[Congressional Record Volume 155, Number 190 (Tuesday, December 15, 2009)]
[Senate]
[Pages S13219-S13242]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009--Resumed

  The PRESIDING OFFICER. The Senator from Louisiana is recognized.
  Mr. VITTER. Mr. President, I rise to strongly support and urge all of 
my colleagues, Republicans and Democrats, to support the upcoming 
Dorgan reimportation amendment which we will be voting on later today 
and, just as important, to oppose the Lautenberg amendment which, as 
everyone knows, is a poison pill to reimportation and is simply and 
surely a way to absolutely kill for all practical purposes the real 
Dorgan reimportation language.
  To me, this is a crystal-clear choice, and it is the sort of choice 
the American people are really interested in and really watching. It is 
a choice between doing something that can make a difference in people's 
lives, something that can help people, that can solve a real problem in 
health care by doing something in a focused way or we can choose to 
keep to the big political deal that was made inside the beltway, inside 
the White House with the pharmaceutical industry. That is the choice. 
This is really a choice between voting for the American people or 
voting for politics as usual in Washington. That is what it all comes 
down to.
  On the positive side, reimportation is a very real and very effective 
solution to a real problem. The problem is obvious. The problem is sky-
high prescription drug prices--the highest in the world--that we as 
Americans pay. These same drugs are sold around the world, and in many 
different cases--in virtually every case--we pay the highest prices in 
the world right here in the United States even though we have the 
biggest marketplace for prescription drugs. That is the system we are 
trying to break up. So I want and supporters of this amendment want a 
true free market in prescription drugs, a world price that will lower 
the U.S. price and dramatically help U.S. consumers.
  It is not just supporters of this amendment and this concept who are 
making these arguments; it is unbiased sources such as the 
Congressional Budget Office and others. The Congressional Budget Office 
says this amendment--this reimportation concept will save the Federal 
Government money, significant money, some $18 billion or more. And 
besides the savings to the Federal Government, the savings to the U.S. 
consumer are much greater--$80 billion or more.
  So that is the positive choice--doing something real about a real 
problem. That is what the American people want us to do. They want us 
to focus on the real problems that exist in health care and attack 
those real problems in a focused way.
  The other alternative is to keep the political deal, to vote yes for 
politics as usual in Washington. Tragically, that is what is 
represented by the political deal that was struck on this global health 
care bill between the White House and the White House's allies here in 
the Senate and the big pharmaceutical industry. It has been widely 
reported--it is no secret--that there was a deal between these bodies. 
The pharmaceutical industry agreed to support the President's 
initiative, putting as much as $150 million of TV advertising cash 
behind that support, if the White House would completely change its 
position on reimportation and other key points.
  The record is clear: When President Obama served right here with us 
in the U.S. Senate, he was completely for reimportation. As a 
Presidential candidate, he campaigned vigorously for reimportation. 
Rahm Emanuel, the White House Chief of Staff, when he served in the 
U.S. House, was strongly for reimportation. But now, all that is off 
because Washington politics as usual has stepped in the way. They have 
reversed their position through this deal with PhRMA. Tragically, that 
has crept into the Senate Chamber as well. Key Senators on the 
Democratic side--Max Baucus and Jay Rockefeller and others--have 
reversed their position and apparently now are urging ``no'' votes for 
a policy they have long supported.
  Well, we will know in a few hours who will be the winner--the 
American people, being given lower prescription prices, or PhRMA and 
politics as usual in Washington. Make no mistake about it, that is the 
choice. It couldn't be laid out in a clearer way. And to choose for the 
American people, to make real progress for lower prescription drug 
prices, we need to do not one but two things: first, to pass the Dorgan 
amendment, and second, and just as important, to defeat the Lautenberg 
amendment side-by-side, which would clearly, by all acknowledged 
sources, be a poison pill to reimportation--an easy way for the 
administration to ensure reimportation never happens.
  I urge all of my colleagues, Democrats and Republicans, to vote for 
lower prescription drug prices, to vote for the American people, and 
certainly to vote against Washington politics as usual, which the 
American people are so completely disgusted and fed up with. I urge 
that vote. Americans all around the country, in all our home States, 
will remember it and will thank us for it because we will actually be 
providing a real solution to a real problem and bringing them 
significantly lower prescription drug prices.
  With that, Mr. President, I yield the floor, and I suggest the 
absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CRAPO. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.

[[Page S13220]]

  The PRESIDING OFFICER (Mr. Udall of Colorado). Without objection, it 
is so ordered.
  Mr. CRAPO. Mr. President, I believe I have 20 minutes remaining; is 
that correct?
  The PRESIDING OFFICER. The Senator from Idaho has 17\1/2\ minutes 
remaining.
  Mr. CRAPO. Mr. President, I ask that the Chair notify me when I have 
2 minutes remaining.
  The PRESIDING OFFICER. The Chair will so notify.
  Mr. CRAPO. Later today, Mr. President, we are going to vote on my 
motion to refer the bill to the Finance Committee and have the Finance 
Committee simply make the bill comply with the President's promise with 
regard to taxes.
  As I have said a number of times on the floor, this bill does not 
correct so many of the problems we need to deal with in health care. It 
drives the cost of health care in premiums up, not down; it raises 
hundreds of billions in taxes; it cuts Medicare by hundreds of billions 
of dollars; it grows the Federal Government by over $2.5 trillion in 
the first 10 years of full implementation; it forces the needy 
uninsured into a failing Medicaid system and does not give them access 
to insurance; it imposes damaging unfunded mandates on our struggling 
States; it still leaves millions of Americans uninsured; and it 
establishes massive government control over our health care. Frankly, 
even if the so-called government option or government health care 
insurance company that is created by the bill were to be removed, there 
would still be massive government intrusion into the control and 
management of our health care system.
  Well, as we were facing the prospect of dealing with this bill, the 
President made a pledge to the American people, and in his terms the 
pledge was:

       I can make a firm pledge, 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 of your taxes. You will not see any of your taxes 
     increased one single dime.

  Yet what we have in this legislation is a whole array of new taxes--
about $493 billion in new taxes to start with. And that is assuming you 
just start with the beginning of the bill and go for the first 10 
years. If you actually compare the number of taxes that will be charged 
by this bill to the American people with that first full 10-year 
implementation period, that is $1.28 trillion in new taxes.
  This chart shows taxes and fees, not just the specific taxes but 
taxes and fees--fees which our Congressional Budget Office and our 
Joint Tax Committee have said repeatedly will be passed on to the 
American consumer. Yet the President said nobody's taxes will be 
increased.
  Let's see the next chart. Here we have further analysis of just four 
of the major tax provisions in the bill. There are many more, but if 
you look at the four major tax provisions in the bill, the Joint 
Committee on Taxation has said that by 2019 at least 73 million 
American households earning below $200,000 will face a tax increase, 
and when you break these numbers down further, it is not just the 
people making between $100,000 and $200,000, or the upper income 
earners, but massive tax increases falling upon people who are making 
well under $100,000 a year.
  The response has been: Wait a minute, this bill also has some tax 
cuts in it, and when you offset the tax cuts against the tax increases, 
there are more tax cuts than there are tax increases.
  I dispute that in a couple ways. First of all, even if you accept as 
fact that there are tax cuts in this bill, which is arguable and I will 
point that out in a minute, they do not offset all the taxes and fees, 
so it is still a net increase in taxes. But there is a subsidy in this 
bill to provide insurance to a group of Americans who do not have the 
financial capacity today to purchase their own insurance. As I 
mentioned earlier, the most needy of this group did not get access to 
insurance. They got put on Medicaid. But some in America will get some 
access to insurance and that subsidy will be provided by the Federal 
Government. The other side is saying that is a tax cut.
  I disagree with that for a couple reasons. First of all, it is 
called, in the bill, a refundable tax credit and it is administered by 
the Internal Revenue Service--which, by the way, is going to need to 
grow by 40 to 50 percent in order to accommodate these new roles in 
managing the health care system. But it is a refundable tax credit in 
only the way Congress could put it together. It is nothing other than a 
government payment to individuals, most of whom pay no taxes. In fact, 
between 2014 and 2019, 73 percent of the people receiving the subsidy, 
or $288 billion of the subsidy, goes to taxpayers who pay no taxes. You 
can call that a tax cut if you want, but CBO, our Congressional Budget 
Office, does not call it a tax cut. The Congressional Budget Office 
scores it as Federal spending, as exactly what it is, spending by the 
Federal Government. It is a subsidy being provided by the Federal 
Government. You can argue about whether it should be provided, but to 
call it a tax cut is a stretch.
  Even if you accept that is a tax cut, there are still 42 million 
American households earning below $200,000 per year who will pay more 
taxes. No matter how you cut it and no matter how you define tax cut, 
the reality is this bill imposes hundreds and hundreds of billions of 
dollars of new taxes squarely on the middle class in violation of the 
President's promise that nobody in America who makes less than $250,000 
as a family or $200,000 as an individual, in order to fund this bill, 
would be required to pay more taxes.
  Some of those who have responded to this have said this is our 
opportunity and, if we support this amendment, we will be killing a 
bill that provides tax relief to the American people. As I have pointed 
out, the amendment does not do anything to the subsidy that is called a 
tax cut. The amendment leaves the subsidy in place. So it is simply 
wrong to say the motion I have asked to have passed would do anything 
to remove this so-called tax relief--or properly called subsidy--from 
the bill. What my motion does is simply to say the bill should be 
referred to the Finance Committee so the Finance Committee can make 
sure it complies with the President's pledge that it does not raise 
taxes on those who are in what the President has described as the 
middle class. It is very simple and straightforward. If there are no 
such taxes, then the motion is irrelevant. But we all know there are--
Joint Tax, Congressional Budget Office, many private organizations have 
squarely pointed it out. In fact, we are still studying it. If we get 
past the first four big taxes in the bill, these numbers I have talked 
about, the 42 million net or the 73 million in reality, in America--and 
those are households, not individuals, who will be paying more taxes--
are squarely going to be hit by this bill.
  Let me give a different perspective on it. If you take all those who 
are supposedly getting tax relief but are really getting a direct 
subsidy, accept the fact that this is truly a tax cut, they represent 7 
percent of the American public. The rest of the American public does 
not get a subsidy. The rest of the American public pays the taxes for 
the establishment of a huge $2.5 trillion new entitlement program that 
will bring that much more of the Federal Government into control of the 
health care economy.
  We are coming back now from a 2\1/2\-hour break because the Democrats 
were at the White House meeting with the President. We do not know what 
was said there. There was apparently a negotiation behind closed doors, 
yet once again, of some other new changes in the legislation, some 
other new portions of the bill. No C-SPAN cameras were there, to my 
knowledge. But we now have an opportunity to talk in the next few hours 
about what will happen with regard to this amendment.
  The President could have asked his friends in the Democratic caucus 
to support this amendment, which simply requires that the bill comply 
with his pledge. I hope he did. I hope it can be accepted. But the 
reality is, this legislation violates not only this pledge but a number 
of the President's other pledges--for example, the pledge that if you 
like what you have, you can keep it. Americans all over this country 
have heard that pledge repeated a number of times. If you are one of 
the employees who has employer-provided insurance and that insurance 
happens to fit in the so-called higher insurance packages that are 
taxed 45 percent by this plan, you are not going to get to keep it. 
Both CBO and Joint Tax have

[[Page S13221]]

made it very clear that you are going to see your health care cut by 
your employer in order to avoid this tax. Then what is going to happen 
is your employer might--probably will--give you a little bit more wages 
to compensate for the cut in your employment benefits. Your net package 
of compensation will not change in value, but you will get at more of 
it in wages and a little less in health care. But the kicker is, the 
wage portion is taxed but the health portion is not so your taxes are 
going to go up and your net package is going to go down. You are going 
to have a less-robust health care plan and you will have a lower 
overall compensation package. Does that comply with the President's 
promise that if you like what you have, you can keep it? What about the 
11 million Americans, I believe it is, who have Medicare Advantage 
policies today who clearly are going to lose about half of that extra 
Medicare Advantage benefit under the Medicare cuts in the bill? If they 
like what they have, can they keep it? No.
  What I am asking is simply that the Senate vote to require that the 
President's pledge in this one case be honored; namely, let's send the 
bill to the Finance Committee, it can be turned around in the Finance 
Committee overnight, take out the provisions that impose taxes on 
people in America earning less than $250,000 as a family or $200,000 as 
an individual and bring it back to the floor.
  You will hear it said this is a killer amendment, that it will kill 
the bill. It will not kill the bill unless it is necessary in the bill 
to tax Americans to the tune of the hundreds of billions of dollars 
that are included in this bill. What it will do is expose that this 
bill cannot be claimed to be deficit neutral or to even reduce the 
deficit unless three things happen: the Medicare cuts of hundreds of 
billions of dollars are imposed; the tax increases of hundreds of 
billions of dollars are imposed, and the budget gimmicks are 
implemented.
  Let me tell you about the most significant of those budget gimmicks. 
In order to make it so they could say this bill does not increase taxes 
or does not increase the deficit, the crafters of the bill have had the 
taxes go into effect on day one, the Medicare cuts go into effect by 
day one, but the subsidy program or the spending part of the bill is 
delayed for 4 years. So we have 10 years of revenue and 6 years of 
spending.
  I, personally, think the way they picked 2014 to be the year in which 
they implement the spending part of the bill is they said: How many 
years do we have to delay the spending impact until we can claim there 
is a deficit-neutral bill? It turned out they had to delay it for 4 
years out of the 10. If it took 5, they would have delayed it 5 years. 
That is a budget gimmick. The reality is we all know if you have the 
spending go into place on day one and the taxes go into place on day 
one and the Medicare cuts go into place on day one and took the 
gimmicks out, this bill would generate a deficit, another promise the 
President pledged not to do.
  There are so many problems with this bill. But most important today, 
as we will have an opportunity around 6 o'clock, is to vote to at least 
have the bill comply with the President's pledge.
  I ask how much time remains.
  The PRESIDING OFFICER. The Senator from Idaho has 3 minutes 
remaining.
  Mr. CRAPO. Mr. President, I would like to reserve the remainder of my 
time, and I will hold that until later in the day.
  The PRESIDING OFFICER. Who yields time? The Senator from Washington.
  Ms. CANTWELL. Mr. President, I ask unanimous consent for 3 minutes 
out of Senator Baucus's time to make a statement.
  The PRESIDING OFFICER. Without objection, it is so ordered. The 
Senator from Washington is recognized.
  (The remarks of Ms. Cantwell are printed in today's Record under 
``Morning Business.'')
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, I wish to make a point. I know my 
colleague from Arizona wishes to engage in a brief colloquy on this 
point. The amendment we are offering, a bipartisan amendment dealing 
with the price of prescription drugs, is a very important amendment. We 
are going to get our vote on that, but then there is also going to be a 
vote on a poison pill amendment that nullifies it. It says if you pass 
the second amendment, it means nothing happens and prescription drug 
prices keep going through the roof.
  I wish to say quickly there have been very few bipartisan amendments 
on the floor of the Senate during this health care debate. That is 
regrettable. This, in fact, is bipartisan. A wide range of 30 Senators, 
including Republicans John McCain, Chuck Grassley and Olympia Snowe and 
so on support this effort and the effort is simple, trying to put the 
brakes on prescription drug prices by giving the American people 
freedom and the ability to find competition among drug prices where 
they are sold in other parts of the world for a fraction of what we are 
charged as American consumers.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.
  Mr. McCAIN. I ask for unanimous consent to engage in a colloquy with 
the Senator from North Dakota.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCAIN. I think it is important for us to recognize what the 
Dorgan amendment is all about. It is about an estimated--according to 
the Congressional Budget Office, and we love to quote the Congressional 
Budget Office around here--$100 billion or more in consumer savings. 
That is what the Dorgan amendment does.
  It cuts the cost of the legislation before us as much as $19.4 
billion over 10 years. We are always talking about bending the cost 
curve, saving money, particularly for seniors who use more prescription 
drugs than younger Americans, and yet there is opposition.
  I would like to ask my colleague from North Dakota, one, how long has 
he been fighting this issue; and, two, why in the world do we think 
anybody would be opposed to an amendment that would save $100 billion 
for consumers?
  Mr. DORGAN. We have been working on this for 10 years--myself, the 
Senator from Arizona, and others. He knows because he was chairman of 
the Commerce Committee. We held hearings on this in the committee. The 
fact is, we have gotten votes on it before. In each case, the 
pharmaceutical industry, which has a lot of muscle around here, 
prevailed on those votes with an amendment that is a poison pill 
amendment saying somebody has to certify with respect to no additional 
safety risk and so on.
  These safety issues are completely bogus, absolutely bogus. They have 
done in Europe for 20 years what we are proposing to do in this 
country, parallel trading between countries. What we are trying to do 
is save the American people $100 billion in the next 10 years because 
we are charged the highest prices in the world for prescription drugs, 
and there is no justification for it.
  I want to show the Senator from Arizona one chart. This is 
representative. If you happen to take Nexium, for the same quantity you 
pay $424 in the United States, if you were in Spain, you would pay $36; 
France, $67; Great Britain, $41; Germany, $37. Why is it the American 
consumer has the privilege of paying 10 times the cost for exactly the 
same drug put in the same bottle made by the same company in the same 
plant? Justify that.
  Mr. McCAIN. Could I also ask my friend, has he seen this chart? This 
chart shows that the pharmaceutical companies in America increased 
wholesale drug costs, which doesn't reflect the retail drug cost, by 
some 8.7 percent just this year, while the Consumer Price Index--this 
little line here, inflation--has been minus 1.3 percent.
  How in the world do you justify doing that? These are lists of the 
increases over a year in the cost of some of the most popular or much 
needed prescription drugs. Why would pharmaceutical companies raise 
costs by some 9 percent unless they were anticipating some kind of deal 
they went into?
  I don't want to embarrass the Senator from North Dakota, but isn't it 
true that the President, as a Member of this body, cosponsored this 
amendment?
  Mr. DORGAN. That is the case. The President was a cosponsor of this 
legislation when he served last year. I do

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want to say as well the American consumer gets to pay 10 times the cost 
for Nexium. Nexium is for acid reflux, probably a condition that will 
exist with some after this vote because my understanding is, after 7 
days on the floor of the Senate, there is now an arrangement by which 
the pharmaceutical industry will probably have sufficient votes to beat 
us, once again, which means the American people lose.
  I also want to make this point. Anyone who stands up and cites safety 
and reads the stuff that has come out of a copying machine for 10 
years, understand this: Dr. Peter Rost, former vice president of 
marketing for Pfizer, formerly worked in Europe on the parallel trading 
system, said:

       The biggest argument against reimportation is safety. What 
     everyone has conveniently forgotten to tell you is that in 
     Europe reimportation of drugs has been in place for 20 years.

