screenings to quit smoking programs to mammograms, you will be 
able to get preventive care at no cost to you under this bill. That we 
do right off the bat so you can stay well even if your family is not 
wealthy.
  Because our seniors should be able to afford the prescriptions they 
need to stay healthy, this bill will shrink the Medicare Part D 
doughnut hole, giving seniors a 50-percent discount on medications. 
That is a huge savings to our people. Because 200 million American 
adults don't have insurance protection in place to handle the cost of 
long-term services and supports, our bill creates a new program that 
will give American families peace of mind, help working people who are 
also taking care of a loved one, and save Medicaid dollars in State and 
Federal budgets.
  Because we need our small businesses to do what they do best--create 
jobs--our bill alleviates their burden by providing a tax credit to 
help them cover the cost of providing health care to their employees, 
as so many of them want to do. And because a buyers' market depends on 
educated buyers, our bill will empower consumers by eliminating the 
fine print in insurance policies. You will be able to make an apples-
to-apples comparison when shopping for health insurance.
  Again, according to the Congressional Budget Office, families and 
businesses will save money because this new marketplace will bring down 
administrative costs, ensuring you get the most out of your premium 
payments and increased competition for your business--competition that 
is increased even further with a strong public option as well.
  The analysis confirms that if you like the plan the way it is, the 
bill explicitly provides that you will be able to keep it. In fact, 
just so we are clear, let me quote from the CBO, the Congressional 
Budget Office, analysis released today. I quote them:

       [I]f they wanted to, current policyholders in the nongroup 
     market would be allowed to keep their policy with no changes, 
     and the premiums for those policies would probably not differ 
     substantially from current-law levels.

  The CBO estimates that as the marketplace gets up and running, the 
deficit will go down by $130 billion in the first 10 years after this 
bill passes and by $650 billion more in the second decade.
  This bill lets you keep your insurance if you like it, this bill 
protects seniors, this bill gives families more choice, and this bill 
saves money.
  While I hope we can keep our facts straight, let me say at the outset 
that I expect this to be a full, open, and at times passionate debate 
in this Chamber, as it should be. This is an issue that represents a 
full one-sixth, as you have heard already, Madam President, of our 
economy, and it affects every single one of our citizens. Still, I 
understand that no matter how patiently and thoroughly we discuss this 
issue, some will, of course, insist we are attempting to rush through a 
piece of partisan legislation. Again, let's get our facts straight. 
Thus far, between the two committees responsible for drafting this 
bill, we have held more than 100 bipartisan meetings, devoted more than 
20 days toward the amendment process, considered more than 400 
amendments, and, despite what I have heard, we accepted 170 amendments 
offered by the minority, including some very substantive ones. Clearly, 
there were technical ones. I am not suggesting otherwise. But to 
suggest that all of these were such is not to portray an accurate 
picture of what occurred. The legislation we will now debate was made 
available online 72 hours before even a procedural vote was cast.
  Well, Madam President, I am committed to ensuring every Senator has 
the opportunity to offer his or her suggestions. That is what we did in 
our committee. It took a long time. But while people may not have been 
happy with the final outcome, I believe people ought to have an 
opportunity to be heard and their ideas to be vetted here and to 
engage, I hope, in a civil debate, a passionate but civil debate, not 
to engage in the ad hominem personal attacks that too often have 
contaminated debate but, rather, you ought to stand or fail based on 
the soundness of your ideas.
  My dear friend Ted Kennedy spent a lifetime, as I said at the outset 
of these remarks, fighting for every American's right for decent health 
care. It is a cause I know we all support. This is our chance to get it 
right.

[[Page S11995]]

  This moment calls for commonsense problem-solving that cuts the cost 
of health care, protects patient choice, and ensures every American 
gets the care they need when they need it, from the doctors and 
providers of their choice.
  This moment calls for compassion. We must finally hear the cry of the 
child whose ear infection goes untreated because his or her parents 
cannot find jobs and cannot afford a doctor; the voice of the small 
business owner who must choose between laying off workers and cutting 
off health benefits for them; the call of future generations who will 
see the rising tide of health care costs become a tsunami if we do not 
act in these days.
  Perhaps most of all, this moment calls for courage. This bill does 
not necessarily guarantee a tickertape parade or a lot of applause 
lines. There are some very tough choices in this bill.
  With the possible exception of the public option and a few other 
items, I suspect that if the roles were reversed here and we were 
sitting in the minority and our friends on the other side were in the 
majority, frankly, the bill we would be considering today might not be 
substantially different because, frankly, the options are not unlimited 
as to how to deal with costs and increased access and prevention. Yes, 
there are differences. I accept that and understand that. But the kinds 
of choices Senator Baucus and his committee made, and the ones we 
considered in our committee, were ones I believe most of my colleagues 
believe generally have to be dealt with: the quality of care, 
strengthening our workforce, dealing with the delivery system, 
increasing prevention and wellness in this country. What steps do we 
take? We can differ over this item or that, but I believe we generally 
believe these are items that must be part of a significant health care 
proposal. So I suspect these bills, were the roles reversed, might not 
be substantially different. It might not be that different.
  Perhaps most of all, it is important we find the means to come 
together. The road we are on, the status quo, leads to ruin, in my 
view, for our economy and for our fellow citizens. The road to reform 
is a long and difficult one, but we have taken so many unprecedented 
steps just to come to this place. It is time now to finish the job.
  So I am prepared--as I know our leader is and as I know my friend 
from Montana, the chairman of the Finance Committee, is, as are the 
members of that committee, as I believe most of our colleagues here--we 
would like a legacy to be left long after we have departed this Chamber 
that will say that in the first decade of the 21st century, when faced 
with the daunting challenge of doing something positive to increase the 
availability, increase the quality, and decrease the cost of health 
care in America, this Congress rose to the challenge and met its 
obligations. I feel optimistic we can achieve that.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, I have a few small matters here before I 
yield to my friend from Iowa.
  First, I cannot thank my colleague from Connecticut enough. He has 
worked so hard as the former chairman of the HELP Committee and now as 
a very active participant in the HELP Committee, along with Chairman 
Harkin. I cannot thank him enough. The Senator from Connecticut has 
worked on health care in such a constructive way. I deeply appreciate 
his efforts.
  Before I give up the floor, I wish to pay my strongest compliments to 
my colleague from Iowa, Senator Grassley. Senator Grassley is one heck 
of a guy. He represents his State, in my judgment, very, very well. As 
I am sure the Presiding Officer knows--certainly my colleague from 
Connecticut knows--we have worked very closely together, Senator 
Grassley and I, on a nonpartisan basis as much as we possibly can 
because we both think--and I know most people think--good legislation 
is legislation where you work together, not where you are fighting each 
other.
  Senator Grassley and I started out trying to get this bill put 
together on a bipartisan basis working together. As it turned out, we 
did not quite get there. But I know in the end he would very much like 
to find a way to vote for health care reform, as most Members of the 
Senate would.
  I am an optimist. I think most of us in this body are optimists. I 
have not given up yet. Who knows how this is going to evolve? Who knows 
what the amendments are going to be? Who knows what the votes are going 
to be in the next several weeks or so? But I am looking for an 
opportunity where Senator Grassley and other very constructive Senators 
will join us, all together, in a way, with a little give and take here, 
perhaps, to find a solution.
  So I just want to end by saying how much I appreciate the Senator. He 
does a super job.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Madam President, I thank the Senator from Montana for 
his kind remarks. He does describe the situation very well, 
particularly one where there was a very close working relationship 
during the summer and up until the middle of September, when people in 
this body felt we were not moving fast enough to get a product before 
the body, and so some of us were shoved to the side, not by Senator 
Baucus but by other people in this body.
  I also compliment Senator Dodd from this standpoint--that as I look 
at this 2,074-page bill we call health care reform, that as he 
described parts of this bill, I think you get a broad consensus that 
the things he talked about should be done. But that does not describe 
everything in this bill and it does not describe the opposition that 
comes to a certain part of this bill now, not only by Members of the 
body, but if you follow polls and town meetings around the country, you 
find a lot of the people are having second thoughts about the words 
``health care reform.''
  I would suggest to you, if you were in a coffee shop in any small 
town of the United States and they were talking about health care 
reform, and I came into that coffee meeting and I said: The bill before 
the U.S. Senate is going to raise premiums, it is going to raise taxes, 
it is going to take hundreds of billions of dollars out of Medicare, 
and it is not going to do anything about the inflation of health care, 
I will bet you that people at the end of that would say: Well, that 
doesn't sound like health care reform to me.
  Even though Senator Dodd describes a lot of things that are neither 
Democratic nor Republican nor even bipartisan, there is kind of a 
consensus that these things ought to be done. He describes it 
accurately. But, still, a lot of goals that were sought by those of us 
who were negotiating these things over a period of several months--that 
we ought to have it be revenue neutral--and on the 10-year budget 
window, it is revenue neutral. But, remember, that is 10 years of 
increased taxes and 6 years of program to make that happen. So you 
raise the question, if it was 10 years of expenditures and 10 years of 
income, would it be revenue neutral? Well, obviously not. And it does 
not do anything about health care inflation. Those are two goals that 
were sought over a long period of time. This 2,074-page bill does not 
do that.
  I believe the people of the United States think our country has the 
best doctors and nurses in the world. But as Senator Dodd pointed out, 
there is widespread agreement that the health care system in America 
does have problems. Costs are rising three times the rate of inflation. 
Americans are uninsured. Millions more fear losing their insurance in a 
weak economy and because of preexisting conditions. Doctors are ready 
to close their doors over high malpractice costs and low government 
reimbursement. So everybody says we need health care reform. Everybody 
agrees on that very much.
  But, today, the Senate begins debate on a bill--2,074 pages--that 
would make a bad situation worse. It is unfortunate that early efforts 
to reach bipartisan solutions in Congress deteriorated into leadership-
driven, partisan exercises.
  The bills in Congress slide rapidly down the slippery slope to more 
and more government control of health care. They contain the biggest 
expansion of Medicaid since it was created 43 years ago. They impose an 
unprecedented Federal mandate for coverage, backed by enforcement 
authority of the Internal Revenue Service. They increase the size of 
government by $2.5 trillion when fully implemented. They give the 
Secretary of Health and

[[Page S11996]]

Human Services extraordinary powers to actually define benefits for 
every private health plan in America and to redefine those benefits 
annually. They create dozens of new Federal bureaucracies and programs 
to increase the scope of the Federal Government's role in health care. 
That is a lot of power over people's lives, and it is concentrated here 
in Washington, DC, in the Federal Government.
  The excesses of the bill appear willfully ignorant of what is going 
on in the rest of the economy outside of health care. These excesses 
make the bill far worse than doing nothing.
  At this point in our Nation's history, we are a nation facing very 
challenging economic times--some people would say the great recession, 
not quite the Great Depression; other people would say the worst 
recession we have had since 1982. What have we seen? We have seen the 
auto industry go into bankruptcy. We have seen banks shutter their 
doors.

