[Congressional Record Volume 155, Number 184 (Wednesday, December 9, 2009)]
[Senate]
[Pages S12791-S12799]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        SERVICEMEMBERS HOME OWNERSHIP TAX ACT OF 2009--Continued

  The PRESIDING OFFICER. The Senator from South Carolina is recognized.
  Mr. GRAHAM. Mr. President, I assume it is our turn to talk a bit.
  Mr. BAUCUS. Mr. President, I remind all Senators that we have an 
hour, equally divided, with each Senator able to speak up to 10 minutes 
each.
  Mr. GRAHAM. I appreciate that. I appreciate the effort to try to 
solve a hard problem. It is easy to criticize in this business, and it 
is hard to bring folks together. Maybe one day we can solve a hard 
problem where we get 70 or 80 votes. I don't think this is that day.
  One thing I will point out about the process is that somehow between 
the time this started until now, something went wrong. This is what 
happened. This is what was said by Candidate Obama in January 2008:

       That's what I will do in bringing all parties together. Not 
     negotiating behind closed doors, but bringing all parties 
     together and broadcasting these negotiations on C-SPAN so 
     that the American people can see what the choices are.

  In November 2007, he talked about, in his Presidency:

       We are going to have a big table and everybody is going to 
     be invited--labor, employers, doctors, nurses, hospital 
     administrators, patients, and advocate groups. The drug and 
     insurance companies, they will also get a seat at the table, 
     and we will work on this process publicly. It will be on C-
     SPAN. It will be streaming over the Net.

  March 2008:

       But here's the difference: I'm going to do it all on C-SPAN 
     so the American people will know what's going on.

  August 2008:

       When we come together around this health care system, I am 
     going to do it all in the open. I am going to do it on C-
     SPAN.

  August 2008:

       I am going to have all the negotiations around the big 
     table. We will have the negotiations televised on C-SPAN.

  The truth is, Mr. President, I am not so sure negotiating on C-SPAN 
is the way to find a solution to hard problems. But being at the table 
with all parties represented is probably a very good idea. And the 
process, as I understand it now, is that our Democratic colleagues are 
trying to negotiate among themselves to get to 60 votes. There was an 
announcement made last night by the majority leader that we have had a 
breakthrough. He said, ``I can't tell you what it is, but it is good.''
  Mr. President, that is not the way we want to change one-sixth of the 
economy. I argue that is not the best process by which to make major 
decisions that affect the quality of Americans' lives.
  The idea of Medicare being changed so dramatically by one party is 
probably not a good idea. What have we done on the Medicare front? The 
actual bill that has been proposed increases spending by $800-something 
billion. To pay for that, there are cuts in Medicare of close to $400 
billion to $500 billion. The money that would be taken out of the 
Medicare system is not plowed back into Medicare but used to fund other 
aspects of this bill. This is at a time when Medicare--the trust fund--
is $36 trillion underfunded and will begin to be exhausted in 2017.
  I argue that both parties should be trying to find a way to save 
Medicare from the pending bankruptcy and do something about 
entitlements in general, Social Security and Medicare, to make them 
solvent so that, one, they don't run out of money and we don't have to 
raise taxes in the future or cut benefits for young people because 
those are the choices we will pass on to the next generation if we do 
nothing.
  Instead of coming together to save Medicare from bankruptcy, we are 
actually reducing the amount of money going to an already-strapped 
system and using it for something else. There is another idea floating 
around that one of the solutions that may come out of this deal, which 
we don't know the details of yet, is we are going to allow more people 
to buy into Medicare under the age of 65, and we will be expanding the 
number of people going into a system that is already about to go 
bankrupt. If we add new people to the system, approaching insolvency, 
something has to give. Who will be coming into the system from 55 to 
64? I argue those people are going to be in as a result of the process 
of adverse selection, people who have health care problems. It is going 
to put more pressure on a system that can't stand one more drop of 
pressure. That doesn't make a whole lot of sense to me.
  We know this Medicare system is very much under siege, that the baby 
boomers are about to come into the system by the millions. There are 
three workers for every retiree today, and in 20 years there are going 
to be two. So what do we do? We take money out of the Medicare system 
and use it for other things, and we are adding more people into the 
system that are going to drive up the cost overall to those already on 
Medicare.

[[Page S12792]]