  It is an insult to the American people to say: You can make this work 
in Europe for the benefit of consumers to get lower prices, but 
Americans don't have the capability to make this happen, don't have the 
capability to manage it. That is absurd. This safety issue is 
unbelievably bogus.
  Mr. McCAIN. Haven't we seen this movie before? The movie I am talking 
about is that we have an amendment or legislation pending before the 
body or in committee that will allow for drug reimportation, as the 
Senator pointed out from that previous chart, in a totally safe manner. 
Then there is always, thanks to the pharmaceutical lobbyists--of which 
there are, I believe, 635 pharmaceutical industry lobbyists, a lobbyist 
and a half for every Member of Congress--an amendment that then 
basically prohibits the reimportation of drugs.
  Haven't we seen this movie before? Apparently another deal was made 
so that they are now going to have sufficient votes to again cost the 
consumers $100 billion more in cost for the pharmaceutical drugs. Their 
representatives are here on the Senate floor ready to tout the virtues 
of an amendment which, as we all know, is a killer amendment. Let's 
have no doubt about that.
  Mr. DORGAN. Mr. President, the Senator from Arizona is right. If this 
is ``Groundhog Day'' for pharmaceutical drugs, the clock strikes 6 and 
the pharmaceutical industry wins. They have been doing it for 10 years. 
We just repeat the day over and over again. My hope is that we will not 
have to repeat it today. My hope is that after a lot of work on a 
bipartisan piece of legislation, the American people will have 
sufficient support on the floor of the Senate to say it is not fair for 
us to be paying double, triple and 10 times the cost of prescription 
drugs that others in the world are paying.
  I wonder if we might be able to yield some time to the Senator from 
Iowa, 5 minutes, unless the Senator from Arizona wishes to conclude.
  Mr. McCAIN. My only conclusion is that what we are seeing is really 
what contributes to the enormous cynicism on the part of the American 
people about the way we do business. This is a pretty clear-cut issue. 
As the Senator from North Dakota pointed out, it has been around for 10 
years. For 10 years we have been trying to ensure the consumers of 
America would be able to get lifesaving prescription drugs at a lower 
cost. And the power of the special interests, the power of the 
lobbyists, the power of campaign contributions is now being manifest in 
the passage of a killer amendment which will then prohibit--there is no 
objective observer who will attest to any other fact than the passage 
of the follow-on amendment, the side-by-side amendment, will prohibit 
the reimportation of prescription drugs into this country which we all 
know can be done in a safe fashion and could save Americans who are 
hurting so badly $100 billion a year or more and cut the cost of the 
legislation before us by $19.4 billion. To scare people, to say that 
these drugs that are being reimported are not done in a safe manner to 
ensure that the American people's health is not endangered is, of 
course, an old saw and an old movie we have seen before. It is 
regrettable that the special interests again prevail at the power of 
the pharmaceutical lobby.
  Of the many traits the Senator from North Dakota has that I admire, 
one of them is tenacity. I want to assure him that I will be by his 
side as we go back again and again on this issue until justice and 
fairness is done and we defeat the special interests of the 
pharmaceutical industry which have taken over the White House and will 
take over this vote that will go at 6 o'clock. It is not one of the 
most admirable chapters in the history of the Senate or the United 
States Government.
  Mr. DORGAN. Mr. President, I yield 5 minutes to the Senator from 
Iowa.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, we have two key votes this afternoon on 
drug reimportation. These votes mean that today is the day we can show 
the American people whether we can pass drug importation or whether the 
Senate will give it lipservice and nothing else.
  We have heard on the Senate floor the concerns that some have about 
drug importation and whether it can be safe. Everyone who knows me 
knows I care deeply about drug safety. The fact is, an unsafe situation 
is what we have today. Today consumers are ordering drugs over the 
Internet from who knows where, and the FDA does not have the resources, 
in fact, to do much of anything about it. The fact is, legislation to 
legalize importation would not only help to lower the cost of 
prescription drugs for all Americans but also should shut down the 
unregulated importation of drugs from foreign pharmacies, the situation 
we have today. The Dorgan amendment, in fact, would improve drug 
safety, not threaten it. It would open trade to lower cost drugs.

  In 2004, my staff was briefed about an investigation that the 
Permanent Subcommittee on Investigations of the Senate Governmental 
Affairs Committee conducted. That subcommittee conducted this 
investigation into what we would call going on right now, current drug 
importation. They found about 40,000 parcels containing prescription 
drugs come through the JFK mail facility every single day of the year, 
40,000 packages each day.
  Now the JFK airport houses the largest international mail branch in 
the United States, but even then that is the tip of the iceberg. 
According to this subcommittee, each day 30,000 packages of drugs enter 
the U.S. through Miami, 20,000 enter through Chicago. That is another 
50,000 more packages each and every day.
  What is worse, about 28 percent of the drugs coming in are controlled 
substances. So we have a situation where we need the basic approach in 
this amendment to assure that imported drugs are safe. That is what the 
Dorgan amendment is all about, to give FDA the ability to verify the 
drug pedigree back to the manufacturer, to require FDA to inspect 
frequently, and to require fees to give the FDA the resources to do 
that.
  The bottom line is, the Dorgan amendment gives the FDA the authority 
and the resources it needs to implement drug importation safely.
  Certainly, the President knows that a great way to hold drug 
companies accountable is to allow safe, legal drug importation. I would 
like to quote this President not when he was a candidate for President 
but a candidate for the Senate. This is what President Obama said then:

       I urge my opponent to stop siding with the drug 
     manufacturers and put aside his opposition to the 
     reimportation of lower priced prescription drugs.

  Now we are hearing about the secret deal with big PhRMA. That was 
revised just this week to solidify support with PhRMA's allies for 
killing this very important Dorgan amendment. The drug companies will 
stop at nothing to keep the United States closed to other markets in 
order to charge higher prices.
  With the Dorgan amendment, we are working to get the job done. What 
we need is to make sure Americans have even greater, more affordable 
access to wonder drugs by further opening the doors to competition in 
the global pharmaceutical industry.
  Americans are waiting. Too often this thing has been stymied, and it 
looks like there is another chance to stymie it. Only I am surprised. 
Most of the time in the past that I have been for the importation of 
drugs, it was my colleagues over here who were trying to stymie it. But 
now it looks as though it is the other side. We ought to

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have a vast majority for this amendment. I would be surprised. It would 
be a crime, if we didn't.
  I yield the floor.
  Mr. ROBERTS. Mr. President, I rise today to talk about prescription 
drug importation and patient safety. Senator Dorgan's amendment to 
allow for the importation of prescription drugs into the United States 
could have grave consequences for patient safety in America.
  In a recent letter to my good friend and home State colleague Senator 
Brownback, the Commissioner of the Food and Drug Administration, Dr. 
Margaret Hamburg, identified the four risks to patient safety that drug 
importation schemes pose: No. 1, the drug may not be safe or effective; 
No. 2, the drug may not be a consistently made, high quality product; 
No. 3, the drug may not be substitutable with an FDA-approved product; 
and No. 4, the drug may be contaminated or counterfeit.
  That is a lot of risk to expose already-vulnerable patients to. And 
think about this: Malta. Cyprus. Latvia. Estonia. Slovakia. Greece. 
Hungary. Romania. These are just a few of the countries that could be 
exporting prescription drugs to the United States if the Dorgan 
amendment passes. As a former chairman of the Senate Intelligence 
Committee, I have grave concerns about the ability of these countries 
to adequately protect their drug supplies.
  Our Food and Drug Administration, the FDA, is the gold standard for 
drug and product safety in the world, and even it has not been one 
hundred percent effective in preventing contaminated and counterfeit 
products from entering our supply chain. The recent scandals involving 
imported heparin, infant formula, and toothpaste have demonstrated the 
unfortunate limitations of the FDA's ability to conduct foreign 
inspections of food, drugs and cosmetics manufacturers abroad. If our 
own safety watchdog can't guarantee our protection, how can we expect 
that protection from Malta or Slovakia?
  There is a real risk that these countries will be vulnerable to 
importing drugs from countries that are known for high rates of 
counterfeiting. In the European Union last year, 34 million counterfeit 
drugs were seized at border crossings in just 2 months. The World 
Health Organization estimates that drug counterfeiting rates in Africa 
and parts of Asia and Latin America are 30 percent or more. And up to 
50 percent of medicines purchased from Internet sites that conceal 
their address are found to be counterfeit. Do we really want an HIV or 
cancer patient in Ohio, or Arizona or Kansas to rely on imported 
medicines that may have zero effectiveness, or which may even be 
harmful?
  According to FDA Commissioner Hamburg, the Dorgan amendment does not 
adequately address these potential risks. In fact, the Commissioner 
says that the amendment ``would be logistically challenging to 
implement and resource intensive'' and that ``significant safety 
concerns . . . and safety issues'' remain.
  Senator Lautenberg has introduced a side-by-side amendment to Senator 
Dorgan's, requiring that, before any law allowing the importation of 
prescription drugs into the United States can become effective, the 
Secretary of Health and Human Services must certify that such a scheme 
will both pose no additional risk to the public's health and safety, 
AND result in a significant reduction in costs for consumers.
  I think that this amendment just makes sense. We must protect the 
prescription drug supply in America.
  Mr. LEAHY. Mr. President, making medicine affordable is part of what 
health reform should be. Today we have the opportunity to include a 
measure long-championed by Senator Dorgan, which makes affordable 
prescription drugs more widely available to Americans.
  Americans pay some of the highest prices for prescription drugs of 
any country in the world despite the fact that many of these drugs are 
made right here, and they are often made with the benefit of taxpayer 
supported research. Prescription drugs are a lifeline, not a luxury. 
The issue boils down to access: A prescription drug is neither safe nor 
effective if you cannot afford to buy it.
  We have to recognize that this imposes real dangers on American 
consumers when they cannot follow their doctor's treatment plan because 
they can't afford their medicine. While we must do more to bring 
affordable healthcare to the millions of Americans who are currently 
uninsured or who do not have good coverage, we cannot continue to deny 
them this immediate market-based solution.
  I am proud to be a cosponsor of the Dorgan-Snowe amendment to allow 
pharmacies and drug wholesalers in the United States to import the very 
same medications that are FDA-approved in the United States from 
Canada, Europe, Australia, New Zealand, and Japan where prices are 35-
55 percent lower than in the United States. Consumers will be able to 
purchase the very same prescription medications from their local 
pharmacies at a third or half of the cost. Additionally, the 
legislation would also allow individuals to purchase prescription drugs 
from FDA-inspected Canadian pharmacies--something Vermonters have 
crossed the border to do many times before.
  For many Vermonters today, purchasing drugs from Canada literally 
means the difference between following their doctors' orders and having 
to throw the dice with their health and sometimes even with their lives 
by doing without their prescription medicines. It makes the difference 
for the woman who has maxed out her health plan's annual prescription 
drug benefit only three months into the year and is then faced with 
purchasing the other nine months worth of medicine at U.S. prices on 
her own. It makes the difference for the elderly man on a fixed income 
who is unable to afford both the heart medicine he needs to live, and 
the gas bill he needs to keep warm. Are we prepared to tell those in 
dire need that they must go back to choosing between paying gas, food, 
and heating bills, or their medicine?
  Of course not, and I urge my fellow Senators to support the Dorgan-
Snowe amendment.
  Mr. ENZI. Mr. President, I rise today to talk about prescription drug 
importation. As my colleagues know, I oppose this proposal.
  It is our job as Senators to debate the issues, put forward our 
ideas, and show where we stand. I was disappointed that Democratic 
leadership chose to prevent the Senate from voting on amendments to 
improve this bill for the past 6 days. I am, however, glad the impasse 
has finally been resolved.
  I am not afraid to show where I stand on this issue. Some of my 
colleagues on both sides of the aisle support importation. Some, like 
me, oppose it. But my position is clear, and does not change with the 
political winds.
  The winds I am referring to include the arrangement that was 
reportedly negotiated with the drug manufacturers. Under the terms of 
this backroom deal, the drug manufacturers have reportedly agreed to 
$80 billion in price cuts and provided a commitment to spend $150 
million in ads supporting the Reid bill.
  In exchange, Senate Democratic leadership and President Obama have 
reportedly agreed to block efforts to enact drug importation from 
Canada.
  According to one Wall Street analyst's report, the Reid bill is 
expected to increase drug company profits by more than $137 billion 
over the next 4 years. Let's do the math on that: $80 billion in cuts, 
leading to $137 billion in increased profits.
  While this may be a good deal from the drug manufacturers and Senate 
Democrats, it certainly is not a good deal for the American people. 
Part of the reported deal will actually increase Medicare costs to the 
taxpayer, because it creates an incentive for Medicare beneficiaries to 
continue using brand-name drugs.
  According to the Congressional Budget Office, Federal Medicare costs 
will be increased by $15 billion over the next decade as a result of 
this deal. In the last few days, there have been new press reports 
highlighting how the drug manufacturers may have agreed to provide even 
deeper discounts on their brand-name drugs. No one knows how much more 
this deal will cost the taxpayers.
  In addition to increasing the price Americans will pay for the Reid 
bill, this deal appears to have also undermined Democratic support for 
a drug importation amendment.
  My colleagues who believe importation is the right way to lower drug

[[Page S13224]]

costs say that it will save the government $19 billion and consumers 
$80 billion over the next 10 years.
  The majority leader has previously voted for drug importation. 
President Obama supported drug importation when he was in the Senate. 
The supporters of drug importation should be able to easily pass this 
amendment without any limitations.
  Yet it looks like the supporters of drug importation will not succeed 
today. It appears likely that safety certification language, similar to 
language included in prior years, will be added to this proposal.
  My colleagues each know where they stand on the issue. But the deal 
with the drug manufacturers is apparently so important that supporters 
of drug importation are going to vote against the proposal.
  It is important for the American people to understand why there has 
been this change of heart on this issue. The drug manufacturers are one 
of the few remaining health care groups that still support the Reid 
bill. They have committed to spend $150 million to buy television ads 
to support the Democrats efforts on health reform.
  If my Democratic colleagues fail to adopt drug importation without 
the safety language, it is because the Senate Democratic leadership and 
the White House have decided they will do whatever it takes to keep the 
support of the drug manufacturers. They believe that the money these 
companies will spend will be enough to convince the American people to 
support their efforts.
  The American people already understand that the Reid bill is not a 
good deal for them. They understand how this bill will raise their 
taxes, increase their insurance premiums and cut Medicare benefits for 
millions of seniors.
  That is why over 60 percent of Americans now oppose the Democratic 
health reform proposals. No amount of advertising, funded by the drug 
companies or anyone else, is going to change that reality.
  Mr. LEVIN. Mr. President, it has become apparent that passage of this 
Dorgan amendment relative to importation of prescription drugs, an 
amendment which I have long supported, could threaten passage of 
broader health care reform. If so, the perfect would become the enemy 
of the good. For that reason, I will vote ``no'' on the Dorgan 
amendment on this bill.
  The PRESIDING OFFICER. The Senator from New Jersey.


                Amendment No. 3156 to Amendment No. 2786

    (Purpose: To provide for the importation of prescription drugs)

  Mr. LAUTENBERG. Mr. President, I offer time to my colleague from New 
Jersey, Senator Menendez--up to 11 minutes.
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. MENENDEZ. Mr. President, I appreciate my distinguished senior 
colleague from New Jersey yielding time. I know he is going to call up 
his amendment shortly, and that is what I want to speak to.
  Mr. President, before I get to the core of my remarks, I want to tell 
my colleague who left the floor, I was tempted to rise under rule XIX 
that says:

       No Senator in debate shall, directly or indirectly, by any 
     form or words impute to another Senator or to other Senators 
     any conduct or motive unworthy or unbecoming a Senator.