  I have a chart that is up. We call it the wall of debt chart. The 
Federal debt has increased by $1.4 trillion just since inauguration. 
This chart shows the growing amount of debt the Federal Government is 
taking on. The amount of increased debt added just since the 
inauguration is $11,500 per household. It now exceeds $12 trillion for 
the first time in history.
  Within 5 years, the Obama administration's policies will more than 
double the amount of debt held by the public, and by 2019 it will more 
than triple the debt. That is not according to this Senator but 
according to the Congressional Budget Office and the White House Office 
of Management and Budget. Already, foreign holdings of U.S. Treasurys 
stands at nearly $3.5 trillion or 46 percent of the Federal debt held 
by the public. In other words, people outside of this country are 
holding 46 percent of our Federal debt.
  At the beginning of this debate, one of the key promises of health 
care reform was--and I said this previously, but I will repeat it now--
that it would bring down Federal health costs. This needs to be done 
before health spending sinks the Federal budget and saddles the 
taxpayer.
  I have another chart, a health spending chart or, more accurately, a 
Federal health spending chart. As this chart illustrates, this bill 
bends the Federal spending curve further upward by $160 billion over 
the next decade. The red area of this chart, emphasizing the red area 
of the chart, shows net additional Federal health spending--again, not 
according to this Senator but according to the Congressional Budget 
Office.
  Americans have rightly lost faith when, in the face of the current 
economic crisis--the ``great recession''--Congress thinks this $2.5 
trillion restructuring of our health care system is a good idea.
  The Reid bill also includes a government-run plan. A government-run 
plan would drive private insurers out of business and lead to a 
government takeover of the health care system. From rationing health 
care to infringing on doctor-patient relationships, a government-run 
system would guarantee U.S. taxpayers a staggering tax burden for 
generations to come.
  The government cannot be a regulator, a funder, and a competitor at 
the same time without doing a great deal of damage to what the private 
sector has been doing for 60-some years. A government-run plan is not 
necessary for health care reform unless perchance the goal is to put in 
place the power of the Federal Government to drive down costs by--how? 
Not just driving them down but the consequences of that: rationing care 
and slashing payments to providers. These problems are bad enough, but 
much worse is that this bill--this bill--fails to solve the fundamental 
problems in health care. None of them take serious steps to reduce 
costs in health care.
  The bills will cause health care premiums for scores of people to go 
up, not down. An analysis just released this very day by the 
Congressional Budget Office confirms our worst fears about the impact 
this bill will have on people's health insurance premiums. According to 
the Congressional Budget Office, the new benefit mandates and 
regulatory changes will actually increase costs of nongroup health 
insurance for individuals and families by 10 to 13 percent. That means 
millions of people who are expecting lower costs as a result of health 
care reform will end up paying more in the form of higher premiums. For 
large and small employers that have been struggling for years with 
skyrocketing health insurance premiums, the Congressional Budget Office 
concludes this bill will do little, if anything, to provide relief.
  In fact, they cover their increased premiums they cause by spending 
even more on subsidies because of the increased premiums. So what 
happens? They do this by handing over close to $500 billion in hard-
earned taxpayer dollars directly to health insurance companies. That 
sure doesn't sound as though this bill is actually reforming the 
market. The nonpartisan Congressional Budget Office analysis makes 
clear the Reid bill is not fixing the problem.
  The Reid bill also imposes new fees and taxes that will be pushed 
directly to the consumer. These new fees and taxes will total about 
one-half trillion dollars over the next few years. On the front end, 
these fees and taxes will cause premium increases beginning next year 
when they go into effect, and those new fees increase premiums--for 4 
years; they are there for 4 years--before most of the reforms take 
effect in 2014.
  Then after forcing health premiums to go up, the legislation makes it 
mandatory to buy health insurance. Let's think about mandatory health 
insurance. The Federal Government is a government of limited powers 
under the 10th amendment. To my knowledge--and I think I know a lot 
about U.S. history--never in 225 years has the Federal Government said 
you had to buy anything. You don't have to buy--you buy what you want 
to buy in America, but not when this 2,054-page bill goes into effect. 
Then you will buy health insurance.
  Somebody is going to throw at us: Well, the States make you buy car 
insurance, and probably most States do. My State of Iowa does. But 
under the 10th amendment, the State governments have a lot of power the 
Federal Government doesn't have.
  The Reid bill also makes problematic changes to Medicare. It imposes 
higher premiums for prescription drug coverage on seniors and the 
disabled. The Reid bill creates a new independent Medicare board with 
broad authority to make further cuts in Medicare, and this bill makes 
that commission permanent. The damage this group of unelected people 
could do to Medicare is, in fact, unknown.
  What is more alarming is that so many providers got exempted--they 
have political power, so they got exempted from the cuts this board 
would make--that it forces the cuts. Then what happens? They fall 
directly and disproportionately on seniors and the disabled.
  Sooner or later, it has to be acknowledged that by making this board 
permanent, those savings are coming more and more--are going to bring 
more and more cuts to Medicare. That is a good example of the 
philosophical differences between the two sides in this body, and as 
the country divides itself more against this 2,054-page bill than for 
it, but still a large number of people in America support going in this 
direction. So those are philosophical differences between the two 
sides.
  There are alternatives. Some of us want to reduce the overall cost of 
the legislation. We want to try to reduce the pervasive role of 
government, make it harder for undocumented workers to get benefits, 
allow alternatives to the individual mandate and harsh penalties, and 
add medical malpractice reforms. I bring a little bit of emphasis to 
medical malpractice reform because at my town meetings throughout this 
past year and particularly during the month of August people would say: 
Why don't you first try to save money in health care costs by taking on 
the lawyers and doing medical malpractice reform? But, instead, the 
prevailing view is to move millions of people from private coverage 
into public coverage and create new government programs that cover 
families making close to $90,000. Yet, even with all of these changes, 
after raising one-half trillion dollars in new taxes, cutting one-half 
trillion dollars in Medicare, imposing stiff new penalties for people 
who don't buy insurance, and increasing costs for those who do--after 
all of these changes, the Congressional

[[Page S11997]]

Budget Office says there are still 24 million people who will not have 
health insurance under the Reid bill.
  I don't think this is what the American people had in mind when the 
President and the Congress promised to fix the health care system.
  It is not too late for bipartisan legislation, so I have the hope 
that Senator Baucus just expressed before I spoke that builds on common 
ground to improve coverage, affordability, increased quality, and 
decreased costs. So here are some more alternatives. I have worked for 
years on bipartisan legislation that would transform Medicare from 
paying for volume of services provided to the quality of care 
delivered. There is also widespread support for stronger rules on 
insurance companies to make coverage more affordable and accessible, 
especially for small businesses and for people who aren't offered 
coverage by their employers, and for reforms to stop denials of 
coverage due to preexisting conditions. Tort reform would reduce 
abusive lawsuits that drive up costs and surely limit access to 
doctors. The nonpartisan Congressional Budget Office estimates that 
comprehensive medical liability reform would reduce Federal budget 
deficits by roughly $54 billion over the next 10 years. It would save 
even more when nonfederal health spending is taken into account. That 
would mean lower premiums for individuals and families.

  So far the Democratic leaders in Congress have little interest in 
creating an environment where doctors don't have to engage in defensive 
medicine just to keep their practices open because somebody might sue 
them. The medical community should continue to make the case for 
reasonable reforms that will cut down on unnecessary medical tests that 
serve no purpose except to reduce malpractice premiums and to protect 
against frivolous lawsuits.
  On several occasions, Republicans tried to take the legislative 
substance in a whole different direction. We tried to ensure the 
President's pledge not to tax middle-income families, seniors, and 
veterans was carried out. However, we were rebuffed at every step of 
the way. Republicans' efforts to provide consumers with a lower cost 
benefit option were consistently defeated. That means despite the 
promise, a lot of people are not actually going to be able to keep what 
they have as they were promised in the last Presidential campaign.
  The Democratic leaders in Congress are advancing their extremist 
health care reform bills with a bare minimum of votes to do the job. I 
disagree with that approach. Health care is one-sixth of the economy. 
That is as large as the entire British economy. The legislation 
Congress is considering will affect every American at every level of 
health and at every stage of employment. When the debate began last 
year--in fact, it was just this month of November that I remember 8 or 
10 of us from different committees met with a solemn pledge. We were 
going to work together in a bipartisan way to get this job done. We met 
again for the next 6 months several times, but it just didn't work out.
  But when that debate began last year, interested legislators of both 
parties set benchmarks that were no-brainers:
  Health care reform should lower the cost of premiums. It should 
reduce the deficit. It should bend the growth curve in health care the 
right way--downward. The Reid bill doesn't do any of these things.
  It is not too late to start over. I guess Senator Baucus has put 
forth that invitation. I hope it materializes. If both sides can set 
aside some philosophical differences, and if the Democratic leaders are 
willing to refocus on the principles that brought us to the table 
months ago, I believe we can produce health care reform that improves 
the quality of life for Americans who are suffering under the current 
health care system and doesn't degrade the quality of life for everyone 
else.
  But it is not the entirety of this 2,074-page bill. These issues can 
be addressed without upending the entire health care system, with the 
result of higher taxes, higher insurance premiums, and deficits and 
debt that will get in the way of opportunities that result from the 
ingenuity and productivity and industry of the American people.
  I get back to that coffee shop meeting, where people are discussing 
health care reform. As I walk into that coffee meeting and I tell them 
that this 2,074-page bill increases taxes, increases premiums, takes 
400 or more billion dollars out of Medicare, and it doesn't do anything 
about controlling costs, according to the Congressional Budget Office, 
that group again will say: That doesn't sound like health care reform 
to me.
  As we start this debate this week, I urge my colleagues to listen to 
the American people. The Reid bill is in the wrong direction.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.