  So if you are over 65, your ability to receive treatment is going to 
be compromised because now we have to accommodate more people. If you 
don't believe me, ask the hospitals and doctors who are very worried. 
The Medicare reimbursement system now makes it very difficult for 
doctors and hospitals to pay the bills. So the hospital association, 
the Mayo Clinic, and others have warned Congress: Please don't expand 
Medicare because we can't survive on the reimbursement rates we have 
today.
  If we add more people, we create more stress on a system that is 
hanging by a thread. I argue that is not change we can believe in or 
accommodate. If you had run for President on the idea that you are 
going to put more people on Medicare and expand that system, not reform 
it, take money out of it and use it for another purpose, you would have 
never had a chance of getting elected. No one during the campaign for 
President ever suggested any of these ideas.
  I just hope we will, as a Congress, stop and think about what we are 
doing and realize if we do this--if we cut Medicare and expand the 
number of people who will be in the system--we make it impossible to 
save it down the road and make it difficult for people coming behind us 
to have the same quality of life we have enjoyed. Between Medicare and 
Social Security and other entitlement programs, we are about $50 
trillion short of the money we are going to need in the next 75 years 
to pay the bills.
  In trying to reform health care, we have taken a weak system and 
almost made it impossible to reform. We have expanded taxes at a time 
when the economy can't bear any more tax burdens because part of the 
bill raises taxes by about $500 billion. You will never convince me or 
anybody else that if you raise $500 billion in taxes to pay for this 
new health care bill, it would not affect the economy in general. There 
has to be a better way.
  I am on the Wyden-Bennett bill. I am a Republican who agrees with 
mandated coverage for everybody. Senators Wyden and Bennett have a 
comprehensive proposal that is revenue neutral. We would take the tax 
deductions given to business over a period of time and give them to 
individuals so that all of us would have tax deductions to go out and 
purchase health care in the private sector. We would have exchanges 
where we can go shop for health care that is best for us.
  If you are single and 22, you would want a plan that is different 
than if you were 45 and had 3 kids. The tradeoff is that the 
Republicans, on the Wyden-Bennett bill, would agree to mandate 
coverage. The Democrats would allow people to purchase health care in 
the private sector. We would all use the Tax Code to fund those 
purchases. If you didn't make enough money to have the tax deductions, 
you would get a subsidy. That makes perfect sense to me.
  I want to solve the problem. I want to make sure everybody is covered 
because a lot of us are paying health care bills for those who are not 
covered that could afford to pay--about 7 million or 8 million people 
make over $75,000 a year, and they don't pay anything for health care 
of their own. So the rest of us have to pay it when they get sick. That 
is not right.
  There is a better way, in my view. I just hope we will understand 
that what we are doing with one-sixth of the economy is going to have a 
lasting effect on the quality of American life, and now is not the time 
to cut Medicare or add more people to it. Now is the time to come 
together in a bipartisan fashion to save Medicare from impending 
bankruptcy. Now is not the time to raise taxes.
  I hope our colleagues will understand that there is a better way.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader is recognized.
  Mr. REID. Mr. President, I ask unanimous consent that the Senator 
from Ohio be recognized following my statement.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. Mr. President, I had a conversation earlier today with the 
distinguished Republican leader. It appears now that we are going to 
get the appropriations bill from the House of Representatives. The bill 
is bipartisan, and everybody has worked hard. There are some conference 
reports we have completed. Yet we didn't find them to work on the 
floor, for reasons everyone understands. That bill will come over from 
the House tomorrow. We can move to that with a simple majority vote, 
and then if I have to file cloture on it tomorrow, we would have a 
Saturday cloture vote. Thirty hours after that--sometime Sunday 
morning--we would have a vote on the conference report.
  I have indicated to the Republican leader that it would probably be 
to everyone's advantage if we allow people to go home for the weekend, 
rather than going through all these procedural gyrations.
  We have worked hard. I had a Senator come to me and say she hadn't 
been home in 2 or 3 weeks, and it was not a good situation. That 
Senator said if we have to be here this weekend, she will be here. We 
need to not be doing things just to delay. I understand the Republican 
leader doesn't want to do health care. I appreciate that, and we have 
different positions on that issue.
  I see no reason to punish everybody this weekend. I hope the minority 
will give strong consideration to the proposal I have made. We are 
waiting for a score to come back from CBO anyway. Anybody who has had 
experience with CBO knows that will take a matter of days. So I hope 
the minority will allow a little bit of time to go by so that we can 
have our respite from the tedious work we have been doing on the Senate 
floor.
  The PRESIDING OFFICER (Ms. Cantwell). The Senator from Ohio is 
recognized.
  Mr. BROWN. Madam President, I have come to the floor most days 
reading letters from people in Ohio--from Springfield to Mansfield to 
Marion--who thought they had good insurance a year or two ago, if you 
asked them, but found out their insurance was not so good when they had 
a preexisting condition or when they got very sick and the costs were 
high and the insurance companies cut them off. In some cases, as the 
Presiding Officer knows, in my State and across the country, women so 
often are paying higher premiums than men.
  Our bill will fix a lot of those things. One of the things the bill 
still needs to fix--and we have gotten letters on this--is what 
happened with the price of prescription drugs. There are many things I 
like about the bill and a few I don't. Here is one.
  I rise to support the Dorgan amendment No. 2793. I will start with a 
story.
  About a decade ago, maybe a little more than that--I live in northern 
Ohio--and I used to take a bus load of senior citizens every couple of 
months--maybe a dozen times--from Elyria to Sandusky into Toledo and 
into Detroit and into Ontario--across the river into Windsor, Ontario. 
I did that so seniors could buy less expensive prescription drugs. I 
would go into a drugstore in Windsor--same drug, same packaging and 
dosage, but the price would be one-half, sometimes one-third of what 
seniors paid in the United States. In many ways, it broke my heart 
that, as a Federal official, I was going to another country to buy 
something that was more often than not made in the United States, when 
the drug companies charge twice or three times that to the United 
States as in Canada. But I thought it made sense for seniors in my 
State--congressional district in those days--to go to Canada and be 
able to get those prescriptions.
  They then would be able to get a refill every 3 or 6 months at least 
a couple times with that doctor's signature they got in Canada to buy 
those drugs.
  I appreciate Senator Dorgan and Senator Snowe offering this 
amendment. I hope it is signed into law as part of health care reform. 
If the drug companies were struggling and not making any money, it 
would be a different situation. Drug companies earn higher profits than 
almost any other industry in America. In fact, they have been one of 
the three most profitable industries in our Nation for decades.
  Just last year, the pharmaceutical industry was the third most 
profitable industry in America, ranking right up there with the oil 
conglomerates.
  Let's face it, to call these corporations American is a stretch. Most 
of them are multinational, and most reap huge profits from around the 
globe.
  It is true they earn higher profits in our country than in any other, 
but that hardly qualifies them as patriotic.

[[Page S12793]]

