[Congressional Record Volume 155, Number 189 (Monday, December 14, 2009)]
[Senate]
[Pages S13157-S13177]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             CLIMATE CHANGE

  Mr. THUNE. Madam President, I wish to start by referring briefly to 
the remarks made earlier by the Senator from Alaska. She indicated 
earlier on the floor that she is going to be offering a motion of 
disapproval for a set of

[[Page S13158]]

regulations that are not final yet but have been announced by the EPA 
that they are coming forward with, the so-called endangerment finding. 
I wish to indicate that I intend to support her on that resolution.
  I cosponsored the amendment she tried offering earlier this year to 
one of the appropriations bills that would have prevented the EPA from 
moving forward with the endangerment finding for a year, which would 
have allowed Congress an opportunity to examine this issue and perhaps 
approach it with a legislative solution as opposed to having the EPA 
move forward in a way even they acknowledge they don't have statutory 
authority to do.
  I might say that the end result of what is being proposed at EPA--if 
they are successful--is they will implement a cap-and-trade program, 
only it will be a cap without the trade.
  The reason they are moving forward, in my view, is because there 
isn't the political will in the Congress to pass a punishing cap-and-
trade proposal this year. The House of Representatives passed it 
narrowly this year. There are a number of Members of the House who I 
think would like to have that vote over again. I know there aren't the 
votes in the Senate because many Senators on both sides realize the 
impact it would have on the economy--the number of jobs that would be 
lost in our economy and how it would punish certain parts of our 
country with crushing energy costs, at a time when we don't need to 
pile costs on small businesses and consumers who are trying to come out 
of a recession.
  This is a wrongheaded move by the EPA. It is something they should 
not be acting on independently. This should be resolved by the Congress 
of the United States. Honestly, if the EPA moves forward, there are a 
number of industries in South Dakota that will be impacted and a number 
of businesses in my State. If the litigation is successful--and, 
inevitably, there will be lots of lawsuits filed--and if the 25,000-ton 
number is reduced to the 250-ton number that is used as a threshhold in 
the Clean Air Act, there will be literally millions of entities that 
will be covered--hospitals, churches, farmers, ranchers, and small 
businesses.
  In South Dakota, we have a lot of farmers and ranchers who make their 
living in small businesses that would be adversely impacted were these 
regulations to be enacted and then move forward with regulating and 
putting the caps in place. If the litigation is successful, we know 
what will be subsequent to that.
  I say that as a lead-in to talk about impacts on small businesses. 
There are so many things happening right now in Washington that have an 
adverse and detrimental impact on the ability of small businesses to 
create jobs. I have heard the President talk about creating jobs--that 
is his No. 1 priority--and we need to give incentives to small 
businesses to create jobs. I have heard my colleagues on the other side 
talk about how important job creation is. Yet everything coming out of 
Washington, whether it is in the form of heavyhanded regulation, such 
as this endangerment finding coming out of EPA, or in the form of a 
cap-and-trade proposal or whether it is this massive expansion of the 
Federal Government--the $2.5 trillion expansion to create a new health 
care entitlement--all these things are raising clouds over the small 
business sector of our economy, which creates about 70 percent of the 
jobs.
  We are essentially telling small businesses that you may end up with 
these massive new energy taxes or with this employer mandate that will 
cost you up to $750 per employee if you don't offer the right kind of 
insurance; you are going to be faced with all these taxes imposed on 
health insurers and prescription drugs and medical device manufacturers 
that will be passed on to you.
  Then we are saying go out and create jobs, in light of all this 
policy and uncertainty in Washington, all these proposals to tax and 
spend and borrow more money by the Federal Government. You cannot blame 
small businesses for acting with a little bit of hesitancy when it 
comes to making major capital investments and when it comes to hiring 
new people.
  Those are the very things we want small businesses to do. We want to 
encourage that type of behavior. We want to encourage that kind of 
investment. We want to encourage job creation. Unemployment is at 10 
percent. We have lost 3.3 million jobs since the beginning of the year. 
Who will put people back to work? It will be the small businesses in 
our economy. In South Dakota, they are about 96 percent of the game, 
when it comes to employment in South Dakota. Here we are debating a 
health care reform bill which, in addition to spending $2.5 trillion to 
create this new health care entitlement, raises taxes on small 
businesses, cuts Medicare, and at the end day, according to the 
experts--the CBO and the Chief Actuary at the CMS, which is the so-
called referee in all this, who tells us what these things will cost 
and their impact--they have all said premiums will either stay the same 
or go up. So the best small business can hope for under this is the 
status quo.
  I hear my colleagues on the other side coming down here, day after 
day, making statements, saying this is going to be good for small 
businesses, and this will help small businesses deal with the high cost 
of health care.
  The problem with all their arguments is one thing: They are 
completely and utterly divorced from reality. You cannot look at this 
health care reform proposal and come away from it and say this is a 
good thing for small businesses, when small businesses are saying this 
will drive up their cost of doing business, it will raise health care 
costs, and these taxes you are going to hit us with will make it harder 
to create jobs.
  Why do we proceed in the face of this and then deny what all these 
small businesses are saying, what the experts are saying, and what 
increasingly the American people are saying, which is that this is a 
bad idea. So why don't you reconsider this and start over again and do 
some things that will actually lower health care costs. That is what 
small businesses are saying.
  We have people down here saying this is good for small business. What 
are small businesses saying--and large businesses, for that matter. The 
NFIB represents small businesses all over the country. They said:

       This bill will not deliver the widely promised help to the 
     small business community.

  They say:

       It will destroy job creation opportunities for employees, 
     create a reality that is worse than the status quo for small 
     businesses. It is the wrong reform at the wrong time, and it 
     will increase health care costs and the cost of doing 
     business.

  That is the National Federation of Independent Businesses, as I said.
  How about large businesses? The Chamber of Commerce expressed their 
disappointment with the Senate health care bill and has weighed in with 
strong opposition against it. That includes the National Association of 
Wholesaler Distributors, the Small Business Entrepreneurship Council, 
the Association of Builders and Contractors, the National Association 
of Manufacturers, the Independent Electrical Contractors, and the 
International Franchise Association. The list goes on and on. The Small 
Business Coalition for Affordable Health Care--50 organizations around 
the country that are members of the group--including many that have 
members in South Dakota, not the least of which is the American Farm 
Bureau Federation. That represents farmers and ranchers who are still 
businesspeople out there trying to make ends meet. They said this:

       Our small businesses and self-employed entrepreneurs have 
     been clear about what they need and want: lower costs, more 
     choices, and greater competition for private interests.

  They say:

       These reforms fall short of long-term, meaningful relief 
     for small business. Any potential savings from these reforms 
     are more than outweighed by the new tax, new mandates, and 
     expensive, new government programs included in this bill.

  That is what small businesses across the country are saying. The 
reason they are saying that is because, as I mentioned, not only are 
they hit with these taxes every year, there is a tax on health plans 
that will amount to $60 billion over 10 years, which will be passed on 
to small businesses. There is a new payroll tax, Medicare tax, which 
incidentally, for the first time ever, instead of going to Medicare, 
will be used to create a new entitlement program. That will hit about 
one-third of small businesses in this country, we are told.

[[Page S13159]]

  As I said earlier, they have the employer mandate, which is going to 
hit a whole lot of small businesses--another $28 billion that will hit 
small businesses across this country. So you have all these new taxes 
heaped upon our small business sector. The small businesses are saying: 
What do we get out of this? What is this going to do to affect our 
health care costs?
  I will show you. This chart represents what the CBO has said health 
care costs would do if this bill is enacted. The blue line represents 
the cost of essentially, if you will, doing nothing. In other words, 
the blue line represents what will happen if Congress does nothing, the 
year over year increases we are already seeing. It represents the 
status quo. We have heard people from the other side say we have to do 
better than the status quo. The President and the Vice President say 
that and our Democratic colleagues say that. You cannot accept the 
status quo and then attack Republicans for being in favor of status 
quo. The blue line represents the status quo. The blue line is what 
will happen year over year, in terms of increases in health insurance 
premiums that small businesses and individuals will deal with.
  It doesn't matter where you get your insurance--the small business 
group market or the large business employer group market or the 
individual market. If you get it in the individual market, your rates 
will be 10 to 13 percent higher. I ask unanimous consent to extend my 
remarks for another 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. THUNE. It doesn't matter which market you get your insurance in, 
except if you are in the individual market, you will pay much higher 
insurance premiums than the status quo, which is locking in double the 
rate of inflation premiums for the foreseeable future.
  The red line on the chart represents the spending under this bill. 
This is what the CBO says will happen. You will see the cost curve bent 
up, not down. You are going to have more money coming out of our 
economy to pay for health care than you do today. That is what small 
businesses are reacting to. That is why they are coming out strongly 
and adamantly opposed to this legislation. It bends the cost curve up, 
increases the cost of health care, rather than bending it down. We 
heard the same thing come out of the Actuary of the CMS just last week.
  Again, the experts are saying--the referees, the people who don't 
have a political agenda--repeatedly, that this will increase the cost 
of health care. This will drive health insurance premiums higher.
  The other point I wish to make, because after I have shown you how 
health care costs will go up under this legislation, the other amazing 
thing about it--this is, again, one of those phony accounting 
techniques or gimmicks that Washington uses, the same old business in 
Washington, the Washington smoke and mirrors, the ways of disguising 
what this really costs: In order to bring this thing in at about $1 
trillion, which is what the majority wanted to do, they had to use 
budget gimmicks.
  The Senator from New Hampshire knows all about this because he has 
followed this closely as chairman of the Budget Committee for many 
years. He can attest to the fact that one of the things they will do is 
start the tax increases immediately. So on January 1 of next year--
which is now 18 short days away--all these businesses across the 
country are going to see their taxes go up--in 18 days. But the amazing 
thing about it is, many benefits don't get paid out for another 1,479 
days. So they front-load all the tax increases; the tax increases will 
be passed on immediately. By 2013, every American family will be 
paying--starting next year--$600 a year. So every American family will 
feel the brunt of the additional costs for taxes and the premium 
increases that will follow from those.
  The remarkable thing about it is, they structured a bill that would 
punish small businesses and people who will pay these taxes on January 
1 of 2010--18 days away. They don't pay out benefits for another 1,479 
days. What does that do? In the 10-year window they use to measure what 
this will cost, it dramatically understates the cost of the 
legislation. So we are faced with not a $1 trillion bill but a $2.5 
trillion bill, when it is fully implemented and when all the budgetary 
gimmicks and phony accounting is actually taken into consideration. 
This is a bad deal for small businesses. That is why all the small 
business organizations have come out opposed to it.
  You cannot get up, day after day, and defy reality, logic, reason, 
and facts. That is what those who are trying to push this huge 
government expansion and huge takeover of health care in this country 
are trying to have the people believe. They are dead wrong.
  I believe the American people are tuning in to that, which is why, 
increasingly, in public opinion polls, they are turning a thumbs down 
on this by majorities of over 60 percent.
  I see the Senator from New Hampshire. I appreciate him indulging me 
for an extra few minutes.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire is recognized.
  Mr. GREGG. Madam President, I ask unanimous consent to speak for 15 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GREGG. Madam President, I appreciate the explanation of the 
Senator from South Dakota of the effects of the bill on small 
business--especially the description of the gimmicks played in the bill 
in order to make it look fiscally responsible, which it is not--the 
fact they use 10 years of revenues in Medicare cuts to offset 5 to 6 
years of spending and then they claim somehow it is in balance.
  I wish to turn to another part of the bill. I think it is important 
to recognize it is not our side so much that is representing the 
failures of the bill. It is actually the administration itself. The 
administration's Actuary came forward with a letter analyzing the Reid 
bill. You have to remember the Reid bill isn't necessarily the bill. 
This is sort of like a ``where is Waldo'' exercise here. We have a bill 
called the Reid bill--it is 2,074 pages--which we got 10 days ago. It 
took 8 weeks to develop it, in camera, by Senator Reid and a few of his 
people.
  Now we are told there is going to be a new bill. Nobody has seen it. 
Nobody on our side has it. I understand most Members on the other side 
have not seen it, but it is supposed to be a massive rewrite of the 
Reid bill. We can only project what that is through news reports. News 
reports are not very good. They represent they are going to expand 
Medicaid which will be a massively unfunded mandate to States and lead 
to letting people into a system that is fundamentally broken, and you 
are going to let people buy into Medicare age 55 and over.
  Medicare is insolvent today. It has $35 trillion of unfunded 
liabilities on the books, and they are going to let people buy into 
Medicare. What sort of sense does that make? It means that seniors who 
are on Medicare--and, by the way, Medicare gets cut significantly under 
this bill--will find Medicare under even more pressure when you put 
people into it.
  Turning from those two obvious problems to the potential bill that we 
have not seen but will be asked to vote on before the week is out, it 
appears, I want to turn to this actuary report done by the CMS Actuary 
who works for the Department of HHS and whose job it is to evaluate 
this bill. He works for the President. He is a Federal employee. He is 
in the administration.
  The CMS made a number of points. Remember, when we started down this 
road, the President said he wanted to do three things, all of which I 
agreed to: One, he wanted to expand coverage so uninsured would get 
covered. Two, he wanted to bend the outyears cost curve of Medicare and 
of health care generally in this country so we could afford it. And 
three, he wanted to make sure if you had insurance, you get to keep it. 
If you like your insurance, if you like the employer plan you have, you 
get to keep it.
  What did the Medicare Actuary--this is not the Republican side, this 
is an independent, fair analysis of the Reid bill--what did they say on 
these three points the President held up as his test for what health 
care should be?
  On the issue of whether this bill bends the outyears cost curve--
which we have to do, by the way. If we do not get health care costs 
under control,

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there is no way we are going to get our Federal budgets under control. 
What did the Actuary say:

       Total national health care expenditures under this bill 
     would increase by an estimated $233 billion during the 
     calendar period 2010 to 2019.