  I could impute, if I wanted to, I guess, that maybe there are some 
who really do not care about this plan as much as they care about 
killing health care reform, but I would not do that. I would not do 
that. So I hope in the context of the debate I am not forced to rise 
under rule XIX.
  Mr. President, I rise in favor of the amendment of Senator 
Lautenberg, who is going to offer it shortly, because it does two 
things that underscore the entire debate about health care reform: It 
protects the American people by putting the safety of families first--
and there is a lot of brushing aside of safety here; safety is 
paramount; safety is paramount--and it lowers costs. At its core, that 
is what this health care debate is all about.
  I appreciate the intentions of the amendment that has been offered on 
the floor, but in my view it is regressive. It harkens back to a time 
when the lack of sufficient drug regulation allowed people to sell 
snake oil and magic elixirs that promised everything and did nothing. 
To allow the importation of untested, unregulated drugs made from 
untested and unregulated ingredients from 32 countries into the 
medicine cabinets of American families without serious safety 
precautions flies in the face of protecting the American people, and it 
is contrary to the context of health care reform.
  The amendment by Senator Lautenberg brings us around to the real 
purpose of why we have been here on the floor, which is to create the 
type of reform that ultimately gives greater health insurance and 
greater safety to the American people.
  They care about honest, real reform that makes health care affordable 
and protects American families, protects them from the potential of 
counterfeit drugs that promise to cure but do absolutely nothing, just 
as we are here to protect them from insurance policies that promise to 
provide health care for a premium and then deny coverage and provide no 
health care at all.
  Basically, what Senator Lautenberg's amendment is going to do is 
modify the Dorgan amendment to allow reimportation but to do it when 
basic safety concerns to keep our prescription medications safe are 
complied with. It includes the Dorgan importation amendment but adds 
one fundamental element of broader health care reform: It protects the 
American people from those who would game the system for profits at the 
expense of the health and safety of American families. That is what 
this reform is all about. Specifically, when it comes to the 
importation of prescription medication, this amendment will help us be 
sure that what we think we are buying in the bottle is, in fact, what 
is in that bottle.
  I want to make reference to a letter. We talk about safety, and there 
is a lot of pooh-poohing that, oh, there are no safety concerns. Well, 
there is one entity in this country that is responsible for safety when 
it comes to food and drugs, and it is called the FDA, the Food and Drug 
Administration. In a letter from FDA Commissioner Hamburg, she mentions 
four potential risks to patients that, in her opinion, must be 
addressed:
  First, she is concerned that some imported drugs may not be safe and 
effective because they were not subject to a rigorous regulatory review 
prior to approval.
  Second, the drugs ``may not be a consistently made, high quality 
product because they were not manufactured in a facility that complied 
with appropriate good manufacturing practices.''
  Third, the drugs ``may not be substitutable with the FDA approved 
products because of differences in composition or manufacturing . . . 
''
  Fourth, the drugs simply ``may not be what they purport to be'' 
because inadequate safeguards in the supply chain may have allowed 
contamination or, worse, counterfeiting.
  It addresses FDA Commissioner Hamburg's statement about the amendment 
of my colleague from North Dakota:

     that there are significant safety concerns related to 
     allowing the importation of non-bioequivalent products, and 
     safety issues--

  ``Safety issues''--

     related to confusion in distribution and labeling of foreign 
     products and the domestic product that remain to be fully 
     addressed in the amendment.

  Senator Lautenberg's amendment addresses this concern. It allows 
importation, but it protects the American people by requiring that 
before any drug is imported to the United States, it must be certified 
to be safe and to reduce costs. So it does what the FDA Commissioner is 
talking about here, the agency responsible for protecting the American 
people. People may just want to not believe it, they may want to ignore 
it, but the fact is, this is the entity responsible in this country to 
protect the food supply and the drug supply.
  We want to be as certain as we possibly can be of the conditions 
under which imported drugs are manufactured, that they are safe to use 
and we know where their ingredients originated before they are 
imported. We want to be absolutely certain patients are getting the 
prescription medications that are the same in substance, quality, and 
quantity that their doctor has prescribed. This amendment requires the 
Secretary of Health and

[[Page S13225]]

Human Services to certify that all imported drugs are safe and will 
reduce costs before they are allowed into America's medicine cabinets.
  I have heard a lot about the European Union here. Well, let's look at 
what the European Union is now saying. They are constantly being 
offered on the floor for the reason why, in fact, we should follow what 
the European Union is saying. Well, let's see what happens if we allow 
unregulated importation. Let's look at the European Union.
  Last week, the European Union Commissioner in charge of this issue 
said:

       The number of counterfeit medicines arriving in Europe . . 
     . is constantly growing. The European Commission is extremely 
     worried.
       In just two months, the EU seized 34 million--

  Hear me: ``million''--

     fake tablets at customs points in all member countries. This 
     exceeded our worst fears.

  I do not want American families to see those fears come to life here. 
I believe that if we do not pass the Lautenberg amendment and if we 
were to pass the Dorgan amendment, we would open the floodgates. The 
European Union's experience only proves my concerns, not alleviates 
them as the other side would suggest.
  Here is the problem: a $75 counterfeit cancer drug that contains half 
of the dosage the doctor told you you needed to combat your disease 
does not save Americans' money and certainly is not worth the price in 
terms of dollars or risk to life.
  Let's not now open our national borders to insufficiently regulated 
drugs from around the world. It seems to me real health reform--
particularly for our seniors and those who are qualified under the 
Medicare Program who receive their prescription coverage under that--
comes by filling the doughnut hole in its entirety, which we have 
declared we will do in the conference, as we are committed to do, that 
provides for the coverage of prescription drugs that AARP talks about 
on behalf of its millions of members. That is what we want to see--not 
by unregulated reimportation.
  We should have no illusions, keeping our drug supply safe in a global 
economy, in which we cannot affect the motives and willingness of 
others to game the system for greed and profit, will be a monumental 
but essential task. It will require a global reach, extraordinary 
vigilance to enforce the highest standards in parts of the world that 
have minimum standards now, so we do not have to ask which drug is real 
and which is counterfeit.
  Let me just show some examples of those. People say: Oh, no, this 
safety issue is not really the case.
  Tamiflu. We saw a rush, when the H1N1 virus came. People wanted to 
buy Tamiflu. As shown on this chart, which is the real one and which is 
the counterfeit one? There actually is one that is approved and one 
that is counterfeit, but the average person would not know the 
difference. Or if it is Aricept, a drug to slow the progression of 
Alzheimer's disease, which one is the real one and which one is the 
counterfeit one? If I did not tell you from the labels, you probably 
would not know, but there is an approved one and there is a counterfeit 
one. As someone who lost his mother to Alzheimer's, I can tell you that 
having the wrong drug in the wrong dosage would not have helped her 
slow the progression of her illness. It makes a difference.
  Let's look at others. Lipitor; very important. You are walking around 
with a real problem with cholesterol, and you think you are taking the 
appropriate dosage and the appropriate drug. But, as shown on this 
chart, which is the real one and which is the counterfeit one? There is 
a counterfeit one and there is an approved one, a real one, but if you 
are taking the counterfeit one and you think you are meeting your 
challenges, you might have a heart attack as a result of not having the 
real one. By the time you figure it out, it could be too late to 
reverse the damage. That is the problem. That is the global economy 
opening up possibilities at the end of the day.
  Mr. President, I ask the Senator from New Jersey for an additional 
minute.
  Mr. LAUTENBERG. Mr. President, I yield 1 more minute to the Senator.
  Mr. MENENDEZ. Finally, this is a gamble we cannot afford to take: To 
open up the potential for these drugs--or the ingredients used in these 
drugs--to find their way from nation to nation, from Southeast Asia, 
where the problem is epidemic, to one of the 32 nations listed in this 
amendment and then into the homes of American families. That is a 
gamble we cannot take. That is not about protecting our citizens. That 
is not about providing prescription drugs that ultimately meet the 
challenge of a person's illness. Filling the doughnut hole totally, 
which is what we are going to do, is the way to achieve it.
  So I do hope that is what we will do. I do hope we will adopt Senator 
Lautenberg's amendment and defeat the Dorgan amendment, for I fear for 
the safety of our citizens, and I fear as to whether we can ultimately 
achieve filling that doughnut hole if this amendment, ultimately, gets 
adopted, and I fear what that means for health care reform at the end 
of the day.
  With that, Mr. President, I yield back the remainder of my time and 
thank the Senator from New Jersey.
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. LAUTENBERG. Mr. President, I call up amendment No. 3156--it is at 
the desk--and I ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from New Jersey [Mr. Lautenberg], for himself, 
     Mr. Carper, and Mr. Menendez, proposes an amendment numbered 
     3156 to amendment No. 2786.

  Mr. LAUTENBERG. Mr. President, I ask unanimous consent that reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in the Record of Thursday, December 10, 
2009, under ``Text of Amendments.'')
  Mr. LAUTENBERG. Mr. President, I rise today because one thing we have 
to do as we progress with this health care reform bill is to make sure 
prescription medicine in our country is safe and affordable. I thank my 
colleague from New Jersey for his excellent review of the conditions 
that cause us to add this amendment to Senator Dorgan's amendment that 
would allow potentially unsafe prescription drugs to be shipped across 
our borders and directly into the medicine cabinets of homes throughout 
America.
  I want to be clear, the effect of this plan Senator Dorgan has 
offered could be catastrophic. That is why President Obama's 
administration has written to the Congress expressing its serious 
concerns with the Dorgan amendment.
  I appreciate the efforts to try to lower prescription drug prices. 
After all, that is what we are doing with the whole health reform 
review--trying to get costs reduced so everyone can have safe and 
affordable health care. We want to make sure people do not harm their 
health with any shortcuts.
  We all want Americans to stay healthy and still have some money left 
in their pockets. But as much as we want to cut costs for consumers, we 
cannot afford to cut corners and risk exposing Americans to drugs that 
are ineffective or unsafe.
  The fact is, this is a matter of life and death. The European 
Commission just discovered that counterfeit drugs in Europe are worse 
than they feared. In just 2 months--and I know Senator Menendez made 
reference to this as well--the EU seized 34 million fake tablets, 
including antibiotics, cancer treatments, and anticholesterol medicine.
  As the industry commissioner of the EU said:

       Every faked drug is a potential massacre. Even when a 
     medicine only contains an ineffective substance, this can 
     lead to people dying because they think they are fighting 
     their illnesses with a real drug.

  Americans buy medicine to lower their cholesterol, fight cancer, and 
prevent heart disease. Imagine what would happen to a mother or a child 
if they start relying on medicine imported from another country only to 
find out years later that the drug was a fake. Imagine the heartbreak 
that might ensue if the medicine Americans were taking was found to be 
harmful. The fact is that drugs from other countries have dangerously 
high counterfeit rates and importation could expose Americans to those 
drugs.
  Under the Dorgan amendment, drugs would be imported from former 
Soviet Union countries where the World Health Organization estimates 
that

[[Page S13226]]

over 20 percent of the drugs are counterfeit. Under the Dorgan 
amendment, drugs that originate in China could find their way into our 
homes. We know that China has been the source of many dangerous 
products in recent years, from toys laced with lead to toothpaste made 
with antifreeze.
  If we are going to trust drugs from other countries, we need to be 
absolutely certain we are not putting Americans' lives at risk. That is 
why the Food and Drug Administration went on record to express its 
concerns with the Dorgan amendment. They say:

       There are significant safety concerns related to allowing 
     the importation of non-bioequivalent products, and safety 
     issues related to confusion in distribution and labeling of 
     foreign products and the domestic product that remain to be 
     fully addressed in the amendment.

  That is from the FDA Commissioner Margaret Hamburg.
  There are problems associated with the possibility of drugs coming to 
this country that are way different than that which is expected to be 
used in the treatment of sickness.
  President Obama's FDA Commissioner also wrote and said that importing 
drugs presents a risk to patients because the drug may not be safe and 
effective, may not have been made in a facility with good manufacturing 
practices, and may not be the drug it claims to be.
  In light of the serious concerns raised by the Obama administration, 
I am offering an amendment to require that the Department of Health and 
Human Services certify that the drugs are safe and will reduce costs 
before they are imported. My amendment is a commonsense bipartisan 
alternative to the Dorgan amendment. In fact, it is the exact same 
language as the Dorgan importation amendment, but with the 
certification requirement that is so important to ensure safety.
  If we are going to allow the importation of drugs from other 
countries, we have to be certain they are safe and affordable. With 
this amendment, I would be in support of the Dorgan amendment. Only 
certification by health experts will provide that assurance. I urge my 
colleagues to support my amendment and oppose the Dorgan amendment.
  We have no way of knowing what the working conditions might be like 
in a plant or a facility, or the sanitary conditions, in other 
countries, or whether in the process of packing and shipping 
temperatures might not be appropriate for the product to arrive without 
deterioration. Thusly, again, I stress--bring in what you want, just 
make sure it is safe for the people. There is no moment in the 
discussion we have had about the health care reform bill that says, 
Look, you can save money by taking a chance on a shortcut here or a 
shortcut there. Absolutely not. We wouldn't think of proposing anything 
such as that, and we ought not to be proposing it here now.
  I yield 5 minutes to my colleague from North Carolina.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mrs. HAGAN. Mr. President, I rise today to speak about drug 
reimportation. With millions of seniors balancing drug regimens that 
entail taking several medicines per day on a fixed income, I believe we 
need to find a way to ensure that they have access to affordable drugs. 
If we could reduce the cost of drugs with reimportation and guarantee 
the safety of those drugs, I would be very supportive. However, I have 
serious doubts that we can adequately ensure the safety of our drug 
supply with the drug reimportation amendment proposed by my colleague 
from North Dakota.
  Even without reimportation, the United States has had trouble with 
counterfeit drugs. At the height of the H1N1 epidemic this fall, the 
FDA was warning consumers to be wary of counterfeit H1N1 treatments. 
These counterfeits came from foreign online pharmacies. In one 
instance, the FDA seized so-called H1N1 treatment tablets from India 
and found them to contain talc and acetaminophen. Last month, the 
Washington Post reported on a coordinated global raid of counterfeit 
drugs from the United States to Europe to Singapore. The United States 
discovered about 800 alleged packages of fake or suspicious 
prescription drugs, including Viagra, Vicodin, and Claritin, and shut 
down 68 alleged rogue online pharmacies.
  Counterfeit pharmaceutical drugs are appearing on the market at 
increasingly alarming rates. In 2007, drugs comprised 6 percent of the 
total counterfeit product seizures. In 1 year, they have now jumped to 
10 percent of all counterfeit product seizures.
  This growing problem is all about unscrupulous criminals preying on 
the sick and the elderly who are in desperate need of cheaper drugs. 
But the consequences are harmful and, in some cases, deadly.
  Officials estimate that some of these counterfeit drugs contain 
either a dangerous amount of active ingredients or were placebos. Some 
counterfeits include toxic chemicals such as drywall material, 
antifreeze, and even yellow highway paint.
  According to a recent Washington Post article, tracing the origins of 
drugs such as Cialis and Viagra took investigators across the globe and 
back again. Supposedly these drugs came from a warehouse in New Delhi, 
though the online company selling the drug was headquartered in Canada 
and was licensed to sell medicine in Minnesota. However, when Federal 
officials investigated the drug origins further, they actually found 
that the online Web site was registered in China, its server was hosted 
in Russia, and its headquarters had previously been listed in 
Louisiana.
  On a local level near our capital, the Baltimore Sun yesterday 
reported on the death of a University of Maryland pharmacologist, 
Carrie John. Ms. John suffered an allergic reaction to a counterfeit 
version of a legal drug in the United States but purchased illegally 
from the Philippines. Apparently, the counterfeit drug so closely 
resembled the legal version that two pharmacologists conducting the 
analysis after Ms. John's death could not tell the difference. Local 
police have yet to identify the contents of the counterfeit drug.
  A few of my colleagues have already mentioned the letter sent last 
week by FDA Commissioner Margaret Hamburg outlining the safety concerns 
the FDA has about reimportation. Specifically, the FDA stated that 
importing non-FDA-approved prescription drugs posed four potential 
risks to patients. Let me go over those four risks.

  No. 1: The drug may not be safe and effective because it did not 
undergo the rigorous FDA regulatory review process.
  No. 2: The drug may not be a consistently made, high quality product 
because the facility in which it was manufactured was not reviewed by 
the FDA.
  No. 3: The drug may not be substitutable with the FDA-approved 
product because of differences in composition or manufacturing.
  No. 4: The drug could be contaminated or counterfeit as a result of 
inadequate safeguards in the supply chain.
  If the agency that oversees drug safety is saying it would have 
difficulty guaranteeing the safety of our Nation's drug supply with 
reimportation, I have grave concerns, particularly since the FDA is 
already underfunded and understaffed.
  But let's take a moment to examine how Europe, which does allow 
reimportation, has fared in terms of safety.
  British authorities say counterfeit drugs often exchange hands 
between middlemen and are repackaged multiple times before reaching a 
legitimate hospital or pharmacist. This creates opportunities for 
counterfeit products, often produced in China and shipped through the 
Middle East, to penetrate the European market.
  The PRESIDING OFFICER. The Senator has used her 5 minutes.
  Mrs. HAGAN. Mr. President, I ask unanimous consent for 3 additional 
minutes.
  Mr. LAUTENBERG. No objection.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. HAGAN. In 2008, British authorities identified 40,000 doses of 
counterfeit Casodex, a hormone treatment for men with advanced prostate 
cancer, and Plavix, a blood thinner.
  More recently, the European Union seized 34 million fake tablets at 
customs points in all member countries. In other countries around the 
world, the World Health Organization estimates that up to 30 percent of 
the medicines on sale may be counterfeit. As a result, numerous people 
have died.