                            Motion to Commit

  Mr. McCAIN. Madam President, I ask unanimous consent to send to the 
desk at this time a motion to commit with instructions.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report the motion.
  The legislative clerk read as follows:

       The Senator from Arizona [Mr. McCain] moves to commit the 
     bill H.R. 3590 to the Committee on Finance with instructions 
     to report the same back to the Senate with changes that do 
     not include the following:

       (1) Medicare Advantage cuts totaling -$118.1 billion.
       (2) Medicare Advantage payment changes totaling -$1.9 
     billion.
       (3) Provider cuts totaling -$150.0 billion.
       (4) The establishment of the Independent Medicare Advisory 
     Board totaling -$23.4 billion.
       (5) Reporting requirements for long-term care hospitals, 
     inpatient rehabilitation hospitals, and hospice programs 
     totaling -0.2 billion.
       (6) Penalties to hospitals totaling -1.5 billion.
       (7) The expansion of CMS spending totaling -1.3 billion
       (8) A Medicare shared savings program totaling -4.9 
     billion.
       (9) Hospital penalties totaling -7.1 billion.
       (10) A revision to the Medicare Improvement Fund totaling 
     -22.3 billion.
       (11) Home health care cuts totaling -42.1 billion.
       (12) Hospice payment changes totaling -0.1 billion.
       (13) Medicare disproportionate share hospital payments 
     changes totaling -20.6 billion.
       (14) Cuts to advanced imaging services totaling -3.0 
     billion.
       (15) A revision of the payment for power-driven wheelchairs 
     totaling -0.8 billion.
       (16) Cuts for certain medigap plans totaling -0.1 billion.
       (17) A reduction in the part D premium subsidy for high-
     income beneficiaries totaling -10.7 billion.
       (18) Outpatient prescription drug cuts in long-term care 
     facilities totaling -5.7 billion.
       (19) Changes to preventive services in Medicare totaling 
     -0.7 billion.
       (20) A limitation on the Medicare exception to the 
     prohibition on certain physician referrals for hospitals 
     totaling -0.7 billion.
       (21) Comparative effectiveness research totaling -0.3 
     billion.
       (22) The elimination of indexing for part B premiums 
     totaling -25.0 billion.
       And reflects the Sense of the Senate that any savings to 
     the Federal Hospital Insurance Trust Fund under section 1817 
     of the Social Security Act (42 U.S.C. 1395i) and the Federal 
     Supplementary Medical Insurance Trust Fund under section 1841 
     of such Act (42 U.S.C. 1395t) by reason of the provisions of, 
     and amendments made by, sections 6401, 6405, 6407, and 6410 
     should be used to strengthen the Medicare program under title 
     XVIII of such Act.

  Mr. McCAIN. Madam President, simply put, this motion to commit would 
be a requirement that we eliminate the one-half trillion dollars in 
Medicare cuts that are envisioned by this bill--one-half trillion 
dollars in cuts that are unspecified as to how, and one-half trillion 
dollars in cuts that would directly impact the health care of citizens 
in this country--Medicare Advantage cuts totaling $118 billion; an 
independent Medicare advisory board that would cost $23 billion; an 
expansion of Medicare hospital penalties totaling $7.1 billion; home 
health care cuts totaling $42.1 billion; and hospice--of all the 
things--payment changes. The list goes on and on.
  All of these are cuts in the obligations we have assumed and that are 
the rightful benefits people have earned--particularly our senior 
citizens--across this Nation. This eliminates one-half trillion dollars 
in cuts to Medicare that are cuts that are unspecified.
  I eagerly look forward to hearing from the authors of this 
legislation as to how they can possibly achieve one-half trillion 
dollars in cuts without impacting existing Medicare programs negatively 
and eventually lead to rationing of health care in this country.

[[Page S11998]]

That is what this motion is all about. This motion is to eliminate 
those unwarranted cuts. All of us know there are enormous savings in 
fraud, abuse, and waste that can be identified. No expert I know of 
believes that would come up to one-half trillion dollars. Hospitals are 
cut by $105 billion. Nursing homes are cut by $14.6 billion. Hospices 
are cut by $7.6 billion.
  These are not attainable cuts, without eventually rationing health 
care in America and rationing health care for our senior citizens, who 
have earned these benefits, and we have guaranteed them these benefits.
  For the life of me, how the AARP can support this 2,000-page 
legislation is beyond my imagination. Seniors all over America, 
including Arizona, including the 330,000 senior citizens in my State 
who are under the Medicare Advantage Program, which will be drastically 
cut by some $120 billion, are outraged. The more they find out about 
it, the more angry they are becoming.
  Here we are, as my colleague from the great State of Iowa, a leader 
on health care, articulated, with a totally partisan measure before the 
Senate, in which no Member on this side of the aisle has been consulted 
in any way. I point out that, historically, there has never been a 
major reform implemented by the Congress of the United States unless it 
is bipartisan in nature, and I don't believe the American people want 
this 2,000-some-page monstrosity, which is full of all kinds of 
provisions that they are either unaware of, or even in the study of 
this legislation, many of us have also become unaware of. But 
fundamentally, the Bernie Madoff/Enron accounting that has been going 
on with this bill is dependent upon envisioning one-half trillion 
dollars in cuts that are not attainable. If they are attainable, it 
would mean a direct curtailment and reduction of the benefits we have 
promised the senior citizens of this country. That is not acceptable.
  What this motion to commit does is send it back to the Finance 
Committee: Come back with another bill. Only this time, don't put the 
cost of it on the backs of senior citizens of this country. Don't do 
it. It was back last summer, 3 months before he was elected President, 
on a campaign stop not far from Washington, DC, now-President Obama 
vowed not only to reform health care but to do it in a new way. He 
said:

       I am going to have all the negotiations around a big table, 
     televised on C-SPAN, so that people can see who is making 
     arguments on behalf of their constituents and who are making 
     arguments on behalf of the drug companies or the insurance 
     companies.

  Americans wanted to believe this would be true. Republicans offered 
to work with the majority on our ideas. But that was rejected. So what 
has happened? Business as usual. Let me read from a report of this past 
weekend about business as usual:

       The Associated Press has moved a story saying that health 
     care lobbyists and other interests have made 575 visits to 
     the White House between January and August. The report is 
     based on records released by the White House on Wednesday.
       The timing of the release smells of a classic Washington 
     tactic--dumping bad news on the getaway day before a long 
     weekend. Clearly, the White House, which prides itself as 
     being the most transparent administration in the history of 
     the world, hopes this nugget gets lost over the four-day 
     Thanksgiving weekend.

  AP's Sharon Theimer:

       Top aides to President Barack Obama have met early and 
     often with lobbyists, Democratic political strategists and 
     other interests with a stake in the administration's national 
     health care overhaul, White House visitors records obtained 
     Wednesday by the Associated Press show.

  All of my fellow citizens watching, I urge you to call the White 
House and say you want to have an appointment to meet with the 
President or members of the administration in the White House. Five-
hundred-seventy-five special interests were able to get in. Why can't 
you? Give them a call. Tell them you want to meet with the members of 
the administration. That is what 575 lobbyists have been able to do. 
Give them a call.
  Continuing to quote:

       The records show a broad cross-section of the people most 
     heavily involved in the health care debate [except for 
     average citizens] weighted heavily with those who want to 
     overhaul the system.

  It talks about who were among them.

       The list also includes George Halvorson, chairman and CEO 
     of Kaiser Health Plans; Scott Serota, president and CEO of 
     Blue Cross and Blue Shield Association; Kenneth Kies, a 
     Washington lobbyist who represents Blue Cross/Blue Shield, 
     among other clients; Billy Tauzin, head of PHARMA, the drug 
     industry lobby; and Richard Umbdenstock, chief of the 
     American Hospital Associations.
       Several lobbyists for powerful health care interests, 
     including insurers, drug companies, and large employers also 
     visited the White House complex, the records show.

  Again, citizens, why don't you call the White House and ask for an 
appointment? The lobbyists and special interests--big donors--get it. 
They are not ambassadors. They are lobbying the White House on this 
issue.
  Health care reform should have been about both sides sitting down 
together and fixing what is broken, reducing health care costs, while 
preserving the highest quality health care in the world.
  Somewhere in the course of this debate, in the process of this 
legislation, we have lost sight of the fundamental problem with health 
care in America, and that is the cost of health care in America, not 
the quality. This legislation will destroy the quality and the 
availability, if the cuts envisioned in this legislation--this Enron 
accounting measure, where the first 4 years after this legislation--
suppose this legislation were signed on the 1st of January by the 
President of the United States. Immediately benefits will begin being 
cut. Immediately taxes will go up. Guess what. None of the benefits 
will be given to any American citizen for 4 years. That is how you get 
deficit neutrality. That is how you get deficit neutrality.
  If you started giving the benefits at the same time you raise the 
taxes, you have got about $1.3 trillion in deficit in a $2.5 trillion 
bill--a $2.5 trillion piece of legislation. Here we are with the 
highest deficits in history, with deficits and debt as far as the eye 
can see, with a stimulus package that has done so well that we now have 
10.2 percent unemployment, and many predict it will go even higher. 
Wall Street is doing fine, and lobbyists are doing fine. Mr. Tauzin, 
the PhRMA lobbyist, is doing fine. I understand his salary is a couple 
million dollars a year, not to mention all the other perks. But the 
average citizen, including the 330,000 citizens of my State, who have 
the Medicare Advantage Program, are going to see it cut and cut over 
and over again--about $120 billion worth.
  So what happened? The White House engaged in the tradition of handing 
out favors to special interests, including PhRMA, AARP, and AMA. Shame 
on AARP and shame on the AMA. We know there are many commonsense 
reforms that Americans want.
  By the way, in this monstrosity, find me any significant, real 
medical malpractice reform. The threat of medical malpractice causes 
physicians to practice defensive medicine. The CBO estimates it would 
be roughly a savings of $54 billion over 10 years. That does not take 
into consideration the cost of defensive medicine that doctors have to 
practice because of fear of being sued.
  I ask the distinguished chairman of the committee: Where is any 
meaningful medical malpractice reform in this 2,000-page bill? Where is 
it?
  I had a townhall meeting the other day in Arizona, as I do quite 
frequently. There were a lot of doctors, nurses, and caregivers who 
came. I asked them: What do you do about medical malpractice reform? 
Every one of them said: We practice defensive medicine. We prescribe 
additional tests and procedures. We have to do it because we will find 
ourselves in court by the trial lawyers.
  Do not underestimate, I say to my friends, the many special interests 
and their influence in this legislation, but do not underestimate the 
stunning success of the American Trial Lawyers Association that has 
made sure there is no provision in this bill that has to do with 
medical malpractice reform.
  By the way, if there is an example, it is called the State of Texas. 
The State of Texas enacted meaningful and yet not draconian medical 
malpractice reform. Premiums have gone down. Cases have gone down. 
Doctors are flooding back into the State of Texas. It has worked.
  We are going to hear from the other side that there may be 
demonstration projects, there may be this, there may be that. The 
demonstration project is the State of Texas. That is all we have to do. 
It has already been proven.