  Instead of going down, they go up. The chart that Senator Thune 
showed is totally accurate. There is no bending down of the outyear 
health costs. There are a lot of reasons for that, and I will go into 
it in a second. Primarily they did not put provisions in the bill I 
would support and should have been in this bill, such as malpractice 
abusive lawsuit reform, such as expanding HIPAA so companies can pay 
people to live healthier lifestyles--if you stop smoking, your company 
could pay you; if you lose weight, your company could pay you--which is 
not in this bill, which would have bent the cost curve down. Those were 
taken out of the bill because the trial lawyers opposed the first one 
and the unions opposed the second one.
  On the second point the President set out as his test, which was 
there would be coverage for everybody who is uninsured, what did the 
Actuary say after he looked at this bill? There are 47 million people 
uninsured. Some people say there are 50 million. The Actuary said after 
this bill is completely phased in, there will still be 24 million 
people uninsured. So for $2.5 trillion--that is what the cost of this 
bill is when it is totally phased in--for the creation of a brandnew 
entitlement, for cuts in Medicare which will be $1 trillion over the 
10-year period when the bill is fully phased in, $\1/2\ trillion in the 
first 10 years, $1 trillion when phased in, $3 trillion of Medicare 
cuts in the first 20 years--for that price, $2.5 trillion, what do you 
get? You still get 24 million people uninsured. Why? Because they set 
the bar so high on the insurance level people still cannot afford to 
get into it and people will be pushed out of their private insurance. 
That is the third point.
  The President said if you like your private plan, you get to keep it. 
That was his third test. I agree with that. I agree with all these 
tests. We should bend the outyear cost curve and get everybody covered. 
The third test is if you like your private insurance, you get to keep 
it.
  What does the Actuary say? Once again, the Actuary works for the 
President through HHS. The Actuary says 17 million people will lose 
their existing employer-sponsored insurance; 17 million people will be 
pushed out of their private plans into this quasi-public plan. Why is 
that? Because the way this bill is structured, there is so much cost 
shifting that is going on as you put people in Medicaid, which only 
pays about 60 percent of the cost of health care of a person getting 
Medicaid, and you put more people into Medicare, which only pays about 
80 percent of what it costs to take care of a Medicare recipient, that 
difference--that 40 percent in Medicaid, that 20 percent in Medicare--
has to be picked up by somebody else. The hospitals have to charge the 
real rate of what it costs them. The doctors have to charge the real 
rate of what it costs them to see that patient. So they put that cost 
on to the private sector. They put it on to private insurance. So the 
private sector is subsidizing, the person who gets their insurance 
through their company is subsidizing the cost of the person who goes 
into Medicaid or the cost of the person who goes into Medicare.
  In fact, today, the private sector is subsidizing the Medicare 
recipient and the Medicaid recipient through the cost of their 
insurance by almost $1,700 a year. Madam President, $1,700 a year of 
your private insurance, if you are insured by an employer plan, is to 
pay that gap in reimbursements, that underreimbursement for people who 
are under Medicaid and under Medicare.
  When you put more people into Medicaid--and this bill assumes 15 
million people are going to go into Medicaid--and you put more people 
into Medicare and this bill puts people age 55 and over into Medicare, 
you end up with even more people being subsidized. Who pays for it? 
Private insurance. So private employers, especially small businesses, 
see their insurance price going up. They cannot afford it. They figure 
it is cheaper to pay a penalty, a tax, essentially, under this bill 
than to keep their insurance for their employees. They have to say to 
their employees: Sorry, folks, you have to go over to the quasi-public 
plan. Seventeen million people, the President's Actuary has estimated.
  There is another point that the President's Actuary makes here. It is 
critical because this Reid proposal is devastating to a program which 
is also under severe stress, and that is Medicare. We know today that 
because of the retirement of the baby boom generation, which doubles 
the number of retired people in this country from 35 million to 70 
million, which generation will be fully retired by 2016, 2017, 2019, we 
know today that because of the demands of that generation for health 
care there is a $38 trillion--that is trillion with a ``t''--unfunded 
liability in Medicare. In other words, there are $38 trillion of costs 
we know we have to pay but have no idea how we are going to pay it. No 
idea. The insurance system does not support it.
  That program is under a lot of stress right now as it stands. As it 
stands, it is under a lot of stress. But when you start cutting that 
plan even further, which is what is proposed in this bill--under this 
bill there is approximately a $500 billion cut in the first 10 years 
for Medicare, $1 trillion in the second 10-year period when it is fully 
phased in, and $3 trillion over the 20 years. When you cut Medicare 
beneficiaries by those amounts and you eliminate essentially Medicare 
Advantage for probably a quarter of the people who get it today, 
providers can no longer afford to provide the benefits to their 
recipients, to the Medicare patient. They cannot make a profit.
  Again, you are going to say, oh, that is just a Republican throwing 
out some language here. No, it is not. That is the Chief Actuary of the 
President of the United States say saying that. Let me read to you: 
Because of the bill's severe cuts to Medicare, ``providers for whom 
Medicare constitutes a substantive portion of their business could find 
it difficult to remain profitable and might end their participation in 
the program (possibly jeopardizing access to care for beneficiaries).''
  That is a quote from the President's Actuary. The Actuary suggests 
that approximately 20 percent of all Part A providers--that is doctors, 
hospitals, and nursing homes--would become unprofitable as a result of 
the Reid bill. What happens when you become unprofitable? You close. 
People will not be available to deliver the care to the senior citizens 
under this proposal.
  The representation from the other side of the aisle is, oh, we don't 
cut any Medicare benefits. They cut Medicare benefits from Medicare 
Advantage, but what they do is cut provider groups. If you don't have 
somebody who is going to see you, you can have all the benefits in the 
world and it is not going to do you any good. That is clearly a very 
significant cut in benefits. It is not me saying this. It is the 
Actuary saying this.
  Madam President, how much time do I have remaining?
  The PRESIDING OFFICER. Four minutes.
  Mr. GREGG. So this is a critical point, that under this bill, the 
Medicare Actuary has said four major things: first, that it doesn't 
bend the cost curve down, it bends it up. Second, it leaves 24 million 
people uninsured when fully implemented. Third, 17 million people will 
lose their private insurance and be forced into quasi-public plans. And 
fourth, there are a lot of providers of Medicare who are going to go 
under and, therefore, will not be available to provide Medicare. That 
is not constructive to the health care debate.

  How should we do this? I will tell you some things we should do that 
are not in this bill, things which are sort of a step-by-step approach, 
rather than this massive attempt written in the middle of the night, 
dropped on our desks for 8 days, 10 days, or for however long. Why 
don't we try to take a constructive, orderly approach? We know there 
are sections of insurance reform that can occur across State lines. We 
know we can do things if we set up the proper coverage scenario for 
preexisting conditions so people do not lose their insurance because of 
a preexisting condition. We know there is a lot of market insurance 
reform that can be done. We also know if we curtail or at least limit 
abusive lawsuits, we can save massive

[[Page S13161]]

amounts of money. We know there is $250 billion of defensive medicine 
practiced every year in this country. CBO scores it as a $54 billion 
immediate savings just like the plans they have in Texas and 
California, which work. Why isn't it in this bill? The trial lawyers 
didn't want it.
  We know if we say to employers you can pay more to employees in the 
way of cash benefits if they stop smoking, get mammograms when they 
should, get colonoscopies when they should, reduce weight so they are 
not subject to obesity issues--if you do that, you get huge cost 
savings. Some employers, such as Safeway, have already proven that. Why 
don't we do that under this law? Because labor unions don't want that 
law, which was actually in the bill passed out of the HELP Committee, 
but it was out of this bill.
  We know there are certain diseases that drive costs in this country--
obesity, Alzheimer's. Why not target those diseases rather than this 
massive bill, $2.5 trillion bill which our kids cannot afford? Change 
the reimbursement system so we reimburse doctors for quality and value 
rather than quantity and repetition. Things such as that can be done.
  If you want to insure everyone, which I do, you can follow the 
suggestion I and other people have made around here. Let people buy 
into a catastrophic plan, especially the young and healthy, people 
between the ages of 20 and 45. They don't need these gold-plated plans 
or bronze-plated plans which have excessive amounts of mandated 
coverage in them. They don't need them. What they need is a plan that 
says if they are severely injured or they contract a very difficult 
disease, they are going to have coverage so their responsibility of 
care does not fall on the rest of the country. That can be done.
  There are a lot of specific things that can be done to improve our 
health care system without this quasi-nationalization effort which is 
going to expand the size of the government so dramatically by $2.5 
trillion that there is no possible way our kids are going to be able to 
afford the debt that is going to come on to their backs as a result of 
this because this will not be fully paid for, in my opinion.
  Certainly, we can at least look at the points made by the Actuary of 
the President who has disagreed with four of the core proposals in this 
bill, saying they do not meet the tests which were set out for good 
health care reform and say in those areas: Let's go back and take 
another look; let's start over again; let's do it right. That is our 
proposal. Let's do it right rather than rush this bill through.
  Remember, most of the programs in this bill do not start until 2014. 
So why do we have to pass it before Christmas, especially when we have 
not even seen the final bill? It makes no sense at all.
  Listen to the Actuary of the President and let's get this right.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. FRANKEN. Madam President, I ask unanimous consent to engage in a 
colloquy with my colleagues from Vermont and Ohio.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. FRANKEN. Madam President, I rise today to urge my colleagues in 
the Senate to support Senate amendment No. 3135 to replace the proposed 
excise tax with a surtax that would affect only those making literally 
millions of dollars a year. Senator Brown and Senator Sanders, with 
whom I will engage in this colloquy, have shown tremendous leadership 
on the issue, and I thank them and join them in their efforts.
  Before I get into this, though, I want to answer a couple of things I 
have seen and heard on the Senate floor. I walked in and my colleague 
from South Dakota, Senator Thune, had a chart up. He had a chart up 
that said when your taxes will kick in and when your benefits will kick 
in. So I didn't hear the whole speech, and I felt bad about that--not 
having heard his whole speech--and I went up to him and said: I didn't 
hear your whole speech.
  And he said: Oh, man, that's too bad.
  But I said: Did you actually happen to mention any of the benefits 
that do kick in right away?
  And he said: No.
  So I think we are entitled to our own opinions, but we are not 
entitled to our own facts. Benefits kick in right away. If you are 
going to hold up a chart that says when taxes kick in and when benefits 
kick in, and you say 1,800 days, you better include the benefits that 
do kick in right away.
  Mr. THUNE. Madam President, will the Senator from Minnesota yield for 
a question?
  Mr. FRANKEN. Absolutely.
  Mr. THUNE. Did the Senator understand that what I was pointing out on 
the chart--the point I was making--was that the tax increases start 18 
days from now, and the benefits--the spending benefits under the bill, 
which are the premium tax credits and the exchanges that are designed 
to provide the benefits delivered under this bill--don't start until 
2014. Did the Senator miss that?
  Mr. FRANKEN. Does the Senator understand that spending benefits start 
right away?
  Mr. THUNE. If the Senator missed that point, I can get the chart out.
  Mr. FRANKEN. I asked a question. I yielded to you for a question. I 
am asking you a question. Does the Senator----
  The PRESIDING OFFICER. The Senator from Minnesota may only yield for 
a question, and the Senator from Minnesota has the floor.
  Mr. FRANKEN. Has to what?
  The PRESIDING OFFICER. Has the floor.
  Mr. FRANKEN. I have the floor. The Senator from South Dakota said: 
Did I realize he was talking about the spending doesn't start for 1,800 
days on health care--that the benefits don't start. Well, here is one: 
$5 billion in immediate Federal support starts immediately for a new 
program to provide affordable coverage to uninsured Americans with a 
preexisting condition.
  I don't know about anyone else in this body----
  Mr. THUNE. Will the Senator yield for an additional question?
  Mr. BROWN. Will the Senator yield?
  Mr. FRANKEN. I yield.
  Mr. BROWN. That is exactly right, what Senator Franken says. The $5 
billion is for the high-risk pool--people who have the most trouble 
because of preexisting conditions, because of the behavior of insurance 
companies. And this debate is really all about the insurance companies. 
My friends on the other side of the aisle always come down with the 
insurance companies. The insurance companies really are the ones that 
are driving so much waste and so much bad behavior in the system.
  Another thing in this bill that is very important now is the Medicare 
buy-in. The Medicare buy-in we have been discussing is for somebody who 
is 58 to 62 years old and who can't get insurance. Maybe they have been 
laid off or maybe they have a preexisting condition or maybe they are a 
part of small business that doesn't insure them. At 58 to 62 years old, 
they simply can't get insurance. This legislation will allow them, so 
far, to buy into Medicare.
  I know my Republican friends can't make up their minds what they 
think about Medicare. They have opposed it, mostly, for 40 years. They 
opposed its creation; they tried to privatize it in the mid-1990s. They 
succeeded in partially privatizing it. They have cut it. Now, when we 
are--at AARP's request, in part--pushing legislation which will cut 
some of the waste out of Medicare, all of a sudden they are big fans of 
Medicare. But then they don't like Medicare again because we are trying 
to do the Medicare buy-ins. I guess I am confused.
  Mr. THUNE. Would the Senator from Ohio yield for a question?
  Mr. BROWN. We gave the other side 30 minutes.
  Mr. FRANKEN. We have our time now.
  Mr. BROWN. Senator Thune wants to sort of monopolize our 30 minutes.
  Mr. FRANKEN. We have our time, and the Senator from South Dakota just 
said, when he gave his presentation, nothing that we are paying for 
starts until 1,800 days from now. There is a whole list of things that 
start. The Patient Protection Affordable Care Act----
  Mr. THUNE. Will the Senator yield for a question?
  The PRESIDING OFFICER. The Senator from Minnesota has the floor. He 
may engage in a colloquy. He does not have to yield for any further 
questions.
  Mr. FRANKEN. The Patient Protection and Affordable Care Act will 
prohibit insurance from imposing lifetime

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limits on benefits starting on day one--starting on day one, Senator. 
He doesn't want to hear it.
  We are entitled to our own opinions, but we are not entitled to our 
own facts. The fact is, benefits kick in on day one and the large 
majority of benefits kick in on day one, and we shouldn't be standing 
up here with charts that say the exact opposite.
  Senator McCain, a week ago, said: Facts are stubborn things. These 
are stubborn things. Small business tax credits will kick in 
immediately. The Senator from South Dakota just said that no payments, 
nothing that costs any money will kick in right away. That is not true. 
We are not entitled to our own facts.
  I stand here day after day and hear my colleagues, my good friends 
from the other side, say things that are not based on fact.
  We hear about this $78 trillion unfunded liability. You know, I 
remember during the Social Security debate that we used to hear about 
this $11 trillion unfunded mandate for Social Security. They asked the 
Actuary what that was about--Treasury Secretary Snowe--because the 
American Actuarial Society got mad about this. You know what it was? It 
was into the infinite horizon, was the liability. It was into infinity. 
That was a figure used by the President of the United States--George 
Bush at the time--that we have an $11 trillion unfunded mandate. What 
was the actuarial thinking behind it? Into infinity, and that people 
would live to be 150 years old.
  Mr. SANDERS. Will the Senator from Minnesota yield?
  Mr. FRANKEN. One second. I want to explain the end of this.
  So this was the unfunded liability--assuming people lived to 150 and 
still retired at 67. That meant an 83-year retirement and that we would 
live to 150. I assume the first 50 years would be great, the next 50 
years not so great, and the last 50 years horrible. Ridiculous stuff.
  Let's have an honest debate, for goodness' sake. Let's not put up 
charts that contend one thing and that are just not true.
  I yield to Senator Sanders.
  Mr. SANDERS. What I wanted to do is to get back to an issue that is 
of great importance to the American people, in addition to everything 
Senator Franken appropriately pointed out; that is, as we proceed 
forward on this legislation, there is a provision in the Senate bill 
that I think needs to be changed. I have offered an amendment to do 
that. I am delighted Senator Brown and Senator Franken and Senator 
Begich, who is not here, and Senator Burris, who is also not on the 
Senate floor, are in support of that amendment, as I think the vast 
majority of the American people are.
  Madam President, this bill is going to cost some $800 billion to $900 
billion, and the American people want to know where that money is going 
to come from. Is it going to come from the middle class whose incomes 
in many ways are shrinking, who have lost their jobs, are having very 
serious financial problems, or is it going to come in a more 
progressive way?
  The amendment that we are supporting would simply say we will get rid 
of the 40-percent excise tax on health care benefits above a certain 
limit and move toward a more progressive way of funding, which is close 
to what exists in the language in the House.
  Essentially, what we would be doing is addressing the fact that the 
so-called Cadillac plan is not a Cadillac plan because in a relatively 
few years, millions of workers with ordinary health care benefits are 
going to be impacted by that. According to a major health care 
consultant, the Mercer Company, this tax would hit one in five health 
insurance plans by the year 2016--one in five. The Communications 
Workers of America have estimated that this would cost families with a 
Federal employees health benefit--Federal employees with a standard 
plan with dental and vision benefits--an average of $2,000 per year 
over the 10-year course of this bill.
  So what this issue is about is do we sock it to the middle class 
again, with the heavy tax that over a period of years is going to 
impact more and more ordinary families, or do we say that at a time 
when we have the most unequal distribution of wealth and income, when 
President Bush gave huge tax breaks to the wealthiest people, that 
maybe we ask people who have a minimum income of $2 million a year to 
start picking up their fair share?
  I yield to my friend from Ohio.
  Mr. BROWN. Madam President, I thank my colleagues for kicking off 
this debate. My understanding is that this amendment would eliminate 
the tax on people's health insurance plans, even people who have pretty 
generous union-negotiated--obviously, not just union, but when a union 
negotiates a good plan, the white-collar workers in those same plants, 
those same companies often get decent plans too. It would take away the 
tax for them, and it would then tax 1 percent, \1/2\ percent of wealthy 
people?
  Mr. SANDERS. Interesting that the Senator asks that. What this 
amendment does is it imposes a 5.4-percent surtax on adjusted gross 
incomes above $2.4 million for individuals and $4.8 million for 
couples.
  What that means, I would tell the Senator from Ohio, is that this 
impacts the top two one-hundredths of 1 percent, which means 99.98 
percent of the American people would not pay one penny in additional 
taxes. It is the top two one-hundredths of 1 percent, and I think that 
is in fact the proper thing to do.
  Mr. BROWN. So that would be 2 out of 10,000--1 out of every 5,000 
families would pay that or 1 out of 5,000 of the wealthiest families 
would pay that; is that what the Senator is saying?
  Mr. SANDERS. That is true. Of the approximately 134 million 
individual tax returns filed in 2005, which is the latest data we have 
available, only two one-hundredths of 1 percent or about 26,000 
individuals reported adjusted gross incomes over $2.4 million.
  Mr. BROWN. So 26,000 out of 134 million people would pay this.
  Mr. SANDERS. That is right.
  Mr. BROWN. As opposed to millions of families who have good health 
insurance that they have negotiated or been provided by their employer.
  This brings me back to the discussion we had earlier this year; that 
when people talk about legacy costs, about pension and health care, 
which many people have, fortunately, almost always these health 
benefits and pensions people earn by giving up pay today. They say: I 
will take a little less pay today if I get a good pension and good 
health insurance. So that is why the Senator from Vermont is arguing 
that we shouldn't be taxing this insurance, I assume.
  Senator Franken.
  Mr. FRANKEN. Let me go into this term ``Cadillac.'' You know, I never 
had a Cadillac, but that was the thing, right?--a Cadillac? That was an 
incredible extravagance--a gold-plated extravagance. But, in fact, this 
would be taxing plans that provide basic comprehensive coverage for 
thousands of middle-class workers and their families. One of the 
problems with the excise tax is that it categorizes plans based on 
their actuarial cost, not solely on the generosity of their benefits. 
Plan characteristics explain only a small percentage of the 
differential in cost. Some reports suggest only 6 percent of the 
difference in cost is explained by generosity of benefits.
  Let me give an example: A small business that employs many older 
workers is going to face--actuarially, it is going to be considered 
higher than a business with a young workforce. So even if both of these 
employers provide the exact same benefits, their costs will be 
different. The employer with the older workforce faces a higher risk of 
falling under this tax--not due to the richness of the benefits but due 
to the age of its employees.