[[Page S13227]]

  Earlier this year, 80 infants in Nigeria died from teething medicine 
that contained a toxic coolant. In July, 24 children in Bangladesh died 
from the consumption of poisonous acetaminophen syrup.
  The Dorgan amendment does not require imported drugs to be FDA 
approved or meet FDA misbranding standards. Furthermore, it does not 
prevent criminals in other countries from repackaging imported drugs.
  Although our safety system is not perfect, we have a thorough FDA 
review system for drug safety that actively involves physicians, 
pharmacists, and patients. As a result, Americans can be generally 
confident that our medications are safe and contain the ingredients on 
the bottle.
  Supporters of reimportation argue that the sick and elderly need an 
alternative way to obtain affordable drugs. However, a study by the 
London School of Economics found that in the European Union, middlemen 
reaped most of the profits with relatively little savings passed down 
to the consumer. Nothing in the Dorgan amendment requires the savings 
to be passed on to the consumer, leaving the door wide open for 
unscrupulous, profit-seeking third parties to get into the 
reimportation game.
  In the United States, we are already trying to reduce the cost of 
prescription drugs through the use of generics. This is one of the most 
effective ways for customers to reap savings, and the generic 
dispensing rate at retail pharmacies is close to 65 percent. The FDA is 
already working with stakeholders to develop drug reimportation policy. 
With the FDA looking into this and significant outstanding safety 
concerns, I cannot in good conscience support the amendment offered by 
my colleague from North Dakota. Instead, I will support the amendment 
offered by my colleague from New Jersey. The Lautenberg amendment will 
allow the importation of drugs only if the Secretary of Health and 
Human Services certifies that doing so would save money for Americans 
and would not adversely affect the safety of our drug supply.
  While it is critical that all Americans, especially our Nation's 
seniors, have access to affordable drugs, it is imperative that we not 
compromise the safety of U.S. drugs on the market. After all, what good 
are cheap drugs if they are toxic or ineffective?
  Thank you, Mr. President. I yield the floor.
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. LAUTENBERG. Mr. President, I believe my colleague from North 
Dakota intends to make further remarks. How much time do we have on our 
side, please?
  The PRESIDING OFFICER. The Senator from New Jersey controls 13 
minutes.
  Mr. LAUTENBERG. Thirteen minutes.
  Mr. President, if Senator Dorgan is here, then we are trying to 
accommodate a colleague who wishes to speak on this. How much time is 
left on the Dorgan side?
  The PRESIDING OFFICER. The Senator from North Dakota has 28 minutes 
remaining.
  Mr. LAUTENBERG. Mr. President, we heard about what is happening in 
the EU having to do with the question of whether drugs are counterfeit 
and the serious consequences of having people take medication that is 
not what it is supposed to be--the consequences of something like that, 
especially interfaced with other products.
  There was a news report last week that was printed in Yahoo News. 
They quote the Industry Commissioner of the European Union--the program 
in Europe that controls drug safety or at least attempts to. We see 
that the European Union has expressed concern about the situation they 
see there. The Commissioner, Mr. Verheugen, said he expected the EU to 
take action to fight the menace of fake pharmaceuticals. Then he said 
he thought the EU would agree, in 2010, that a drug's journey from 
manufacture to sale should be scrutinized carefully and there will be 
special markings on the packages.
  There is a lot of concern about this, and we ought not to dash willy-
nilly through here without understanding what the consequences of fake 
medication might be. I wish to see our people pay as little as they can 
to get the medicines they need. Part of that has to include a safety 
factor. As I said earlier, we would not suggest anything in the health 
reform bill that would take a shortcut and disregard safety. I have a 
letter that was sent from the Department of Health and Human Services, 
which I quoted a little bit ago. They say the letter is being sent on 
the amendment filed by Senator Dorgan. The administration supports this 
program, which I agree to, to buy safe and effective drugs from other 
countries and included $5 million in our 2010 budget.
  They go on to say--and this is from the Commissioner of Food and 
Drugs--that:

       Importing non-FDA-approved prescription drugs presents four 
     potential risks to patients that must be addressed: (1) the 
     drug may not be safe and effective because it was not subject 
     to a rigorous regulatory review prior to approval; (2) the 
     drug may not be consistently made, high quality product 
     because it was not manufactured in a facility that complies 
     with appropriate good manufacturing practices; (3) the drug 
     may not be substitutable with the FDA-approved product 
     because of differences in composition or manufacturing; and 
     (4) the drug may not be what it purports to be, because it 
     has been contaminated or is a counterfeit due to inadequate 
     safeguards in the supply chain.

  I ask unanimous consent that this letter, sent to Senator Tom Carper, 
from the Department of Health and Human Services, be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

         Department of Health and Human Services, Food and Drug 
           Administration,
                              Silver Spring, MD, December 8, 2009.
     Hon. Tom Carper,
     U.S. Senate,
     Washington, DC.
       Dear Senator Carper: Thank you for your letter requesting 
     our views on the amendment filed by Senator Dorgan to allow 
     for the importation of prescription drugs. The Administration 
     supports a program to allow Americans to buy safe and 
     effective drugs from other countries and included $5 million 
     in our FY 2010 budget request for the Food and Drug 
     Administration (FDA or the Agency) to begin working with 
     various stakeholders to develop policy options related to 
     drug importation.
       Importing non-FDA approved prescription drugs presents four 
     potential risks to patients that must be addressed: (1) the 
     drug may not be safe and effective because it was not subject 
     to a rigorous regulatory review prior to approval; (2) the 
     drug may not be a consistently made, high quality product 
     because it was not manufactured in a facility that complies 
     with appropriate good manufacturing practices; (3) the drug 
     may not be substitutable with the FDA-approved product 
     because of differences in composition or manufacturing; and 
     (4) the drug may not be what it purports to be, because it 
     has been contaminated or is a counterfeit due to inadequate 
     safeguards in the supply chain.
       In establishing an infrastructure for the importation of 
     prescription drugs, there are two critical challenges in 
     addressing these risks. First, FDA does not have clear 
     authority over foreign supply chains. One reason the U.S. 
     drug supply is one of the safest in the world is because it 
     is a closed system under which all the participants are 
     subject to FDA oversight and to strong penalties for failure 
     to comply with U.S. law. Second, FDA review of both the drugs 
     and the facilities would be very costly. FDA would have to 
     review data to determine whether or not the non-FDA approved 
     drug is safe, effective, and substitutable with the FDA-
     approved version. In addition, the FDA would need to review 
     drug facilities to determine whether or not they manufacture 
     high quality products consistently.
       The Dorgan importation amendment seeks to address these 
     risks. It would establish an infrastructure governing the 
     importation of qualifying drugs that are different from U.S. 
     label drugs, by registered importers and by individuals for 
     their personal use. The amendment also sets out registration 
     conditions for importers and exporters as well as inspection 
     requirements and other regulatory compliance activities, 
     among other provisions.
       We commend the sponsors for their efforts to include 
     numerous protective measures in the bill that address the 
     inherent risks of importing foreign products and other safety 
     concerns relating to the distribution system for drugs within 
     the U.S. However, as currently written, the resulting 
     structure would be logistically challenging to implement and 
     resource intensive. In addition, there are significant safety 
     concerns related to allowing the importation of non-
     bioequivalent products, and safety issues related to 
     confusion in distribution and labeling of foreign products 
     and the domestic product that remain to be fully addressed in 
     the amendment.
       We appreciate your strong leadership on this important 
     issue and would look forward to working with you as we 
     continue to explore policy options to develop an avenue for 
     the importation of safe and effective prescription drugs from 
     other countries.
           Sincerely,
                                              Margaret A. Hamburg,
                                   Commissioner of Food and Drugs.


[[Page S13228]]


  Mr. LAUTENBERG. Mr. President, I will now suggest the absence of a 
quorum and ask unanimous consent that it be charged equally to both 
sides.
  The PRESIDING OFFICER. Is there objection?
  Mr. GRASSLEY. Reserving the right to object, Mr. President. You can't 
do that to us because we only have 8\1/2\ minutes left on our side.
  Mr. LAUTENBERG. You have considerably more based on--
  Mr. GRASSLEY. We only have 8\1/2\ minutes.
  Mr. DORGAN. Mr. President, I ask the Senator to withhold his request 
for a quorum.
  Mr. LAUTENBERG. Yes, I withdraw the request.
  Mr. DORGAN. Mr. President, back in the mid-1800s, when Lincoln and 
Douglas were having their famous debates, at one point Lincoln was 
exasperated because he could not get Douglas to understand something he 
was saying. He said to Douglas: Listen, how many legs does a horse 
have? Douglas said: Four, of course. Lincoln said: If you call the tail 
a leg, how many legs would he have? Douglas said: Five. Lincoln said: 
There is where you are wrong. Simply calling a tail a leg doesn't make 
it a leg at all.
  Yes, that is exactly what my colleagues have done, suggesting the 
amendment we are offering is for untested, unregulated drugs. It is not 
true. The only drugs we are talking about are FDA-approved drugs that 
are made at an FDA-inspected plant, part of a chain of custody equal to 
the U.S. chain of custody. It is simply not true that we are talking 
about untested, unregulated drugs. That is not true. Simply saying that 
doesn't make it true.
  Here is why we are on the floor of the Senate. We are reforming 
health care. That is what the bill is. Part of health care is 
prescription drugs. A lot of people take prescription drugs to keep 
them out of a hospital bed. It manages their disease. Prescription 
drugs are very important.
  Here is what happened to the prices year after year. As you can see 
on this chart, the rate of inflation is in yellow and the prescription 
drug prices are in red. This year alone, it is up 9 percent, at a time 
when inflation is below zero.
  Well, why do we want to be able to access the same FDA-approved drug 
where it is sold elsewhere at a fraction of the price? Because the 
American people will pay in the next decade--if we don't pass this 
legislation--$100 billion in excess prescription drug prices. If you 
need to take Nexium for acid reflux--maybe after this vote we will all 
need it. But if you are going to buy Nexium, it costs $424 for an 
equivalent quantity in the United States. You can buy it for $41 in the 
UK, $36 in Spain--but it is $424 here. Sound fair? Not to me.
  Lipitor is the most popular cholesterol-lowering drug in the world. 
It is $125 in the United States for an equivalent quantity. You get the 
same thing for $40 in the UK or one-third of the price. It is $32 in 
Spain, one-fourth the price. It is $33 in Canada. The American people 
get to pay triple or quadruple the price. By the way, it comes in these 
bottles. I ask unanimous consent to use the bottles.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. They both contained Lipitor that is made in Ireland by an 
American corporation. They have different colored labels, but they are 
made in the same plant, FDA approved, and they are sent to different 
places--this one to Canada and this one to the United States. But we 
have the privilege of paying triple the price. Sound fair? Not to me it 
doesn't.
  Here is a sample. Boniva, for osteoporosis, is up 18 percent this 
year. Singulair, for asthma, is up 12 percent. Enbrel, for arthritis, 
is up 12 percent. Here is Plavix--the list goes on.
  The question is, Is there something we ought to do about this or 
should we say let's pass health care reform and ignore what is 
happening to the price of prescription drugs? This amendment I offered, 
along with Senators McCain and Grassley and other colleagues on this 
side--30 cosponsors--is all about freedom for the American people. If 
this is a global economy, how about giving the American people the 
freedom to access identical prescription drugs, which we know are 
identical because we require safety if it doesn't even exist in our own 
supply. Those who talk about safety, I remind them 40 percent of the 
active ingredients in prescription drugs of the United States come from 
India and China--from places that have never been inspected.
  The Wall Street Journal did terrific expose about this. There were 
over 60 people who died from Heparin in this country. It was 
contaminated. Here is where they were making it. This picture was in 
the investigation. Here is a rusty old pot being stirred with a limb 
from a tree. Those are active ingredients for American drugs. This guy 
is working with pig intestines--guts from a hog. This old man here, 
with a wooden stick--it looks unsanitary doesn't it? That is the source 
of Heparin. These are the photographs by the Wall Street Journal 
investigative reporter. They are telling us FDA-approved drugs coming 
from other countries, with a chain of custody identical to ours, would 
pose some sort of threat. Are you kidding? You can make that charge 
without laughing out loud?
  Let's talk about the existing drug supply for a moment. This is a 
young man named Tim Fagan. He was a victim of counterfeit domestic 
drugs in this country--not imported FDA-approved drugs. Do you know 
where this guy's drug came from? Here is the report done on that. It is 
made by Amgen. It went through all these places. It ended up at a place 
called Playpen, which is a south Florida strip club--in a cooler in the 
back room of a south Florida strip club. At one point it was stored in 
car trunks. Finally, it was prescribed and administered to this young 
man named Tim Fagan. He survived, but he was getting medicine with one-
twentieth the necessary strength for a serious disease that his doctor 
intended for him.
  Don't talk to me about the issue of prescription drug safety. We are 
talking about safety that doesn't now exist in the domestic drug 
supply, but safety standards are included in this amendment. Every drug 
should have a pedigree to track where it came from and, in every 
respect, between manufacture and consumption. There ought to be batch 
lots and tracers for every drug. There ought to be pedigree for the 
domestic drug supply as well.
  I wish to quote a former vice president of Pfizer Corporation, a 
prescription drug manufacturer, Dr. Peter Rost:

       Right now, drug companies are testifying that imported 
     drugs are unsafe. Nothing could be further from the truth.

  This is from a vice president of one of the major drug companies--
``nothing can be further from the truth.'' He was fired, to be sure. 
You can't say that if you are working for a drug company. Their 
business is to try to keep the pricing strategy the way it is.
  I might say, I don't have a beef with the drug industry. I have a 
beef with their pricing policy that says we will sell the same drug 
everywhere in the world at a fraction of the price we charge the 
American consumer. How do you make that stick? By a sweetheart deal in 
law that says the American consumer cannot import the drug. The Spanish 
can import drugs from Germany. The French can import drugs from Italy. 
But the American consumer is told you don't have the freedom to shop 
for that same FDA-approved drug--approved because the place where it is 
produced is inspected by the FDA, in a country with an identical chain 
of custody, but the U.S. consumer doesn't have the freedom to make that 
purchase.
  If I might, Dr. Peter Rost, the same guy just I quoted, said:

       During my time responsible for a region in northeastern 
     Europe, I never once--not once--heard the drug industry, 
     regulatory agencies, the government, or anyone else say this 
     practice was unsafe, and I personally think it is outright 
     derogatory to claim that the Americans would not be able to 
     handle the reimportation of drugs, when the rest of the 
     educated world can do this.

  Dr. Peter Rost also said:

       The biggest argument against reimportation is safety. What 
     everyone has conveniently forgotten to tell you is that, in 
     Europe, reimportation of drugs has been in place for 20 
     years.

  Hank McKinnell, a former Pfizer CEO, said:

       Name an industry in which competition is allowed to 
     flourish--computers, telecommunications, small package 
     shipping, retailing, entertainment, and I'll show you lower 
     prices, higher quality, more innovation, and better customer 
     service. There is

[[Page S13229]]

     nary an exception. OK, there is one. So far, the health care 
     industry seems immune to the discipline of competition.

  Nowhere is that more evident with respect to pharmaceutical drugs.
  The question today is, Will we once again offer a prescription drug 
importation bill that will save consumers and the Federal Government 
$100 billion; that contains safety standards that do not exist even in 
the domestic drug supply; that will not pose risk but, in fact, reduces 
risk, reduces prices for the American people, provides fair pricing for 
American consumers? Will we be able to vote for that legislation that I 
and Senator McCain, Senator Grassley, Senator Stabenow, Senator 
Klobuchar, and so many others have brought to the floor of the Senate? 
The answer is, yes; we are going to vote on that.
  The question is, In the 7 days since I have offered this amendment, 
has the pharmaceutical industry been able to pry enough people away 
from this amendment because they are raising all kinds of issues of 
safety?
  How many votes will we get? By the way, the side-by-side amendment is 
a killer amendment. We will have a second vote. A lot of people will 
say: We will vote for the Dorgan amendment and then vote to nullify it 
by voting for the Lautenberg amendment.
  Let me read the AARP letter which was sent yesterday:

       On behalf of the AARP's nearly 40 million members, we urge 
     you to support the Dorgan-Snowe importation amendment to . . 
     . H.R. 3590, the Senate health care reform legislation. This 
     amendment provides for the safe, legal importation of lower-
     priced prescription drugs from abroad. CBO has scored the 
     amendment as saving taxpayers more than $19 billion.

  That is just for the Federal Government. There is much more for 
consumers.

       We also urge you to vote against an alternative importation 
     amendment proposed by Senators Lautenberg, Carper, and 
     Menendez. AARP strongly opposes this amendment because it 
     includes the unnecessary addition of a certification 
     requirement which is simply a thinly veiled effort to 
     undermine importation and preserve the status quo of high 
     drug prices.