[[Page S11999]]

  Instead of a reform which could save tens if not a couple hundred 
billion dollars, what are we going to do? We are going to cut hospitals 
by $505 billion, nursing homes by $14.6 billion, hospices by $7.6 
billion, and the list goes on and on, up to one-half trillion dollars. 
My motion will send it back to the Finance Committee and tell them to 
remove these unnecessary, unneeded, unwanted, harmful cuts in the 
Medicare system, which will not allow us to fulfill our obligation to 
the senior citizens of this country.
  Buried in this partisan legislation, as I mentioned, are 10 years of 
tax increases and Medicare cuts, a total over $1 trillion. Using CBO 
numbers, this stack of partisan legislation costs $2.5 trillion over 
its 10-year implementation.
  Let me put this in different terms for you. Suppose you want to buy a 
house. You go and buy the house, but the terms of the contract of 
purchasing the house say you have to make payments on the house for the 
first 4 years and then after 4 years you can move in. That is why this 
is Bernie Madoff accounting. It is a sham. It is a sham. It is a sham 
to make people pay taxes and have their benefits cut for 4 years and 
then only after 4 years do the benefits kick in. That is the way, with 
this kind of accounting, they get to deficit neutral. It is crazy. It 
is crazy.
  The increased taxes and Medicare cuts begin impacting Americans and 
our economy in 32 days, if this is passed. Let me repeat this. Starting 
in January 2010, just 1 month from now, the majority begins tax 
increases and Medicare cuts, starting in January, and incredibly delays 
implementation of this bill for 4 years. That is 1,460 days and 208 
weeks of new taxes and Medicare cuts before implementation. That is 
playing games with the American people.
  If they were not playing games by delaying implementation of the bill 
4 years after the tax increases and Medicare cuts, we would not even be 
discussing this pile of legislation because it would be scored as 
adding over $1 trillion to our deficit.
  If the other side wanted to be honest and reject the Madoff-Enron 
accounting, they would be talking about the first 10 years of real 
costs and the first 10 years of their tax increases and Medicare cuts.
  The respected dean of the Washington press corps, David Broder, 
pointed this out just last week in his column in the Washington Post 
entitled ``A Budget-Buster in the Making.'' By the way, the majority 
leader then felt compelled to come down and trash one of the most 
respected columnists in America whom I don't need to take the time to 
defend; he can defend himself and so will many others who have great 
respect for David Broder.
  David Broder's column said:

       It's simply not true that America is ambivalent about 
     everything when it comes to the Obama health plan.
       The day after the Congressional Budget Office gave its 
     qualified blessing to the version of health reform produced 
     by Senate Majority Leader Harry Reid, a Quinnipiac University 
     poll of a national cross section of voters reported its 
     latest results.
       . . . by a 16-point margin, the majority in this poll said 
     they oppose the legislation moving through Congress.

  Broder went on to say:

       I have been writing for months that the acid test for this 
     effort lies less in the publicized fight over the public 
     option or the issue of abortion coverage than the 
     plausibility of its claim to be fiscally responsible.
       This is obviously turning out to be the case. While the CBO 
     said that both the House-passed bill and the one Reid has 
     drafted meet Obama's test by being budget-neutral, every 
     expert I have talked to says that the public has it right. 
     These bills, as they stand, are budget-busters.
       Here, for example, is what Robert Bixby, the executive 
     director of the Concord Coalition, a bipartisan group of 
     budget watchdogs, told me: ``The Senate bill is better than 
     the House version, but there's not much reform in this bill. 
     As of now, it's basically a big entitlement expansion, plus 
     tax increases.''
       These are nonpartisan sources, but Republican budget 
     experts such as former CBO director Douglas Holtz-Eakin 
     amplify the point with specific examples and biting language. 
     Holtz-Eakin cites a long list of Democratic-sponsored 
     ``budget gimmicks'' that made it possible for the CBO to 
     estimate that Reid's bill would reduce federal deficits by 
     $130 billion by 2019.
       Perhaps the biggest of these maneuvers was Reid's decision 
     to postpone the start of subsidies to help the uninsured buy 
     policies from mid-2013 to January 2014--long after taxes and 
     fees levied by the bill would have begun.
       Even with that change, there is plenty in the CBO report to 
     suggest that the promised budget savings may not materialize. 
     If you read deep enough, you will find that under the Senate 
     bill, ``federal outlays for health care would increase during 
     the 2010-2019 period''--not decline. The gross increase would 
     be almost $1 trillion--$848 billion, to be exact, mainly to 
     subsidize the uninsured. The net increase would be $160 
     billion.
       But this depends on two big gambles. Will future Congresses 
     actually impose the assumed $420 billion in cuts to Medicare, 
     Medicaid and other federal programs? They never have.

  Why don't we tell the truth to the American people and take these 
supposed cuts out of this bill? Tell them the truth about what it costs 
and tell them the truth that this is a dramatic expansion of 
entitlements, but at the same time those presently eligible, those 
senior citizens, such as the 330,000 who are under the Medicare 
Advantage Program in my home State of Arizona, will not see that 
program maintained. You cannot reach these kinds of savings, these 
kinds of reductions, these kinds of cuts without impacting existing 
programs. I know of no expert who says it will who is an objective 
observer. I believe Dr. Coburn, Dr. Barrasso, and others in the medical 
profession will say the same thing. Every time Congress has enacted so-
called cuts in Medicare or contemplated it, they have never taken 
place.
  That doctor fix? We took care of that problem. We just took it out of 
the bill. But you know what we are going to do about the doctor fix. 
Every year we are going to delay it, delay it and delay it and it will 
never happen. That has been the history of the so-called doctor fix 
since its beginning.

       And will this Congress enact the excise tax on high-premium 
     insurance policies (the so-called Cadillac plans) in Reid's 
     bill? Obama has never endorsed them, and House Democrats--
     reacting to union pressure--turned them down in favor of a 
     surtax on millionaires' income.
       The challenge to Congress--and to Obama--remains the same: 
     Make the promised savings real, and don't pass along unfunded 
     programs to our children and our grandchildren.

  That means taking this legislation back, taking out these cuts in 
Medicare and programs that are vital to the citizens of this country 
and come back with a realistic--a realistic--piece of legislation that 
has malpractice reform, the ability to go across State lines to get the 
health insurance policy of your choice, rewards for wellness and 
fitness, expansion of health savings accounts, and medical malpractice 
reform.
  There are many cost-saving measures we can enact to bring the cost of 
health care in America under control and preserve quality. Instead, we 
are doing the opposite.
  If you are going to make these kinds of cuts--the $420 billion in 
cuts to Medicare and Medicaid and other Federal health programs--then 
you are going to impact the provision of health care in America.
  Americans have been clear overspending has to stop, nor do the 
American people believe empowering Washington bureaucrats in a new 
Federal health care entitlement is health care reform. The other side 
disregards the message from the American people all across the country, 
and the bill does the opposite.
  I wish to talk just for a minute about a provision in this bill that 
is very important; that is, the transfer of power, the massive transfer 
of power in this bill to the Secretary of Health and Human Services. 
This is a huge transfer. ``HHS would become federal giant under Senate 
plan'' by Susan Ferrechio:

       A quick search of the Senate health bill will bring up 
     ``secretary'' 2,500 times.
       That's because Health and Human Services Secretary Kathleen 
     Sebelius would be awarded unprecedented new powers under the 
     proposal, including the authority to decide what medical care 
     should be covered by insurers as well as the terms and 
     conditions of coverage and who should receive it.

  I wish to repeat that. In this bill, the Secretary has the 
``authority to decide what medical care should be covered by insurers 
as well as the terms and conditions of coverage and who should receive 
it.''
  We saw a little precursor of that the other day with, for example, 
recommendations concerning mammograms. A board recommended that women 
under 50 should not get routine

[[Page S12000]]

mammograms. Of course, the response was incredible and justified. Women 
all over America are now alive today because they had mammograms prior 
to the age of 50. The Secretary of Health and Human Services said that 
would not be carried out, et cetera. We are creating a situation where 
the Secretary of Health and Human Services and a board would decide 
that.