  The same goes for small workforces. If a small business offers one 
set of health benefits and a large company offers the exact same set of 
benefits, the cost for the smaller employer is higher because its risk 
pool is smaller.
  Do we really want to penalize small businesses or workplaces that 
retain older workers?
  Senator Sanders.
  Mr. SANDERS. Let me pick up on the point the Senator from Minnesota 
made. When you use the term ``Cadillac,'' the implications are that 
maybe we will get some of those guys at Goldman Sachs who have this 
off-the-wall outlandish benefit package.
  The reality is, the CWA--Communications Workers of America--has done 
a bit of work on this. What their

[[Page S13163]]

estimate is, as health care costs continue to rise--and we are seeing 6 
percent, 7 percent, 8 percent increases every year--obviously, the way 
the language of this legislation is written, it will impact more and 
more health care plans. By the year 2019, it will burden one out of 
three health care plans in this country. Does that sound like a 
Cadillac plan, one out of three plans? And eventually, as health care 
costs continue to rise, it will impact virtually every plan in this 
country.
  The bottom line we are talking about is, yes, we need to raise money. 
How do you do it? Do you do it by socking it to the middle-class and 
working families? And as the Senator from Ohio has indicated, many of 
these workers have given up wage increases in order to maintain a 
strong health care benefit. Are those the people we are going to tax or 
do you tax the top two one-hundredths of 1 percent, many of whom have 
received generous tax breaks in recent years?
  Mr. BROWN. If the Senator will yield, I want to talk for a moment 
about the people who will be paying more taxes. The Senator said their 
income is over a couple of million a year, those who will pay these 
taxes.
  During the last 10 years--during the 8 years President Bush was in 
the White House, the tax system changed pretty dramatically during that 
time. It is my understanding--maybe the Senator can shed some light on 
this, either colleague--my understanding for sure is that the tax 
system, as it changed, had much more of a tilt toward the wealthy; that 
is, President Bush's tax cuts always included a few middle-class 
people, so a family making $50,000 might get $100 in tax savings over a 
year but, on the other hand, if you made millions of dollars, you got 
huge tax cuts.
  I remember Warren Buffett, one of the most successful businesspeople 
in America, who generally likes what we are doing here and wants a 
fairer tax system, Warren Buffett said he pays a lower tax rate than 
his secretary and he said he pays a lower tax rate than a soldier 
coming back from Iraq.
  Talk, if you would, either Senator, Senator Franken or Senator 
Sanders, about what happened over the last decade to taxes for the 
group of people, the wealthiest, who we think should pay a little more 
under this plan.
  Mr. SANDERS. I think the evidence is overwhelming that one of the 
reasons we have seen recordbreaking deficits and we have a $12 trillion 
national debt--it is not just the war in Iraq but also the huge tax 
breaks that have been given to the very wealthiest people in this 
country. As the Senator from Ohio indicated, the facts are very clear. 
Yes, the middle class may have gotten some benefit, but the lion's 
share of tax breaks went to the people on top.
  What we are seeing in this country is a growing gap between the very 
wealthy and virtually everybody else. In many ways, the middle class is 
shrinking. Poverty is increasing. It makes zero sense to me that in the 
midst of all of that, we ask the middle class to pay more in taxes to 
provide health care to more Americans and we leave the top one-
hundredth of 1 percent alone.
  Let me also say this: There is a lot of support out there for the 
amendment Senator Brown, Senator Franken, Senator Begich, Senator 
Burris, and I are offering. Let me just read one. This is from the 
president of the Fraternal Order of Police. These are cops out on the 
street. Most people do not think the police are getting extravagant 
health care benefits.
  This is what he said:

       I am writing to you on behalf of the membership of the 
     Fraternal Order of Police to express our support for your 
     amendment which would eliminate the excise tax on high cost 
     insurance plans.

  Et cetera, et cetera.

       This provision is intended to tax the health plans of the 
     wealthiest Americans, but it will also tax the plans of many 
     law enforcement officers who need high cost and high quality 
     insurance due to the dangerous nature of their profession. 
     The Fraternal Order of Police strongly supports your 
     amendment, because health care reform legislation should not 
     increase the tax burden for those who fearlessly risk their 
     health, and even their lives, to keep our communities safe.

  Mr. FRANKEN. Again, let's think about what these folks, these union 
folks who negotiated these health care policies and sacrificed in 
salary--what are they getting? They are getting affordable deductibles. 
They are getting affordable co-pays. Sometimes, they are getting vision 
and dental care. This is comprehensive health care we want Americans to 
get. That is who is going to get hit.
  Over the last 20, 30 years, we have seen a squeeze on these people. 
We have seen a squeeze on the middle class, a shift in the risk to 
people. That is what this whole bill is about. We are trying to 
eliminate the risk of losing your health care if you have a preexisting 
condition; we are trying to lose the risk of going bankrupt. That is 
the whole point of this bill. Let's not shift more risk onto these 
folks who are doing these kinds of jobs and supporting their families 
with their salaries and their benefits.
  Mr. BROWN. Exactly right. Think about that. We want to give 
incentives for people to do the right thing. We are glad when people 
have good health insurance because then they do not rely on Medicaid or 
they don't show up in the hospital or the emergency room and get the 
care for free, while other people have to pay for that care--others who 
use the emergency room and have insurance, others who use the hospital. 
So the hospitals don't get stuck with the costs. If they have dental 
care, they are getting the right kind of preventive care so they do not 
have more expensive care later.
  Ideally, we want everybody to have one of these ``Cadillac'' plans. 
We want people to have insurance that includes vision, that includes 
eye care, that includes catastrophic coverage, that includes preventive 
care. If more people had this, there would be a lot less burden on 
taxpayers to take care of everybody else.
  It is clear the arguments here are not just it is the right thing for 
police officers, as Senator Sanders said. It is the right thing for the 
person Senator Franken talked about who is getting dental and vision 
care, but it is good for society as a whole, that people are willing to 
give up some of their wages to get a good medical plan.
  Mr. SANDERS. If I could jump in, a moment ago Senator Brown asked me 
a question about the extent of the tax breaks given to the wealthiest 
people, and I do have that information. Since 2001, I say to Senator 
Brown, the richest 1 percent of Americans received $565 billion in tax 
breaks. In 2010 alone, the most wealthy 1 percent of Americans are 
scheduled to receive an additional $108 billion in tax breaks. That is 
point No. 1.
  Point No. 2--let me be a little political here. In the Presidential 
election of 2008, one of the candidates said that it was a good idea to 
tax health care benefits. That candidate--Senator McCain--lost the 
election. The other candidate said it was a bad idea to tax health care 
benefits. That was Barack Obama; he won the election.
  Let me quote from what then-Senator Obama said when he was running 
for President. On September 12, 2008, he said:

       I can make a firm pledge, under my plan no family making 
     less than $250,000 will see their taxes increase, not your 
     income taxes, not your payroll taxes, not your capital 
     gains taxes, not any taxes. My opponent, Senator McCain, 
     cannot make that pledge and here is why. For the first 
     time in American history--

  This is Senator Obama speaking about Senator McCain's plan.

       For the first time in American history, he, Senator McCain, 
     wants to tax your health benefits. Apparently, Senator McCain 
     doesn't think it's enough that your health premiums have 
     doubled. He thinks you should have to pay taxes on them, too. 
     That's his idea of change.

  I agree with what Senator Obama said in 2008. I disagree with what 
Senator McCain said then. Right now, we are in a position to follow 
through on what Senator Obama said at that point and make sure the 
middle class of this country does not pay taxes on their health 
benefits.
  Mr. BROWN. If the Senator will yield, I say thank you. I think that 
made it very clear.
  Earlier, the Senator talked about what the tax cuts for the 
wealthiest citizens during the Bush years did to our national debt. He 
mentioned the war in Iraq, the trillion-dollar war in Iraq and 
Afghanistan, not to mention the huge cost it is going to be to continue 
to take care of the men and women who served us courageously with their 
physical and mental injuries from Iraq.

[[Page S13164]]

  Senator Franken is so familiar with this because of tours he made as 
a private citizen to battle zones, year after year, to talk to our 
troops and entertain our troops. He didn't get a lot of credit for 
that, but he didn't care about the credit for that. He was there, 
always doing that.
  One of the things that is pretty interesting, listening to my 
Republican friends on the other side of the aisle talk about this bill 
now, which the Congressional Budget Office says is paid for and more, 
while they continue on their side to talk about the budget deficit, it 
was that group who passed--Senator Sanders and I were both House 
Members at that time and voted against it--passed the Medicare 
Privatization Act, and the people who were on the floor talking to us 
voted for cloture for the Medical Modernization Act. That bill was not 
paid for. That bill was a giveaway to the drug industry and the 
insurance industry. It has added tens and tens of billions of dollars 
to our national debt.
  On the one hand, they support these tax cuts that are not paid for, 
they support the Iraq war which was not paid for, and they now want us 
to go into Afghanistan and not pay for it, yet increase the number of 
troops. They continue down this road when we are on this bill doing the 
right thing. Even with our amendment here to eliminate the Cadillac--
the taxing Cadillac plans, we are saying we are going to find another 
way to pay for it. We are not just going to eliminate that cut in 
taxes. We want to, but we are going to pay for it some other way.
  I yield for Senator Franken.
  Mr. FRANKEN. We are actually addressing that doughnut hole that was 
in the Medicare Part D bill. We are closing it by half. Do you know 
when it starts? Next year.
  Mr. BROWN. I thought Senator Thune said none of the benefits started 
then.
  Mr. FRANKEN. Senator Thune did say none of the benefits started next 
year, but I guess he just hasn't read the bill. I have so many 
constituents come to me and say: Read the bill, read the bill. I ask--
--
  Mr. BROWN. If the Senator will yield, perhaps if you are going to 
vote against it, you do not need to read it? Is that the way to think 
about it?
  Mr. FRANKEN. I do find that many of my colleagues with whom I am very 
friendly have not read the bill and are not very familiar with it. I 
think if you are going to get on your feet and debate and make 
assertions, you should really be familiar with the content of the bill. 
That is what I thought. I have only been here a while, so maybe I am 
naive, but I think when you say none of the benefits are going to start 
next year, you should be right.
  Mr. SANDERS. If I could just add to the point Senator Brown and 
Senator Franken have made regarding concern about the national debt, 
every day there is a Republican coming up here to say we have a $12 
trillion national debt and we have to cut this and cut that--all that. 
Yet I think virtually every one of them is in support of the repeal of 
the asset tax, which would benefit solely the top three-tenths of 1 
percent and would cost the Treasury $1 trillion over a 20-year period--
$1 trillion over a 10-year period. I am sorry, $1 trillion over a 10-
year period.
  I am really concerned about the deficit, I am concerned about the 
national debt, but I am prepared to vote for repealing the entire 
estate tax which only impacts--gives $1 trillion in tax breaks over a 
10-year period to the top three-tenths of 1 percent.
  Some may question the sincerity about their concern about the 
national debt.
  Mr. FRANKEN. In fairness, I am not sure they are all for that. I 
think I have heard some soundings from the other side to extend what we 
have this year because this runs out on January 1 and we do not want to 
see a lot of plugs pulled.
  Mr. SANDERS. I am talking about what happens now. Overall, the vast 
majority of our Republican friends----
  Mr. FRANKEN. Yes, in theory.
  Mr. SANDERS. Want to abolish the estate tax, which is $1 trillion in 
tax breaks.
  Mr. FRANKEN. I just want to bend over backward to be fair to my 
colleagues on the other side.
  Mr. SANDERS. The Senator is so nice.
  Mr. FRANKEN. Maybe I do that to a fault, and I apologize to our side.
  Mr. SANDERS. Madam President, polls show there is overwhelming 
support among the American people for what we are discussing today. 
Organizationally, it has the support of the AFL-CIO, the National 
Education Association, the Fraternal Order of Police, the United 
Steelworkers of America, AFSCME, the American Postal Workers Union, and 
a number of other organizations representing millions of working 
people. This is not a complicated issue. Somebody will have to pay for 
this bill. Should it be the middle class and working families or should 
it be the people at the top two one-hundredths of 1 percent who, over 
the period of the last 8 or 9 years, have enjoyed huge tax breaks? This 
is kind of a no-brainer.
  The good news here is that our friends in the House have moved 
correctly in this area. The bill before us in the Senate does not. What 
we are trying to do is to get an amendment to take out the tax on 
health care benefits and replace it with similar language, not exactly 
the same as exists in the House.
  Mr. FRANKEN. Let's get back to the excise tax and what it is 
purportedly supposed to do. It is supposed to bring down costs and 
generate revenues. Those are both necessary objectives. I have been 
submitting stuff over and over again to bring down costs, including a 
90-percent medical loss ratio, including uniform standardized insurance 
forms which will save billions of dollars. I don't think this excise 
tax is the best way to bring down costs and generate revenue. We should 
be focusing on actually bringing down the cost of services instead of 
trying to limit the availability of care.
  One way to actually bring down the cost of services is the value 
index in the bill, which Senator Cantwell introduced in the Finance 
Committee and which is still in this bill, and which Senator Klobuchar 
fought for, and many of us from high-value States. That will change the 
Medicare reimbursement rates to incentivize value. Another unintended 
consequence of the excise tax is its effective penalty on comprehensive 
benefit packages secured for workers by their unions. Again, I come 
back to these unions who gave up salary benefits, who gave up earning 
benefits. As soon as this gets going, this is going to be returning 
year after year as we see medical inflation go up and up. This is the 
cost of living index plus 1; right?
  Mr. SANDERS. Right.
  Mr. FRANKEN. Plus 1 percent. That is not what we have seen from 
medical costs.
  Mr. SANDERS. That is the point. The point is that medical costs are 
going up substantially more than inflation. In fact, general inflation 
is actually going down. There is no question but that as medical 
inflation continues to remain high, millions and millions more workers 
are going to be forced to pay this tax. One of the other side effects 
of this tax is that many employers, in order to avoid it, are going to 
start cutting the health care benefits that workers receive. Today it 
may be dental; tomorrow it will be vision. The next day it will be more 
copayments, more deductibles. This is grossly unfair to working 
families.
  Mr. BROWN. Again, it is making the choices. Unlike the Medicare 
Modernization Act, which Republicans pushed through in 2003--I know 
Senator Ensign voted against that although he voted for cloture, but he 
actually opposed that, to his credit--that was legislation that wasn't 
paid for. It was a giveaway to the drug insurance industry. It wasn't 
paid for. Our legislation is, and our amendment is. We made a choice. 
Do you charge the middle class? Do you say to the middle class, you are 
going to pay a tax on your health care benefits, or do we have someone 
else pay who has gotten a lot of advantages in the last few years? 
Since 2001, the richest 1 percent of Americans, because of the Bush tax 
cuts, got $565 billion in tax breaks. This year that same wealthiest 1 
percent of Americans are scheduled to receive an additional $108 
billion in tax credits. It is clear we want to go to the right place in 
this. We want to keep it fiscally sound. We want to keep it balanced. 
We want to pay for it, something my friends on the other side of the 
aisle rarely do when it comes to