  So there it is. We are always told this bill is a finely crafted 
piece; it is like embroidering with some sophisticated colors. This is 
a finely crafted piece and don't mess with it because if you adopt your 
amendment, somehow the whole thing is going to come apart. It is like 
pulling a thread on a cheap suit. You pull the thread and an arm falls 
off. God forbid anybody should adopt an amendment such as this.
  Here we are 7 days after I offered this amendment, and we have a 
circumstance where we now have a side-by-side in order to try to 
nullify it. We have had all kinds of dealing going on. I have not been 
a part of it. I don't know what the deals are. I don't know what time 
they were consummated. Somebody told me late last night. I am like an 
old Senator who served long ago. I am not part of any deal. I am not 
part of it. This deal is for the American people.
  We are going to pass some health care legislation, and then we are 
going to shuffle around with our hands in our pockets, maybe thumbing 
our suspenders, sticking out our shined shoes, and say: We did this all 
right. We feel really good about it, but we couldn't do a thing about 
prescription drug prices. We couldn't do that. We didn't have the 
support because the pharmaceutical industry wouldn't let us. Oh, 
really? Maybe at last--at long, long last--there will be sufficient 
friends on this vote on behalf of the American people to say: We stand 
with the consumer. We are standing with the American consumers today. 
We like the pharmaceutical industry. We want them to produce 
prescription drugs. We want them to make profits. We just don't want 
them to charge us 10 times, 5 times, 3 times, or double what is being 
charged others in the world for the identical prescription drug because 
we don't think it is fair to the American people.
  Mr. President, how much time remains?
  The PRESIDING OFFICER. The Senator has 13\1/2\ minutes.
  Mr. DORGAN. Mr. President, let me at this point yield the floor. I 
suggest the absence of a quorum. I don't know whether the Senator from 
New Jersey has other speakers. I believe we have a couple other 
speakers who will be here. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the quorum 
call be charged against both sides.
  The PRESIDING OFFICER. Is there objection?
  Mr. LAUTENBERG. Mr. President, there was an objection to having the 
time equally divided expressed by the Senator from Iowa before.
  How much time is available on our side, Mr. President?
  The PRESIDING OFFICER. The Senator from New Jersey has 7 minutes.
  Mr. LAUTENBERG. Seven?
  The PRESIDING OFFICER. Yes, 7 minutes.
  Mr. LAUTENBERG. Mr. President, I, too, have people who want to speak 
to the issue. If we can equally divide the quorum call, that is all 
right with me. I have no objection.
  Mr. DORGAN. I believe the quorum call will be momentary. We have 
people coming to speak. If not, I will take some additional time, as 
perhaps will the Senator from New Jersey. I suggest the absence of a 
quorum and ask unanimous consent that it be charged to all sides 
equally.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, I did not speak about the letter from the 
Food and Drug Administration. My colleagues have described this letter, 
which I said could have come out of a copying machine. A similar letter 
has come each time we consider this legislation. It is interesting to 
me that we export a lot of American jobs. All kinds of jobs are leaving 
our country. Then we import contaminated wallboard, children's toys 
that kill kids. And, yes, that has happened. We import contaminated pet 
food and contaminated toothpaste. We import 85 percent of the seafood 
into this country every day--85 percent of the seafood--and 1 percent 
is inspected, by the way. One percent of that seafood is inspected. The 
rest is not.
  We import fruits and vegetables. I am wondering if the Food and Drug 
Administration is sending letters around with concern about the risk to 
health of fruits and vegetables and seafoods that are not inspected.
  In many places, these products are produced with insecticides and 
various things that would not be permitted in this country. I am 
wondering where the FDA's letter is with respect to that.
  I called the Food and Drug Administration. I talked with the head of 
the FDA. I said: I understand there are rumors around that you are 
going to send a letter here. This was 24 hours before the letter came.
  The head of the FDA said: I know nothing of such a letter.
  My question is, Where did the letter come from? Who prompted the 
letter? I think I know.
  I find it interesting, I don't see anybody at the FDA sending letters 
here about the issue of safety on fruits, vegetables, and fish. They 
raise the issue of safety with respect to a drug importation bill which 
has the most specific and the most rigorous safety standards not only 
for imported drugs but for the existing domestic drug supply, the kind 
of safety standards that the pharmaceutical industry has objected to 
for many years.
  Mr. LAUTENBERG. Will the Senator yield for a question?
  Mr. DORGAN. Of course, I will be happy to yield.
  Mr. LAUTENBERG. I know Senator Dorgan very well. He is a man of great 
principle and skill, I might say. But I say the list of aberrations, 
the lack of care about the various products--the toys, wallboards, and 
food--I have had a great interest in those items. It is interesting 
that it is being suggested by the Senator from North Dakota that is an 
acceptable standard and we ought to go ahead and continue it.

[[Page S13230]]

  Mr. DORGAN. The Senator is not asking a question. I yielded to the 
Senator for a question. If he would truncate it, I would appreciate it.
  Mr. LAUTENBERG. The question is whether, if you think that casual 
standard for bringing in food and other products is acceptable--
  Mr. DORGAN. Reclaiming my time.
  Mr. LAUTENBERG.--therefore, we ought to do the same with drugs?
  Mr. DORGAN. Reclaiming my time, the answer is self-evident by the 
question. Of course, we would benefit from stricter standards for fish, 
vegetables, and fruits. That was the point I was making. But what we 
have done with respect to importation of prescription drugs is we have 
included batch lots and pedigrees and tracers that do not exist in the 
existing drug supply. Why? The existing drug supply does not have those 
provisions because they have been objected to over the years by the 
pharmaceutical industry.
  We have put in place procedures that will make this safe. You cannot 
say the same thing about fruits, vegetables, and seafood, 
unfortunately. A lot of work needs to be done there. But we do not 
bring a bill to the floor of the Senate, a bipartisan group of 
legislators, a bill that would in any way injure or provide problems 
with respect to safety.
  What we do is bring to the floor of the Senate legislation that 
dramatically enhances the margin of safety for prescription drugs. But 
I understand, I understand completely. If I were trying to protect, and 
I were the drug industry trying to protect billions, boy, I understand 
the exertion of effort to try to protect that.
  My only point is this: I have a beef with an industry that decides 
they are going to overcharge the American people, in some cases 10 
times more, in some cases 5, double the price that is paid in other 
parts of the world for the identical drug. I don't think that is fair, 
and I don't think we should allow it to continue. The way to prevent it 
is to give the American people the freedom--every European has that 
freedom.
  Let me end with how I began. For somebody to come out here and say 
this is about unregulated, untested drugs is absolute sheer nonsense. 
It is not. We do not have to debate what words mean and what words say. 
That is not a debate we ought to take time to have. All we have to do 
is read it and then represent it accurately, which has not been the 
case on the floor of the Senate, regrettably.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, is it the case when a quorum call is 
requested it is equally charged?
  The PRESIDING OFFICER. No.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the quorum 
call be equally charged on both sides. I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Mr. President, I would like to remind us why we are 
here--health care reform--and why health care reform is so important. I 
would like to go through the costs of inaction, what the consequences 
are if we do not pass health care reform.
  First of all, rising health care costs are wrecking the lives of 
Americans. In 2007, 62 percent of bankruptcies were due to medical 
costs. This legislation will help reduce the rate of growth of health 
care costs. In fact, the President's Council on Economic Advisers and 
the President just announced today or yesterday there will be a 1-
percent reduction in national health care costs. CBO basically said 
this bill is deficit neutral, and it will have an effect on reducing 
health care costs. This bill will reduce health care costs.
  A Harvard study found, in addition, when people do not have health 
insurance, they are more likely to be much more ill.
  Harvard found every year in America lack of health insurance leads to 
45,000 deaths. If Americans do not have health insurance, it leads to 
45,000 deaths in our country. That is intolerable. How can we in the 
United States of America--we pride ourselves as the biggest, the 
strongest, the most moral country on the globe. How can we allow 45,000 
deaths just because somebody does not have health insurance? People 
without health insurance have a 40-percent higher risk of death than 
those with private health insurance.
  How does this bill affect Medicare? According to the CMS Actuary, 
Medicare is projected to go broke in about the year 2017. CMS has 
estimated this will actually extend solvency to the year 2026.
  That is very important, Mr. President. It is an important message to 
seniors--that the Medicare trust fund solvency will be extended under 
this legislation for at least 9 more years, beyond 2017. I wish it were 
further, but that is a lot better than not extending solvency--
extending solvency for that period of time.
  The bill also would increase the percentage of people who have health 
insurance from about 83 percent to 94 percent. That, too, is no small 
matter.
  Our legislation would reform the insurance market to protect those 
with preexisting conditions. It would prevent insurance companies from 
discriminating and capping coverage, and it would require insurance 
companies to renew policies as long as policyholders pay their 
premiums.
  Let me just say a bit more, with a little more precision, about 
premium costs. The Centers for Medicare & Medicaid Services, the Office 
of the Actuary, confirmed this. They confirmed that this legislation 
will cover 33 million Americans who are currently uninsured and will do 
so while significantly reducing Medicare costs and Medicaid spending. 
Think of that. This legislation will cover 33 million Americans who are 
currently not covered at the same time reducing Medicare and Medicaid 
costs.
  Don't take my word for it. That is the projection of the Chief 
Actuary of CMS. In addition, as I mentioned, the Chief Actuary says 
this will extend the life of the trust fund for 9 years.
  Moreover, this legislation reduces the cost to seniors, to a family, 
by $300 by 2019. Medicare Part B premiums, according to the Actuary, 
will be $300 lower than it otherwise would be. The out-of-pocket costs 
would be, for a couple--I think it is roughly $400. That is a total of 
about a $700 reduction for a couple in 2019. So a reduction in Medicare 
Part B premium costs and a reduction in out-of-pocket costs.
  Essentially, the Actuary concludes, and I will read the quote:

       The proposed reductions in Medicare payment updates for 
     providers, the actions of the Independent Medicare Advisory 
     Board, and the excise tax on high-cost employer-sponsored 
     health insurance would have a significant downward impact on 
     future health care cost growth rates.

  Again, a ``significant downward impact on future health care cost 
growth rates.'' The Actuary says the bend in the cost curve is evident. 
The Actuary also concludes that in 2019 health expenditures are 
projected to rise by 7.2 percent with no change but 6.9 percent under 
the proposal. That is, under the proposal, health care costs will rise 
at a lower rate than they will if this legislation does not pass.
  In addition, this report shows how health insurance costs for 
millions of Americans will reduce premiums by 14 to 20 percent for 
people in the individual market. Actually, that was the Congressional 
Budget Office that reached that conclusion and not the Actuary. The 
Congressional Budget Office has basically concluded that for 93 percent 
of Americans premiums will be lowered. For 93 percent of Americans 
premiums will be lower.
  It is true that for those who are employed--the five-sixths of 
persons who now have health insurance--their premiums would not go down 
a heck of a lot, but they will start going down due to this 
legislation. For the 7 percent whose premiums are not reduced, they get 
a better deal. That 7 percent will have much higher quality health 
insurance than they now have, basically because of no more denial of 
care for preexisting conditions, market reform,

[[Page S13231]]

rating reform, no more rescissions, et cetera. So this is a very good 
deal.
  I would like to say one word, too, on health care cost reduction. A 
lot of Senators have quoted an article by Dr. Gawande from The New 
Yorker magazine--I think it was dated June 2--explaining the phenomenon 
of geographic variations in this country and why health care costs are 
much higher in some parts of America and much lower in other parts of 
America, which is due mostly to the way we pay health care providers 
and doctors in the system, therefore explaining the basic reason there 
is so much waste in the American health care system.
  Dr. Gawande published another article in The New Yorker a week or 2 
ago, and in that article he basically says of all the ideas that have 
been suggested by economists, by practitioners, by providers, and 
people worried about the rise of health care costs in America, all of 
the ideas are in this legislation. They are all in here. All the ways 
to work to start to lower health care costs are in this legislation.
  He also says the pilot projects and the demonstration projects in 
this legislation are good because you have to work a little bit, you 
have to experiment a little, you have to try this and try that to see 
where bundling works and see where it does not work. But the provisions 
are there.
  We can all be quite confident that this administration is going to do 
its level best to make sure these projects work--that is the bundling, 
the moving toward quality as a basic reimbursement in the way of 
quantity. The administration is going to work very hard to make sure 
they work. I will say, too, as chairman of the Finance Committee, the 
committee of primary jurisdiction over these subjects, that we are 
going to have a lot of oversight hearings next year because it is very 
much in the interest of the American people to make sure this 
legislation works and works very well. Clearly, with aggressive 
oversight hearings next year we can help make sure that happens.
  One other point. This bill represents a net tax cut, not a tax 
increase--a net tax cut for individuals, not a tax increase. Why do I 
say that? I say that because that is what the Joint Committee on 
Taxation says. What is the Joint Committee on Taxation? It is a 
committee, an organization in Washington that serves both the House and 
the Senate. It serves Republicans and Democrats. There is not one iota 
of partisanship in it. It is totally objective, very solid, very 
confident. They are the outfit we rely on when we write tax 
legislation.
  Basically, they say by the year 2019, Americans will see a net tax 
cut of $40 billion, and that tax cut is equal to an average tax 
decrease of more than $440 per affected taxpayer. And for low- and 
middle-income taxpayers making less than $200,000, this cut is even 
greater. The average tax credit is equal to more than $640 per affected 
taxpayer in the year 2019.
  To repeat: This bill, according to the Joint Committee on Taxation, 
is a net tax cut for individuals--a cut, not an increase but a cut--
almost as great as the 2001 tax cut. Many of us know how great that 
was. This is the biggest tax cut since 2001--this legislation.
  I also want to discuss a couple other points. A lot of people say: 
Well, gee, some of this does not take effect for several years. Let's 
go through what takes effect right away, in 2010. What are the 
provisions that take effect right away? I will read the list.
  The first is--the fancy term is ``pools''--to help people with 
preexisting conditions get access to health insurance even before the 
actual denial of preexisting conditions kicks in. There is $5 billion 
of Federal support for higher risk pools providing affordable coverage 
to uninsured persons with preexisting conditions. That takes effect 
right away.
  Second, reinsurance for retiree health benefit plans. Basically, that 
means there is immediate access to Federal reinsurance for employer 
plans providing coverage for early retirees--for ages between 55 and 
64. Essentially, that means extra dollars are available for the 
outliers. That is a fancy term for saying the high-cost people in that 
age group--55 to 64.
  In addition, we extend dependent coverage for young adults. Today, a 
young couple buys health insurance for themselves and their kids, and 
once the child is 21 there is no more health insurance. We raise that 
level to the age of 26 so that person can stay with the family and have 
the family's health insurance.
  Moreover, this legislation requires that health insurers must provide 
prevention and wellness benefits but no deductibles and no cost-sharing 
requirements. That, too, will help quite a bit. That takes effect right 
away.
  Moreover, right away, in 2010, the legislation prohibits insurers 
from imposing annual and lifetime caps. Not later but right away there 
is a prohibition against insurers from imposing annual lifetime dollar 
limits--a big problem today.
  Moreover, right away, this legislation will stop insurers from 
nullifying or rescinding health insurance policies when claims are 
filed. Rescissions are a big problem today. In 2010, when this 
legislation passes, no more rescissions of health care policies.
  Moreover, this legislation sets minimum standards for insurance 
overhead costs to ensure that most premium dollars are spent on health 
benefits, not costly administration or executive compensation and 
profits. We also require public disclosure of overhead and benefit 
spending and premium rebates. That is right away.
  What about small business persons--small businessmen? This 
legislation offers tax credits to small businesses with low wages to 
make covering their workers more affordable. It takes effect in 2010, 
and credits of up to 50 percent of insurance premiums will be available 
to firms that choose to offer coverage.
  I might also say there are stronger small business provisions, too, 
that I am quite certain will be in the managers' amendment. Greater 
incentives to the tune of about $12 billion to $13 billion for small 
businesses will be in this legislation and will also be in the 
managers' amendment.
  Moreover, what will take effect next year, not later, is we have 
closed the coverage gap for the Medicare drug benefit. Basically, that 
means we have closed the doughnut hole--we are starting to close the 
doughnut hole. Seniors pay very high prices for brand-name drugs if 
they are in that so-called doughnut hole. We close it so that seniors 
don't have to pay those high prices anymore.
  There is public access to comparable information, more transparency, 
and I could go on and on and on. There are many provisions which take 
effect right away and not at a later date.
  Mr. President, I believe that debate is drawing to a conclusion on 
the four matters under consideration. We may be able to have votes as 
soon as 5:30.
  I see my colleagues from Kansas and Iowa on the Senate floor, and I 
yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas is recognized.
  Mr. BROWNBACK. Mr. President, I ask unanimous consent to use 5 
minutes of Senator McConnell's time--the Republican leader's time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BROWNBACK. Mr. President, I thank my colleagues for this 
opportunity to address the Lautenberg amendment and speak in favor of 
the Lautenberg amendment.
  I oppose the base bill. I oppose the bill overall. I have spoken a 
number of times in opposition to the overall bill. It is way too 
expensive, it cuts Medicare, raises taxes, and inserts the funding of 
abortion, which is something we haven't looked at in 30 years. The Hyde 
language has not allowed funding of abortion, and instead this does and 
puts it in, and I think it will result in poorer health care for a 
number of Americans.
  But the issue I rise on today is on the Lautenberg amendment, and in 
support of the Lautenberg amendment. This is an amendment we have seen 
in this body four times previously over the last 10 years. Each time 
the Lautenberg amendment has passed overwhelmingly, and that is because 
of the safety concerns for drugs coming into the United States.
  I would note that Secretary Sebelius, Secretary of HHS--Health and 
Human Services--who before being named to this position was the 
Governor of the State of Kansas for 6 years, with whom I worked over 
the years, through her office has stated they cannot basically certify 
the safety of these drugs.

[[Page S13232]]

  There is a letter that has been gone over in some depth and length 
from the Food and Drug Commissioner saying that it is going to be very 
difficult for them to certify the safety of these drugs. Yet what the 
Lautenberg amendment does is it says: OK, if you can certify safety, 
and this is going to reduce the price, then they can be admitted.
  That seems to make sense. That is why 4 times over the last 10 years 
this body has passed the Lautenberg amendment, or an equivalent, and I 
think that is appropriate.
  I would also note there is a huge industry in the United States--the 
pharmaceutical industry--that is quite concerned about the safety and 
efficacy of what this bill would do in not allowing the safety of the 
drugs if you don't pass a Lautenberg amendment. They are very concerned 
about that. And toward that regard, I will read pieces of a letter sent 
to me by Kansas Bio. It is the Kansas Biosciences Organization. They 
sent this letter to me saying:

       On behalf of the members of Kansas Bio, please accept this 
     letter in opposition to Senator Dorgan's drug importation 
     amendment to the health care reform legislation which may be 
     voted on by the Senate. We believe that the promotion of drug 
     importation is an extremely risky endeavor which threatens 
     the livelihood of one of Kansas' fastest growing bioscience 
     industry sectors--the service providers to our Nation's and 
     our world's drug development and delivery companies.
       KansasBio is an industry organization representing over 150 
     bioscience companies, academic institutions, State 
     affiliates, and related economic development organizations in 
     the State of Kansas, throughout the Kansas City region. . . . 
     Senator Dorgan's amendment opens up the risk of allowing 
     foreign drugs that do not have FDA approval into the United 
     States and thereby posing significant health and safety risks 
     to the patients.