       ``The legislation lists 1,697 times where the Secretary of 
     Health and Human Services is given the authority to create, 
     determine or define things in the bill,'' said Devon Herrick, 
     a health care expert at the National Center for Policy 
     Analysis.
       For instance, on Page 122 of this 2,079-page bill, the 
     secretary is given the power to establish ``the basic per 
     enrollee, per month cost, determined on average actuarial 
     basis, for including coverage under a qualified health care 
     plan.''
       The HHS secretary would also have the power to decide where 
     abortion is allowed under a government-run plan, which has 
     drawn opposition from Republicans and some moderate 
     Democrats.
       And the bill even empowers the department to establish a 
     Center for Medicare and Medicaid Innovation that would have 
     the authority to make cost-saving cuts without having to get 
     the approval of Congress first.
       ``It's a huge amount of power being shifted to HHS, and 
     much of it is highly discretionary,'' said Edmund Haislmaier, 
     an expert in health care policy and insurance markets at the 
     Heritage Foundation, a conservative think tank.
       Haislmaier said one of the greatest powers HHS would gain 
     from the bill is the authority to regulate insurance. States 
     currently hold this power, and under the Senate bill, the 
     federal government would usurp it from them. This could lead 
     to the federal government putting restrictions and changes in 
     place that destabilize the private insurance market by 
     forcing companies to lower premiums and other charges, he 
     said.
       ``Health and Human Services doesn't have any experience 
     with this,'' Haislmaier said. ``I'm looking at the potential 
     for this whole thing to just blow up on people because they 
     have no idea what they are doing. Who in the Federal 
     Government regulates insurance today? Nobody.''
       ``The health care reform legislation would rely on the U.S. 
     Preventive Services Task Force for recommendations as to what 
     kind of screening and preventive care should be covered. Last 
     week, the group, which operates under HHS, drew sharp 
     criticism for advising that mammograms should begin at age 
     50, a decade later than the current standard.''
       ``Critics of the bill said this was an example of how the 
     new bill could empower HHS to alter health care delivery, but 
     Democrats argue they would rather have the government making 
     these decisions.''

  That is the key to it. They would rather have the government making 
these decisions. If you like the way the post office is run, you will 
love the way HHS runs health care in America.
  I understand the amendment of the other side may address some of 
this, but under the Reid bill the Senate moved to consider, beginning 
in 32 days, the language from the bill on page 1,189 authorizes the 
Secretary to modify benefits under Medicare pursuant to task force 
recommendations. As I mentioned, how many women would have died if the 
coverage provisions guiding the new Federal plan under mammograms had 
been implemented? Then, on the following page, 1,190, the Secretary is 
authorized to deny payment for prevention services that the task force 
recommends against. So if this unelected panel changes the preventive 
recommendation for some other type of cancer, the Federal Government 
plan would not cover it. I don't think the American people want their 
health coverage decisions coming from a panel in Washington.
  The Reid bill drives up costs and premiums. Just today the CBO 
released its assessment of what will happen to health insurance 
premiums under the new entitlement compared with premiums today. The 
CBO dealt a blow to claims the health care bill introduced by Senator 
Reid will lower premiums when they released an analysis showing that 
premiums will go up significantly in the individual market. Premiums 
for individuals without employer-sponsored coverage would increase 10 
to 13 percent or $2,100 per family in 2016. The Democrats' bill 
therefore requires individuals to purchase insurance that is more 
expensive than would be available under current law. For small 
businesses and employers, the bill largely preserves the status quo and 
does little if anything to lower the cost. In fact, CBO estimates that 
under the Reid bill the average family with employer-sponsored coverage 
will soon pay more than $20,000 per year for health insurance.
  President Obama said the following during the campaign:

       I have made a solemn pledge that I will sign a universal 
     health care bill into law by the end of my first term as 
     President that will cover every American and cut the cost of 
     a typical family's premium by up to $2,500 a year.

  Well, CBO's analysis shows that the President is breaking that pledge 
by both failing to achieve universal coverage and raising premiums, 
just as it contradicts an analysis by MIT economist John Gruber 
released by the White House this weekend claiming that individual 
premiums would go down. In fact, even with the generous assumptions 
made by CBO in a number of areas, premiums will either go up or remain 
unchanged.
  From the CBO report just today, CBO says premiums in the individual 
market would be 10 percent to 13 percent higher in 2016 than under the 
current law. Average premiums would increase by $300 for an individual 
policy and by $2,100 for a family policy. The new benefit and coverage 
mandates actually drive up premiums by 27 to 30 percent, and this 
increase is offset by other factors, such as new administrative 
efficiencies.
  CBO says that little more than half of enrollees in the individual 
market would receive a government subsidy. However, the bill before us 
would still require nearly 14 million Americans to purchase 
unsubsidized insurance that is more expensive than they have today.
  President Obama has promised that seniors will not see a reduction in 
benefits. In fact, he said recently:

       People currently signed up for Medicare Advantage are going 
     to have Medicare and the same level of benefits.

  How did he get there? How do you get there when you are cutting 
Medicare Advantage by $120 billion? There is no math--old or new--that 
gets you to no change in the benefits that they have under Medicare 
Advantage and yet cutting $120 billion. Traditional Medicare doesn't 
offer coordinated benefits that can improve the quality of care. 
Traditional Medicare doesn't have many of the aids or benefits for our 
seniors.
  President Obama has also promised several times, ``If you like what 
you have, you can keep it.'' The American people took those words as a 
promise that if they had a health benefit they were happy with, they 
could keep it. I want to make sure we are helping the President keep 
his promise. I want to help him keep his promise by sending this bill 
back, taking out the cuts that are in it on Medicare, on the $105 
billion cuts to hospitals, nursing homes by $14.6 billion, hospices cut 
by $7.6 billion, Medicare Advantage by $120 billion. I want to send it 
back to the Finance Committee and come back with a bill that the 
American people can believe in that will preserve the solemn 
obligations we have made to our senior citizens.
  Medicare Advantage provides the only choice in the Medicare Program 
allowing an option for seniors who want additional benefits or a better 
option. Medicare Advantage is working for nearly 11 million seniors to 
give them a choice about their health care and better benefits. As I 
mentioned, 330,000 beneficiaries in my State of Arizona are in Medicare 
Advantage, and they will see benefit reductions or their plan 
disappear. Eighty-nine percent of seniors need and have some form of 
supplemental coverage on top of Medicare to provide protections against 
out-of-pocket costs or additional benefits. Many low-income Americans 
and minorities rely on Medicare Advantage as their supplemental 
coverage.
  Some have claimed that cutting the ``extra payments'' to Medicare 
Advantage plans reduces insurance company profits. Under Federal law, 
that is simply not the case. The fact is, 75 percent of those ``extra 
payments'' go directly to better benefits for seniors under current 
law. The other 25 percent goes back to the Federal Government. 
Unfortunately, those extra benefits will be taken from seniors who are 
enrolled in Medicare Advantage.
  This bill contains $120 billion in direct cuts to private Medicare 
plans. Common sense says you can't do that without affecting benefits. 
The Congressional Budget Office thinks so as well. CBO assumes the Reid 
bill will cut benefits by more than half, from an average of $98 in 
additional benefits to $41 a month.

[[Page S12001]]

  I see one of my colleagues is waiting to speak, but I hope the 
American people will understand what we are trying to do. All we are 
trying to do is send this back to be reworked, to be fixed on a 
bipartisan basis, and not to force $400-some billion in cuts and 
benefits that we have promised the American people. We want to send it 
back and come out with a bipartisan approach. Sit down, for the first 
time, Republicans and Democrats, have the C-SPAN cameras rolling--the 
way the President promised he would a year ago last October.
  Let's sit down together and figure out how we can fix this.
  The best way to fix it is to preserve the quality of health care in 
America and bring down the cost, not to pass a 2,074-page monstrosity 
that is full of the measures that would impair the ability, 
particularly of our senior citizens, to keep the benefits they have 
earned and we have promised them.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Madam President, I rise to speak about health care, as we 
begin the debate in the Senate. I am grateful we are finally at this 
point where the Senate at long last will be debating our health care 
bill. It has been a long time in coming. Some of us have waited years, 
some have waited for decades to be at this point in our history.
  On the Senate floor now is the Patient Protection and Affordable Care 
Act, and we are going to be discussing various aspects of that over the 
next couple of weeks.
  I am reminded, as I rise today, of something Hubert Humphrey said a 
long time ago. He said the test of the government is how it treats 
those in the dawn of life--our children--those in the shadows of life--
those who have challenges in their life, as we try to help them--and 
those in the twilight of life--older citizens across America. In large 
measure, we will be talking about each of those Americans in one way or 
another and a lot of other Americans as well. I rise to speak of our 
children but also to spend a couple of moments talking about older 
citizens, especially in light of some of the arguments made most 
recently on the Senate floor.
  I will start with our older citizens. I come from the State of 
Pennsylvania where in our little State, with more than 12 million 
Pennsylvanians, we have almost 1 million Pennsylvanians over the age of 
65. We have a very high number of Pennsylvanians on Medicare and also a 
lot of families who rely upon that kind of health care coverage, as we 
have for many generations. So when we speak of those in the twilight of 
life, we speak of many Americans who are covered by Medicare.
  I want to make a couple of points about the bill that is on the floor 
now. First of all, with regard to older citizens, a couple of basic 
points on which I will provide a little more background. First of all, 
this bill, as it relates to Medicare, will protect Medicare's already 
guaranteed benefits. The bill also reduces premiums and copays for 
older citizens. It will ensure that older citizens can keep their own 
doctor or doctors with whom they have developed a relationship, on whom 
they have come to rely, and in whom they have confidence. So we want to 
make sure they can keep their own doctors.
  The bill keeps Medicare from going bankrupt in 8 years by stopping 
waste, fraud, and abuse and by other provisions as well. The bill 
provides new preventive and wellness benefits--something we have talked 
about for every age group, but we are finally going to do something 
about it to give people better health care options.
  The bill also, as it relates to older citizens, lowers prescription 
drug costs. We will talk more about that. We have had a lot of 
discussion over the last couple of years about the so-called doughnut 
hole. That is a very nice-sounding way of describing falling into a 
period of coverage, if you are an older citizen getting prescription 
drug coverage, where you have to pay the whole freight, so to speak. 
This bill provides relief for those who are in that so-called doughnut 
hole with regard to Medicare prescription drug coverage.
  Finally, this bill keeps older citizens in their homes and limits 
those who would be compelled, if they didn't get additional help, to go 
into nursing homes. Some do. Some choose to do that. But we want to 
provide more opportunity for people to stay in their homes, if they 
can.
  In terms of preserving Medicare without the changes made in this 
bill, Medicare is going broke in 8 years--not 18, not 80, but 8 years--
if we do nothing. Older citizens will have trouble accessing their 
doctors if we don't take action. Older citizens will have trouble 
affording prescription drugs if we don't take action. Finally, without 
reform, cost sharing for older citizens will increase to completely 
unaffordable levels.