[[Page S13165]]

war, when it comes to tax breaks for the rich, when it comes to 
giveaways to the drug and insurance companies.
  We are doing it that way. That is why the Sanders-Franken-Begich-
Brown amendment makes so much sense.
  Mr. FRANKEN. One last word on the deficit and the debt. May I remind 
everyone that when the Republicans were in the majority and President 
Bush came to Washington, we had a surplus, a record surplus. At the 
time the Chairman of the Fed, Alan Greenspan, testified to Congress 
that we had a new problem. The new problem was that because of the 
projected surpluses, we were, in a number of years, going to have too 
much money, that we were going to pay off the debt and the Federal 
Government would be forced to buy private equities and that this would 
not have a maximizing effect on our economy. That is what he said, 
after Bush became President. That was what he said. He said we were 
going to have too much money. That is what the Chairman of the Fed 
said. So we handed the ball off to President Bush, and we handed the 
ball off to these Republicans. The problem was, we were going to have 
too much money. That is not a problem anymore, is it? Now you hear them 
screaming about the deficit. Think about the deficit they left us. 
Think about the economic circumstances they left us in. We are talking 
about getting rid of this excise tax, but we are talking about paying 
for it. The CBO has scored this bill as cutting the debt in the next 10 
years by $179 billion and then $500 billion in the next 10. That is 
responsible.
  What we saw in the years that we had a Republican President and a 
Republican House and a Republican Senate was an explosion in the 
deficit. I don't want to hear lectures about the deficit. When I hear 
presentations from my colleagues, I want them to remember what Senator 
McCain said when he said facts are stubborn things.
  When we debate in this Hall on this floor, let's stick to the facts. 
So many of the benefits in this bill start immediately. It is simply 
not fact to say they don't.
  Mr. SANDERS. Madam President, how much time do we have remaining?
  The PRESIDING OFFICER. There was no time limit on the colloquy.
  Mr. SANDERS. I think we are coming to the end of it. I hope, focusing 
on the issue of the excise tax, the Senate is prepared to support our 
amendment. If that is not the case, certainly support what the House 
has done in the conference committee. Taxing middle-class workers is 
not the way we should fund health care reform.
  Mr. FRANKEN. I thank the Senator. I thank both of my colleagues from 
Vermont and Ohio, and urge my colleagues to support amendment No. 3135.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader.
  Mr. REID. Madam President, I ask unanimous consent that I be allowed 
to engage in a colloquy with the senior Senators from Connecticut and 
Montana.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. Madam President, when the American people demanded last 
November and throughout this year that we make it possible for every 
American to afford to live a healthy life, they did so because they 
know from personal experience how broken our country's health care 
system is. As the Senate has worked to answer that call this year, we 
have drafted a bill that will save lives, save money, and save 
Medicare. Many aspects of the current bill achieve that goal. But there 
is one more thing we could do, closing the notorious gap that 
arbitrarily charges seniors in Nevada and throughout the Nation 
thousands and thousands of dollars for prescription drugs.
  As seniors know all too well, the prescription drug plan is called 
Medicare Part D, and the coverage gap is commonly known as the doughnut 
hole. Right now Medicare will help seniors afford their prescription 
drugs only up to a certain annual dollar limit, $2,700 a year, then 
stop, then help it again only once their bills reach another much 
higher level, $6,100. So from $2,700 to $6,100, that is the notorious, 
bad doughnut hole. Between these two points, seniors are stuck with the 
full bill. Imagine if you had car insurance that covered you until you 
drove 2,700 miles in a given year, then stopped, then started covering 
you again once you hit 6,100 miles. From 2,700 to 6,100 miles would be 
pretty scary. That wouldn't work for drivers, and the doughnut hole 
doesn't work for seniors. The effects of this broken system are 
painfully simple. More and more seniors have to skip or split the pills 
they need to stay healthy. It means that in January someone will pay 
$35 to fill a prescription, but by October he or she could be asked to 
pay thousands of dollars for the very same pills.
  I was at CVS a day or two ago to pick up some stuff for my wife at 
the prescription counter. They had on the counter there where you were 
waiting a list of the cost of all drugs. I didn't fully understand it, 
but I looked at it. Some had values of thousands of dollars to fill a 
prescription. The only one I saw--I didn't want to flip through the 
pages--but the one page, $9,800 for one prescription. I don't know if 
that was 30 pills or what, but it was striking.
  If someone will pay $35 to fill a prescription, that is fairly 
inexpensive. But by October, he or she would be asked to pay thousands 
of dollars. That is what it is. It is not an uncommon problem. Millions 
of seniors, a quarter of all in the Part D Program, reach that no man's 
land during the year, the doughnut hole. But only a small fraction get 
to the other side. Both numbers will only get worse if we don't act. 
Not surprisingly, those caught in the middle don't take the medicine 
they need at far greater rates than those who do have coverage. Like we 
see with uninsured Americans of all ages, those who can't afford the 
treatments they need to get healthy will get even sicker. Down the road 
that means more expensive doctor visits, more expensive hospital stays, 
and more expensive medicines. It means more sickness and more death.
  We have already taken the first steps to fix this in the current 
bill, closing the gap by half and by an additional $500 for 2010. 
Because I am committed to saving lives, saving money and saving 
Medicare, I personally am committed to fully closing the doughnut hole 
once and for all. Once we pass this bill out of the Senate, we will do 
so in the conference committee with the House, whose bill already 
closes the gap. The House legislation closes the doughnut hole. The 
legislation we will send to President Obama for signature will make 
good on his promise and ours to forever end this indefensible injustice 
for America's seniors.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. DODD. Madam President, I agree with my friend the majority leader 
that we must close the doughnut hole. I think it is something all of us 
appreciate. I second his commitment to doing so with this bill that we 
will send to the President. As most seniors live on modest incomes, we 
all know it is imperative that they can afford the prescriptions they 
need. As the majority leader has noted, seniors who have trouble paying 
for prescription drugs are more likely to skip doses or stop taking 
their medications altogether which would lead to more serious health 
problems and higher long-term costs, both for them and our health care 
system as a whole. In my State of Connecticut, 25 percent, a quarter of 
all Part D enrollees fall into the doughnut hole. I understand the 
significance of delivering on the commitment to fixing this problem.
  We have a responsibility, as all of us can appreciate, to protect and 
strengthen Medicare and to improve the lives of our seniors. If we fail 
to act, the doughnut hole, we are told, will continue to grow in size, 
doubling in less than 10 years. The size of the doughnut hole is 
directly tied to drug prices, prices that are rising at an alarming 
rate.
  Seniors who have spent thousands and thousands of dollars--not 
including the cost of their premiums--before they get out of the 
doughnut hole and get the treatments they need cannot afford to wait 
any longer to close this costly gap.
  Our historic reform effort must improve the quality and affordability 
of Medicare. Closing the doughnut hole is a very clear and concrete way 
to do that.
  I understand we may not have the opportunity to fix this issue in the 
Senate bill before it leaves this Chamber,

[[Page S13166]]

but I want it to be known that I support the idea of closing the 
doughnut hole in the conference committee that will meet with the other 
body.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, closing the doughnut hole is clearly the 
right thing to do. Medicare beneficiaries face extremely high out-of-
pocket costs for outpatient prescription drugs. In fact, they face 
costs that are six times higher than out-of-pocket costs for those of 
us fortunate enough to have employer-sponsored coverage.
  The doughnut hole contributes to these high out-of-pocket costs. As a 
result, the doughnut hole often results in seniors skipping vital 
medications.
  Eliminating the coverage gap in the Medicare prescription drug 
program will save people with Medicare thousands of dollars every year. 
Lowering the costs for seniors will also keep them healthier by 
ensuring they can afford their medications.
  In my home State of Montana, 33 percent of seniors enrolled in the 
Medicare prescription drug program fall into the doughnut hole every 
year--one-third. We all know what the consequences are when people 
cannot afford the medicines they need to stay healthy, both for the 
affected individuals and for society at large.
  Recognizing the scope of this problem, in his address to a joint 
session of Congress in September, President Obama promised to close the 
doughnut hole once and for all. It is our responsibility to make good 
on this promise and provide this needed relief to seniors. I join my 
colleagues in committing that we will send a bill to the President that 
closes the doughnut hole and fulfills his promise.
  The PRESIDING OFFICER. The majority leader.
  Mr. REID. Madam President, I wish to, if I could, ask my two 
colleagues, through the Chair, if it is their understanding that the 
President fully supports this action.
  Mr. BAUCUS. Madam President, responding to the leader, that is my 
full understanding.
  Mr. DODD. Madam President, I would add, that is my full understanding 
as well.
  The PRESIDING OFFICER (Mrs. Hagan). The Senator from Nevada.
  Mr. ENSIGN. Madam President, I want to address a few of the things 
that were mentioned on the floor just now. However, I want to start by 
talking about how this health care bill will affect small businesses.
  Small businesses are the engine that drives our economy. We know they 
are struggling right now. The President met with some bankers today at 
the White House because many of the large banks are not loaning money 
to small businesses. We all know that. Many small businesses are 
struggling to keep their doors open.
  One of the reasons small businesses are a little nervous right now is 
because they do not know if this bill goes into effect, what that 
massive effect is going to be on them. They are uncertain about the 
future.
  Let me tell you a few things.
  First of all, we all know that there is a $500 billion tax increase 
contained in this 2,074-page bill that is before us today. In that 
bill, there is also an employer mandate of $28 billion. This is what 
the nonpartisan Congressional Budget Office has said about that $28 
billion: Not only does it fall heavily on small businesses, but the CBO 
goes further to say that ``workers in those firms would ultimately bear 
the burden of those fees'' in the form of reduced compensation. That is 
a direct quote.
  This bill also discourages small businesses from hiring folks. CBO 
went on to say: `` . . . the employment loss would be concentrated 
among low-income workers.'' Do we want to do that to folks out there 
who are struggling right now? We have heard across this country that 
record numbers of people are signing up for food stamps, welfare, 
unemployment insurance, and all of the various government subsidies 
that are out there to try to help people through a tough time. Do we 
want to keep them from getting a job?
  The Medicare payroll tax, that is $54 billion in this bill, will hit 
one-third of all small business owners. Those small business owners 
that it will hit about 30 million people in the United States. If you 
put a tax on somebody, especially during a recession, you are going to 
inhibit them from investing in their business and creating jobs.
  I have heard many people from the other side of the aisle say that it 
is not a good time to raise taxes, and yet they are raising taxes in 
this bill. Sometimes they call them fees, penalties, assessments, or 
different things, but they are taxes.
  This bill will also require small businesses to buy a government-
approved insurance plan. So even for those small businesses that 
currently have a plan that they like, one that works for them and their 
employees, and one that is affordable and even though these small 
businesses have tried to do the right thing, the plan that they have 
selected may not quite meet the government criteria. This may be 
because the plan they chose was a little more of a bare-bones type of 
plan--in any event, this bill will require them to spend more money for 
a higher level of coverage than maybe they can afford.
  What will that do? Well, if the small business is barely getting by 
now, barely keeping its doors open, and the government requires it to 
spend more money on health insurance, some employees may be laid off or 
in some cases, small businesses may close and all its employees may 
lose their jobs.
  Most people in this body have never operated a small business. I 
built, owned, and operated two different small businesses--veterinary 
clinics. I understand how difficult it is for a small business owner, 
especially when you are just starting out and you are investing, you 
are putting everything you have into it, with all your hard work, and 
the few profits you make you plow right back into the business. You are 
trying to expand. You are trying to hire the next person, and you are 
trying to grow your business. When the government comes along and puts 
extra taxes and extra burdens on you, it makes it tough. That is not 
what we should be doing, especially during a time of recession.
  This bill before us also caps what are called flexible spending 
accounts at $2,500. Flexible spending accounts are used by a lot of 
small businesses, but they are also used by a lot of Federal employees. 
They are used by a lot of people. They are especially used by a lot of 
people who have serious chronic diseases.

  If you are a Federal employee, for instance, you can put $5,000 in a 
flexible spending account, and then you can pay, for instance, for 
approved out-of-pocket health care expenses. This bill caps that at 
$2,500 a year. So for somebody who has multiple sclerosis or somebody 
who has diabetes or somebody who has a chronic disease that requires a 
lot of medical attention, you are hurting those people who need that 
money the most. That is not something we should be doing, but that is 
exactly what this bill does.
  Let me talk about some of the general provisions in this bill and not 
just how it affects small businesses. We have talked about the Medicare 
provisions in the bill a lot on the floor. We know there is a $500 
billion cut in Medicare. Folks on the floor were just talking about the 
doughnut hole for senior citizens in the Part D prescription drug plan 
under Medicare. Under this bill, Medicare Advantage will be cut by $120 
billion. Most Medicare Advantage plans have no doughnut hole, yet this 
bill would take $120 billion out of Medicare Advantage, cutting extra 
services. According to CBO, there will be a 64-percent reduction in 
extra benefits by the year 2016 for those seniors who have Medicare 
Advantage.
  Ten million seniors in the United States today have Medicare 
Advantage. They have chosen it. They were not forced into it. As a 
matter of fact, Medicare Advantage is a relatively new program. Seniors 
do not like change that much, yet they saw an advantage in this 
program. They did not have pay to pay their Medigap insurance. They did 
not have a doughnut hole. Many of them get vision and dental services, 
yet their extra benefits are going to be cut by 64 percent because of 
this bill.
  Overall, because of the smoke and mirrors that are used, it is said 
this bill only costs $849 billion. But, the costs are hidden. First of 
all, $849 billion is a huge number. But it is actually a $2.5 trillion 
spending bill. The reason is because when you look at it fully 
implemented--right now, a lot of the benefits do not start right away 
but the taxes start right away--when

[[Page S13167]]

you look at the full 10 years when taxes, benefits, and everything is 
implemented, it is a $2.5 trillion bill. This is a massive increase in 
the Federal Government.
  As an example, within the 2,074 pages of this bill there are almost 
1,700 new places where authority is provided to the Secretary of Health 
and Human Services to make health care decisions for the American 
people. Madam President, this bill gives the Secretary of Health and 
Human Services the authority to make health care decisions for the 
American people 1,700 times. If that is not a massive government 
expansion into our health care field, I do not know what is.
  There is also about $500 billion in new taxes. I have this chart in 
the Chamber. This is a quote by President Obama on his health care 
promises. He said:

       Let me be perfectly clear. . . .if your family earns less 
     than $250,000 a year, you will not see your taxes increased a 
     single dime. I repeat: not one single dime.

  He said:

       Nothing in this plan will require you or your employer to 
     change the coverage or the doctor that you have. Let me 
     repeat this: nothing in our plan requires you to change what 
     you have.

  And thirdly, he said:

       Under the plan, if you like your current health [care] 
     insurance, nothing changes, except your costs will go down by 
     as much as $2,500 per year.

  Let me focus on the first quote about the new taxes that are in this 
bill. The bill includes a 40-percent insurance plan tax. There is a 
separate insurance tax on top of the 40-percent insurance plan tax. 
This is the one, by the way, that several of my colleagues were talking 
about that the unions are all up in arms about. It is the Cadillac 
plans they were talking about that are going to be taxed. Most union 
members have a Cadillac plan, and their plans are going to be taxed at 
40 percent above a certain dollar figure. Because this tax is not 
indexed to inflation, by the end of a decade, most Americans' plans 
will be subject to this 40-percent tax.
  There is also an employer mandate tax. But as the Congressional 
Budget Office said, this tax actually gets shifted down to the workers. 
There is a drug tax. Every time you purchase drugs, taxes are passed 
onto you by the drug companies, so all of us are going to be paying 
more for drugs. There is a laboratory tax. Every time you go in, there 
is a tax on lab work. All of these taxes end up raising health care 
premiums. There is a medical device tax. There is a failure to buy 
insurance tax. There is a cosmetic surgery tax. And, there is an 
increased employee Medicare tax.
  At this point, let's remember that first quote I showed where 
President Obama said he would not raise taxes on families making 
$250,000 or less, and on individuals making $200,000 a year or less. 
Well, 84 percent of the taxes in this bill will be paid by people 
making less than $200,000 a year--84 percent of the taxes.
  I would like to point out another problem with this bill. It contains 
a sense of the Senate on medical liability reform. In his September 
address on health care reform, the President talked about the need to 
do something about medical liability reform. The problem is that this 
bill before us today only includes a sense of the Senate on medical 
liability reform. Let me show you. As shown on this chart, this is how 
much money this health care bill saves with their sense of the Senate. 
Zero.
  However, the Congressional Budget Office said that real medical 
liability reform would save $100 billion in this country--between what 
the government spends and what the private sector spends, that is $100 
billion in total.
  The problems with this bill are so numerous that we could go on and 
on discussing them, but we truly do need to start over. We need to 
start over and take more of a step by step approach. We need to develop 
an incremental approach, where both sides can agree on some of the 
reforms we need to do--without destroying our current health care 
system. We need to enact meaningful medical liability reform.
  We need to agree on provisions about eliminating preexisting 
conditions. We need to agree on an incremental approach to reward 
people for engaging in healthy behaviors. It is cheaper to insure 
people who are nonsmokers and people who are not obese. It is about 
$1,400 less to insure a non-smoker versus a smoker; and it is about 
$1,400 less to cover someone who has the proper body weight versus 
somebody who is obese. Encouraging individuals to engage in healthy 
behaviors is a good thing. We can agree on that.
  We also need to allow small businesses to join together to take 
advantage of purchasing power in the same manner that big businesses 
do. This is an incremental reform proposal that would not destroy the 
quality of our health care system and would not take the costs and put 
them on the backs of small businesses. This is something we should do. 
This is something we can do.
  The only way to enact these incremental reforms is to stop the bill 
that is before us today. The only way for us to do that is to sit down 
together, not as Republicans or Democrats, but to sit down together and 
come up with ideas that we can all agree on that will actually help the 
health care system in America. That is what this body should do if we 
want to do what is right for the American people.
  I yield the floor.
  The PRESIDING OFFICER. The Republican leader.
  Mr. McCONNELL. Madam President, I ask unanimous consent that Senator 
McCain and I be permitted to engage in a discussion regarding the 
health care matter.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCONNELL. Madam President, last Friday, we heard from two 
entities. We heard from the Center for Medicare & Medicaid Services, 
indicating health care costs in this country would actually go up under 
the Reid bill. We also heard from CNN. We heard from CMS and from CNN. 
We heard from CNN about how the American people feel about this 
measure. At a time when all the polls indicate the American people do 
not favor this bill, do not want us to pass it, and when the 
government's Actuary indicates the bill will actually not cut health 
care costs, which we thought was what this debate was all about in the 
first place, we are being confronted with a procedure that is quite 
unusual: an effort to restructure one-sixth of the economy through a 
massive bill that it appears almost no one has seen.
  At what point, I would ask my friend and colleague from Arizona, 
could we expect that the American people would have an opportunity to 
see this measure that has been off in the conference room here and 
being turned into sausage in an effort to get 60 votes?
  Mr. McCAIN. I would say to my friend, the Republican leader, that I 
have seen a lot of processes around here and a lot of negotiations and 
a lot of discussions, but I must admit I have not seen one quite like 
this one, nor do I believe my leader has.
  I was on the floor in a colloquy with the assistant Democratic leader 
a couple days ago, and I said: What is in the bill? He said: None of us 
know. Talk about being kept in the dark.
  I would say to my friend from Kentucky, we have to put this into the 
context of what the President of the United States said in his campaign 
because the whole campaign, as I well know better than anyone, was all 
based on change. On the issue specifically surrounding health care 
reform, I quote then-Candidate Obama on October 18, 2009:

       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 is making 
     arguments on behalf of the drug companies or the insurance 
     companies.