  It is signed by the president and CEO, Angela Kreps, of KansasBio.
  I am ranking member on the Senate Appropriations Subcommittee on 
Agriculture, Rural Development, and the Food and Drug Administration, 
so I am keenly interested in the committee structure in this issue.
  In addition, the University of Kansas in my State, in addition to 
having the top-ranked basketball team in the country, has the top-
ranked pharmaceutical school in the country. They are a part of 
KansasBio and concerned about the Dorgan amendment in place. That is 
why they support things like the Lautenberg amendment which assure two 
things: that you have safety and that any value in this proposal is 
passed along to the consumer.
  The FDA has been tasked with the responsibility of safeguarding this 
country's prescription drug supply and has executed that 
responsibility, I believe, quite well. It would be unwise for this 
body, then, to not value their opinions in regard to this matter. The 
Lautenberg amendment counts on the FDA expertise and proven track 
record and permits legal importation of prescription drugs into the 
United States only if Secretary of Health and Human Services, Secretary 
Sebelius in this administration, as head of the FDA, can certify to 
Congress that prescription drug importation will do two things: No. 1, 
pose no additional risk to the public health and safety; and, No. 2, 
result in a significant reduction in the cost of covered products to 
the American consumer. The safety and cost savings certification 
amendment would restore this language.
  The Lautenberg amendment does that. This Congress must require a 
safety and cost savings certification from the Secretary of HHS before 
opening the floodgates of drug importation. Requiring this 
certification is the responsible way to ensure that American citizens 
will be protected from potentially life-threatening counterfeit, 
contaminated, or diluted prescription drugs.
  As I mentioned, the Senate has voted on this previously four times, 
each time overwhelmingly adopting something like the Lautenberg 
amendment. As many of my colleagues may remember, the safety and cost 
savings certification was first signed into law when the Senate passed 
the Medicine Equity and Drug Safety Act of 2000. During that debate, 
concerns were raised by many in this body that drug importation would 
expose Americans to counterfeit and polluted prescription drugs. To 
alleviate these well-documented fears, the Senate passed this second-
degree amendment then unanimously.
  To date, as noted earlier, no HHS Secretary has been able to certify 
that drug importation will not pose a significant health and safety 
threat. For those reasons, I support the Lautenberg amendment.
  I yield the floor.
  The PRESIDING OFFICER. The time of the Senator has expired.
  The Senator from New Jersey is recognized.
  Mr. LAUTENBERG. Mr. President, I think we have some time available. I 
wish to continue with some remarks. I thank the Senator from Kansas for 
his remarks and his concern also about the efficacy and the safety of 
drugs that might reach our citizens.
  I listened carefully to the remarks of my colleague from North 
Dakota. He said the principal focus of our amendment is to protect the 
profits of the drug companies. No, I want to protect the health and 
well-being of American citizens. I look at an industry that has 
prolonged life expectancy, has made life more productive and pleasant 
for many whose disabilities may have them imprisoned in their homes.
  We look at what has happened over the years, where treatment for 
conditions such as malaria, polio, smallpox were discovered, and 
antibiotics and chemotherapy have continued to be developed, primarily 
by American drug companies. Those are the companies that have the 
reputation for bringing the best products to market, the most carefully 
scrutinized, and most effective. What I want is for those companies to 
continue to be developing drugs that will extend wellness and will 
continue to improve longevity. I want these products to be available 
more reasonably, more cheaply--more affordably.
  I had an experience in my life--people have heard me talk about this 
at times--whereby my father got cancer, was disabled with cancer when 
he was 42 years old. Our family was virtually bankrupt as a result of 
the cost for drugs and hospital services and physicians, so I know how 
costly they are. My father had cancer then, and I have seen what has 
happened now, with the opportunities for some optimism in situations 
where cancer develops. We are looking to make these drugs more 
available, more affordable.
  The thing that strikes me, as we review where we are in the 
development of a new health plan or a reform of the existing health 
programs, and I hear the criticism coming from people who have 
indicated they do not support more available health products, I think 
about what happens when votes come about that move the health care bill 
along. There is absolute obstinacy that prevails with many of our 
friends on the Republican side.
  I look at what good, proper products can do and the hope we have for 
childhood diseases that are so painful to see. We look for improvements 
in those--whether it is autism or diabetes or other conditions. We want 
desperately for companies in this country of ours to continue to 
develop drugs to treat them--or companies anywhere. But when they come 
to this country we have to know they are safe because there is nothing 
that can excuse the sacrifice of safety, for whatever discounts you 
might get on the product, products that, as has been noted, can kill 
you if they are the wrong formula or contaminated product.
  Our differences between the Dorgan and Lautenberg amendments boil 
down to one word: safety. Knowing that when you open the bottle, that 
when you take the liquid, you are not doing something or your children 
or your loved ones are not doing something that harms their health. We 
owe them that feeling of security and comfort as they try to cure 
themselves from sickness or disease. That is what we are looking at 
here. I hope my colleagues will stand up and say no, don't let these 
products come in without the tightest scrutiny that can be developed; 
without the most secure process of production and shipment that can be 
exercised.
  I yield the remainder of my time.
  The PRESIDING OFFICER. Who yields time?
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, I ask how many minutes I have remaining.
  The PRESIDING OFFICER. The Senator has 15 minutes remaining.
  Mr. BAUCUS. I yield 5 minutes to my good friend from Iowa who I think 
is

[[Page S13233]]

going to be speaking against my position but he is a good fellow so I 
think he should have 5 minutes.
  Mr. GRASSLEY. This is typical of the comity of the Senate. I thank my 
good friend for doing that. I have a little different view on some of 
the things he said about taxes here. I respect him giving me some time 
because we don't have time on this side. It is nice, his doing that.
  Republicans and Democrats are working off of the same data provided 
by the Joint Committee on Taxation. For some reason my friends on the 
other side of the aisle seem to want to read this data selectively, so 
I wish to look at this data. I want to stress this data is from the 
nonpartisan Joint Committee on Taxation. They are experts. They are 
nonpolitical people who tell it like it is.
  My friends on the other side are correct in one thing: This bill 
provides a tax benefit to a small group of Americans. You can see right 
here that this benefit is to the people here where the minus sign is in 
front of the numbers. These numbers are in white.
  As I pointed out previously, when you see a negative number on this 
chart, the Joint Committee on Taxation is telling us these people are 
receiving a tax benefit. This income category--the income categories 
where you see these negative numbers begin at zero and stretch to 
$50,000 for individuals and $75,000 for families. That will be $50,000 
to $75,000. I give my Democratic friends credit for being right on this 
part of the data. But I want to show you where I disagree with them and 
their choosing to overlook other parts of the data, the data I will 
soon refer to here on this chart.

  When we see negative numbers on this chart, as I have said, the Joint 
Committee on Taxation is telling us that there is a tax benefit. So, 
conversely, where there are positive numbers--this will be an example 
of positive numbers--the Joint Committee on Taxation is telling us 
these taxpayers are seeing a tax increase. Those numbers I have already 
pointed to begin at $50,000 for an individual and go up to $200,000 for 
an individual.
  When we see a positive number, then, it is the reverse. The Joint 
Committee on Taxation is telling us these taxpayers are in fact seeing 
tax increases. So if we see positive numbers for individuals making 
more than $50,000 and we see positive numbers for families making more 
than $75,000, it is just this simple: We know these people's taxes are 
going to go up.
  The Joint Committee on Taxation is telling us that taxes for these 
individuals, once again, for a third time, will go up under this 2,074-
page Reid bill.
  These individuals and families are making less than $200,000. What is 
significant about less than $200,000 is that this violates what the 
President promised in his campaign, that individuals who are middle 
class, under $200,000, are not going to see one dime of tax increase.
  To come to any different conclusion is saying that the data on this 
chart--and of course the professionals at the Joint Committee on 
Taxation--both are wrong. To come to any different conclusion is saying 
the chart produced by the Joint Committee on Taxation is wrong.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. How much time remains?
  The PRESIDING OFFICER. There is 11 minutes.
  Mr. BAUCUS. On this side? Does anyone have remaining time?
  The PRESIDING OFFICER. The Senator from Idaho has 3 minutes. The 
Republican leader has 3\1/2\ minutes. The Senator from North Dakota has 
7\1/2\ minutes. The Senator from New Jersey has 1 minute.
  Mr. BAUCUS. Mr. President, I yield myself 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. I would like to make it clear, essentially this 
legislation does several things. This is the core part of this 
legislation. What is it? First, this legislation very significantly 
reforms the health insurance industry, especially for people who 
individually buy insurance and also for people who buy for a small 
company and even buy insurance for a large company. It is insurance 
market reform. It stops insurance companies from, frankly, undertaking 
practices which are un-American; that is, denying people coverage based 
on preexisting conditions, denying them health insurance because they 
have some kind of preexisting something--that is ridiculous--or saying: 
You can't have health insurance because you have some other health care 
status or saying: Sure, we will give you a policy, then a month, 2 
months later, rescind it willy-nilly or putting in restrictive limits 
on what the company will pay during your lifetime or what the company 
might pay in health insurance benefits for a year.
  In addition, this legislation reforms what are called rating 
provisions that States have. States basically allow companies to charge 
whatever they want, if you are a little older compared to if you are 
younger, if you are a woman compared to a man. There are lots of 
different ways States allow insurance companies to charge based upon 
different categories. So, No. 1, insurance market reform. This 
legislation stops some outrageous practices that insurance companies 
practice today.
  No. 2, this legislation begins to get control over health care costs. 
We have to start to get control over health care costs. This 
legislation does so. It also is deficit neutral. It does not cost one 
thin dime for us to enact this legislation. It is all paid for. It 
provides health insurance coverage. About 31 million Americans who 
currently do not have health insurance will have health insurance, if 
this legislation passes. I don't have to remind my colleagues of the 
importance of health insurance. Insurance market reform that lowers the 
cost of health care in this country, provides full coverage and, 
equally important, begins to put in place delivery system reforms. That 
is kind of wonkish, but it is one of the most important parts of this 
bill, starting to change the way we pay doctors and hospitals, pay 
based more on quality rather than quantity, start putting into effect 
different systems that sound kind of wonkish but will be important over 
3, 4, 5 years. It is bundling, group homes. It is lowering the practice 
of hospitals that readmit too quickly after a patient is discharged.
  There are so many reforms here. I strongly urge everyone to keep 
their eye on the ball. Insurance market reform in this legislation, 
lowering costs in this legislation, lowering taxes in this legislation, 
insurance coverage for 31 million Americans who today do not have it, 
and starting to put in place payment reforms which will help get this 
country on the right path so, after several years, we have a health 
care system we are all proud of, one that gets rid of all the waste we 
have in the country today. We pay $2.5 trillion a year in health care, 
about half public and half private. People who study this say we waste 
as much as $800 billion a year--not million, billion--in fraud, waste, 
dollars that don't go directly to health care. This legislation starts 
to get a handle on that. It stops all the waste. You get a better 
handle on fraud so after 2 or 3 years, we will have something we are 
very proud of. Let us remind ourselves, again, if we don't pass this 
legislation, we will rue the day we didn't because we will have to 
start all over again, 2 or 3 or 4 or 5 years from now, and the problem 
will be much worse. The cost for families is going to be much greater, 
the cost to American businesses much greater. Our budgets are going to 
be in much worse shape, Medicare and Medicaid. This legislation extends 
the solvency of the Medicare trust fund for another 9 years.
  Remember the bottom line, remember the basics. Let's not get too 
caught up in the details of the weeds and get distracted by a lot of 
stuff that is not the core of this bill. The provisions I outlined are 
compelling reasons why this legislation must pass and why it would be 
so good for America.
  I reserve the remainder of my time.
  The PRESIDING OFFICER. The Senator from Idaho.
  Mr. CRAPO. I ask unanimous consent to use the remainder of my time as 
well as that of the Republican leader.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CRAPO. Mr. President, I would like to respond to a couple of the 
points made about whether this bill truly does address what the 
American people are asking it to address. If you ask most people in 
America what they want out of health care reform--and

[[Page S13234]]

they do want reform--they will tell you they want to see control of the 
skyrocketing cost of health care, particularly the cost of insurance 
premiums. They would like to see increased access to quality medical 
care. It has been said a number of times by the proponents of this 
legislation that this bill accomplishes those objectives, but let's 
look at exactly what the Congressional Budget Office has told us on the 
core issue; namely, what is going to happen to your insurance premiums 
if this bill is passed.
  What the Congressional Budget Office very clearly said, which is also 
backed by 7, 8, 9 or 10 other studies from the private sector as well 
as the Joint Committee on Taxation and backed by the Chief Actuary for 
the Center for Medicare and Medicaid Services, is that for at least 30 
percent and the most vulnerable people in America, if you are looking 
at whether your insurance premiums are going to go up or down, they are 
going to go up, not down. If you are a member of the 17 percent of 
Americans who get your insurance in the individual market, your 
insurance is going to go way up. In fact, it is going to go up by as 
much as 10 to 13 percent in addition to what it would have gone up 
without the bill. If you are someone who gets your business from small 
groups, from a small group market, your insurance costs are going to go 
up from 1 to 3 percent. If you are one of the Americans who is able to 
get your insurance in the large group market, then you can basically 
expect that the bill will have no significant impact on you. There is a 
possibility of a slight reduction, but the potential is, it is going to 
have no impact at all.
  What does the bill do? For 17 percent of Americans in the individual 
market and for 13 percent of Americans in the small group market, it 
clearly makes your health care premiums go up. For those who are in the 
remainder of the market, it basically doesn't achieve the objective of 
health care reform--and at what price? We often hear we need to bend 
down the cost curve. As I have indicated, this legislation doesn't bend 
down the cost curve Americans are talking about; namely, the price of 
their health care or their health insurance. What does it do with 
regard to the Federal Government? It is going to increase the cost to 
the Federal Government on health care by $2.5 trillion in a massive new 
entitlement program. So that price curve is not bent down.
  Then what are we left with? Some say the deficit will go down under 
this bill. There is only one way the deficit can go down under this 
bill; that is, if you take away the budget gimmicks, massive tax 
increases, and massive Medicare cuts. But I will just talk about the 
budget gimmicks because of a lack of time. The spending side of this 
bill is delayed for 4 years. The taxing and cutting Medicare side of 
the bill is implemented on day one. So we have 10 years of tax 
increases to offset 6 years of spending. I think that is the way the 
number was reached. You have to figure out how many years to delay the 
spending start before you can say there was a deficit-neutral bill. The 
reality is, this bill doesn't deal with any of those spending curves.
  The matter we will be voting on in a few minutes is my motion that 
would address the tax side of the bill. All it says is: Let's change 
the bill to comply with the President's promise; namely, that people 
making less than $200,000 a year or $250,000 as a couple would not pay 
more taxes. What we found from the Joint Tax Committee is, 73 million 
Americans in that category will pay more taxes. In fact, it is not 73 
million Americans, it is 73 million American households who will pay 
more taxes and see a tax increase under this bill and not just a small 
one. It is massive, hundreds of billions of dollars of new taxes that 
will be imposed by this bill.
  In response, the proponents of this bill say: But this bill is a tax 
cut. The only way they can say this bill is a tax cut is by looking at 
the subsidy that is going to be provided as a tax cut. It is called a 
refundable tax credit, although three-fourths of it, 73 percent to be 
accurate, goes to people who do not pay taxes. Yet it is called tax 
relief because it is administered through the Tax Code and is described 
as a refundable tax credit. The CBO gets this and Americans get it. The 
Congressional Budget Office says these aren't tax cuts. This is 
spending, and it is scored that way by the CBO as it analyzes the bill. 
The only way you can say this bill involves these kinds of tax cuts is 
if you say that a provision that will simply result in the payment of a 
check by the Federal Government to an individual who has no tax 
liability to assist them with their health care costs is a tax cut. 
Let's accept that.
  Even in that case, only 7 percent of Americans qualify for that 
subsidy, and the rest qualify for the tax increases. To say the 
President's promise was that I will not cut your taxes more or I will 
not increase your taxes more than I will cut someone else's taxes and, 
by the way, I will call a direct subsidy a tax cut, is not exactly what 
I think the President meant. It is not what the American people thought 
he meant when he said Americans making less than $200,000 or $250,000 
as a family would not pay more taxes under this bill.
  My proposal simply says send this bill back to the Finance Committee. 
They can turn it around quickly, if they want to. Have them take out 
the provisions that violate the President's pledge on taxes.
  I retain the remainder of my time.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. I yield 3 minutes to the Senator from Ohio.
  Mr. BROWN. Mr. President, I rise in support of the Dorgan amendment 
on reimportation. This is not about importing drugs from China or India 
or Mexico, where drug safety standards are not up to par. Although 
American companies have outsourced a lot of their manufacturing to 
those countries and found a lot of problems with the ingredients they 
import into American drugs, that is not the issue. That underscores the 
hypocrisy of U.S. drug companies in opposing the Dorgan amendment.
  This is about importing drugs from countries such as Canada and 
Germany and Australia and New Zealand and Japan, countries with highly 
developed drug safety regimes. Patients in England and France and 
Germany and New Zealand and Canada have the same protections we do. I 
have been in drugstores in Canada just 2 hours from Toledo, less than 
that, and you see the same drug and the same dosage, the same 
packaging, the same company making them. In Canada, it is 35 to 55 
percent lower than in the United States. One drug, the cholesterol-
lowering drug Lipitor, is $33 in Canada, $53 in France, $48 in Germany, 
$63 in the Netherlands, $32 in Spain, $40 in the United Kingdom. Same 
packaging, same company, same dosage, same drug is $125 in the United 
States We pay more, even though, in most cases, these drugs are either 
manufactured in the United States or developed, in some cases, by U.S. 
taxpayers, developed certainly in the United States for Americans, but 
we pay two and three times more.
  A 2009 Consumer Reports survey found that due to high drug prices, 
one out of six consumers failed to fill a prescription, one out of six 
consumers skipped doses.
  Mr. President, 23 percent of consumers cut back on groceries. They 
choose between do I get my groceries or pay for this drug? Consumer 
after consumer will cut their pill in half and take one part today and 
one part the next day, which is not what their doctor says they should 
do. We know this is not good for Americans' health. We know this is not 
good for Americans' pocketbooks. We know this is not good for 
taxpayers. It is not good for small business. It is not good for big 
business, large American companies that are paying the freight, that 
are paying these costs. American consumers and taxpayers and businesses 
are suffering from these high costs.
  Pharmaceutical companies hike up prices, rake in massive profits. 
They are one of the three most profitable industries in this Nation and 
have been for decades. The pharmaceutical industry, in 2008, recorded 
sales in excess of $300 billion, with a 19-percent profit margin. This 
is in a bad year--a bad year for most of us in this country, in 2008. 
In the last year alone, the brand-name prescription drug industry 
raised their prices by more than 9 percent.
  I ask my colleagues to support the Dorgan amendment.
  The PRESIDING OFFICER. The Senator's time has expired.
  The Senator from Montana.