  Next, we have to make sure older citizens across America have the 
opportunity to continue to receive guaranteed protection for hospital 
stays, access to doctors, home health care, nursing home, and 
prescription drug coverage. We have to make sure we extend the life of 
the Medicare trust fund beyond 2022. Without reform, we cannot extend 
the Medicare trust fund beyond 2022. Without reform, we do not have the 
opportunity to ensure that trust fund will be there for older citizens 
across America. Finally, health reform will not interfere with any 
medical decisions made by patients and their doctors.
  Let me step back a moment and reflect upon what we are talking about 
with regard to Medicare: Protecting our seniors, protecting their 
benefits. It is interesting to note this whole debate started January 
of 2009, in a fully engaged way, when staffs of all relevant committees 
were working on this, month after month. Then it went into the summer, 
working on health care reform in the Health, Education, Labor, and 
Pensions Committee and the Finance Committee, improving bills, changing 
the bills. Now we have one bill that is the result of all that work. So 
this has been going on for months and months.
  I keep hearing criticisms from my Republican colleagues on various 
aspects of the bill. There is nothing unusual about that. It is natural 
to have a decision and a debate. We are starting that today, at least 
on the floor. But we have been having a debate over many months. My 
point is that on the one hand you have the legislation that resulted 
from work by the two committees into one bill, so you have the Patients 
Protection and Affordable Care Act on the floor and you have had 
basically the ideas contained in that being discussed for many months. 
But what we have not seen, what I have been waiting for and have not 
seen, is a bill by the other side.
  In other words, when we were working in June and July in the HELP 
Committee or when the Finance Committee was working all summer and into 
the fall, you would think that one of the results from that would be 
that Democrats had a point of view and they produced a bill; 
Republicans had a point of view. But they did not produce a bill. So 
you basically have a choice before the American people: the bill before 
us, which will change and which will be amended. I have some things I 
would want to change. But the answer cannot be let's go back to square 
one, where we were a year ago or 5 years ago or 10 years ago and just 
cancel this and try to start over. This is the result of many years of 
work, especially many months of work by people at the staff level and 
Senators across the board.
  Unfortunately, the other side does not have a plan, so I can only 
conclude they want to stay with the status quo. They think where we are 
in health care is OK; that we should stay where we are, maybe tinker 
with it a little bit but not change much. I think that is unacceptable. 
Too many people I run into, in Pennsylvania especially, have said to 
us: Please provide some protections for me. We are talking about 
individuals who have health care. Provide some consumer protections. 
Make sure the Medicare trust fund will always be there. Help me with 
this doughnut hole problem. This is the problem too many seniors run 
into when they cannot pay for prescription drugs at a certain point in 
the delivery of that benefit.
  I do not think the response of doing nothing or staying where we are 
is acceptable. That is one of the reasons why we have to make sure we 
focus on changes or debates about this bill, not going back to where we 
were in January or where we were 5 years ago and basically doing 
nothing year after year about health care and saying it is OK to stay 
where we are.

[[Page S12002]]

  We have a long way to go. But I think it is also important to point 
out this is not just a debate between Republicans and Democrats. We 
have had groups, across the board, that are neutral arbiters that weigh 
in on public policy but are not representing a Democratic point of view 
or a Republican point of view. The AARP said on November 20 of this 
year:

       Opponents of health reform won't rest. They are using myths 
     and misinformation to distort the truth and wrongly suggest 
     that Medicare will be harmed. After a lifetime of hard work, 
     don't seniors deserve better?

  So says the AARP, just a couple of weeks ago--not even a couple of 
weeks ago, 10 days ago. The AARP also said on November 18, 2 days 
earlier:

       The new Senate bill makes improvements to the Medicare 
     program by creating a new annual wellness benefit, providing 
     preventive benefits, and most notably for AARP members, 
     reducing drug costs for seniors who fall into the dreaded 
     Medicare donut hole [that I spoke about earlier] a costly gap 
     in prescription drug coverage.

  That is the AARP weighing in on not a concept, not a theory but the 
bill in front of us.
  The American Medical Association, on that same day, November 20, 
2009:

       We are working to put the scare tactics to bed once and for 
     all, and inform patients about the benefit of health care 
     reform.

  I could go on from there, but we have ample evidence that there is 
strong support for the ways this bill will strengthen Medicare.
  I wish to move to the second topic I was going to cover today and 
that is the other end of Hubert Humphrey's test of government, what we 
do and what the test is of our Government as it relates to those in the 
dawn of life. I spoke of older citizens a moment ago. At the dawn of 
our life are children.
  It has been a topic and a focus of mine since the very beginning of 
this debate, which for me began last spring when I was working in the 
Health, Education, Labor, and Pensions Committee before our work this 
summer on the bill. The Patient Protection and Affordable Care Act, 
which is the bill before us today, deals with many aspects of our 
health care system. One of them is how we take care of our children. I 
have come back to this issue over and over. I have had just a basic 
test for this legislation. It is very simple. It is four words: No 
child worse off, especially and importantly, children who are low 
income and are particularly vulnerable, therefore, and children with 
special needs. So ``no child worse off'' should be the foundation of 
what we do in this bill for our children.
  That is particularly true for those who are vulnerable, as I said 
before; they are vulnerable or children with special needs. That is the 
foundation of what we should be doing, the foundation for a guiding 
philosophy. The way I look at this, every child in America, no matter 
who they are, no matter what circumstance, every child in America is 
born with a light inside them. For some, that light is boundless 
because of their circumstance, because of their ability, because of 
advantages they have. Their potential is unlimited and that light burns 
very brightly without any help from anyone else. That is some children.
  Then there are other children who have a light inside them and are 
deserving of our care and protection and advocacy. We have a lot of 
people around here who get besieged by lobbyists for different points 
of view, but very rarely do we have the same kind of lobbying power, 
the same kind of power in our system to stand for children. So we have 
to do that if an interest group will not. There are plenty who have 
advocated strongly for our children, but they don't get enough 
attention in my judgment.
  There are some children who are born with a light inside them that 
does not burn very brightly because of their own circumstances or 
limitations or because of particular vulnerabilities that they have. 
They are the ones for whom we have to fight the hardest. They are the 
ones we have to stand up to the special interests for because they 
cannot do it for themselves. They don't have a voice sometimes in this 
debate unless the Senate stands up for them.
  I believe no matter what the light is inside a child, no matter what 
the limit or whether it is unlimited potential, we have to make sure 
that potential is reached, the full potential--not most of it, not some 
of it, the full potential of every child, the full burning of that 
light inside them.
  There are two programs that work well to do that. They are Medicaid 
and the Children's Health Insurance Program. Thank goodness both these 
programs came along: Medicaid, some 40 years ago, and Children's Health 
Insurance Program less than the last 15 years.
  We have the opportunity to listen to people who come up to us on the 
street or who send us an e-mail or who send us a letter. It just so 
happens one of my constituents in Pennsylvania sent us a note the other 
day, literally 2 days ago, November 28. I will not give away her 
identity, but I will give you a general sense of what her challenge is.

  She wrote to us talking about her two children who are covered by the 
Children's Health Insurance Program in Pennsylvania. By the way, 
Pennsylvania is one of the first States that put into place this 
program, almost 20 years ago, back in 1992-1993.
  She wrote and said she was concerned that the House, in their bill, 
had made some changes that would adversely impact her situation. She 
said:

       We qualify for free Children's Health Insurance Program 
     benefits in Pennsylvania but my husband's income is greater 
     than the 150 percent of the Federal poverty level which means 
     our children wouldn't qualify for the coverage under the 
     House's proposed plan.

  Then she says:

       This has us terrified.

  She goes on to talk about what she and her husband are trying to do 
to make ends meet. She says:

       Our water bills will increase and we are nervously awaiting 
     the annual increase in heating.

  I will not go through the whole letter, but suffice it to say we have 
a program in place now, the Children's Health Insurance Program, that 
works for families right now. Now we are engaged in a great debate on 
health care on the floor of the Senate and we deal with programs such 
as the Children's Health Insurance Program. What we have to make sure 
about is that we do nothing in this process to injure or harm or set 
limits on what we can do with a program that we know works.
  This is a program which is good for a child, to make sure he or she 
reaches the full potential of that light inside them. This is good for 
his or her family. Imagine the peace of mind that a mother or father 
has in the course of the day, whether they are going off to work or 
whether they are home, to know their child has health care. Yet we have 
some families, some parents, terrified even with the coverage they 
have, worried that coverage will not remain in effect for their 
children. So we have to make sure that rule is followed: No child worse 
off in America. We want to fix what is broken and build upon what 
works.
  I wish to make sure, as we go through this, we have a sense of what 
the difference is between these benefits and what can happen down the 
road. One of the things that will have an adverse impact on our health 
care system, generally, but in particular on a program such as the 
Children's Health Insurance Program, will be the skyrocketing cost of 
coverage. The share of household incomes spent on premiums is climbing. 
The New America Foundation reports that in 2008, household income 
spent--on the side, ``percent of median household income spent on 
health care''--is 26.3 percent. That is far too high as of 2008.
  With no action, if we stay where we are, go down the same road we are 
on, the status quo, don't change anything, let's start over and keep 
scratching our head about this, here is what is going to happen by 
2016, 7 years away. That median household income dedicated to health 
care will skyrocket to 45 percent nationally.
  Unfortunately, in Pennsylvania, it goes up over 51 percent instead of 
45 percent, so that is the ``do nothing'' path right now. Do nothing, 
and we can guarantee that those costs are going to keep going up and 
up.
  I said before we know the Children's Health Insurance Program works. 
By the way, when that bill passed and when it was reauthorized, we had 
help from both sides of the aisle--sometimes not enough help but we 
have had help supporting that program. We know this program works 
because we can see it from the results achieved by our children because 
of this program.
  Let's compare this to some other challenges in the economy. The 
national poverty rate. In 2007, a little