  As drugmakers earn billions, U.S. drug spending is fueling double-
digit increases in health insurance premiums. There is a reason health 
insurance premiums go up. Certainly, the insurance industry is one of 
the reasons. We know about insurance industry profits. We know about 
insurance industry executive salaries. In the 10 largest health 
insurance companies in this country, CEO's average around $11 million 
in income. That is part of the reason.
  Another reason is drug prices continue to fuel the high cost of 
health insurance. Drug prices continue to drain tax dollars out of the 
Federal Treasury, and drug spending is undermining the financial 
security of millions of seniors and other Americans, of course, but 
especially seniors who can ill afford to be the piggy bank for big 
PhRMA's--that is a drug company trade association--global operations.
  Because we do not allow importation--a decision our government has 
reached in all too close consultation with the drug lobby--Americans 
are forced to pay more for the same drugs than everyone else in the 
world.
  It is not about safety. We know that. The equivalent of the Food and 
Drug Administration in Canada or in France or in Germany or in Israel 
or in Japan knows how to make sure drugs are safe in their country. It 
is not a question of safety. It is a question of industry profits.
  Prohibiting importation has cost American consumers and taxpayers 
dearly. It has driven up the cost of insurance premiums and it has 
driven up the cost of Medicare, paid by taxpayers, Medicaid, paid by 
taxpayers, TRICARE, paid by taxpayers, and all Federal health care 
programs, again paid by taxpayers.
  It has reduced--and this is equally important--not just the cost, but 
it reduces access to lifesaving medicines. Some people simply cannot 
afford the cost of these drugs. It has reduced seniors' budgets to the 
point where they buy groceries or heat their homes or purchase 
prescription drugs but not both. Too often seniors cut their pills in 
half, take their prescriptions in smaller doses, and that, obviously, 
is jeopardizing health also.
  This amendment is a step in the right direction for increasing access 
to those drugs.
  In 2008, the pharmaceutical industry had more than a 19-percent 
profit margin and had sales of $300 billion. I am way more interested 
in protecting U.S. consumers, U.S. taxpayers, and U.S. small businesses 
that are burdened by these high drug costs than I am U.S. drugmakers 
and their inflated drug prices.
  The CBO estimates this amendment will save the government $20 billion 
over the next 10 years--$20 billion. I wish to encourage more 
competition. I do not want this body, again, to come down on the side 
of preserving monopolies.
  As it stands now, the U.S. Government permits the drug industry to 
hold American consumers hostage. Meanwhile, the largest drug 
companies--Pfizer, Merck, and others--continue to outsource operations 
abroad to cut costs and increase profit margins.
  Here is what happens: It is OK for big PhRMA to look abroad to cut 
costs and boost profits while American consumers and businesses are 
stuck paying the bill. The drug industry is trying to convince us--the 
Senate, the House and, more importantly, trying to convince the 
American people--that importation is unsafe. Wait a second. They go to 
China--I had hearings about this in the Health, Education, Labor, and 
Pensions Committee. We have had hearings, which Senator Kennedy, a 
couple years ago, asked me to chair, involving American drug companies 
outsourcing their production to China. They could not tell us about the 
entire supply chain that supplied the ingredients to these drug 
operations in China that later made their way back to the United 
States. We know about Heparin, a drug that killed several people in 
Toledo, OH, because it was contaminated with who knows what ingredients 
that came from China.
  So these drug companies are arguing these products are unsafe, these 
drugs you can buy in Windsor, Ontario, or pharmaceuticals you can buy 
in Bristol, England, or pharmaceuticals you can buy in Marseilles, 
France, or pharmaceuticals you can buy in Dusseldorf. They are saying 
those are unsafe, but they are unwilling to import drugs themselves.
  Lipitor, one of the best-selling drugs in the United States, for 
years, was made in Dublin. They can import their drugs from abroad. 
They can import ingredients from China, which has nothing like the Food 
and Drug Administration, and they are going to hire all their lobbyists 
and they are going to go around desk to desk, Member to Member, office 
to office--435 House Members, 100 Senate Members--and they are going to 
tell us these drugs are unsafe? We know better than that.
  This amendment would simply make imported medicines available to 
consumers. It is a free-market mechanism. Open it so people can 
compete, giving customers more purchasing power so they can pay lower 
prices. The drug industry should not be protected from the same 
competition that every other industry faces in a global marketplace.
  I urge my colleagues to support the bipartisan amendment of Senator 
Dorgan from North Dakota, Senator Snowe, Senator Grassley, and Senator 
McCain--all three Republicans from Maine, Iowa, and Arizona. This 
amendment makes sense for taxpayers. It makes sense for consumers. It 
makes sense for businesses. It makes sense for our country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. THUNE. Madam President, I wish to speak to a couple issues this 
evening. The first one has to do with what we understand to be the 
evolving so-called deal that is being worked out by the other side on 
the public option/government plan and the attempt to try and reach 60 
votes on the other side, in what appears to be a process that continues 
to unravel and break down because every single day there is a new story 
about some new gimmick thrown out there to attract the requisite number 
of Senators to get to that threshold of 60.
  The most recent one--and, of course, as I said, I cannot verify all 
of this because we have not been privy or included in any of the 
discussions that have occurred behind closed doors. In fact, one of 
those meetings just occurred earlier this evening.
  We read from press reports that one of the proposals contemplated by 
the majority to get that requisite number of votes is the expansion of 
the Medicare Program. What is interesting about that is that has 
engaged organizations that prior to this time had essentially been at 
the table and negotiated their own kind of agreement. But that has 
gotten the interest level up of the American Hospital Association, the 
Federation of American Hospitals, the AMA, the physician group, and I 
even have something here from the Mayo Clinic.
  It is interesting that would be considered now as an alternative to 
what previously had been discussed in terms of a public option. Here is 
why. Medicare, as we all know, is destined to be bankrupt in the year 
2017. It is a very large program that benefits a lot of seniors across 
the country. We all support reforming it, making it more sustainable, 
putting it on a pathway to where it will be solvent well beyond that 
date and extending its lifespan.

  What this would appear to do is allow people younger than 65 or 62, 
down to 55, to buy into Medicare. Essentially, you would allow more 
people to participate in a program that, as I said before, is destined 
to be bankrupt in the year 2017. So what you are doing with this 
proposal--because we all know the underlying bill cuts Medicare 
reimbursements to hospitals, nursing homes, hospices, home health 
agencies, and to Medicare Advantage beneficiaries by about $1 trillion 
over 10 years, when it is fully implemented--you are going to take $1 
trillion of revenue out of Medicare--remember, this is a program that 
is already destined to be bankrupt in 2017--you are going to take $1 
trillion of revenue out of it over the 10-year period, when it is fully 
implemented, and expand and add the number of people who are going to 
be on it. It is equivalent to putting more people on a sinking ship. In 
fact, that is what has gotten the attention of provider groups around 
the country.
  Hospitals, as we know, cannot recover their costs with the 
reimbursements they are currently receiving under Medicare. In most 
States, it varies a little bit--80 to 90 cents on the

[[Page S12794]]

dollar. So hospitals, every time they serve a Medicare patient, shift 
that cost over to the private payers and increase costs for everybody 
who is receiving insurance in the private market.
  Essentially, what you will be doing is expanding the government-run 
Medicare Program which underreimburses hospitals, physicians and other 
health care providers and forcing even more of a cost shift. You are 
exacerbating the cost shift already occurring, making it worse and 
getting all the provider hospital groups--the American Hospital 
Association, the American Medical Association--engaged in this debate 
because they see what a train wreck it would be for them.
  Frankly, what that means is you would have a lot of providers that 
would not be able to make ends meet. They would have to shut their 
doors and go out of business because many of them are very dependent on 
Medicare patients.
  In my State of South Dakota, most of our hospitals, especially in 
rural areas, are heavily dependent--70 percent or thereabouts--between 
Medicare and Medicaid. If they are not a critical access hospital and 
still getting reimbursed under the traditional Medicare Program, they 
are going to have a very hard time making ends meet because right now 
what they do is what all hospitals do. They shift costs over to the 
private payers.
  Here is what AMA said about the proposal:

       AMA has a longstanding policy of opposing expansion of 
     Medicare given the projections for the future.

  That is what the doctors group said.
  The American Hospital Association urged all Senators to reject 
expansion of Medicare and Medicaid as part of the public option, saying 
Medicare pays hospitals just 91 cents of each dollar of care provided. 
This again would expand the number of people they would have to cover 
and shrink the private-payer market and lump more and more of the costs 
on those so everybody else's premiums would go up.
  The Federation of American Hospitals, which is the private hospitals 
across the country, said any Medicare buy-in would invariably lead to 
crowdout of the private health insurance market, placing more people 
into Medicare. Such a policy will further negatively impact hospitals 
after we have already agreed to contribute a maximum level to 
sustainable reductions in the deal they struck earlier. It seems to me 
these deals have fallen off the table.
  This latest proposal--if, in fact, what we are reading is true--I 
think they recognize would be a disaster. Here is what the Mayo Clinic 
in their letter said:

       Any plan to expand Medicare, which is the government's 
     largest public plan, beyond its current scope does not solve 
     the nation's health care crisis, but compounds it.