  He went on to say that a couple more times.
  I would ask my friend: Hasn't it been several days that we basically 
have been gridlocked over one amendment, which is the amendment by the 
Senator from North Dakota that would allow drug reimportation from 
Canada and other countries?
  So then, guess what the reports are today:

       PhRMA renegotiating its deal? Inside Health Policy's Baker, 
     Pecquet, Lotven and Coughlin report: `The pharmaceutical 
     industry is negotiating with the White House and lawmakers on 
     a revised health care deal under which the industry would 
     ante up cuts beyond the $80 billion it agreed to this summer, 
     possibly by agreeing to policies that would further shrink 
     the . . . doughnut hole. . . .'

  I will not go into all the details of that.

[[Page S13168]]

  Just a few minutes ago on the floor, guess what. They announced there 
would be some change made, an amendment that would be included in the 
managers' package.
  I would ask my friend, is it maybe the case that the majority leader, 
who is having a meeting, as we speak, of all the Democratic Senators 
behind closed doors, without C-SPAN, has cut another deal along with 
the White House with--guess who--the pharmaceutical companies that have 
raised prices some 9 percent on prescription drugs this year?
  This is a process the American people don't deserve, so I would ask 
my friend from Kentucky.
  Mr. McCONNELL. I would say to my friend from Arizona, that is a 
process that gives making sausage a bad name.
  Mr. McCAIN. So we were hung up--or should I say gridlocked--for 2 or 
3 days, over the entire weekend. The Republican leader even agreed to a 
unanimous consent agreement that would allow a Democratic side-by-side 
amendment, and that was not agreed to--until over at the White House, 
according to this report, PhRMA renegotiated its deal and apparently 
they now have sufficient votes to defeat the Dorgan amendment which, as 
of last summer, according to the New York Times, said the last deal 
shortly after striking that agreement, the trade group--the 
Pharmaceutical Research Manufacturers of America, or PhRMA--also set 
aside $150 million for advertising to support the health care 
legislation.
  I ask my friend, is this changing the climate in Washington or is it 
not only business as usual but, in my opinion, I haven't seen anything 
quite like this one.
  Mr. McCONNELL. I would say to my friend, it certainly is not changing 
business as usual in Washington. Even more important than that, it is 
not changing American health care for the better, which is what we all 
thought this whole thing was about when we started down this path of 
seeing what we could do to improve America's health care, which almost 
everyone correctly understands is already the best in the world.
  Mr. McCAIN. Hadn't there been charge after charge that Republicans 
are ``filibustering'' and Republicans have been blocking passage of 
this legislation? I would ask my friend, hasn't the Republican leader 
offered a series of amendments we could get locked into and have votes 
on?
  Mr. McCONNELL. We have been trying to get votes on the Crapo motion, 
for example, since last Tuesday. It will be a week tomorrow. Maybe at 
some point we will be able to have amendments again.
  We started off on this bill with each side offering amendments, and 
we went along pretty well until, I think, the majority decided it was 
not only better to write the bill in secret, it was better to not have 
any amendments to the bill. So they began to filibuster our efforts for 
Senators to have an opportunity to vote on aspects of this bill, such 
as the $\1/2\ trillion worth of cuts in Medicare which we, fortunately, 
were able to get votes on; the $400 billion in new taxes, which we 
would like to be able to get votes on.
  This is the core of the bill. The American people have every right, I 
would say to my friend from Arizona, to expect us to debate the core of 
the bill--the core of the bill, the essence of the bill--which is not, 
of course, going to be changed behind closed doors or during this 
meeting that is going on with Democrats only.
  Mr. McCAIN. As I understand it, there is a meeting going on behind 
closed doors, again, where there are no C-SPAN cameras.
  According to the Washington Post this morning, it says:

       The Senate will resume debate Monday afternoon on a popular 
     proposal to allow U.S. citizens to buy cheaper drugs from 
     foreign countries which led to a last-minute lobbying push by 
     drug makers last week and bogged down negotiations over a 
     health care reform bill.

  It goes on to say:

       The fight over the imported drugs proposal poses a 
     particularly difficult political challenge for President 
     Obama who cosponsored a similar bill when he was in Congress 
     and who included funding for the idea in his first budget. 
     But the pharmaceutical industry, which has been a key 
     supporter of health care reform after reaching agreement with 
     the White House earlier this year, has responded with a 
     fierce lobbying campaign aimed at killing the proposal, 
     focusing on Democratic Senators from States with large drug 
     and research sectors.

  So it will be interesting to watch the vote.
  I would also point out to my friend, it is clear that if we allow 
drug reimportation, we will save $100 billion, according to CBO, and 
the deal that was cut--the first deal that was cut with the White House 
was they would reduce it by $80 billion, so they had a $20 billion 
cushion. Now it will be very interesting to see what the latest deal is 
and how the vote goes.
  But, again, I wish to ask my Republican leader, we get a little 
cynical around here from time to time and we see sometimes deals cut 
and things done behind closed doors. I am past the point of 
frustration; I am getting a little bit sad about this. Because I think 
we know we are now bumping up against Christmas. Sometime we are going 
to break for Christmas. So the pressures now are going to be even more 
intense because I think it is well known and reported that if they 
don't get a deal before we go out for Christmas, then it will be very 
much like a fish sitting out in the sun. After awhile, it doesn't smell 
very good, when people see a 2,000-page bill which has all kinds of 
provisions in it.
  So I understand, without C-SPAN cameras, that all the 60 Democratic 
Members of this body are going to go down to the White House for 
another meeting tomorrow, and we will see what happens then.
  Mr. McCONNELL. I would say to my friend from Arizona, talk about an 
example of manufactured urgency. Is it not the case, I ask my friend 
from Arizona, that the benefits under this bill don't kick in until 
2014?
  Mr. McCAIN. Well, my understanding is, if you go out and buy a car 
today from any car dealer, you don't have to make payments for a year. 
You can get that kind of a deal if you want it. This deal is exactly 
upside down. You get to make the payments early, and then you get to 
drive the car after 4 years.
  Mr. McCONNELL. So the urgency, it strikes me, I would say to my 
friend from Arizona, is to get this thing out of the Congress before 
the American people storm the Capitol.
  We know from the survey data, do we not, that the American people are 
overwhelmingly opposed to this bill? So what is the argument I keep 
hearing on the other side? I was going to ask my friend from Arizona: I 
hear the President and others say: Let's make history. Well, there has 
been much history made but much of it has actually been bad, right?
  Mr. McCAIN. I would also like to say, there is a history we should 
not ignore; that is, that every major reform ever enacted in the modern 
history of this country has been bipartisan, whether it be Medicare, 
whether it be Social Security, whether it be welfare reform, as we 
remember under President Clinton. Every major reform has been 
accomplished by Democrats and Republicans sitting down together and 
saying: OK, what is it we have to do? What kind of an agreement do we 
have to make?
  Some of us have been around here long enough to remember that in 
1983, Ronald Reagan and Tip O'Neill, a liberal Democrat from 
Massachusetts and the conservative Republican from California, sat down 
with their aides across the table and key Members of Congress when 
Social Security was about to go broke.
  Why can't we, since there must be areas we agree on, now say to our 
Democratic friends and the President, rather than trying to ram 60 
votes through the Senate, why can't we now sit down and proceed in a 
fashion--we will give things up. We are willing to make concessions to 
save a system of Medicare that is about to go broke in 6 years. We will 
make some concessions but get us in on the takeoff and don't expect us 
to be in on the landing when already the bill is written and the fix is 
in, as the fix apparently is in on the Dorgan amendment.
  Mr. McCONNELL. Could I say to my friend from Arizona, no one has done 
more in the Senate, in the time I have been here, to express opposition 
to and warn us about the perils of excessive spending.
  As I recall, one of the things the Senator from Arizona told us after 
he came back following his campaign was, what the American people are 
concerned about is the cost of health care--the cost. Of course, we are 
also

[[Page S13169]]

concerned about government spending--the cost to consumers of health 
care and the cost to government spending. Dr. Christina Romer, a part 
of the White House's economic team, said on one of the shows yesterday:

       We are going to be expanding coverage to some 30 million 
     Americans and, of course, that's going to up the level of 
     health care spending. You can't do that and not spend more.

  Maybe she didn't get the talking points for yesterday's appearances. 
But we have conflicting messages out of the White House on this very 
measure.
  In short, it is safe to say this is a confused mess, a 2,100-page 
monstrosity of confusion and unintended consequences. Yet they are in 
this rush to enact a bill--the benefits of which don't kick in until 
2014--before Christmas Day this year. I am astonished at the 
irresponsibility of it.
  Mr. McCAIN. Madam President, it is a remarkable process we are going 
through. I see that my friend from Tennessee is here. I know he, being 
the head of our policy committee and a major contributor to keeping us 
all informed and up to date, would also like to say something.
  First, I will say something I had not planned on saying; that is, 
this has been a vigorous debate. I think we have been able to act in an 
effective way, which has been reflected in the polls of the American 
people who are largely opposed to this measure and greatly supportive 
of a process where we can all sit down together--with the American 
people in the room, to be honest--when we are talking about one-sixth 
of the GDP. The Republican leader's job has been compared by one of his 
predecessors to herding cats--I agree with that--or keeping frogs in a 
wheelbarrow. I have not seen the Republican Members on this side of the 
aisle as much together and as cohesive and working in the most 
cooperative and supportive fashion of each other since I have been in 
the Senate. For that, I congratulate the Republican leader.
  Mr. McCONNELL. I thank my friend.
  Mr. ALEXANDER. I congratulate the Senator from Arizona for his 
comments and his own leadership on this issue. I want to add my 
commendations to the Republican leader.
  My thought is that the reason we are working so well together is 
because we are afraid our country is about to make a historic mistake. 
There is a lot of talk about making history. There are a lot of ways to 
make history. Put aside all of the laws about race--don't talk about 
them. When we talk about race, that is often misunderstood. We didn't 
fail to make a historic mistake on laws about race until the 1960s, 
when we began to correct those laws. Let's put aside all the historic 
mistakes we might have made in failing to stop aggression before World 
War II. We know about those mistakes. We can remember historic 
mistakes.
  I ask the Republican leader if the Smoot-Hawley tariff sounded like a 
good idea when President Hoover pushed it in the late 1920s. We were 
going to raise tariffs on 20,000 imported goods, create more American 
jobs, and it created the Great Depression. The Alien and Sedition Act 
sounded like a great idea. That made a little history. Shortly after 
our country was founded, we made it a crime to publish false and 
scandalous comments about the government. It has never been repealed. 
Our Supreme Court said it was a historic mistake. Then there was the 
Medicare Catastrophic Coverage Act of 1988. I wonder if the Senators 
might have been here then.
  So we are capable of making historic mistakes. As the Senator from 
Arizona has said very well, most Americans, if presented with a 
problem, would not try to turn the whole world upside down to solve it. 
They would say: What is the issue? The issue is reducing costs. We can 
all talk to family members and others--we know what they are paying 
monthly for premiums, and we would like that to be less, and we would 
like for the government's costs to be less.
  Why don't we, as we have proposed day after day, and as the Senator 
from Arizona has said--why don't we go step by step in the direction of 
reducing costs.
  I will not go into a long litany of proposals we have made. We can 
take five or six steps on small business health plans, reducing junk 
lawsuits against doctors, or buying health insurance across State 
lines. We should be able to agree on that instead of a 2,000-page bill 
that raises premiums, raises taxes, and seems to have a new problem 
every day.
  I think the cohesion on the Republican side is not so partisan. I 
like to work across party lines to get results. That is why I am here. 
I am just afraid that our country is about to make a historic mistake, 
and we are trying to help and let the American people know what this 
bill does--what it does to them and their health care.
  Mr. McCONNELL. The fear is palpable. In addition to the public 
opinion polls we have all seen, we are each having experiences with 
individuals. I will cite three.
  I ran into a police officer--a long-term police officer, an African 
American. He came up to me and said: Senator, you have to stop this 
health care bill.
  Then there are the health care providers. I see Dr. Barrasso from 
Wyoming. Within the last week, I spoke to one of the Nation's fine 
cardiovascular surgeons. He said: Please stop the health care bill. 
This is going to destroy the quality of our profession. He told me of a 
friend of his, a neurosurgeon, who called him with the same concern.
  I get the sense that there are an enormous number of health care 
providers--physicians, hospitals, everybody involved in the health care 
provider business--apparently, with the exception of the pharmaceutical 
industry, which seems to have cut a special deal--who are just 
apoplectic about the possibility that the finest health care in the 
world is going to be destroyed by this--as the Senator from Tennessee 
points out--``historic mistake.''
  Mr. McCAIN. I will mention, also, on the issue of PhRMA, again, here 
we are in the direst of economic times, with a Consumer Price Index 
that has declined by 1.3 percent this year, and they have orchestrated 
a 9-percent increase in the cost of prescription drugs--that is 
remarkable--laying on an additional burden, which naturally falls more 
on seniors than anybody else since they are the greatest users of 
pharmaceutical drugs. I don't blame them for fighting for their 
industry. But the point is, what they are doing is harming millions and 
millions of Americans.
  Again, about contributing to the cynicism of the American people, 
whether you are for or against the issue of drug reimportation, to cut 
a deal behind closed doors and then, apparently, because of support of 
an amendment by Senator Dorgan, go down and negotiate another deal--how 
do you describe a process like that?
  Mr. ALEXANDER. Well, ``unsavory'' would be a minimum word that comes 
to my mind. The problem I have is that Americans have a perfect right 
to their view, and the pharmaceutical industry has a perfect right to 
advocate its point of view.
  As I hear the Senator describe what has been going on, am I hearing 
correctly? I mean, the pharmaceutical industry is saying we don't like 
drug reimportation. The White House says: OK, we will cut a deal with 
you behind closed doors--as far as we can tell--and we will change the 
law this way, and then--
  Mr. McCAIN. The original deal was published in every newspaper, and 
it was that they would close the so-called doughnut hole by some $80 
billion. CBO said their profits would be reduced by some $100 billion 
if we allow reimportation. They had a $20 billion cushion.
  Mr. ALEXANDER. So it is a negotiation between the White House, the 
President, and big industry about profits: I will do this, you do that, 
and then you go out--and my understanding is that you write in as part 
of the deal that the industry spends $150 million on television 
advertisements in support of the deal. Is that the deal?
  Mr. McCAIN. But then, incredibly, they counted the votes. The votes 
were there to pass the Dorgan amendment. According to published 
reports, the pharmaceutical industry is negotiating with the White 
House and lawmakers on a revised health care deal under which the 
industry would ante up cuts beyond the $80 billion it agreed to this 
summer.