[[Page S13235]]

  Mr. BAUCUS. Mr. President, I ask unanimous consent that at 6 p.m. 
today, the Senate proceed to vote in relation to the amendments and 
motion specified in the order of December 14 regarding H.R. 3590; that 
prior to each vote, there be 2 minutes of debate, equally divided and 
controlled in the usual form; that after the first vote in the 
sequence, the succeeding votes be limited to 10 minutes each; further, 
that all provisions of the December 14 order remain in effect.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from North Dakota.
  Mr. DORGAN. Mr. President, some issues we deal with here in the 
Senate are unbelievably complicated. This one is not. This is painfully 
simple, the question of whether the American people should be charged 
and continue paying the highest prices in the world for brand-name 
prescription drugs--my amendment says no--from other countries in which 
there is a safe chain of custody that is identical to ours. The 
American people ought to have the freedom to shop for those lower 
priced FDA-approved drugs that are sold there at a fraction of the 
price.
  I especially wish to thank Senator Begich from Alaska for his work. 
This is bipartisan, with a broad number of Democrats and Republicans 
working on this importation of prescription drugs bill, giving the 
American people the freedom to acquire lower priced drugs. Senator 
Begich has been a significant part of that effort. I want to say thanks 
to him for his work on this amendment.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. BEGICH. Mr. President, if I could ask a question of the Senator 
from North Dakota.
  I say to the Senator, I appreciate his comments, and I think he is 
right. Of all the complexity of this bill, this seems so simple. I know 
when I was mayor, we worked on this issue. It seems logical for Alaska. 
Since we border so much of Canada, it seems logical to do what we can 
in this arena.
  I know the Senator stated these comments before, but I think it is 
important for especially my viewers who are now watching from Alaska, 
with the 4-hour difference. But the Senator talked about the savings. 
There are savings to the taxpayers that are very clear, and there are 
savings to the consumer, which is even more significant. Can the 
Senator remind me what those numbers are? I think I have them. I want 
to be sure, as I talk about this bill.
  Mr. DORGAN. Mr. President, this amendment will save $100 billion in 
10 years, nearly $20 billion for the Federal Government and nearly $80 
billion for the American consumers.
  Mr. BEGICH. That is what this health care bill is about, not only 
getting good-quality care but also finding those opportunities, as we 
just heard one Senator talk about, bending that cost curve--I hate that 
term--but it is impacting the consumers in a positive way by $80 
billion.
  The other thing I have heard a lot about on the floor--and the 
Senator talked quickly about it--is the chain of control, which I drove 
here for 19 days with my family through Canada, and 5 days we bought 
some drugs when I had a cold, but I am still here. I am standing. I am 
healthy. Remind me of that chain of control for these drugs and where 
they are produced.
  Mr. DORGAN. I would say to the Senator from Alaska, these 
prescription drugs would be able to be reimported from Australia, New 
Zealand, Japan, and the European countries that have identical chains 
of custody to our chain of custody so that there is safety.
  It is also the case that we are in politics, so the floor of the 
Senate is the place of a lot of tall tales. I understand that. I have 
been in politics for a long time.
  Mr. BEGICH. Yes, I have learned that as a new Member.
  Mr. DORGAN. But early on, one of my colleagues said this is about 
untested, unregulated drugs coming from, oh, parts of the Soviet Union. 
That is so unbelievable. It is not describing the amendment I have 
offered. We are talking about a chain of custody that is identical to 
the United States. When that is the case--if it is the case--why would 
the American people not have the freedom to acquire that same drug when 
it is sold at one-tenth the price, one-fifth, one-third, or one-half 
the price? Why not give the American people that freedom?
  Mr. BEGICH. The Senator from North Dakota and I have just one last 
question. Even though we did not ask for a colloquy, this is kind of a 
colloquy, and I appreciate the back-and-forth.
  This is one reason I support this bill--not only today but many 
months ago--for all the reasons the Senator just laid out. The control 
is there. The protection to the consumer is there. The savings to the 
consumer and the taxpayer are enormous, as we deal with these issues. 
If there is one thing I have heard over and over through e-mails and 
correspondence to my office, it is: Help us save on prescription drugs.
  To emphasize that point once more, to make sure I have the numbers 
right, over 10 years, between the Federal Government and the consumer, 
it is over $100 billion.
  Mr. DORGAN. Mr. President, the savings is over $100 billion. Look, I 
want the pharmaceutical industry to do well, to make profits, to make 
prescription drugs. I just want fair pricing for the American people. I 
do not have a beef with the industry. I want them to do well. I want 
them, however, to give the American people a fair price because we are 
paying the highest prices in the world for brand-name prescription 
drugs, and I think it is flat out unfair. This amendment will fix that.
  There is a competing amendment that nullifies it, that simply says 
all this is going to go away and we are done with this bill and nothing 
has happened to put the brakes on prescription drug prices.
  I hope my colleagues will stand with me and with the American people 
saying: We support fair drug prices for the American people. That is 
what we are going to vote on in a few minutes.
  I appreciate the questions from the Senator from Alaska.
  Mr. BEGICH. Thank you, Mr. President. And I thank the Senator from 
North Dakota for allowing me these questions and again clarifying for 
my residents in Alaska how important this bill is. Thank you.
  The PRESIDING OFFICER. The Senator's time has expired.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, parliamentary inquiry: The order that was 
just entered provided for 2 minutes, equally divided, before, I 
suppose, the vote on each of the amendments. Is that in addition to or 
is that a part of the time that has been allocated to Senators?
  The PRESIDING OFFICER. In addition to.
  Mr. BAUCUS. I thank the Chair.
  The PRESIDING OFFICER. The Senator from Montana has 5 minutes 
remaining.
  Mr. BAUCUS. So, Mr. President, if the Senator from Montana wishes to 
speak on his amendment, he has 5 minutes, plus 2 minutes.
  The PRESIDING OFFICER. Five minutes plus 1 minute.
  Mr. BAUCUS. Excuse me. The time is equally divided. Thank you.
  Mr. President, I just want to make it as clear as I can that the 
Congressional Budget Office essentially says that premiums will go down 
for about 93 percent of Americans. I say that because I think my good 
friend from Idaho was leaving a different impression.
  But let me just summarize what CBO says. I would put a chart that CBO 
provided in the Record, but under the Senate rules we cannot put charts 
in the Record. So I am just going to summarize what this chart says.
  OK. Seventy percent of Americans will get their health insurance in 
what is called the large group market. That is people who work for 
larger employers--70 percent. CBO said for that 70 percent of 
Americans, premiums will go down a little bit. It will be about a 3-
percent reduction in premiums.
  The next group of Americans getting health insurance are in what is 
called the small group market. Those are people in small companies, 
small businesses, primarily. That is where 13 percent of Americans get 
their insurance. CBO says for that 13 percent, maybe the premiums will 
go up between 1 percent or down 2 percentage points overall. But for 
those folks, those small businesspeople who get tax credits--

[[Page S13236]]

and there are some very significant tax credits in this bill, and I 
think it will be even more significant when the managers' amendment is 
out--CBO says, even with modest tax credits, those premiums will go 
down 8 to 11 percent.
  That is, for 13 percent of Americans who have insurance, their 
premiums will go down 8 to 11 percent, among those who have credits.
  Let's look at what is called the nongroup market, the individual 
market. That is 17 percent of Americans. For those folks, if you 
compare their current insurance with what they will have in the future, 
those premiums will go down 14 to 20 percent--down 14 to 20 percent--
according to CBO.
  In addition, though, CBO says that persons who have tax credits--we 
are talking now about the individual market--those people will find, on 
average, their premiums will go down 56 to 59 percent. Remember, 17 
percent of Americans buy insurance individually. Of that 17 percent, 10 
percent, because of tax credits in this bill, will find their premiums 
go down 56 to 59 percent.
  The 7 percent that are remaining--remember I started off by saying 
for 93 percent, there will be a reduction. The 7 percent remaining will 
find that because of better benefits, their premiums will go up 10 to 
13 percent, but they will have a lot better benefits. They will have a 
lot higher quality insurance than they have today. Frankly, my judgment 
is, the higher quality insurance they have, because of this 
legislation, will outweigh the increase in the premiums.
  But anyway, for 93 percent, premiums will go down.


                           Amendment No. 3183

  Mr. President, let me speak a little bit on my amendment which, as I 
understand it, is going to be the first amendment voted on.
  I remind my colleagues that the underlying legislation is a tax cut 
bill. It cuts taxes. It cuts taxes very significantly. Over the next 10 
years, for example, this bill will provide Americans with a $441 
billion tax cut to buy health insurance--$441 billion in tax credits to 
buy health insurance. Credits are tax reductions.
  In the year 2017, taxpayers who earn between $20,000 and $30,000 a 
year will see an average tax cut of nearly 37 percent. These are people 
who have a hard time making ends meet. People who earn between $20,000 
and $30,000 will see an average tax cut of 37 percent. That is 
according to the Joint Committee on Taxation.
  In addition, 2 years later, the average taxpayer making less than 
$75,000 a year will receive a tax credit of $1,500. Just to repeat, the 
average taxpayer making less than $75,000 a year will receive a tax 
reduction--a tax credit--of more than $1,500.
  The Crapo motion to commit is really an attempt to kill health care 
reform. It is, thus, a plan to keep Americans from getting these tax 
cuts. I think we want Americans to get these tax cuts. If the Crapo 
motion is successful, Americans will not get any of these tax cuts. We 
want them to. The underlying bill gives Americans these tax cuts. 
Therefore, I think we should reject this procedural maneuver designed 
to kill the tax cuts in this health care bill.
  That is what my side-by-side amendment says--that is going to be the 
first amendment voted on--and that is, let's vote to keep our current 
tax cuts. I urge a positive vote on my amendment and a ``no'' vote on 
the Crapo motion, which eliminates the tax cuts, which is not what I 
think most Americans want. So I urge my colleagues to vote for the 
side-by-side amendment.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. Under the previous order, there will be 2 
minutes of debate equally divided prior to a vote on the Baucus 
amendment.
  Who yields time?
  The Senator from Mississippi.
  Mr. COCHRAN. Mr. President, the legislation that we are discussing 
today, the Patient Protection and Affordable Care Act, could have a 
profound impact on the United States for decades to come. I am 
especially concerned about the tax implications of the legislation. We 
need to take a thorough look at these tax provisions before approving 
this legislation.
  It is plain to see that if you have insurance, you get taxed; if you 
don't have insurance, you get taxed; if you need prescription drugs, 
you get taxed; if you need a medical device, you get taxed; if you have 
high out-of-pocket health expenses, you get taxed. Everyone gets taxed 
under this proposal.
  This legislation also changes the core principle of Social Security 
and Medicare financing, a model called ``social insurance.'' Since 
Social Security was created in the 1930s and the Medicare Program in 
1965, payroll tax revenues have been dedicated to financing these 
programs. In current tax law, all funding from the Medicare payroll tax 
finances the Medicare Program. This legislation proposes to increase 
the hospital insurance portion of the payroll tax on wages from 1.45 
percent to 1.95 percent and uses the revenues to fund programs outside 
of Medicare. If this proposal becomes law, future Congresses will have 
the ability to take payroll tax revenues and use them for highways or 
defense or other nonsocial insurance spending. This will be a serious 
precedent, a long-term game-changer in how we finance our government, 
and I do not think it is wise to do this today.
  Additionally, individuals who fail to maintain government-approved 
health insurance coverage would be subject to a penalty of up to $2,250 
in 2016. This individual mandate tax is regressive and will largely be 
strapped on the backs of those who can least afford such a penalty.
  Analysis by the Joint Committee on Taxation reveals that while a 
relatively small group of middle-class individuals, families, and 
single parents may benefit under this bill, a much larger group of 
middle-class individuals, families and single parents will be 
disadvantaged. According to the analysis by the Joint Committee on Tax, 
this legislation increases taxes by a 3 to 1 ratio on people making 
less than $200,000 a year, in other words for every one individual or 
family that gets the tax credit, three middle-income individuals and 
families are taxed. Roughly 42 million individuals and families, or 25 
percent of all tax returns under $200,000 will, on average, pay higher 
taxes under this bill, even with the tax credits factored in.
  There are only about 17,000 Mississippi tax filers who earn more than 
$200,000, so we are looking at over 2.5 million people who earn less 
than $200,000 and could easily be forced to pay higher taxes. This 
legislation will affect a large majority of our tax base.
  Tax spending as proposed in the legislation before us provides 
credits for health insurance to individuals and families between 100 
percent and 400 percent of the Federal poverty level, FPL. For example, 
a family at 100 percent of the Federal poverty level can pay no more 
than 2 percent of their income on premiums, and the government would 
pick up the rest of the cost. Although this furthers the goal of trying 
to get everyone insured, only 7 percent of Americans will be eligible 
for a tax credit and 91 percent of Americans will experience an 
increase in taxes. This hardly seems like a solution.
  The health care industry, including many small businesses in my 
state, would be subject to fees imposed by this legislation. Health 
insurance companies that administer a self-insured policy on behalf of 
employers would be subject to fees imposed on the industry. This $6.7 
billion annual fee will undoubtedly be passed on to consumers.
  This legislation imposes a nondeductible $2.3 billion fee on 
manufacturers of prescription drugs, which is an example of yet another 
fee that will be passed on to consumers.
  Medical device manufacturers will be on the hook for $2 billion in 
annual fees. Again, this will be passed on to consumers.
  Of additional concern is the ``free-rider'' penalty for employers 
with more than 50 employees that do not offer health insurance 
coverage. These employers would be required to pay a fee for each 
employee. Businesses that pay any amount greater than $600 to corporate 
providers of services would have to file an information report with the 
IRS, adding further regulatory burdens on business and on an agency 
that does not traditionally deal in health care.
  According to a recent study, taxes in this proposal will place 
approximately 5.2 million low-income workers at risk of losing their 
jobs or having their hours reduced. An additional 10.2 million workers 
could see lower wages and

[[Page S13237]]

reduced benefits. Why would we want to put people at risk of losing 
their jobs? A small business owner in my State told me that 8 percent 
of his income goes to pay for health insurance for his employees. If 
this amount is increased, he will be forced to reduce the size of his 
staff. Why would we want to hurt small businesses at a time like this?
  We all remember President Obama's campaign promise that he would not 
raise taxes on families earning less than $250,000 a year. The Joint 
Committee on Taxation conducted an analysis that shows that in 2019--
when the bill is in full effect--on average individuals making over 
$50,000 and families making over $75,000 would have seen their taxes go 
up under this legislation. In other words, 42 million individuals and 
families earning less than $200,000 would pay higher taxes.
  Arguably millions more middle-class families and individuals could be 
hit with a tax increase from the health care industry ``fees'' or taxes 
proposed. According to testimony of the Congressional Budget Office 
before the Senate Finance Committee, these fees would be passed through 
to health care consumers and would increase health insurance premiums 
and prices for health care-related products. If the President signs 
this legislation in its current form, he would break his pledge not to 
raise taxes on people making less than $250,000 a year.
  My distinguished friend from Idaho, Senator Crapo, offered an 
amendment in the Senate Finance Committee markup providing that ``no 
tax, fee or penalty imposed by this legislation shall be applied to any 
individual earning less than $200,000 per year or any couple earning 
less than $250,000 per year.'' The amendment was rejected.
  Small businesses in my State do not support this legislation. With 
unemployment at a 26-year high and small business owners struggling to 
simply keep their doors open, this kind of reform is not what we need 
to encourage small businesses to thrive. Small businesses need reform 
that will lower insurance costs. They need a bill that will decrease 
the overall cost of doing business. If a bill increases the cost of 
doing business or fails to reduce costs, then the bill fails to meet 
its intended goal of reigning in health care costs.
  I would submit that the bill fails to lower national health 
expenditures; it fails to lower the amount of money the federal 
government spends on health care; and it does not bend the cost curve 
of rapidly increasing national health care costs. If we were running a 
large company, this would be an unsuccessful business proposal.
  In Mississippi, we could insure a majority of the uninsured if we 
enrolled all eligible children in the State Children's Health Insurance 
Program: If more small businesses offered health insurance, and if 
people who could afford health insurance purchased health insurance, 
this would be reform.
  Mr. President, I would like to see our Nation's health system 
reformed, but these reforms cannot be on the backs of individuals and 
businesses that we need to succeed. Reform should not add to the 
already high costs of doing business.
  The PRESIDING OFFICER. The Senator from Idaho.
  Mr. CRAPO. Mr. President, I will just take 1 minute on this, and then 
I think we will probably be ready to vote.
  Again, I think there are two contrasting amendments here. The Senator 
from Montana has indicated that my motion, which would simply ask the 
Finance Committee to make this bill comply with the President's pledge, 
would somehow kill the bill--that is not at all true--and, secondly, 
that it would stop the tax relief in the bill that the Senator from 
Montana has identified, the refundable tax credits. The bottom line is, 
my amendment does not even address the refundable tax credits. They 
remain in the bill.
  All my amendment does is say: Let's have the President's pledge to 
the American people honored in this legislation. Let's take out the 
taxes that 73 million American households will pay under this 
legislation--hundreds of billions of dollars of new taxes.
  The PRESIDING OFFICER (Mrs. Shaheen). The Senator's time has expired.
  The Senator from Montana.
  Mr. BAUCUS. Madam President, essentially, the Crapo motion to commit 
the underlying bill, the pending bill, is to the Finance Committee to 
take out all the tax cuts. That is what it is, so I oppose it.
  I urge Senators to vote for my amendment, which is a sense of the 
Senate that the Senate should reject such procedural motions, 
basically, because we want to keep the tax cuts that are in this bill.
  Madam President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the amendment.