  They go on to say:

       Expanding the system to persons 55 to 64 years old would 
     ultimately hurt patients by accelerating the financial ruin 
     of hospitals and doctors across the country. A majority of 
     Medicare providers currently suffer great financial loss 
     under the program. Mayo Clinic alone lost $840 million last 
     year under Medicare. As a result of these types of losses, a 
     growing number of providers have begun to limit the number of 
     Medicare patients in their practices.

  That is what we are talking about. If you expand this program and you 
have a reimbursement system that currently does not cover the cost of 
hospitals, they are going to cease covering Medicare patients in the 
same way they currently are not covering Medicaid patients.
  They say about 50 percent of physicians today have chosen not to 
accept Medicaid patients. So you compound the access problem that many 
people in rural areas already experience.
  There are big problems with this proposal. I have to come back to 
what Congressman Anthony Weiner said about this issue:

       Extending this successful program to those between 55 and 
     64, a plan I proposed in July, would be the largest expansion 
     of Medicare in 44 years and would perhaps get us on the path 
     to a single payer model.

  Therein, I think, lies the ultimate goal, and that is to expand 
Medicare to where we have a whole government-run health care system in 
this country on the way to single-payer status. That is precisely what 
many of our colleagues on the other side want to see happen.
  Ironically, there are some who have expressed concern about this. Our 
colleague from North Dakota, the chairman of the Senate Budget 
Committee, Senator Conrad, said when asked about this proposal:

       It's got many of the same problems I have with previous 
     versions of the public option. That then ties you to Medicare 
     levels of reimbursements for a whole new population.

  He contended that the hospitals in his State would go bankrupt. His 
State of North Dakota is not unlike my State of South Dakota. Hospitals 
are not going to be able to make it if these reimbursement levels that 
are currently afforded them under Medicare are extended to a whole new 
population.
  I hope this is a bad idea that is just being thrown out as one of 
these things that is being thrown at a wall and hoping it sticks in a 
desperate effort to get to 60 on the other side because this is a bad 
idea and the provider groups are weighing in heavily against it.
  It is pretty clear it would be a disaster for health care delivery in 
rural areas of the country and, for that matter, Mayo Clinic and many 
of the providers that weighed in on this. It would literally make it 
more difficult for people to have access to health care and 
exacerbating the cost-shifting issue that already exists with regard to 
the private-payer market and make their costs and everybody else's 
costs go up more.
  I want to shift gears for a moment because tomorrow Senator Hutchison 
and I will be offering a motion to commit. Basically, what it deals 
with is the whole tax component of this health care reform bill. In 
very simple terms--and I will demonstrate exactly why this is a 
relevant issue--if you look at the cost of this health care proposal, 
the Reid proposal before us, you can see what the costs are in the 
early years and then you can see how the costs explode in the outyears. 
There is a reason for that. The revenues kick in right away. The tax 
increases start coming in right away, but the spending proposals and 
many of the benefits that will go out under this bill don't occur until 
much later.
  So what we have is a 10-year budgetary picture and cost for this 
program that completely understates what the true cost of the program 
is. If you look at this particular chart, look at the years 2010 to 
2019, you can see how, particularly in the early years, it doesn't look 
like there is that much spending. In fact, the number in the first 10 
years is $1.2 trillion in spending. However, if you look at the cost of 
this when it is fully implemented--take the year 2014 and extend it 
through the year 2023--you can see how the costs explode, and the total 
fully implemented cost over a 10-year period is $2.5 trillion.
  There is a reason for that, as I said. A lot of budgetary gimmicks 
were used to understate the cost, particularly in the first 10 years, 
so people could say it costs only $1 trillion. In fact, as you can see, 
when it is fully implemented, it is $2.5 trillion. One of the major 
reasons for that is because the tax increases in the bill take effect 
23 days from now--January 1 of the year 2010. That is when many of the 
tax increases in this legislation go into effect. But the spending and 
the benefits that are going to be distributed--the exchanges and the 
premiums, the premium subsidies, and that sort of thing, the tax 
credits--don't begin to kick in until the year 2014 or 1,484 days 
later. So for those 1,484 days--well, back out the 23 days from that--
so for those 1,461 days, taxes are going to be assessed and levied 
against people in this country--on small businesses, families, and 
individuals--but you will not see any benefits for over 1,000 days, 
almost 1,500 days.
  What the Hutchison-Thune motion to commit does is it aligns the tax 
increases, the fees--the taxes included in this proposal--with the 
benefits in terms of timeline so that the tax increases and the 
benefits occur at the same time. In other words, we would delay the tax 
increases in this bill until such time as the benefits package and 
structure would kick in so that they are in sync.
  Right now, there is essentially 4 years--at least 4 years--of tax 
revenues coming in, tax increases being borne by people all across this 
country, including businesses. Incidentally, there is a lot of 
discussion now about job creation and the need to grow the economy. The 
worst thing you can do to small businesses, when you are trying

[[Page S12795]]