  In other words, because that wasn't sufficient to get votes to kill 
the Dorgan amendment that would allow reimportation of drugs, they went 
down and renegotiated. What is that called?

[[Page S13170]]

  Mr. ALEXANDER. Well, if I am remembering right, earlier this year the 
Republican leader made a talk on the Senate floor. The attitude of the 
White House toward a large company in Kentucky, as I remember, was: If 
you don't agree with us on health care, we will tax you. That was the 
attitude, it seems, to come out. If you don't agree with us, we will 
tax you, or we will make it difficult for you to do business. If you do 
agree with us, we will make a deal with you that affects your profits.
  Mr. McCONNELL. I say to my friends, beyond that, the administration 
basically told this company to shut up. They issued a gag order that 
was so offensive, even an editorial in the New York Times said it 
should not have been done. They could not communicate with their 
customers the impact of various parts of this bill on a product they 
buy, Medicare Advantage. The tactics have been highly questionable, it 
strikes me, from the beginning of the year up to the present. What 
Senator McCain is talking about is just the most recent example.
  Mr. McCAIN. Can I also give you this to illustrate it graphically? In 
this news report, several lobbyists told Inside Health Policy--that is 
the organization that is reporting this--they have heard that the 
Pharmaceutical Research and Manufacturers of America may have already 
reached a deal with the White House and AARP to close the Senate bill's 
coverage gap by 75 percent versus the 50 percent under the current 
bill. PhRMA declined to confirm the reports that it may be agreeable to 
reforms that would further close the doughnut hole but signaled 
discussions were underway, and AARP said no agreement has been reached. 
We haven't seen a deal.
  Here are our old friends at AARP at it again. They are at it again.
  Mr. McCONNELL. Will the Senator yield for this point?
  Mr. McCAIN. Yes.
  Mr. McCONNELL. Is that the same AARP that would, I am told, actually 
benefit from the decline of Medicare Advantage because they sell 
policies themselves that would be more likely to be purchased by 
seniors? Is that the same AARP?
  Mr. McCAIN. When you lose Medicare Advantage, as Dr. Barrasso will 
fully attest, then you are almost forced into the so-called Medigap 
policies, which then cover the things that are no longer covered under 
Medicare Advantage, such as dental, vision, fitness, and other aspects 
of Medicare Advantage.
  So if you destroy Medicare Advantage, then people will be forced into 
the Medigap policies. Who makes their money off Medigap policies? AARP.
  Mr. SESSIONS. If the Senator will yield for a question about this 
deal with big PhRMA, a few days ago I made reference to and quoted from 
a scathing editorial by Robert Reich, who served as Secretary of Labor 
in the Clinton administration, who is a leading intellectual liberal 
Democrat who criticized these deals in the most scathing terms. He used 
words I was reluctant to use on the floor--as my colleague said, 
``unseemly,'' whatever. I would say it goes beyond that. He used the 
word ``extortion.'' I don't think he used that word lightly.
  I think it is the kind of process--the Senator has been here and many 
who are on the floor now have been here for a long time--but it seems 
to me this is pushing the envelope on dealmaking to the point that 
really is a dangerous step. It goes beyond anything we should 
countenance, in my view.
  Mr. McCAIN. I agree with the Senator. Again, I would like to ask Dr. 
Barrasso because he has treated patients who are under Medicare 
Advantage. Before I do, I want to say again that the whole process has 
been wrong. The process of going behind closed doors; the process 
where, after nearly a year of addressing this issue, the 
distinguished--and he is a fine person, a fine Senator from Illinois--
the No. 2 leader in the majority, in a colloquy I had with him just 2 
days ago, said no one knows what is in the bill. He said no one knows 
what is in the bill. This is after a year. It is wrong. What it does 
is--this issue is vital, but it destroys the confidence of the American 
people to be truly represented here to have their interests overridden 
by the special interests, of which PhRMA and this deal that is going on 
right now is a classic example. I ask Senator Barrasso.
  Mr. ALEXANDER. Before Dr. Barrasso speaks, just listening to the 
Senator from Arizona, it seems to me it puts the Democratic leadership 
in the extremely awkward position of even its leadership--proposing a 
bill that affects 17 percent of our economy and the leadership of the 
Democratic Senate doesn't yet know what is in the bill, we certainly 
don't know what is in the bill, and they are in the awkward position--
at least they have been the last few days--of filibustering their own 
bill at a time when they are insisting that we pass the bill before 
Christmas, which we can hear the sleigh bells ringing. It is just a few 
days before that happens.
  Mr. BARRASSO. It seems, as we are on the Senate floor talking--
  Mr. McCAIN. May I interrupt? I ask unanimous consent that the Senator 
from Tennessee take over this colloquy.
  The PRESIDING OFFICER (Mrs. Shaheen). Without objection, it is so 
ordered.
  Mr. McCAIN. Go ahead. I am sorry.
  Mr. BARRASSO. It seems to me, as we are on the Senate floor 
discussing the issue wide open--any American can come in here and 
listen to us--hidden behind closed doors is the other party, maybe 
sharing what is in the secret negotiations, maybe not, because it 
sounds as if a number of their members don't know.
  What I do know from practicing medicine for 25 years and taking care 
of families around the State of Wyoming is that people depend on 
Medicare for their coverage. There are seniors who depend on Medicare 
and Medicare Advantage. The reason they call it Medicare Advantage is 
because there are advantages to being in it. It coordinates care. It 
helps with preventative care, which is not part of the regular Medicare 
Program.
  Yesterday, I heard my colleague from Arizona say there are those who 
want to shut down Medicare Advantage--AARP, he said--because they are 
the ones to benefit and profit if, in fact, Medicare Advantage is lost 
to the seniors in this country. Madam President, 11 million Americans 
depend on Medicare Advantage. Yet they are losing because of a vote 
this body took. This body voted to strip $120 billion away from our 
folks who depend on Medicare Advantage.
  I know the Senator from Arizona has another important point he wants 
to make.
  Mr. McCAIN. The point I want to make is this process has turned into 
something, again, like I have never seen before. I was just handed this 
FOX News, just-reported breaking news that Harkin said--I guess 
referring to the Senator from Iowa--Harkin said that Medicare buy-in 
and public option are now dead. I don't know what to say except it 
seems to me they are just throwing everything against the wall and 
seeing what sticks and what doesn't stick. This is really, again, one 
of the most astounding kinds of situations I have observed in the years 
I have been in the Senate. Medicare buy-in is dead, public option is 
now dead.
  What I would like to see is that Harkin would report that now 
Republicans and Democrats will sit down together and try to work out 
something of which the American people would heartily approve.
  Mr. BARRASSO. I have great concerns about the health care 
availability for the people of our great country. This is a front-page 
story in the Wyoming Tribune Eagle on the 13th: ``Doctor shortage will 
worsen.'' That is what I am worried about. I am worried about the 
patients at home. I am worried about the folks in Arizona, Alabama, and 
Tennessee. ``Doctor shortage will worsen.'' ``It is estimated that as 
many as one-third of today's practicing physicians will retire by 
2020'' and provider shortages will continue to increase. It says that 
based on health care so-called reforms they are proposing, the strain 
on certainly Wyoming's physician shortage will even possibly lead to 
longer wait time for appointments as patients travel even farther for 
care.
  As I look at this bill that raises taxes $500 billion, cuts Medicare 
$500 billion, and causes people who already have insurance--insurance 
they like but they are concerned about the cost--they will see the cost 
of their premiums going

[[Page S13171]]

up. There is very little in this bill that I think the American people 
would be interested in having for themselves.
  The President has made a number of promises. He said: I won't add a 
dime to the deficit. Eighty percent of Americans do not believe him. 
Recent poll, CNN: 80 percent of Americans don't believe the President 
on that point. How about taxes? With taxes, he said he won't add a dime 
to your taxes. Eighty-five percent of Americans don't believe him 
there. They believe their taxes are going to go up. Yet they don't 
believe the quality of their care will be better.
  So when we talk about a bipartisan solution, we want to improve 
access to care, we want to get costs under control. This bill raises 
costs.
  Mr. ALEXANDER. I see the Senator from Idaho is here. We both had the 
experience of being Governors, as did the Presiding Officer in her 
State of New Hampshire. We were talking the other day--and I hope he 
doesn't mind me repeating that--I worked with a Democratic legislature 
the whole time I was Governor. But what we always did on anything 
important was we sat down together. We had our different positions, we 
fought during elections, but we worked things out. We didn't go forward 
unless we found a way to agree. That meant I usually didn't get my way. 
I got some of my way, but I had to take into account that someone 
else--in this case, the Democratic legislature in Tennessee--might have 
a different idea. Sometimes it was a better idea.
  I ask the Senator from Idaho, we talk a lot about bipartisanship 
around here. The reason for bipartisanship is that these big bills are 
tough bills. We are expected to make difficult decisions: Are we going 
to reduce the growth of Medicare? Are we going to expand Medicaid? Are 
people going to be required to buy insurance? What are we going to do 
about health care premiums? Many of these decisions are controversial.
  When the American people look at Washington and they see that just 
one side of the political spectrum is pushing a bill through and the 
other side says: Absolutely not, what kind of confidence is that going 
to give the American people? On the other hand, if they look at 
Washington as they did with the civil rights legislation we talked 
about in the 1960s when Lyndon Johnson, a Democrat, was President and 
Everett Dirksen was the Republican leader, they saw the Republican 
leader and the Democratic President saying: OK, this is a tough 
problem, but we have a solution with which we both agree. Then the 
American people had some confidence in that.

  Bipartisanship is not just a nice thing; it is a signal to the 
American people that people of different points of view think a 
controversial decision is in the country's interest. Isn't that totally 
lacking here? Isn't that bipartisanship signal lacking across the 
country?
  Mr. RISCH. I thank the Senator. I am astonished at the process that 
is involved here. If one steps back and has a look at this from 30,000 
feet and you look at what we are doing here, what we are doing here 
is--and I say ``we'' but it is actually the other side of the aisle--
what the other side of the aisle is doing here is attempting to 
entirely revamp the health care system of this country and they are 
doing it all in one bill, which we think is a mistake. It should be 
broken into its component parts. The bill contains and attempts to 
address quality, cost, accessibility, and the insurance industry all 
put into one bucket and stirred and expected to resolve all of these 
problems at one time.
  If you look at what has happened here, the House produced three 
bills, a multithousand-page bill. Those bills were stirred around over 
there, and eventually in the dead of night they finally got one of them 
passed with one or two votes to spare. Then it came over here. There 
were already two bills over here.
  The two bills were produced through the committee process. The 
committee process is a very good process by which we produce bills. 
Admittedly, both of those bills were heavily skewed to the Democratic 
side, and all of the Republican amendments--or virtually all of the 
Republican amendments, certainly all the significant amendments--were 
voted down on a party-line basis.
  Those two bills came out of those committees. One would expect that 
then they came to the floor and would go through the process. But, no, 
the two bills were taken over to the majority leader's office, doors 
shut, curtains closed, and various people were brought in. We don't 
know who, we don't know how, we don't know what the negotiations were, 
but at the end of the day, a third bill over here was produced, and it 
is 2,074 pages long. It is usually kicking around here on the desks. I 
see they removed most of them. I suspect they removed most of them 
because most people were afraid they were going to fall over and hurt 
somebody. These were 2,074 pages that were put together. Nobody really 
knows exactly what is in them. There are some generalities that we 
know, but we don't know all the specifics.
  Then what happened is a week ago, they decide they will put 10 people 
in a room, leave the rest of the 90 of us out, and they will try to 
come up with some type of compromise. And they did. The next day, I got 
calls from home: I guess it is over; they put out an announcement; they 
have a compromise. I said: That is news to me. I don't know what is in 
it. I started to make some calls. Nobody would release the details of 
what this supposed compromise is.
  Remember, in the last election we were promised things would be 
changed. Change we could believe in. These things would be done out in 
the open, without lobbyists coming and getting their input in the bill 
behind closed doors. That is exactly what has been produced. You have a 
secret document that has been produced that we have not even seen.
  In spite of all this, the other side is saying: By golly, we are 
going to produce a bill before Christmastime. Christmas is coming, and 
Christmas is very close.
  I can tell you, after looking at these 2,074 pages--not looking at 
the compromise because we are told we cannot see it--it would be 
reckless, absolutely reckless to shove down the throat of the American 
people something that has been put together in secret, something that 
has been put together in the dead of night, something they will not let 
us look at and examine, and to say: We are going to take this now and 
shove it down the American people's throats before Christmastime.
  This is not a Christmas present the American people want. If you 
don't believe me, all you have to do is look at the polling. The 
polling shows every single day support for this bill deteriorates. It 
deteriorates amongst Republicans, amongst Democrats, and amongst 
Independents. The last poll, I think, was up to 61 percent of the 
American people said: Don't do this to us.
  We need health care reform in this country. We want health care 
reform in this country. But this monstrosity that has been produced, 
and whatever it is they are going to drag out of the alley tomorrow and 
say: This is what we are going to vote on now, is not what the American 
people want.
  I have a message for those on the other side from the American 
people: Don't do this to us. Stop. Bring some sanity into this. Do it 
right.
  I yield the floor back to my good friend from Tennessee.
  Mr. ALEXANDER. Madam President, may I ask the Senator from South 
Dakota, unless the Senator from Arizona wants to, to lead the colloquy.
  Mr. McCAIN. If I can speak for just about 10 seconds.
  Mr. ALEXANDER. Let me ask the Senator from South Dakota to lead the 
colloquy on the Republican side.
  Mr. McCAIN. Very briefly, I say to my friends, apparently, if the 
news reports are right, the public option and Medicare is out. That is 
an interesting twist, and again, I think affirmation that they are just 
throwing things against the wall to see if anything sticks. But it 
doesn't change the core of the bill, which the Senator from South 
Dakota has been so eloquent about, and that is the $\1/2\ trillion in 
cuts from Medicare and increases in taxes.
  So you can take the public option out or leave it in, and it still 
doesn't change the fundamental fact that it is going to restructure 
health care in America and do nothing to reduce the cost and nothing to 
improve the quality. I just wanted to make that comment and ask for 
comment from the Senator from South Dakota.

[[Page S13172]]

  By the way, could I just mention, I haven't quite seen anything on 
the floor of the Senate as I saw when the Senator from South Dakota was 
challenged earlier today. I was watching the proceedings on the floor, 
and I wonder if the Senator from South Dakota would like to maybe 
respond to accusations of misleading information, I guess is the 
kindest way I could describe it.
  Mr. THUNE. I appreciate the Senator from Arizona yielding and the 
discussion of all our colleagues on the Senate floor this evening, 
pointing out how flawed this process is and that it is being conducted 
behind closed doors in contradiction of all the promises and 
commitments that were made that this would become a transparent and 
open process. I think the Senator from Arizona has been great at 
holding the other side accountable when it comes to all these 
pronouncements about how this was going to be an open, transparent 
process, and that is just not the case. There is something going on 
right now that we are not privy to, and I think at some point they are 
going to throw something, as the Senator from Arizona said, at the 
wall, hoping that the latest thing will stick.
  But I do want to make an observation with regard to the discussion 
held earlier today because a Member from the other side--the Senator 
from Minnesota--had indicated that he thought this chart was somehow 
inaccurate or misleading, and I want to point out again, Madam 
President, that the chart is very accurate. In fact, the taxes in the 
bill begin 18 days from now, on January 1 of next year. January 1, 
2010, is when the taxes in this bill begin.
  In fact, almost $72 billion of taxes will have been collected before 
the benefits that start to kick in will be paid out--the premium 
subsidies that are going to support the exchanges, that are supposedly 
going to help those who don't have insurance get access to it. That is 
1,479 days from now.
  The Senator from Minnesota got up and said, and I quote: We are 
entitled to our own opinions; we are not entitled to our own facts. The 
fact is, benefits kick in on day one. The large majority of benefits 
kick in on day one, and we shouldn't be standing up here with charts 
that say the exact opposite.
  Well, Madam President, it is not me saying this; it is the 
Congressional Budget Office. The Congressional Budget Office has said 
that 99 percent of the coverage spending in this bill doesn't kick in 
until January 1, 2014--1,479 days from now.
  Now, I ask my colleagues, and most Americans around this country: Do 
you think it is fair to construct a bill that in order to understate 
its total cost starts raising taxes in 18 days, but doesn't start 
delivering 99 percent of the coverage benefits until 1,479 days from 
now?
  If the other side wants to have an argument about whether 99 percent 
of the coverage benefits kick in in the year 2014 or 100 percent, I am 
happy to have that argument. The point is simply this: Taxes start 18 
days from now--tax increases--so that $72 billion in taxes will have 
been imposed upon the American people, and the benefits 1,479 days from 
now.
  So, Madam President, I want to make that point and refute the 
argument that was made by the Senator from Minnesota that a large 
majority of benefits kick in on day one. Ninety-nine percent of the 
benefits don't kick in until later.
  Incidentally, I have an amendment on which I hope we will get a 
chance to vote that delays the taxes until such time as the benefits 
begin. We think it is only fair to the American people that we 
synchronize the tax increases with the benefits. Many of us don't 
support the tax increases in the first place, which is why we will be 
supporting the Crapo amendment to recommit the tax increases back to 
the committee to get rid of them. But if you are going to have tax 
increases and start raising revenue immediately, you ought to start 
paying out the benefits today, or at least delay the tax increases so 
the benefits and the tax increases are synchronized. That, to me, is a 
fair way to conduct and do public policy for the American people.
  The reason it was done this way, let's be honest about it--and the 
newspapers have made it pretty clear in some of their statements--for 
instance, the Washington Post states:

       The measure's effective date was also pushed back to the 
     year 2014. That projection represents the biggest cost 
     savings of any legislation to come before the House or Senate 
     this year.