[[Page S12003]]

more than 37 million Americans were in poverty, 12.5 percent of the 
population. In 2008, it was up to 13 percent. So the poverty rate went 
up from 2007 to 2008. The child poverty rate went from 18 percent to 19 
percent, almost 1 million more kids in 1 year falling into poverty 
because of changes in the economy. People without health insurance, 
2007 versus 2008, that has gone up. It may only be 15.3 to 15.4, but 
look at the overall number, from 45.7 to 46.3. Everything is going up. 
We would expect that, as tragic as that is, when times are bad. The 
national poverty rate is up, the child poverty rate up, and the 
uninsured rate is up.
  What has not gone up between 2007 and 2008 is the number of uninsured 
children: 8.1 million in 2007 were covered; 7.3 million kids covered in 
2008. That is good news, that the number of uninsured children is 
actually going down from roughly 8 to 7 million. That is good news. Why 
is that happening? It is not magic. If we didn't have a Children's 
Health Insurance Program, that number would be going up just as the 
other numbers. Why is the uninsured number for children going down? One 
basic reason--and we could point to maybe a few others--is because we 
have a program called the Children's Health Insurance Program which 
works and which, fortunately, we reauthorized a couple of months ago. 
Thank goodness we did that, or more and more children would fall into 
poverty. We are on a path now to go from the number of children who are 
insured, to get that number that is now in the double figure millions, 
to get that to 14 million children, to have that uninsured number keep 
going down and cover more and more children. In a couple of years, we 
will have the opportunity to say that in America, we have 14 million 
kids covered. What we have to do is make sure we have a successful 
program that works for the child, for their family, and for our 
society. Because guess what. We are going to have a better economy 
because of the Children's Health Insurance Program. If we invest in a 
child early, they get health care, and they will learn better. When 
they learn better, they will be doing better in school and have a 
better job and have a higher skill level. This whole debate about 
children's health insurance isn't just a nice thing to do; it is how we 
compete around the world in a tough economy. It is how we build a 
skilled workforce in a tough economy. It is how we build strong 
families.
  This isn't just some nice program. This has real results for our 
economy, for gross national product growth, economic growth, for a 
skilled workforce. Fill in the blank. You could add 10 themes to that 
in terms of the impact of the legislation. But you have to be careful. 
In the midst of this health care reform debate, we have to make sure we 
don't do what some have urged which is to take the Children's Health 
Insurance Program, this program that we know works, and drop that into 
the health insurance exchange that will be created as a result of this 
bill. The exchange is a good idea to cover a lot of people. It just 
happens to be a bad idea when it comes to merging or putting the 
Children's Health Insurance Program in there. It needs to remain a 
stand-alone program.
  One of the reasons why we can say we are at that point where it is a 
stand-alone program still is because during the debate in the Finance 
Committee, Senator Rockefeller of West Virginia ensured that we kept 
the Children's Health Insurance Program out of the exchange and that 
the program would continue until 2019. Unfortunately, the House doesn't 
have the same provisions, and we want to make sure we do that by the 
end of the debate.
  I filed an amendment today to make sure that children are protected 
by health care reform, so we can truly say that no child is worse off 
as a result of our health care reform bill. In a nutshell, this 
amendment will strengthen and safeguard health care for children in 
CHIP from now until 2019 and beyond with whatever changes the future of 
health care reform brings.
  I will provide a couple of highlights. It continues funding through 
2019. It ensures that children have access to the essential care they 
need. It streamlines and simplifies enrollment. The amendment also 
provides financial incentives for States to increase enrollment of 
eligible but uninsured children and calls for a study of children under 
the Children's Health Insurance Program compared to coverage of 
children under the so-called insurance exchange.
  These are just some highlights of my amendment. I will be talking 
more about it.
  I conclude with this thought. I know Senator Baucus was here a moment 
ago, chairman of the Finance Committee, who has worked very hard on 
this bill, this program, the Children's Health Insurance Program, and 
on the health care reform bill overall to protect our kids. I return to 
this letter I got 2 days ago from a mother, in essence commending the 
benefits of this program, that this program gives her peace of mind. 
What we have to do is make sure we keep the Children's Health Insurance 
Program intact and, if anything, strengthened over time so this mother 
doesn't have to worry again, so she doesn't have to be ``terrified'' of 
changes that will adversely impact her two children, especially in the 
midst of a bad economy but even if it were not.
  I thank the Chair and yield the floor.
  The PRESIDING OFFICER (Mrs. Shaheen). The Senator from Wyoming.
  Mr. ENZI. Madam President, I thank the Senator from Pennsylvania for 
his comments. I certainly hope no one who is listening thinks that 
anybody wants to make any child worse off. That is a basic premise, and 
I appreciate his pointing out the way the House makes some children 
potentially worse off.
  I want to constrain my comments to the Medicare amendment because I 
think that is one of the key parts of this whole bill. The Senator from 
Pennsylvania mentioned that there wasn't a Republican bill. Actually, 
there are four Republican bills, and there is one bipartisan bill out 
there that meets all of the goals the President put out. When we were 
going through the HELP Committee amendment process, we put one of those 
out, and it was voted down with one vote. We said: That didn't work 
very well. There were a lot of good ideas in there. They ought to have 
to consider every one of those.
  We have been putting our ideas out one at a time so that hopefully 
the other side will glean something out of the amendment that will be 
worthwhile to be a part of the bill. All the good ideas couldn't be on 
one side of the aisle.
  We began the day with kind of a stunt which, of course, was to have 
the leader propose a unanimous consent. He proposed that the Social 
Security money ought to stay with Social Security. I don't think there 
was any problem with that. But then he proposed that CLASS Act money 
ought to stay with the CLASS Act. That is a fund that isn't even 
actuarially sound to begin with. It is just a piece of the bill that is 
already in existence around here. He left out what he should have put 
in that unanimous consent request. He should have said Medicare money 
should be reserved for Medicare. That would have relaxed a lot of 
seniors. But it would have been untrue and impossible to pass this bill 
if that were the UC, because Medicare money is going to expansion of 
new programs outside of Medicare. That is what is upsetting seniors. 
And it ought to.

  Medicare, as everybody has said, is going broke. That is a government 
option that is going broke. Well, never mind. But Medicare is going 
broke. We all agree on that. So why would we take $464 billion out of 
Medicare to use on other programs and then recognize that Medicare is 
going broke and throw in a special commission that will come to us once 
a year and suggest cuts to Medicare? That is not a bad idea, but some 
side deals have been made in this whole thing that keep that from being 
a very realistic option either. The hospitals can't be cut any more. 
The doctors, we are going to have to fix that, and that is where some 
of the phony accounting comes in.
  The pharmaceuticals, the little deal they made for the doughnut hole, 
that will provide extra help to seniors through the doughnut hole, but 
it has to be on brand name products. We know that generics are a lot 
less expensive and a lot of seniors switch to generics, especially when 
they get to the doughnut hole and have to make decisions on their own 
and they want to save a few dollars. But that will not be a possibility 
under this bill because of the deal that was made with the

[[Page S12004]]