to create jobs, is to levy new taxes on them. But that is what this 
bill does. And, by the way, in that first 4 years, almost $72 billion 
of taxes will be collected. I say the first 4 years, I think that is 
through the year 2014. But you have all these taxes that kick in on 
January 1 of 2010--less than 23 days from now--and then actually you 
have this amount of time--as I said, almost 1,500 days--before the 
benefits begin to pay out.
  So all we are saying in our motion to commit is let's align the tax 
increases and the benefits structure so you don't have this period of 4 
years where people are paying taxes and receiving literally no benefits 
under this health care reform bill.
  The advantage that has is that it accurately reflects the cost of 
this program in the first 10 years, rather than understating it because 
of the revenues that kick in immediately and the benefits that don't 
kick in until much later. It is very straightforward, very simple, very 
understandable. Tax increases that are designed to kick in on January 1 
of this next year would not kick in until such time as the benefits 
kick in. So the fees, the taxes, and the tax increases in this bill are 
all aligned and sync'd up, so to speak, with when the spending under 
the bill begins.
  Of course, what that does is give us a more accurate reflection of 
the overall cost of the bill. And many of these tax increases which 
will kick in 3 weeks from now, or a little over 3 weeks from now, on 
January 1 of next year, are going to be distributed across a wide range 
of businesses, but most will be passed on to consumers across this 
country. In fact, the CBO, in a letter to Senator Evan Bayh on November 
30 of this year, said essentially that all these fees and taxes in the 
bill--and there are fees on medical devices, there are fees on 
prescription drugs, there are fees on health care plans--all these fees 
would tend to raise insurance premiums. In testimony in front of the 
Finance Committee, the CBO, when this question was posed during the 
deliberations at the Finance Committee level as to what all these fees 
would do to insurance premiums, they said, roughly, it would increase 
premiums dollar for dollar.
  So we have the taxes and fees that will kick in immediately, and that 
will have an upward impact on premiums so that people across the 
country will begin to see those premium increases take effect. The tax 
increases, of course, are taking effect on medical device manufacturers 
and on prescription drugs, and there is a whole other range of taxes in 
here--there is the tax on high-cost insurance plans, there is a health 
insurer fee, there is a Botox tax, which starts January 1 of 2010, and 
you can kind of go down the list. There are limits on FSAs, flexible 
spending accounts, which is something people use to put aside money so 
they can buy a high-deductible plan and have dollars available to deal 
with the incidental health care costs they have. So the taxes are going 
to go up on those. You can go through this whole list of taxes, all of 
which, as I said, are going to go into effect in the near term, but 
none of the benefits kick in until many years later.
  Unfortunately for the American public, they are going to see the 
premium increases that will come as these taxes are imposed on all 
these various sectors of the health care economy and which will all be 
passed on to consumers in the form of higher premiums. So the American 
consumer--the American public, the taxpayers of this country--are going 
to see the costs immediately and won't see the benefits for 5 years. 
That is not fair. It is not the right way to set policy here in 
Washington, DC. It is much more transparent if we have these dates of 
the tax increases and the fees and the taxes in this bill sync'd up--
synchronized, aligned--with the benefits when they begin so that 
everything starts at the same time.
  So the motion to commit is, again, simply a motion to commit this 
back to the Finance Committee, and to create a level playing field 
where the revenues that are raised under the bill don't begin to kick 
in until the benefits start to kick in and the spending starts to kick 
in. That will give us the true picture, the actual picture of the cost 
which, as I said before, is $2.5 trillion over 10 years when it is 
fully implemented, and not the $1 trillion, or under $1 trillion that 
is being used by the other side. You have to look at the full picture 
over a 10-year period, when it is fully implemented. Obviously, that 
gives you a very different perspective about the overall true cost of 
this particular proposal.
  The basic contours of this bill we have in front of us have not 
changed, nor do we expect them to change. They will tweak around with 
this government plan. There was already a vote on the issue of 
abortion, which I happen to believe taxpayer funds should not be used 
to finance. We have had that vote. There will be some other votes on 
individual aspects. But some of those things are not going to affect 
the fundamental core elements of this plan, which have stayed the same 
throughout the entire process. And those core elements are a massive 
expansion of Federal spending--$2.5 trillion over 10 years when it is 
fully implemented--massive cuts to Medicare--about $1 trillion over 10 
years, when fully implemented, affecting hospitals, nursing homes, home 
health agencies, hospices, and beneficiaries of Medicare Advantage, of 
which there are about 11 million across the country--and it is also 
financed with increases in taxes, which I have mentioned. Those are the 
basic components of this bill. Seventy new government programs are 
called for. All the new spending, all the new bureaucracy, all the new 
taxes, and all the Medicare cuts, those things have not changed since 
this bill first started being debated several months ago.

  That is where we are today. That is why I believe this is such a bad 
proposal for the future of this country. Because even after all that, 
if you look at the impact it has on premiums, according to the 
Congressional Budget Office, 90 percent of Americans end up the same or 
worse off. When I say the same, I mean year over year increases in 
their insurance premiums that are double the rate of inflation. So if 
you are buying in the small-group market today, or the large-group 
market, according to the Congressional Budget Office, you are going to 
see your insurance premiums continue to go up over time. If you buy in 
the individual market, you are going to see them continue to go up, but 
way more--a 10- to 13-percent increase in premiums for people who buy 
in the individual marketplace, above and beyond the rate of inflation 
that will impact people in the large- and small-group markets.
  So the bottom line is, if you are looking for reform, if you are the 
average American citizen out there, the person I represent in South 
Dakota, who is hearing about health care reform, to them it means a 
couple of things. It means affordable access to health insurance for 
people across this country; and something that most of us--at least 
here on our side--think ought to be a part of this, and that is 
measures or proposals that actually bend the cost curve down rather 
than up. But what we have seen consistently throughout the course of 
this debate, with all the spending and all the tax increases and all 
the Medicare cuts, is no positive impact on premiums. The best that 90 
percent of Americans can hope for is to maintain the status quo--stay 
where you are--which is double your increases year over year, double 
the rate of inflation in your health insurance premiums or, worse yet, 
increases of 10 to 13 percent above and beyond that. That is what 90 
percent of Americans are looking at as a result of the health care 
reform proposal that is currently before the Senate.
  There is a better way, and we believe the way to get this right is to 
start over and to actually focus on solutions that will drive down the 
cost of health insurance, that will bend that cost curve down, such as 
interstate competition, allowing pooling for small businesses, medical 
malpractice reform. We have a whole series of things that we think 
represent the consensus view of the people in this country. There is 
common ground we can all stand on. But regrettably, we have not been 
included in any of the discussions, nor have any of our ideas been a 
part of those discussions. Rather, they have chosen to pursue this 
course of a big spending program, with the higher taxes, and the 
Medicare cuts and the higher premiums.
  I truly hope there will be support, as this process moves forward and 
we get onto the critical votes ahead of us, for a more rational step-
by-step approach, doing this right, getting away from