  The measure's effective date was also pushed back. They keep pushing 
the date back to understate the cost. The reason they want to start 
collecting revenue right away and not start spending until later is 
because they know if they start the spending early on, they are going 
to start inflating significantly the cost, and the goal was to try to 
keep it under $1 trillion. We all know now, and they have acknowledged, 
the 10-year, fully implemented cost of this isn't $1 trillion, it is 
$2.5 trillion.
  The American people deserve to know the facts. That is the fully 
implemented cost. The only reason they can say in the 10 years it comes 
in at $1 trillion or thereabouts is because the tax increases started 
January 1, 2010, and the benefits--99 percent of the benefits--don't 
start kicking in until January 1, 2014.
  So I thank the Senator from Arizona for giving me the opportunity to 
clarify that. It is important we make this debate about the facts. I 
have tried to do that when I speak, and I am happy to have the 
opportunity to restate the facts as they exist and as they have been 
presented to us by the experts--by the Congressional Budget Office and 
by the CMS Actuary, both of whom have concluded the same thing when it 
comes to the benefits and the impact this will have on premiums in the 
country. I think that is probably the most devastating blow to the 
argument the other side has made in support of this bill--when the CMS 
Actuary came out last week and said this is actually going to increase 
the cost of health care in this country by $234 billion over the next 
10 years.
  So, Madam President, I am happy to yield. I see a number of our 
colleagues on the Senate floor, and the leader is here as well, and I 
would certainly yield time to the leader.
  Mr. McCONNELL. If I could, Madam President, Senator McCain and I had 
an opportunity to talk off the floor about things that may be in or out 
of the current Reid bill. It is over there behind closed doors.
  Whether things are popping up or being left out, and whether any of 
that is significant, I would say to my friend from Arizona, it doesn't 
make a whole lot of difference, does it? Because the core of the bill, 
that which will not change, has not changed in any of these various 
iterations of Reid that we have seen, with $\1/2\ trillion in cuts in 
Medicare, $400 billion in new taxes, and higher insurance premiums for 
everyone else.
  I would ask my friend from Arizona, if he thinks any of that is going 
to change?
  Mr. McCAIN. I would respond by saying whether the public option is in 
or out or whether expansion of Medicare is in or out, the core of this 
legislation will do nothing to reduce or eliminate the problem of 
health care in America, which is the cost of health care not the 
quality of health care. In fact, it will, in many ways, impact directly 
the quality of health care, increase the cost, as we all know, by some 
$2.5 trillion, according to the chairman of the Finance Committee.

  But I also want to point out the back and forth of this--is it in 
there, is it out? Well, let's try this. Who, up until a week ago, ever 
heard we were going to expand Medicare? Now it is out, now it is in. We 
used to have hearings around here, proposals, witnesses, and then we 
would shape legislation, which would be amended in the committee, and 
then brought to the floor and amended on the Senate floor. Here we have 
to get news flashes to know whether the public option is in or out, 
whether Medicare expansion is in or out. Again, this is kind of a 
bizarre process.
  But my friend is right; it doesn't affect the core problem with this 
legislation, which is that it does not reduce cost, and it increases 
the size and scope of government and the tax burden that Americans will 
bear for a long period of time, including, by the way--and, again, I 
don't mean to sound parochial, but there are 337,000 of my citizens in 
the Medicare Advantage Program. The other side has admitted that the 
Medicare Advantage Program will go by the

[[Page S13173]]

wayside. That is affecting a whole lot of people's lives, I would say, 
and that is in the core of the bill. That will not be changed by 
expansion of Medicare or with a public option or with no public option.
  Mr. THUNE. Would the Senator from Arizona yield? I see a number of 
our colleagues and the leader.
  I would simply add that this idea of expanding Medicare, which just 
emerged last week, was a bad one, and one even I think a lot of the 
Democratic Senators have come out in opposition to, which is why we are 
now back to the drawing board. But this relentless effort to try to 
tweak this bill around the edges, to somehow get that 60th vote, 
doesn't do anything to change the fundamental features of the bill, 
which the leader and the Senator from Arizona have been talking about, 
and that is the tax increases and spending.
  Mr. McCAIN. If I could just mention this. Over the weekend, obviously 
people watched football games. I was obviously pleased to see my alma 
mater prevail over those great cadets at West Point. We have a tendency 
to divert our attention--even seeing, for a change, the Redskins 
winning a football game--but what we talked about late last week is 
vitally important. The Centers for Medicare and Medicaid Services had 
some devastating comments to make.
  This is the organization that is tasked to provide us with the best 
estimates of the consequences of legislation--specifically Medicare and 
Medicaid.
  The CMS, referring to this bill, said:

       . . . we estimate that total national health expenditures 
     under this bill would increase by an estimated total of $234 
     billion during calendar years 2010 to 2019.

  It goes on and on and talks about the devastating effects of this 
legislation, whether the public option is in or out, whether we expand 
Medicare or not. It is remarkable information that is in this study, a 
study being ignored by the other side. Clearly, what is happening on 
the other side is only one Senator is throwing proposals back and forth 
to the CBO until they get something that perhaps looks like it might be 
sellable. But the CMS has already made their judgment on this 
legislation.
  Mr. CORKER. If I could respond to that, I have only been around here 
by about 3 years, but I passed an incredible scene--I think many of you 
coming to the floor may have seen it--a huge gaggle of journalists and 
reporters and folks waiting outside a room where our colleagues are 
meeting. There is reason this bill does not lower cost. I came from a 
world where if you had a problem, you identified what the problem was 
and then you had sort of a central strategy that you built out to try 
to lower cost, which I think is what all of us thought that health care 
reform should do--let's lower cost and create greater access for the 
American people.
  Well, instead of that, we have had a process where it has been 
literally like 50 yellow stick-ums were put up on the wall to figure 
out how they could get 60 votes. There hasn't been an attempt to 
actually lower cost. There hasn't been an attempt to try to create a 
mechanism where Americans can actually choose, with transparency, the 
type of plans that work for them. Instead, it has been a game from the 
very beginning of trying to get 60 votes, and that is why none of the 
goals, except for one, has been achieved that they set out to achieve.
  This is going to drive up premiums, it is going to add to the 
deficit, and it is going to make Medicare more insolvent, which is 
pretty incredible because when I got here there was a bipartisan effort 
to make Medicare more solvent. Instead we are using money from that to 
leverage a whole new program with unfunded mandates to States, new 
taxes, as the Senator from South Dakota was talking about.
  So, again, what is happening in this room, and the reason I bring up 
the 50 yellow stick-ums on the wall, some of which were circled to try 
to get votes, that is what this has been about from day one. What is 
happening in the room right now is they are sitting around not dealing 
with the core of this bill, which is very detrimental to our country. 
But they are in this room trying to figure out which yellow stick-ums 
will get them the 60 votes. In the process, doing something that is 
going to be very detrimental to this country.

  Mr. McCONNELL. It could be the reason they are so anxious to do this 
before Christmas is they think Americans will be too occupied with the 
holiday season and somehow they can sneak this unpopular bill through 
and everybody will be busy opening presents or taking care of their 
families and somehow the American people will not notice.
  I suggest to my colleague, I think this is going to be a vote that 
will be remembered forever. This is going to be one of those rare votes 
in the history of the Congress that will be remembered forever.
  Mr. McCAIN. If I could, before my friend from Alabama, I wonder also, 
when we are talking about dropping expansion of Medicare as is reported 
by news reports--I don't know; we have not been informed--could it 
possibly have anything to do with the fact that the AMA came out in 
opposition to it? Could it have anything to do with the fact that the 
American Hospital Association came out in opposition to it? Of course, 
that the PhRMA situation is a parliamentary procedure that is awaiting 
action on the floor speaks for itself.
  Mr. SESSIONS. I agree with the Senator completely. As Senator McCain 
already said, it is baffling. Here we are, all these weeks, and now we 
are being told the public option is being dropped? Today? And maybe 
this expansion of Medicare? Oh, we just changed our mind on this? On a 
bill that is designed to reorganize one-seventh of the entire American 
economy? This is how we are being led here? I say to Senator McCain, it 
is historic. I think the American people have rejected this plan.
  The numbers do not add up. The money is not there to pay for these 
schemes. I think the American people know it. So I guess I would 
suggest--my colleague from Tennessee, Senator Alexander, is not here--
rather than jamming forward before Christmas, isn't it time to slow 
down and think this thing through and start over in a step-by-step 
process that might actually produce some positive change in health care 
in America?
  Mr. McCONNELL. Absolutely. That is what Senate Republicans have said 
for quite a while. Let's start over and go step by step to deal with 
the cost issue. Instead, there is this consuming desire on the other 
side of the aisle to transform one-sixth of our economy, to have the 
Government take it over and to make history and, as has been pointed 
out in this colloquy by many Senators: There are many things that 
happened in our history that we wish had not occurred. This is 
certainly going to be one of them.
  I am optimistic. We just need one Democrat, just one to stand up and 
say: Mr. President, I am sorry, this is not the kind of history I want 
to make. I would love to listen to you but I also want to listen to my 
constituents and it is very clear where my constituents are. If I have 
to choose between you and my constituents, with all due respect I am 
going to pick my constituents. Just one Democrat needs to stand up and 
say I am willing to listen to the American people rather than 
arrogantly assume that all the wisdom resides in Washington.
  If we figure this out, we are going to do it for you whether you want 
us to or not.
  Mr. RISCH. I want to add to what the Republican leader has said. I 
think there is this push to get this done before Christmas because they 
think people are not watching. People are watching. If you look at the 
poll, the poll is moving. It is moving in the wrong direction for them, 
but it is clearly moving.
  More important, I have news for the people on the other side. If they 
think this is going to go away after Christmas, they have another 
``think'' coming. This is one of the largest issues to be debated in 
this room for a long time. Every senior citizen in America is going to 
wake up after Christmas and say: Wait a minute, let me get this 
straight. Those people in Washington, DC cut $500 billion out of 
Medicare? Don't they care about me? The system is already going broke 
and they took $500 billion out of Medicare, benefits I have paid into 
all my working life, and transferred it over to start a new program, a 
new social program that also is not sustainable? What is wrong with 
those people?

[[Page S13174]]

  This discussion is going to go on. Because of the complexity of this, 
because of the size of this bill, there are going to be news stories 
every single day from now until November 2 of 2010. My friends, 
November 2 of 2010 is coming a lot quicker than you think. By the time 
you get there you are not going to be able to run from this vote. The 
American people are wisely going to respond and they are going to tell 
Washington, DC, through their voting what they think of what happened 
in this debacle that is called health care reform. It is misnamed, 
health care reform. It is higher taxes, higher insurance premiums, it 
is stealing from the Medicare Program, and it is creating a new giant 
Washington, DC bureaucracy.
  The American people do not want this.
  I yield to my friend from Wyoming.
  Mr. BARRASSO. It is interesting because what you are doing now is 
fundamentally talking about the core of the bill, the core that cannot 
be changed as they drop this or add that. It is the core that led the 
dean of Harvard Medical School to say this bill, the core, is going to 
make spending worse. It is going to drive up spending and it is going 
to not improve quality.
  This physician at Harvard has said people who are supporting this are 
living in collective denial. It is no surprise that the American people 
are very skeptical, very suspicious. It is why the dean at Johns-
Hopkins Medical Center this past week wrote an editorial that said 
``this bill will have catastrophic effects'' and it will do more harm 
than good. We are talking about the health care of the people of our 
country.
  Mr. SESSIONS. Will the Senator yield? Those two deans are saying that 
the entire promises of this bill--that it would reduce cost and improve 
quality--both are not true?
  Mr. BARRASSO. That is what we are hearing from the deans of medical 
schools. It is what I hear at home all the time. People in Wyoming read 
this and say this is wrong. This is going to make it harder for doctors 
to practice, harder for us to recruit doctors, harder for hospitals to 
stay open. We are saying in Wyoming--the Washington Post said it on 
Saturday, ``Medicare Cuts Could Hurt Hospitals, Expert Warns.'' We are 
seeing that affecting the quality of care. We are seeing it in terms of 
will we have a doctor shortage? Will that worsen? We are going to deal 
with that at home, but people are seeing it all across the country 
because fundamentally this bill is flawed. It does not address the sort 
of concerns we have, and we are trying to get costs under control. This 
will drive up costs. We are trying to help improve the quality of care. 
This will not improve the quality of care. We are hoping to improve 
access for patients. This will make it harder. This will make longer 
waiting lines, this will limit people's choices, it will limit care in 
the rural community. I know about those in Wyoming. You know about them 
in Alabama.
  When we read the report by the Actuaries from the committee that 
oversees Medicare--and they didn't rush to do this. They are talking 
about the bill that now has been out, the 2,000-page bill that has been 
out for people to read for 3 weeks. It took them 3 weeks to do the 
report because they wanted to do a very thorough evaluation and they 
looked at it, and they said we think one out of five hospitals in the 
United States will end up closing within 5 years and one out of five 
doctors offices will close if this goes through. This is what the 
Democrats are proposing, something that is going to lead to one in five 
hospitals closing, one in five doctors offices shutting their doors, 
saying we can't continue to keep the doors open under these 
circumstances.
  This report has said the whole effort to drive down the costs of care 
is wrong. At its core it is wrong; that the cost of care is going up if 
we pass this bill that is ahead of us now, regardless of the little 
changes they may make at the periphery. At the core this is going to 
drive up the cost of care. At the core it is going to cut our seniors 
who depend on Medicare for their health care.
  Medicare is going broke. This is not going in any way to help that. 
It is going to make it worse. Then if they try to put more people into 
that Medicare ship that is already sinking, that is going to make it 
worse as well.