pharmaceuticals. They are going to pay their percentage on brand name 
products only. Why would they do that? If they can get you to use brand 
name products through the doughnut hole, when the government starts 
paying again, you will still use the brand name.
  One of the ideas with health care is to get a little skin in the game 
with everybody so people are making good choices on health care. How 
much of a good choice are you going to make if you don't have to make a 
choice and you can keep on doing what you have been doing, whether it 
is the best choice for you, whether it is even what the doctor agrees 
with, and whether it is a whole lot more expensive for the government 
to keep Medicare going?
  I rise to support the McCain motion to commit this bill and eliminate 
its Medicare cuts. Senator Reid's bill cuts $464 billion from the 
Medicare Program. These cuts will eliminate benefits for Medicare 
patients. They will make it harder for them to see doctors and other 
providers and will threaten the survival of hospitals, nursing homes, 
and home health agencies. Don't take my word for it. The 
administration's own chief actuary recently reviewed the House bill 
with its similar levels of Medicare payment cuts and reached the same 
conclusion I just said.
  Richard Foster, chief actuary at the Centers for Medicare and 
Medicaid Services, CMS, wrote that if these cuts were to take effect, 
many providers ``could find it difficult to remain profitable and might 
end their participation in the program.'' He also noted that this could 
jeopardize Medicare beneficiaries' access to care. I have heard similar 
messages from doctors, home health aides, and nursing home owners back 
in Wyoming. They are all concerned about the one-half trillion dollars 
in Medicare cuts and what it will do to their ability to treat Medicare 
patients.
  I have heard from folks at the Baggs Senior Center, the Star Valley 
Senior Citizens, the Southwest Sublette County Pioneers Senior Citizen 
Center, and from other Wyoming nursing homes about how the $15 billion 
in Medicare cuts to nursing home payments will devastate their ability 
to provide care for seniors in Wyoming. Many of these nursing homes are 
small businesses. They struggle to make payroll every month and deal 
with an ever increasing burden of government regulations. We have never 
cut those back. They tell me how their Medicare payment rates have 
already been reduced and how the additional cuts in the bill could 
force them to close their doors.
  Connie Jenkins, executive director of the Star Valley Senior Center, 
recently wrote to me about the important role nursing homes play in 
rural towns in Wyoming. She noted that ``in a rural state such as ours, 
closure of nursing homes would mean families travelling farther to 
visit [their] loved ones and in some cases loss of access altogether.''
  In rural States--and we are about as rural as you can get; we have 
the least population in the Nation, and we have a lot of land mass--
there is a lot of distance between towns. If the nursing home in your 
town closes down, it is a long way to the next nursing home. The Reid 
bill would also cut $135 billion in Medicare payments to hospitals. In 
a State such as Wyoming, with an older population, between 40 to 50 
percent of our hospital revenue comes from Medicare. Medicare already 
pays a fraction of what private insurers pay, and the cuts in this bill 
will undermine those hospitals' ability to continue to operate. I have 
heard from several Wyoming hospital executives that because of the 
payment cuts in this bill, they are going to need to ask their people 
to work fewer hours and take pay cuts.
  They also said they may need to lay some folks off and to find ways 
to scale back the services they offer to their patients. They do not 
want to compromise the care they provide, but the payment cuts in this 
bill will not leave them a choice.
  The Reid bill also cuts nearly $8 billion in payments to hospice 
care. Hospice care helps to relieve the suffering of people who are 
dying from diseases such as cancer. These are terminal patients, 
terminal patients who, of course, are not going to be cured. But the 
hospice is intended to help manage the pain and other symptoms of the 
patients with the terminal illness, and working with the families, much 
on a volunteer basis.
  According to National Hospice and Palliative Care Organization, the 
cuts in the Reid bill, combined with prior regulatory cuts, would 
reduce Medicare payments to hospice providers by 14.3 percent through 
2019. According to a June 2008 report from the Medicare Payment 
Advisory Commission, hospices already operate with narrow profit 
margins that average just 3.4 percent.
  Smaller nonprofits and hospices in rural areas such as Wyoming 
already operate with negative profit margins. Many depend on charitable 
fundraising to keep their doors open and to enable them to keep 
treating patients. Yet the Reid bill would further cut their Medicare 
payments by $8 billion. This will force many hospices to close, which 
will threaten dying seniors' access to that type of care.
  The Reid bill also cuts more than $40 billion in Medicare payments to 
home health agencies. According to the analysis done by one industry 
association, this level of cuts could put nearly 70 percent of all home 
health agencies at risk of having to close their doors. I want to say 
that again. The $40 billion in Medicare cuts to home health agencies, 
according to an analysis done by one industry association, could put 
nearly 70 percent of all home health agencies at risk of having to 
close their doors.
  There are a lot of people who are out of nursing homes because they 
are getting home health care. If we eliminate home health care, we 
drive up the cost of care. If the Senate passes this bill, it will mean 
that Medicare patients may not be able to get the skilled nursing care, 
the physical and speech therapy, and the assistance that home health 
aides provide with many daily activities, such as dressing, bathing, 
helping patients live more fully with a disability.
  The Medicare cuts in the Reid bill are not limited to slashing 
payments to hospitals and other providers. The bill also cuts $120 
billion from the 11 million seniors on Medicare Advantage. These cuts 
make a mockery out of President Obama's promise that if you like what 
you have, you can keep it. As a result of these cuts, millions of 
Medicare beneficiaries will lose the benefits currently provided by 
Medicare Advantage plans.
  Supporters of Senator Reid's bill have tried to gloss over the impact 
these Medicare Advantage cuts will make, arguing they will only result 
in a loss of ``extra benefits.'' For the seniors who have come to rely 
on Medicare Advantage plans to provide things such as flu shots, 
eyeglasses, hearing aids, and protections against catastrophic costs, 
these are not extra benefits but items and services they depend on.
  We all agree Medicare needs to be strengthened and reformed. Its 
financing is unsustainable. The Hospital Insurance Trust Fund, which 
pays for hospital services, will be insolvent in 2017. The physician 
payment formula, which calls for Medicare payments to doctors to be cut 
by more than 40 percent over the next 10 years, is fundamentally 
broken. We know that. We even had a vote on that in this Chamber. We 
said it had to be paid for.
  Let's see, $464 billion coming out of Medicare. Medicare is what is 
being affected by the doctors' payments. Why wouldn't we use some of 
that? But it is a lot of money. It is a lot of money, but it is not as 
much money as we are taking out of Medicare.
  Unfortunately, the Reid bill does nothing to fix these problems. 
Instead, it cuts one-half trillion dollars from Medicare to create a 
brandnew entitlement program for the uninsured. This approach fails to 
address the real problem facing Medicare; and that is the physician 
formula. Instead, it uses the same gimmick that Congress has repeatedly 
used to fix this problem and provides a temporary fix in 2010, which 
will actually lead to steeper cuts in subsequent years.
  Physicians have grown increasingly frustrated by Congress's repeated 
failure to replace the current payment formula. We kind of like to keep 
them hanging on a year at a time. I think it is a little bit of a 
hostage situation, but that is the way Washington works. It should not 
be that way. We should redo the formula. If we do not address this 
problem soon, many more physicians are going to decide it is not

[[Page S12005]]

worth it to continue to treat Medicare patients.
  The Congressional Budget Office has estimated that truly fixing the 
physician payment formula could cost upwards of $250 billion, yet the 
Reid bill does not address this problem.
  Spiraling costs associated with medical liability lawsuits directly 
increase Medicare costs. These costs are calculated directly into 
payment formulas for providers such as physicians. In addition, 
physicians and hospitals order billions of dollars in extra tests and 
procedures to protect themselves from the threat of potential lawsuits.
  We know that enacting commonsense medical liability reforms directly 
reduces the liability insurance premiums doctors pay. We have seen the 
results in States such as Texas, where physicians liability insurance 
premiums have decreased every year since the State-enacted reforms, 
with average liability rates dropping a total of 27 percent.
  The Reid bill does nothing to address the problems of medical 
liability. Instead of including reforms that would help reduce Medicare 
costs and extend the solvency of the program, the only thing the Reid 
bill does is include a meaningless sense-of-the-Senate resolution on 
liability reform. That will not pay the bills.
  We owe it to the 43 million people who depend on Medicare to reject 
the arbitrary cuts in the Reid bill. We need to come up with better 
solutions that will not endanger their ability to see a doctor or to 
get care at a hospital or a nursing home. Yes, if we do not pay the 
doctors, the doctors will not take them because in Medicaid they 
already will not take 40 percent of the patients; and in Medicare it is 
20 percent already. A lot of people are being asked, when they call a 
doctor, if they are a Medicare patient. It is my contention if you 
cannot see a doctor, you do not have any kind of insurance at all. We 
do not take care of that problem, so we do need to come up with a 
better solution that will not endanger their ability to see a doctor or 
to get care at a hospital or a nursing home or to have home health 
care.
  I believe we can do better. If the Senate passes this motion to 
commit, we can develop bipartisan reforms that will eliminate the 
unsustainable payment cuts and address the underlying problems facing 
the Medicare Program.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Madam President, I am not in favor of doing nothing. 
The previous Democratic speaker, Senator Casey, said if we do nothing, 
costs will go up. I think the fact is, if you look at CBO's analysis, 
it says costs will go up even more if this bill, this 2,074-page bill, 
passes. So I want to spend some time because there has been some 
obfuscation on what this Congressional Budget Office letter to Senator 
Bayh means.
  This morning, the nonpartisan Congressional Budget Office sent a 
letter to Senator Bayh providing a very detailed analysis of what 
health insurance premiums will look like as a result of this 2,074-page 
bill. I have the letter from the Congressional Budget Office right 
here, if anybody wants to read it in detail.
  Like many of us, Senator Bayh wants to know if the Reid bill is 
addressing our constituents' No. 1 priority: costs. I think if you were 
to have a Saturday morning coffee club meeting in almost any of the 
small towns of America, and they were discussing health care reform--
and emphasis upon the word ``reform''--and I walked into that meeting, 
and if I told them under this 2,074-page Reid bill that costs were not 
going to be brought under control, taxes were going to go up, premiums 
were going to go up, and we were taking $400 billion out of Medicare to 
set up a new health care program, they would probably unanimously 
respond: Well, that does not sound like health care reform to me.
  A lot of Senators are concerned about costs because that is what we 
are hearing from the grassroots of America. Everyone, from the dean of 
Harvard's Medical School to even the New York Times, has said this bill 
does not sufficiently address the rising cost of health care. But 
before today, we were still all anxiously waiting to hear what the 
Congressional Budget Office has now said about that issue of rising 
costs. Well, today, CBO has spoken loudly and clearly. The Reid bill 
not only fails to bring down costs, it will actually raise costs for 
millions of Americans. I think that bears repeating. The Reid bill will 
make health insurance more expensive. Families will end up paying 10 to 
13 percent more as a result of this 2,074-page bill.
  Some proponents of the bill are trying to spin this, what they 
consider unfortunate news, and tell the American people that taxpayer-
funded subsidies will actually offset these cost increases. In fact, 
tonight some Members have already been saying that this CBO analysis 
shows costs will come down.
  But I want to make it very clear CBO says that is not the case. Well, 
this may be true; if you take $500 billion of taxpayers' hard-earned 
money and give it out in subsidies directly to insurance companies, 
sure, some people may end up paying less for health insurance. But this 
argument fails to recognize two big underlying problems.
  First, most Americans will not qualify for any subsidies. They will 
end up paying higher premiums. In fact, 160 million Americans who stay 
in employer-based plans will not see any help. In fact, despite all the 
rhetoric about how employers cannot afford the status quo, CBO says 
this bill does little, if anything, to lower costs for employers. Maybe 
that is why the National Federation of Independent Businesses, the U.S. 
Chamber of Commerce, and a host of other business groups, oppose this 
2,074-page bill.
  The nonpartisan Congressional Budget Office goes on to say that 14 
million people who cannot get coverage through an employer will not get 
any help either, but they will see a 10- to 13-percent increase in 
premiums. And, of course, an intrusive new insurance mandate will be 
enforced by the IRS if you do not do what has never been done in the 
225-year history of America. Never has the Federal Government said any 
American had to buy anything. Now you have to buy insurance. If you do 
not buy it, pay the IRS more money. Some people are going to say: Well, 
you have to buy car insurance. But under the tenth amendment, the State 
governments have any powers that are not prohibited by the Federal 
Constitution to them.
  So families who would have paid $13,100 under current law will 
actually pay more than $15,000 as a direct result of this 2,074-page 
bill. And people in employer-based coverage will be paying more than 
$20,000 a year for health insurance in 2016.
  The second big problem is this: Health insurance premiums are still 
more expensive in the Reid bill than they would be under current law. 
The government is cutting Medicare and raising taxes to offset the 
increases. So instead of addressing the underlying issue of cost, as 
was promised, this bill enacts policies that drive up costs by close to 
30 percent, and then hands over close to $500 billion in hard-earned 
taxpayer dollars directly to health insurance companies to offset the 
increases.
  Well, you might not believe the spin. In fact, you better not believe 
the spin because the nonpartisan Congressional Budget Office has 
confirmed it. This bill fails to drive down the cost of health 
insurance premiums. It simply drives up prices with a bunch of 
arbitrary regulatory reforms, very cutely shifting the cost on to the 
American people in the form of higher taxes and massive Medicare cuts. 
So, once again, don't take my word for it. Read what the nonpartisan 
Congressional Budget Office says. They have confirmed what we have been 
hearing for months: The Democratic leadership bill means higher costs 
for millions of Americans.

  I yield the floor.
  Mr. ENZI. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DURBIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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