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this huge massive expansion of the Federal Government here in 
Washington, DC, and seriously focusing on solutions that actually do 
bend the cost curve down, that don't rely on these huge cuts to 
Medicare, that don't rely on these huge tax increases, but that 
actually find savings. And they can be achieved in the market by 
putting policies in place that will constrain costs and put downward 
pressure on the prices most people pay for health insurance in this 
country. It can be done. But it is going to require some boldness on 
the part of some of our colleagues on the other side.
  I think our side is pretty well united. This is a bad policy, a bad 
prescription, if you will, for America's future. But we are going to 
need some help from a courageous Democrat or two to make sure this 
massive expansion of the Federal Government is defeated and that we can 
go back, start over, do this in a step-by-step way--the right way--and 
in a way that actually does lower costs for people in this country. I 
certainly think that is what my constituents in South Dakota expect, 
and I think that is what most Americans expect. They deserve to have 
health care reform that gives them that outcome--lower cost and access 
to affordable health care.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER (Mr. Begich). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BROWNBACK. Mr. President, I ask unanimous consent the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BROWNBACK. Mr. President, I ask for 10 minutes to be allotted to 
me under the minority time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BROWNBACK. Mr. President, in the past few months this body has 
been forced to stand aside as Senator Reid and a few others crafted a 
2,000-page bill behind closed doors, the one we are on right now. 
Unfortunately, the product that was resolved at the closed-door 
meetings--at least the one we have now, I don't know about a future 
one--still raises taxes by $\1/2\ trillion. Probably under any new bill 
that comes out you are going to have taxes going up $\1/2\ trillion, 
cut Medicare by $\1/2\ trillion, raise premiums on American families, 
fail to bend the cost curve down, and expand government's encroachment 
further and further into people's health care decisions.
  What I want to go through is a series of charts about how inflation 
is going to end up being the tax collector's best friend in this 
overall plan and how the tax of inflation is going to be one of the key 
features of how the overall bill is paid for.
  I hope most people remember when we had inflation. A lot of people 
maybe don't remember when we had significant inflation. It is a cruel 
tax. It is a very cruel tax on people on fixed income, a very cruel tax 
on people in low-income status because constantly the dollars you have 
stay pretty stable, and everything you are buying goes up. So inflation 
kills you. It kills you in the pocketbook and is one of the things we 
have to be concerned about, particularly with the amount of money that 
is out in the money supply today and the likelihood of this moving 
forward and how it is built in to pay for this huge expansion that we 
can't afford in this bill.
  I am joining my colleagues today in speaking against the $500 billion 
in new taxes that are in the Democrats' proposal to levy on the 
American people and the job-creating small businesses this is going to 
be put on, in an attempt to pay for this big 2,000-page bill.
  This monstrous bill is flawed economic policy. I will develop that 
point for you as well. It fails to lower health care premiums, fails to 
bend the cost curve down, and will further cripple the struggling 
economy with massive and burdensome tax increases.
  This careless legislation reminds me of a cautionary tale that is 
still being played out in another part of the world. That is what 
happened in the early 1990s in Japan. Japan, a surging economic giant 
at the time, suffered a severe economic recession in the early 1990s, 
of which the effects are still lingering even today in Japan.
  During Japan's ``lost decade,'' from 1991 to 2003, their gross 
national product grew a paltry 1.4 percent annually, creating a decade 
of stagflation--that is where you have a stagnant overall growth but 
inflation in the economy--and limited economic growth. Most economists 
believe that Japan's economic recession would not have lasted nearly as 
long as it did had it not been for one fatal error that the Japanese 
government made. In the late 1990s, as their economy was recovering and 
appearing to be pulling out of its economic slump--so the economy is 
just getting going, starting to pull out of the economic slump--the 
Japanese government made a catastrophic decision to raise taxes. The 
result was that this one decision aborted the strong recovery the 
Japanese economy was starting to experience and plunged it back further 
into an economic downturn that lasted for many more years, the hangover 
from which is still on them today.
  What are we doing here today, discussing a $2.5 trillion government 
entitlement expansion that raises taxes $\1/2\ trillion, plays budget 
gimmicks with our $12 trillion deficit and raises health premiums and 
costs for all Americans in the middle of the country's economic 
recession? What are we even talking about, why are we doing it? That is 
what I get from the people back home. They say why are you talking 
about this while are we in this recession? Why are you talking about 
this with the health care situation the way it is, to raise the cost, 
raise the insurance premiums, cutting Medicare when Medicare needs 
more, not money taken out of it? Now is not the time, this is not the 
bill, and this is not the way the American people want to see their 
health care reformed. What the American people want is for this body to 
lower health care costs and induce an economic recovery that creates 
jobs, not kills them, and grows the American economy, not thwarts it.
  The way to do that is not to raise taxes, as is evidenced by what 
happened in Japan. Increased mandates, increased regulations, and 
increased taxes are a recipe for disaster. It is a recipe that kills 
jobs. In fact, President Obama's chief economic advisor, Dr. Christina 
Romer, stated earlier this year that as many as 5.5 million jobs could 
be lost due to the Democrats' new tax proposal in this 2000-page 
government takeover of health care. Nothing can be worse at a time when 
the Nation is already experiencing a 10-percent unemployment, a 26-year 
high. This bill will impose $28 billion in new taxes on employers that 
will ultimately be paid by American workers in the form of reduced 
wages and lost jobs.
  Under this burdensome legislation employees will face stunted wages 
and the loss of their benefits as their employers attempt to find ways 
to fund these newly imposed mandates. As small businesses struggle to 
keep their doors open, tough decisions will have to be made on whether 
to raise prices, cut wages, or let go workers in order to find the 
funds necessary to comply with the Federal mandates imposed in this 
bill.
  Furthermore, this bill will kill jobs by penalizing small businesses 
who are looking to grow--and small businesses are the growth engine for 
the country. In this bill, firms with more than 50 workers that did not 
offer coverage would have to pay a penalty or a tax to the Federal 
Government for each full-time worker if any of their workers obtain 
subsidized coverage through the government-run exchange.
  What businessman would decide to hire that 50th employee, knowing 
full well if he did that the government would penalize his business and 
slam him with a new costly tax? So now people try to stay under this 
limit rather than constantly looking to grow the business.
  Furthermore, under certain circumstances, firms with relatively few 
employees and relatively low average wages would be eligible for tax 
credits to cover portions of their health insurance premiums. That is 
relatively few would be eligible.
  I ask, what employer would decide to increase the number of employees 
or increase the amount of their wages if they stand to lose government 
handouts, supports, subsidies, or face an increased tax burden? They 
simply will not be willing to do it.
  One of the most disturbing aspects of this legislation is the use of 
inflation

[[Page S12797]]

to fund it--the use of inflation, a hidden tax increase on working 
families, to fund it.
  I am the ranking member on the Joint Economic Committee and we look 
at these aspects a great deal. The use of inflation is built into the 
base of this to fund it. We know the consumer, the individual taxpayer, 
pays all taxes. No matter how the government claims to assess those 
taxes, they are paid by individuals.
  I have a couple of examples I want to show. First, I want to talk 
about: High-cost Plans Tax Hits the Middle Class. Let me talk about 
that. This is the tax on the so-called Cadillac health insurance plans.
  We know that insurance policies and benefit plans will be altered to 
avoid that tax. In other words, if you get an insurance plan that is up 
above a certain level you get taxed on that higher end, that so-called 
Cadillac plan. So in all probability most groups will not provide this 
high-quality health care because they say you are going to get taxed on 
it.
  Benefits that taxpayers with insurance currently receive on a pretax 
basis--right now they get it so the company is paying for it, is pretax 
to the individual--will gradually shift to after-tax benefits resulting 
in higher payroll and income taxes. So now that you have cut this 
Cadillac plan to get underneath it being taxed, and then the company 
says OK, we will pay you in wages or we will do this somewhat 
differently. Then you have to go around and supplement or have a lower 
quality of health insurance. You are going to have to pay for it with 
after-tax dollars. That will result in more taxes, but you don't get 
more benefits from this. This is a big tax hit on the middle class of 
people who are going to have to pay this as their higher income or 
their higher based insurance plans are taxed.