  Plus the way they try to solve this, to say we are going to cover all 
these new people, many of them, the majority of them are going to be 
put on Medicaid--Medicaid, a program that Governors across the 
political spectrum have all said is a failed program, a program that is 
driving the States into bankruptcy, a program that Governors call the 
mother of all unfunded mandates--that is the way they are trying to get 
the costs down, by putting the cost on the States.
  It is still the same people of America who have to pay those bills, 
whether you are paying your taxes here or there. Plus they are going to 
raise taxes. This report from the Medicare Services Group looked at 
that and said all of those taxes are going to go up, $500 billion in 
taxes. Of course those are going to get passed on, so people of all 
different income brackets in the United States, all people are going to 
get hit with those taxes. Some people may see a little benefit, but by 
4 to 1, four times as many people are going to get taxed as people who 
are going to see any benefits.
  We are looking at a program, a core fundamental of a bill that to me 
is fatally flawed--fatally flawed--that will raise prices, raise 
insurance premiums for people who have insurance, cut Medicare and 
raise taxes. And you say, how could people support that?
  We need the solution to improve quality, get costs under control and 
improve access. This does not do any of those things. Plus it starts 
collecting taxes, as my friend from South Dakota said--it starts 
collecting taxes in 3 weeks but yet doesn't give services for 4 years.
  Mr. CORKER. If the Senator will yield, I was listening to him talk 
about this bill being fundamentally flawed, which it is. I think back 
about the comments Senator McConnell said on the floor, and I think 
Orrin Hatch, from Utah, the other day expanded on it. Anything that is 
this major, this major of a reform that we are going to live with for 
generations, should be done in a bipartisan way. I know Senator Hatch 
talked about the fact that something of this size should have 70 votes, 
to pass a bill that will stand the test of time.
  Earlier today I heard a friend on the other side of the aisle talk 
about the fact that Republicans walked away. I don't look at it that 
way. But I remember very early on when we saw the basic, fundamental 
building blocks of this bill, almost every Republican Senator wrote a 
letter to Senator Reid, our majority leader, and told him if there were 
going to be Medicare cuts that were used to leverage a whole new 
entitlement, we could not support the bill. So what did the majority 
leader and the finance chairman, Max Baucus, do? They used that as one 
of the fundamental building blocks of this bill. That is paying for 50 
percent of this bill--taking Medicare cuts, a program that is 
insolvent, and using it to leverage a new program.
  What I would say--and I see the leader here on the floor--I agree a 
bill of this size has to have bipartisan support. I don't know how you 
get bipartisan support, though, when almost everyone in our caucus 
wrote a letter in the very preliminary stages of negotiation to let 
them know that we considered that to be a fundamental flaw; we 
considered that not to pass the commonsense test. Yet it has been the 
major building block in causing this bill to come to fruition or to 
come to where it is today.
  Mr. McCONNELL. The Senator from Tennessee is entirely correct. We 
made a major effort. Senator Grassley and Senator Enzi, the two ranking 
members of the relevant committees, as well as Senator Snowe, were in 
endless discussions with the majority. Then it became clear that they 
were not interested in doing anything short of this massive 
restructuring of one-sixth of our economy, which includes, as the 
Senator indicated--we expressed our concerns early about these $\1/2\ 
trillion cuts in Medicare to start a program for someone else.
  I would go so far as to suggest the reason the public's reaction to 
this has been so severe is because they have chosen such a partisan 
route. Had they chosen a different route, had we produced a bill in the 
middle, a bill much more modest in its intention rather than this 
audacious restructuring, the American people would see us behind it and 
they would be behind it.

[[Page S13175]]

  By choosing this sort of narrow ``my way or the highway'' approach, 
``we are going to get the 60 votes and jam you,'' they have made it 
impossible to make this a proposal that they could sell to the American 
people.
  The American people are not foolish. The difference between this 
issue and most issues is everybody cares about health care regardless 
of age. The older you get the more you care about it, but everybody 
cares about health care. But they are paying attention and they see 
that this is not in any way a bipartisan proposal. So they have created 
for themselves not only a terrible bill, in my judgment, that should 
not pass and probably will not pass, but an enormous political problem 
for themselves along the way that would have been entirely avoidable 
had they chosen a different route from the beginning.
  Mr. CORKER. I think the fact is the two parties certainly have 
differences. We are seeing that by the huge amount of spending that is 
taking place right now. But the fact is, when we come together around 
bills, we do things that can stand the test of time.
  When we do that, it is not about political victory, it is about us 
airing our differences and seeing those places where we have common 
ground. I have watched each of you in your deliberations on the floor. 
I know very early on we talked about the fact that if we could just 
focus on the 80 percent we agree upon, we could pass a piece of 
legislation that would stand the test of time. Maybe it wouldn't solve 
every problem in the world, maybe it wouldn't go from end zone to end 
zone, but maybe if we went 50 yards down the field, it was 50 yards of 
solid gain for the American people, something that would stand the test 
of time, then we could come back and maybe get another piece of it as 
we moved along.
  I know almost everyone in this room has been a part of discussions to 
increase access, increase competitiveness, to drive down cost, to 
increase choices. This may be historic, if it passes. I actually still 
believe there is a chance that some of our friends on the other side of 
the aisle will realize that this is historic. But what is historic 
about it is this: If we pass this bill or if the Senate passes this 
bill, we will have missed a historic opportunity to work together and 
do something that will stand the test of time. All the energy would 
have been expended on a bill that does not pass the commonsense test, 
where the basic fundamentals are flawed.
  This issue will not come up again for a long time. I know how the 
calendar on the floor is. I certainly know about the patience of the 
American people. But the history part of this, we will have missed a 
historic opportunity to do something that will be good for the American 
people. That is the part, I guess, that bothers me the most.
  Mr. THUNE. Madam President, the Senator has been the mayor of a good-
sized city, a small businessperson, actually probably bigger than a 
small businessperson. But if you were running a business and you were 
in an environment such as we are in today, a tough economy, trying to 
figure out ways to cut back on your costs and figure out a way to sell 
a little bit more of whatever it is you are making or doing, and 
somebody comes to you and says: We are going to reform health care and 
we want to do something that will get health care costs down and yet 
what they are selling is going to raise your taxes and, according to 
the referees--the Actuary at the Center for Medicare Services is sort 
of a referee in all this; they don't have a political objective; they 
simply want to get the facts out. Of course, that is the role that is 
played traditionally in Congress by the CBO, both of which now say--the 
CBO says it is going to increase health care spending by $160 billion 
over the first 10 years and the CMS Actuary is now saying it will 
increase health care costs by $234 billion over the first 10 years. You 
also have now the CMS Actuary saying it could close 20 percent of the 
hospitals, that 17 million people who get their insurance through their 
employers are going to lose it, that the Medicare cuts are not 
sustainable on a permanent basis in this legislation, and that a lot of 
these tax increases are being passed on in the form of higher premiums 
which will mainly be borne by people trying to provide insurance. If 
you are sitting there as a businessperson--and you have been there--and 
you are looking at that balance sheet and that income statement and 
somebody is trying to sell you on an idea about health care reform that 
has the features I mentioned, how do you react to something such as 
that? I see what small business organizations are saying, but the 
Senator has been there. Tell me how you view it.
  Mr. CORKER. I met with a businessman in Tennessee on one of my more 
recent trips. They have an annual payroll of $4.2 million--their health 
care costs are $4.2 million a year for their employees. They file their 
tax return as a sub S company. The income from the company actually 
ends up being attributed to the partners. So when they file an income 
tax return, they don't take the money out of the company. They leave 
the money in to invest and make sure it is productive and they have 
jobs for other people. But that income is attributed to them. So he was 
showing me what this bill did to them. First, their percentage of 
health care costs is 12 percent of their payroll. He is way above the 
minimums this bill has said you have to be. I think it is 7 percent or 
something such as that. By the time he looked at the taxes that were 
going to be assessed to them because they filed--in other words, it 
was, again, their individual income, even though the money stayed in 
the company itself. What he was saying is: This means not only will we 
not hire any additional employees, we are not going to do that. But in 
addition, we are going to seriously look at dropping our health care 
plan and paying the penalties that come with this bill. I do fear, one 
of the things people do when they see that the government--a lot of 
companies in this country do things because they think it is the right 
thing to do. But a lot of companies, when they see government sort of 
mandating what they have to do or if they don't do that, there is an 
option for them to opt out and pay a penalty, when they feel like the 
government is being intrusive, sometimes they decide: Look, I am not 
going to do this anymore.
  What I would say, to answer the Senator's question is: No. 1, you end 
up depressing people's wages when you have these huge increases. 
Because at the end of the day, you have to have a profit to operate. 
You encourage people who are trying to do the right thing. You tax 
people at a level that, because of the way our taxation system works, 
takes money out of the company which, again, is used for productive 
good and to hire employees. At the very time when we are trying to 
create jobs--and I know you have been out here a great deal talking 
about the fact that we need to create jobs--we have legislation. This 
legislation that is before us is a job killer. The uncertainty of 
American companies about health care and then the fiscal issues and 
then this whole notion of cap and trade is, in fact, what resoundingly 
people across the country are saying is keeping them from hiring 
people.
  Mr. McCONNELL. I hear--and I know my colleagues have--they are about 
to send us another stimulus bill. I think I hear the Senator from 
Tennessee saying the single most important thing we could do to jump-
start this economy would be to stop this job-killing health care bill.
  Mr. CORKER. There is no question--and return to certainty. The fact 
is, people, businesspeople--and I know sometimes it is hard for the 
other side of the aisle to see this, but it is all about the cost of 
delivering goods; secondly, understanding what the environment is going 
to be into the future. This body has been so active and this President 
so active producing legislation that is a job killer, No. 1, but also 
producing such uncertainty that they are afraid to hire. That is, 
again--I know I have said this before--resoundingly, that is the No. 1 
reason people are not hiring people on Main Street.
  I do hope we stop this. I do believe this directly will kill jobs. 
But I also hope we will stop it and the American people will see we are 
working on things that save money and not things that cost money and 
take money out of businesses' pockets, out of Americans' pockets, 
which, by the way, that works hand in hand from the consumption 
standpoint. But this body doesn't seem to have gotten that message yet. 
I am feeling that a few of my friends on the other side of the aisle 
are greatly concerned. I hope, as the leader has said,

[[Page S13176]]

we can stop this but then work together on something that lowers cost 
so businesses will actually have a desire to hire even more people.
  Mr. BARRASSO. I would like to ask my colleague, we are talking about 
a job-killing bill, and we are not talking about a couple of jobs. The 
National Federation of Independent Business estimates that mandating 
that employers provide health care will cost 1.7 million jobs over the 
next 4 years, between now and 2013. We are not talking about a couple 
jobs, 1.6 million jobs when our unemployment rate is already 10 
percent. When I look at this as a job-killing bill, bad for our economy 
at a time when the No. 1 issue I hear about at home are jobs and the 
economy, that is another fundamental reason to take a look at a bill 
that at its core is fatally flawed and say: Don't do that right now. 
Our economy can't afford it. The jobless rate, we cannot afford to see 
that number get worse.
  Mr. CORKER. It is amazing the Senator brings that up. If he 
remembers, during the General Motors and Chrysler debate, which I know 
Americans equally paid attention to, there was this discussion about 
the fact--advocates for government funding talked about the fact that 
they had to compete against companies in other countries that may not 
provide health benefits. If you remember this whole discussion began 
around the fact that we wanted to lower costs, lower health care costs 
so our economy would be more productive. I think all of us said that is 
exactly what we need to do. So here we end up with a 2,074-page bill 
that does exactly the opposite. How we got here, it is kind of like you 
couldn't make this up--that a year ago here we were, as a matter of 
fact almost this exact time, having another historic vote around the 
whole issue of what might happen with these automotive companies and 
the big driving issue being, we can't be competitive because we have 
costs that they don't and all of us saying: Health care costs do make 
our country less competitive. So here we have a bill that is going to 
take us in exactly the opposite direction.
  This is why so many people have lost, rightfully so, faith in our 
ability to solve problems.
  Mr. THUNE. The Senator has made a payroll. He knows what this is 
like, how hard these decisions are when it comes to making decisions 
about whether you are going to hire somebody and to try and squeeze 
those costs down so you can buy a new piece of equipment. I think all 
small businesses are dealing with that. The Senator from Wyoming 
mentioned the National Federation of Independent Business which, of 
course, is a very business-oriented organization that represents a lot 
of small businesses across the country, indicating the employer mandate 
would cost about 1.6 million jobs so the job issue is so absolutely 
pertinent to this debate. That is why NFIB and the Chamber of Commerce 
and every business organization I think I know of in this country, 
including organizations such as the American Farm Bureau organization, 
which represents a lot of farmers and ranchers in my State, those are 
the organizations that speak for these various small businesses. They 
have all weighed in, and they weighed in heavily, in no uncertain 
terms, that this sets us back. This does not move us forward. You 
talked about getting that cost curve down. Every analysis that has been 
done, including by the referees--the Congressional Budget Office, the 
Actuary at CMS--all come back with the same conclusion.
  The Senator from Alabama also probably has a lot of small businesses 
in his State, members of the National Federation of Independent 
Business, the Chamber of Commerce, the Association of Wholesale 
Distributors, the National Association of Manufacturers, lots of these 
organizations that have weighed in. It seems to me they have looked at 
this carefully, and they have come to the same conclusion. I would be 
interested in what the Senator from Alabama might be hearing from the 
small businesses he represents, with regard to the impact this would 
have on jobs.
  Mr. SESSIONS. I say to Senator Thune, I think you have made the point 
about the cost curve. And I say to Senator Corker, you hit it right on 
the head. There is a need for us to work together to help reduce the 
cost of health care and not hurt its quality at the same time. This 
bill does not do that. I say to Senator Corker, what businesses tell me 
is that when you make it more expensive to hire a worker, that makes 
you less able to hire more workers. If this bill, in effect, is driving 
up the cost of health care--not to mention the new taxes that are out 
there--as an economic principle, it does mean we are jeopardizing jobs. 
Would you agree?
  Mr. CORKER. Look, I do not think that could be debated in a real way. 
There is no question when you add these mandates, you add the taxes, 
you actually drive up one of the major costs around hiring an employee 
in a firm. Then you add all the government intrusion. There is just the 
whole hassle factor of having to meet all the obligations that are laid 
out in this type of legislation. All those things just cause people to 
not want to hire folks.
  The thing is, it actually affects the most responsible companies 
most. The way this bill is written, if you are one of those companies 
that has not been providing health benefits, you can just pay a 
penalty, just pay a penalty and not cover them. But this bill actually 
does not just stymie job creation, it punishes the companies that are 
the most responsible smaller companies in our country.
  So, again, you all said it over and over again: The core of this 
bill, regardless of all the accouterments--and maybe we get three votes 
if we do this and lose one vote. I am sure there is some scribe in 
there that is confused with all the vote counting that has been taking 
place over the last few weeks. But the fact is, regardless of all these 
accouterments, the core of this bill is detrimental to our country.
  I certainly appreciate serving with all Senators, and I know all of 
us would love to see appropriate health care reform. I hope we are 
going to have the opportunity, after this bill is hopefully defeated, 
to be able to do that.
  I thank everyone for the time and patience.
  Mr. THUNE. I think we have to wrap up. But I just want to make one 
point in closing and say to the Senator from Tennessee, the Senator 
from Wyoming--the leader is here from Kentucky--that the citizens in my 
State of South Dakota, and I think most citizens, would expect that if 
we are going to reform health care, we do something about their cost, 
which clearly that point has been made very clear, repeatedly, here--
that all the studies say that does not happen.
  The other thing I will mention is, I cannot imagine any of our 
constituents would say that if you are going to implement public 
policy, you should raise taxes in 3 weeks and not start the benefits 
until 4 or 5 years later. It just seems to me the average American out 
there has to be saying: OK, that is like me going to the bank and 
taking out a mortgage, but I can't move into the house for another 4 or 
5 years, and in the meantime I will be making payments.
  Mr. CORKER. I would say to the Senator, if I could, his point is so 
good. So many businesses in my State are saying: I wish I could go to 
my local banker and use 6 years' worth of cost and 10 years' worth of 
revenues to get a loan. They are saying: We can't do that back home. I 
think it is that very thing the Senator pointed out so eloquently, it 
is that very thing, again, that builds the huge amount of distrust. 
They know it does not work. They know it does not pass the commonsense 
test in South Dakota and Tennessee. I think they continue to again 
wonder: You can't make this kind of stuff up. Certainly, you can't do 
it back home.
  I thank the Senator.
  Mr. THUNE. I thank my colleagues from Tennessee, Wyoming, Alabama, 
Kentucky, and Arizona, all who have been here.
  In closing, I will quote the Associated Press:

       In part to reduce costs, the legislation would delay until 
     Jan. 1, 2014, creation of so-called insurance exchanges in 
     which individuals and small businesses could shop for 
     affordable coverage.

  All done to disguise the bill's real cost of this, which it is being 
acknowledged now widely by the Democrats as well. This is not a $1 
trillion bill; this is a $2.5 trillion bill. It is a job killer. It 
cuts Medicare, raises taxes, and raises premiums for most of the 
American people.
  I yield back our time.
  The PRESIDING OFFICER (Mr. Merkley). The Senator from Mississippi.

[[Page S13177]]

  Mr. COCHRAN. Mr. President, we have heard this described as a 
historic moment. My friend from Iowa, Mr. Harkin--we have served 
together on the Agriculture Committee and have worked closely on 
appropriations and other issues--he has described this as a ``historic 
moment.'' I think we can all agree on that, but that is about all we do 
agree on in regards to this issue.
  I think we just have to come out and say it: This Patient Protection 
and Affordable Care Act is controversial. It sounds like it is just 
what the doctor ordered, until you look at it closely. If you look at 
it closely, doctors are not favorably impressed with it. Neither are 
the taxpayers, especially those who earn less than $200,000 a year, 
they are not impressed with it.
  Another issue that is troubling is Senator Dorgan's amendment on the 
reimportation of drugs. The Food and Drug Administration has concerns 
about the safety of the reimportation of drugs.
  If the Senate tries to ignore these and other serious concerns about 
the bill before the Senate, it will be an act of hope over reality. It 
will be an act which this Senator cannot support.
  The PRESIDING OFFICER. The majority leader.

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