  Here is what the Joint Committee on Taxation said about the 
distribution impact of the high-cost tax plans: Despite the President's 
promises the majority claims--91 percent of taxpayers will be affected 
by this tax earning under $200,000. The tax will hit married filers 
more severely than singles; 62 percent of the high-cost plans tax 
impact will fall on married filers compared to 25 percent on single 
filers. Why are we building the marriage penalty back into the 
insurance? We worked a long time in this body to get rid of key 
portions of the marriage penalty, saying we should not tax marriage, we 
should support this institution. It is being built back into this plan.
  This bill also imposes an additional Medicare tax on wage and 
salary--or certain types of business incomes of single taxpayers with 
incomes above $200,000 and married taxpayers with incomes of more than 
$250,000. Right off the bat there is a new marriage penalty. People 
living together but unmarried making $150,000 each won't pay the tax. 
Two married people paying the same amount will. What is right about 
that?
  Making matters worse, the thresholds are not indexed for inflation--
no indexing for inflation. Inflation is a cruel tax and unfortunately 
in this situation it is not only going to be inflation, but you are 
going to be taxed, then, as you get inflated into these categories. 
From 2013 to 2019, the number of returns of people earning under 
$200,000 in today's dollars will rise from 75,000 to 345,000 under the 
current trajectory on inflation. We are making the tax man's best 
friend inflation. That is wrong. So you are going to move 75,000 to 
345,000 for new tax revenue. Married couples will be hit hard, as I 
mentioned earlier. Then you are looking at inflation: 2013, 2015, 2017, 
2019--the number of people growing into this taxable category affected 
by this Medicare tax that will increase in 2009 dollars from $75,000 to 
$345,000.
  If you want to think about this, think about when the alternative 
minimum tax was first put in place. The alternative minimum tax was 
supposed to be on very wealthy individuals. That was all it was going 
to be on. But it was not indexed for inflation. Now you get whole 
swatches of people hit by it and this body regularly tries to change 
that or deal with it on a 1-year basis because it was not indexed for 
inflation. What you build into the base of this bill is, if you want to 
pay for the bill, you want inflation. So you get inflation and it hurts 
people on fixed incomes and you get more people taxed than you started 
off with. You didn't tell them about it at the outset.
  This plan clearly should be indexed for inflation. We know that 
should take place. Yet this is where a major part of the money for the 
bill comes from--inflation. Is that something the Federal Government 
should be banking on, that we will get inflation to pay for this health 
care bill? I don't think the American public wants to see that taking 
place.
  To put this in context, let's not just look at returns under 
$200,000, let's look at all returns and how this tax will spread. 
According to the Census Bureau estimates, between 2013 and 2019, the 
working-age population of the country will grow by 1.6 percent. Joint 
Tax estimates that the number of returns that will be affected by this 
tax will grow by 52.6 percent and revenue collected as a result of the 
tax will grow by more than 54 percent. Over time, the Reid bill 
Medicare tax isn't just for the wealthy. Comparing the increase in 
taxes with growth in the working-age population, this is how many more 
people will be impacted. Inflation becomes the tax man's key friend.
  During Japan's lost decade, from 1991 to 2003, their gross national 
product grew a paltry 1.4 percent annually, creating a decade of 
stagflation and limited economic growth. It was because of policies 
such as this where you have inflation, where you have tax increases put 
in place. These are the things that caused that to take place. It 
should not be done.
  I will just add as a final note, when I am talking with people back 
home, all the time they raise this health care bill. They talk about it 
constantly. If they are small businesspeople, they are talking about 
not doing anything until the political environment is more stable in 
their estimation, about how much taxes we are talking about, about how 
much regulation we will be talking about.
  You have what is going on with a climate change debate and 
regulations in Copenhagen. That tells a lot of people in my area who 
are energy users and producers, don't do anything until this 
stabilizes. When you talk about tax increases or inflation being a part 
of this proposal, you have a bunch of people saying: Don't do anything. 
Just stay on the sideline. That is a prescription for no job growth. 
That is a prescription for killing jobs. You want people out there 
investing and creating jobs and opportunities. You want them to see a 
stable political environment where they are not worried about 
increasing taxes, not worried about increasing regulation but, rather, 
saying: This is a stable environment in which we can invest and grow. 
That is not what they are doing today. That is repeating the lesson the 
Japanese learned of raising taxes when you are coming out of a 
recession. It is harmful. It is the wrong economic strategy. It should 
not be a part of this bill.
  I yield the floor.
  Mr. ENZI. Mr. President, I voted to support Senator McCain's motion 
to commit the bill back to the Finance Committee to protect all seniors 
from the Medicare cuts in this bill.
  Section 3201(g) of the Reid bill shields Florida from the sweeping 
payment reductions to Medicare Advantage plans. Democratic Senators 
from Florida, New York, Oregon and Pennsylvania have also reportedly 
sought carve outs to protect seniors in their States from these cuts.
  It is unfair to protect only seniors in Florida from these cuts. 
President Obama said if you like what you have, you can keep it. I 
believe that principle should apply to all Medicare beneficiaries.
  At least some of my Democratic colleagues are honest about what they 
are doing. The New York Times yesterday quoted the Senator from Florida 
as saying, ``It would be intolerable to ask senior citizens to give up 
substantial health benefits they are enjoying under Medicare . . . I am 
offering an amendment to shield seniors from those benefit cuts.''
  Bloomberg News also quoted that same Senator as saying, ``We're 
trying to grandfather in seniors so that they don't lose the benefits 
they have.''
  Now, I disagree with these sweetheart deals. But I understand the 
motivation behind them. We should not be

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taking benefits away from Medicare beneficiaries.
  What I don't understand is how other Democrats can deny that the Reid 
bill cuts Medicare benefits. I have heard my Democratic colleagues 
repeatedly argue that there no cuts of any ``guaranteed benefits'' in 
the Reid bill.
  I was not familiar with the term ``guaranteed benefits,'' so I asked 
my staff to review the Medicare statute. They searched through the 
entire Social Security Act, which governs Medicare, and could not find 
that term anywhere. That is because the term doesn't exist. The other 
side just made it up.
  Medicare Advantage plans provide extra benefits to beneficiaries who 
enroll in these plans. These are the benefits that will be cut under 
the Reid bill. Clearly the Senator from Florida understands the value 
of these benefits. That is why he and other Democrats are fighting 
tooth and nail to undo the cuts in their States.
  At the same time, other Democratic Senators continue to argue that 
Medicare Advantage is neither Medicare nor an advantage.
  That is false. Medicare Advantage is Part C of Medicare. If you go to 
the Web site of the Department of Health and Human Services, it says 
Medicare Advantage is part of Medicare.
  As to the ``advantage'' part, Medicare Advantage does provide extra 
benefits, and seniors place great value on them. It's that simple. That 
is why the Senator from Florida and others are trying to get carve outs 
for seniors in their States.
  Under the Reid bill, seniors will lose vision benefits. Apparently, 
the other side does not think vision care is an advantage.
  The Reid bill will cut dental benefits for seniors. These are also 
apparently not an advantage for seniors.
  The Reid bill will cut hearing benefits for seniors. These are 
apparently not an advantage for seniors.
  The Reid bill will cut home care for seniors with chronic illnesses. 
The other side thinks these benefits are not an advantage.
  The Reid bill will cut disease management programs for seniors. These 
benefits are also apparently not an advantage.
  The Reid bill will cut nurse help hotlines for seniors. The majority 
apparently does not believe this is an advantage.
  The Reid bill will end reduced cost sharing for primary care 
physician visits. This is apparently not an advantage for seniors.
  The Reid bill will eliminate reduced premiums for Part B. This is 
apparently not an advantage for seniors.
  The Reid bill will eliminate reduced cost sharing for breast cancer 
screening. This is apparently not an advantage for seniors.
  The Reid bill will eliminate reduced cost sharing for prostate cancer 
screening. This is apparently not an advantage for seniors.
  Most disturbing of all, the Reid bill will cut seniors' protections 
against catastrophic costs under Medicare Advantage. The other side 
says they want to keep medical bills from driving folks into 
bankruptcy. At the same time, they are eliminating Medicare Advantage 
benefits that actually protect Medicare beneficiaries from catastrophic 
medical costs.
  How is catastrophic coverage not an advantage to seniors? It seems to 
me few things could be more advantageous than not losing your life 
savings because of medical bills.
  It is obvious to anyone who listened to the list I just read that 
these are real benefits. Furthermore, it should be equally clear that 
the Reid bill will take these benefits away from millions of Medicare 
beneficiaries.
  Anyone who doubts what affect the Reid bill will have on Medicare 
beneficiaries should look at the last time that Congress made cuts like 
this. The impact was severe.
  Congress enacted the Balanced Budget Act of 1997, which included 
similar types of cuts. Once it took effect, nearly one out of every 
four of the plans, then known as Medicare+Choice, pulled out of the 
program.
  According to an article in the Fort Lauderdale Sun Sentinel, when the 
Prudential Medicare+Choice plan withdrew from Florida, nearly 12,000 
seniors in Broward, Palm Beach and Miami-Dade lost their coverage of 
prescription drugs, eyeglasses, hearing aids or other benefits.
  You can bet seniors in Broward, Palm Beach and Broward counties 
haven't forgotten these cuts, losing their plans, sometimes their 
doctors, and certainly those benefits.
  According to the Baton Rouge Advocate, over 50,000 Louisiana seniors 
lost the extra benefits that had been provided by Medicare+Choice 
plans. The cuts were so disruptive and confusing that State Insurance 
Commissioner Jim Brown had to air public service announcements. You can 
bet Louisiana seniors remember those cuts.
  After these cuts went into effect, the Chicago Daily Herald reported 
that the Senior Health Insurance Program run by the Illinois Department 
of Insurance was ``deluged with phone calls from senior citizens 
affected by the move of some health maintenance organizations to drop 
Medicare.''
  By that time, United Healthcare had decided to no longer offer 
Medicare+Choice plans in DuPage, Kane, Lake and Will counties. This 
affected 12,000 seniors in these Chicago suburbs.
  By 2000, the Daily Herald reported that Aetna and Humana were also 
pulling out, dropping coverage for 2,794 beneficiaries in Lake County 
and 6,180 Aetna enrollees in Cook, Lake, Kane and DuPage counties. All 
of these beneficiaries lost the extra benefits they had previously 
received from their plans.
  Brian Carey, director of Senior Services for Schaumburg Township, was 
quoted as saying, ``It's just thrown so many people into, in some 
cases, a complete state of panic.''
  By 2002, the Chicago Tribune quoted CMS administrator Tom Scully as 
saying there were no--that's zero--Medicare plans serving Chicago and 
its suburbs.
  If the Reid bill is passed, we will again see millions of Medicare 
beneficiaries lose the benefits they currently receive from Medicare 
Advantage.
  Medicare beneficiaries understand this program provides real 
advantages to those who enroll in the program. They do not want to lose 
these benefits.
  I hope that all of my colleagues support the McCain amendment and 
ensure that these seniors continue to receive these benefits.
  Mr. JOHNSON. Mr. President, today I rise to recognize the 
overwhelming need for health care reform. Earlier this year I asked 
South Dakotans to share their personal health care stories with me, the 
good and the bad, so that I could share these with my colleagues and 
ensure that the people of South Dakota have a voice in this national 
debate. Thousands have responded to my request and through their 
stories I have gained immeasurable insight into the challenges my 
constituents face in our current health care system. The experiences of 
these hard working families, business leaders, patient advocates, and 
health care providers poignantly demonstrate the urgent need for health 
care reform.
  David, a farmer in Madison, SD, was forced to sell his land when a 
heart attack left him with $60,000 in medical bills. His wife Patty 
wrote to me to tell me his story. As a farmer, David couldn't afford to 
buy private health insurance in the individual market but didn't 
qualify for public programs. Insurance companies refused him coverage 
after his heart attack because he now had a serious preexisting 
condition. Last year he suffered a second heart attack and accrued 
another $100,000 in medical bills. Struggling to pay this debt, Patty 
and David exhausted all their resources. David feels he has no hope of 
finding insurance coverage for his heart health, the very condition 
that requires treatment the most. Patty and David live in fear of a 
serious illness knowing that, like many families, adequate health 
insurance is beyond their reach.
  The situation Patty and David find themselves in is not unique. A 
recent study by the Access Project found that 44 percent of ranchers 
and farmers in South Dakota get their health insurance on the nongroup 
market, where they pay on average $10,395 for coverage. For the past 
few decades, premium rates have been rapidly outpacing increases in 
incomes. According to the study, almost half of those surveyed spent 
over 10 percent of their income on health care. Like Patty and David, 
one in four of the farmers and

[[Page S12799]]

ranchers surveyed had to dip into savings, retirement funds, or take 
loans against their farms or ranches to cover health care costs.
  Managing heart disease requires regular checkups and treatments to 
manage the disease, improve overall health and prevent future 
complications. Without access to these services, Patty fears what will 
happen to their family and their farm in the event David suffers 
another heart attack.
  There are several provisions in the Patient Protection and Affordable 
Care Act to benefit Americans like Patty and David. It will extend 
access to affordable and meaningful health insurance for all Americans. 
The bill stands up on behalf of the American people and puts an end to 
insurance industry abuses that have denied coverage to hardworking 
Americans when they need it most. According to the non-partisan 
Congressional Budget Office, the Senate reform proposal will extend 
coverage to 31 million more Americans when fully enacted.
  Immediately after enactment, a new program will be created to provide 
affordable coverage to Americans with preexisting conditions who have 
been denied the coverage they need. People like David will be 
guaranteed health insurance coverage after years of struggling without 
this basic security.
  In addition, this legislation will create health insurance exchanges 
in every State through which those limited to the individual market 
will have access to affordable and meaningful coverage. The exchange 
will provide easy-to-understand information on various health insurance 
plans, help people find the right coverage to meet their needs, and 
provide tax credits to significantly reduce the cost of purchasing that 
coverage. No matter what plan you have, every American will have the 
added security of knowing that your insurance company will no longer be 
able to deny coverage for preexisting conditions and won't be able to 
drop your coverage if you get sick. Patty, David, and all Americans 
deserve this basic security.
  The PRESIDING OFFICER. The Senator from Montana.

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