 =========================== NOTE =========================== 

  
  On page S13237, December 15, 2009, the Record reads: The 
question is on agreeing to the motion.
  
  The online Record has been corrected to read: The question is on 
agreeing to the amendment.


 ========================= END NOTE ========================= 

  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Indiana (Mr. Lugar).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 97, nays 1, as follows:

                      [Rollcall Vote No. 375 Leg.]

                                YEAS--97

     Akaka
     Alexander
     Barrasso
     Baucus
     Bayh
     Begich
     Bennet
     Bennett
     Bingaman
     Bond
     Boxer
     Brown
     Brownback
     Bunning
     Burr
     Burris
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Coburn
     Cochran
     Collins
     Conrad
     Corker
     Cornyn
     Crapo
     DeMint
     Dodd
     Dorgan
     Durbin
     Ensign
     Enzi
     Feingold
     Feinstein
     Franken
     Gillibrand
     Graham
     Grassley
     Gregg
     Hagan
     Harkin
     Hatch
     Hutchison
     Inhofe
     Inouye
     Isakson
     Johanns
     Johnson
     Kaufman
     Kerry
     Kirk
     Klobuchar
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     LeMieux
     Levin
     Lieberman
     Lincoln
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Pryor
     Reed
     Reid
     Risch
     Roberts
     Rockefeller
     Sanders
     Schumer
     Sessions
     Shaheen
     Shelby
     Snowe
     Specter
     Stabenow
     Tester
     Thune
     Udall (CO)
     Udall (NM)
     Vitter
     Voinovich
     Warner
     Webb
     Whitehouse
     Wicker
     Wyden

                                NAYS--1

       
     Nelson (NE)
       

                             NOT VOTING--2

     Byrd
     Lugar
       
  The PRESIDING OFFICER. On this vote, the yeas are 97, the nays are 1.
  Under the previous order, requiring 60 votes for the adoption of the 
amendment, amendment No. 3183 is agreed to.
  Mr. BAUCUS. Madam President, I move to reconsider the vote, and I 
move to lay that motion on the table.
  The PRESIDING OFFICER. Under the previous order, the motion to 
reconsider is considered made and laid upon the table.


                            Motion to Commit

  The PRESIDING OFFICER. Under the previous order, there will now be 2 
minutes of debate equally divided prior to a vote in relation to the 
Crapo motion to commit.
  Mr. CRAPO. Madam President, this is a very simple vote we are going 
to have. This is a vote that will correct the bill to comply with the 
President's promise not to tax anyone who makes under $200,000 as an 
individual or $250,000 as a family.
  I think the vote we just had was a unanimous vote for it. It said not 
to take tax relief out of the bill. We have had plenty of debate about 
tax relief--whether it is in the bill or not in the bill. This motion 
says let's fix the bill and take out the hundreds of billions of 
dollars of taxes that will fall squarely on the middle class.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Madam President, the Crapo motion to commit is an attempt 
to kill health care reform. If it succeeds, we will keep 31 million 
Americans from getting health care coverage. If it succeeds, it will 
keep Americans from getting the tax cuts in the bill. If the motion 
succeeds, over the next 10 years, Americans will get $441 billion less 
in tax credits to buy health insurance.
  I urge that we not vote in favor of the Crapo motion, and I ask for 
the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?

[[Page S13238]]

  There is a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 45, nays 54, as follows:

                      [Rollcall Vote No. 376 Leg.]

                                YEAS--45

     Alexander
     Barrasso
     Bayh
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Cantwell
     Chambliss
     Coburn
     Cochran
     Collins
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Klobuchar
     Kyl
     LeMieux
     Lincoln
     Lugar
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Wicker

                                NAYS--54

     Akaka
     Baucus
     Begich
     Bennet
     Bingaman
     Boxer
     Brown
     Burris
     Cardin
     Carper
     Casey
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Franken
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Kirk
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Warner
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--1

       
     Byrd
       
  The PRESIDING OFFICER. On this vote, the yeas are 45, the nays are 
54. Under the previous order requiring 60 votes for the adoption of 
this motion, the motion is withdrawn.


                    Amendment No. 2793, as Modified

  The PRESIDING OFFICER. Under the previous order, there will now be 2 
minutes of debate equally divided prior to a vote in relationship to 
amendment No. 2793, as modified, offered by the Senator from North 
Dakota, Mr. Dorgan.
  The Senator from North Dakota.
  Mr. DORGAN. Madam President, this amendment is about fair pricing for 
prescription drugs for the American people. A colleague of mine just 
came up to me and said: My daughter takes Nexium. It costs her $1,000 a 
month. I said: I happen to have a chart about Nexium here. This 
illustrates better than I know how to illustrate the difference in 
pricing.
  Here is what Nexium costs: $424 worth of Nexium in the United States 
is sold for $40 in Great Britain, $36 in Spain, $37 in Germany, $67 in 
France. If you like this kind of pricing where the American people pay 
the highest prices in the world for prescription drugs, if you like 
this kind of pricing, then you ought to vote against this amendment. 
But this amendment is bipartisan--Republicans and Democrats. Over 30 
Members of this Senate have supported this approach, saying let's 
provide fair pricing for a change for the American people.
  We should not be paying the highest prices in the world for 
prescription drugs. All I ask is that you support this amendment to 
give the American people the opportunity for fair pricing for a change.
  The PRESIDING OFFICER. The Senator's time has expired.
  The Senator from New Jersey.
  Mr. MENENDEZ. Madam President, I rise to oppose the Dorgan amendment. 
Let's be clear, there are those who want to deminimize safety. But the 
one entity in this country that is responsible for the food and drugs 
is the FDA, and Commissioner Hamburg has mentioned in her letter all of 
the potential risks of the Dorgan amendment.
  Secondly, we have heard about the European Union as an example why we 
should permit reimportation. What did we hear from the European 
Community last week? In 2 months, they seized 34 million fake tablets 
at customs points in all member countries, and this was beyond their 
greatest fears.
  Thirdly, how do we create affordability? By closing the doughnut 
hole. And this amendment will not do that, it will undermine that.
  And finally, Senator Lautenberg's amendment, which comes up after 
this amendment, is the one that permits reimportation but takes care of 
the safety issues that the FDA has said are critical.
  We want to make sure when you buy Nexium that what you get is the 
substance and the quality and the quantity that you want, not something 
less that can undermine your health care. Vote against the Dorgan 
amendment.
  Mr. DORGAN. Madam President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be.
  The question is on agreeing to the amendment. The clerk will call the 
roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. 
Byrd), is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 51, nays 48, as follows:

                      [Rollcall Vote No. 377 Leg.]

                                YEAS--51

     Alexander
     Begich
     Bennet
     Bingaman
     Bond
     Boxer
     Brown
     Coburn
     Collins
     Conrad
     Corker
     Cornyn
     Crapo
     DeMint
     Dorgan
     Feingold
     Feinstein
     Franken
     Graham
     Grassley
     Harkin
     Hutchison
     Johanns
     Johnson
     Klobuchar
     Kohl
     Leahy
     LeMieux
     Lincoln
     McCain
     McCaskill
     McConnell
     Merkley
     Murkowski
     Nelson (NE)
     Nelson (FL)
     Pryor
     Risch
     Sanders
     Sessions
     Shaheen
     Shelby
     Snowe
     Specter
     Stabenow
     Thune
     Udall (NM)
     Vitter
     Webb
     Wicker
     Wyden

                                NAYS--48

     Akaka
     Barrasso
     Baucus
     Bayh
     Bennett
     Brownback
     Bunning
     Burr
     Burris
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Cochran
     Dodd
     Durbin
     Ensign
     Enzi
     Gillibrand
     Gregg
     Hagan
     Hatch
     Inhofe
     Inouye
     Isakson
     Kaufman
     Kerry
     Kirk
     Kyl
     Landrieu
     Lautenberg
     Levin
     Lieberman
     Lugar
     Menendez
     Mikulski
     Murray
     Reed
     Reid
     Roberts
     Rockefeller
     Schumer
     Tester
     Udall (CO)
     Voinovich
     Warner
     Whitehouse

                             NOT VOTING--1

       
     Byrd
       
  The PRESIDING OFFICER. On this vote, the yeas are 51, the nays are 
48. Under the previous order requiring 60 votes for the adoption of 
this amendment, the amendment is withdrawn.


                           Amendment No. 3156

  Under the previous order, there will now be 2 minutes of debate, 
equally divided, prior to a vote in relation to amendment No. 3156, 
offered by the Senator from New Jersey, Mr. Lautenberg.
  Mr. LAUTENBERG. Madam President, this is a simple solution to a 
complicated problem. My amendment contains the Dorgan amendment. The 
work done by our friend from North Dakota is significant. But what it 
did not have is a guarantee, as much as possible, that the product was 
safe; that there were no counterfeits, that there were no mixtures of 
things that might not work well with other drugs.
  My amendment adds a simple requirement that imported drugs be 
certified as safe by the Health and Human Services Secretary. I hope we 
will be able to pass this, which will include the Dorgan amendment, to 
make sure the products that get here are safe, no matter what the price 
will be. If it is not safe, it is worthless. We want to be sure every 
product that reaches our shore is safe to take and will be sold at a 
more reasonable cost.
  Mr. BAUCUS. Madam President, I have long supported measures that 
allow Montanans to buy safe and effective drugs from foreign countries. 
This is why I support the Lautenberg amendment.
  Currently, the Food and Drug Administration is required to review the 
safety and effectiveness of domestically produced drugs. FDA is also 
required to ensure the safety and effectiveness of legally imported 
drugs. Through FDA's robust inspection and other regulatory compliance 
activities, consumers can have a high degree of confidence in the 
quality of the drugs.
  The Lautenberg amendment allows importation of drugs manufactured 
outside the United States and includes

[[Page S13239]]

numerous protective measures in addition to these activities. These 
measures address the health and safety risks of importing foreign 
drugs.
  Most importantly, it requires the Secretary of Health and Human 
Services to certify that the imported drugs do not pose any additional 
risk to the public's health and safety and create savings for American 
consumers.
  With recent increased awareness of potentially dangerous food and 
drug products, it is more important than ever to protect American 
consumers.
  This amendment ensures that consumers are protected from the risk of 
unsafe drugs. And it ensures Americans have access to consistent, 
reliable medicines.
  The PRESIDING OFFICER. The time of the Senator has expired. Who 
yields time in opposition?
  The Senator from North Dakota?
  Mr. DORGAN. Madam President, we have all seen this movie before. We 
have had these votes before. All I say is this: The pharmaceutical 
industry flexes its muscles and defeats an attempt for fair 
prescription drug prices for the American people so we can keep paying 
the highest prices in the world. And then there is another amendment 
offered that makes it seem like something is being done when, in fact, 
nothing is going to be done, nothing will change.
  Do not vote for this amendment and go home and say you have done 
something about the price of prescription drugs because your 
constituents will know better. This amendment does nothing. If you 
believe, at the end of the evening, we should do nothing, by all means 
vote for it. Don't count me in on that vote.
  Mr. HARKIN. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The question is on agreeing to the amendment. The clerk will call the 
roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  The PRESIDING OFFICER (Mr. Udall of Colorado). Are there any other 
Senators in the Chamber desiring to vote?
  The result was announced--yeas 56, nays 43, as follows:

                      [Rollcall Vote No. 378 Leg.]

                                YEAS--56

     Akaka
     Alexander
     Barrasso
     Baucus
     Bayh
     Bennett
     Bond
     Boxer
     Brownback
     Bunning
     Burr
     Burris
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Cochran
     Cornyn
     Crapo
     Dodd
     Durbin
     Ensign
     Enzi
     Gillibrand
     Hagan
     Hutchison
     Inhofe
     Isakson
     Johnson
     Kaufman
     Kerry
     Kirk
     Landrieu
     Lautenberg
     LeMieux
     Lieberman
     Lincoln
     Lugar
     Menendez
     Mikulski
     Murkowski
     Murray
     Nelson (NE)
     Reed
     Reid
     Risch
     Roberts
     Rockefeller
     Schumer
     Shelby
     Specter
     Tester
     Udall (CO)
     Voinovich
     Warner

                                NAYS--43

     Begich
     Bennet
     Bingaman
     Brown
     Coburn
     Collins
     Conrad
     Corker
     DeMint
     Dorgan
     Feingold
     Feinstein
     Franken
     Graham
     Grassley
     Gregg
     Harkin
     Hatch
     Inouye
     Johanns
     Klobuchar
     Kohl
     Kyl
     Leahy
     Levin
     McCain
     McCaskill
     McConnell
     Merkley
     Nelson (FL)
     Pryor
     Sanders
     Sessions
     Shaheen
     Snowe
     Stabenow
     Thune
     Udall (NM)
     Vitter
     Webb
     Whitehouse
     Wicker
     Wyden

                             NOT VOTING--1

       
     Byrd
       
  The PRESIDING OFFICER. On this vote the yeas are 56, the nays are 43. 
Under the previous order requiring 60 votes for the adoption of this 
amendment, the amendment is withdrawn.
  The Senator from Texas.


                            Motion to Commit

  Mrs. HUTCHISON. Mr. President I have a motion at the desk, and I ask 
that it be brought forward.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Texas [Mrs. Hutchison] moves to commit the 
     bill H.R. 3590 to the Committee on Finance with 
     instructions to report the same back to the Senate with 
     changes to align the effective dates of all taxes, fees, 
     and tax increases levied by such bill so that no such tax, 
     fee, or increase take effect until such time as the major 
     insurance coverage provisions of the bill, including the 
     insurance exchanges, have begun. The Committee is further 
     instructed to maintain the deficit neutrality of the bill 
     over the 10-year budget window.

  Mrs. HUTCHISON. Mr. President, this is a motion that Senator Thune 
and I are putting forward. It is a very simple motion. A lot of people 
don't realize that the taxes in the bill we are discussing actually 
start in about 3 weeks. They start in January of 2010. The effect of 
the bill, whatever the proposals are going to be in the bill, whatever 
programs are available, will not come into play until 2014. The taxes 
will start this next year, and they will be paid for 4 years before any 
of the programs the bill is supposed to put forward will be there. The 
motion Senator Thune and I put forward merely says that taxes start 
being collected when the bill is implemented. So whatever programs are 
being offered to the people, whatever insurance programs, whatever 
kinds of benefits there might be in the bill would start at the same 
time as the taxes start. So you are not going to be paying taxes before 
you have any options that you would be able to take in this bill.
  It is simple. It is clear. We believe that if you pay taxes for 4 
years before you see any of the programs in this bill, the American 
people can't be sure there will ever be a program, because there will 
be intervening Congresses and intervening Presidential elections that 
will occur before this bill is designed to start in 2014. We have 
congressional elections in 2010. We have a Presidential election plus 
congressional elections in 2012. And 2 years following that, 2014, is 
when this bill will be implemented.
  I hope everyone will look at this motion and support the amendment we 
are putting forward. It is a motion to commit the bill to fix this 
issue, that America should not be looking at higher drug prices, higher 
medical device prices, and higher costs of insurance, all of which are 
the first taxes that will take effect.
  Let's walk through it. Starting next year in January, 3 weeks from 
today, there will be $22 billion in taxes on prescription drug 
manufacturers that will start. The price of prescription drugs, 
aspirin, anything that people take will go up because the drug 
manufacturers are going to start paying a tax. There is $19 billion in 
taxes on medical device manufacturers. So medical devices we use, 
hearing aids, things we use to treat ailments will be taxed to the tune 
of $19 billion next January. There is $60 billion on insurance 
companies starting next month. That is about $100 billion in taxes that 
start in about 3 weeks. So the insurance companies have probably 
already priced in the negotiations that they are having now with people 
about their insurance premiums. I am sure they realize that they are 
going to have to be locked in for a year or two or three and, 
therefore, these rises in insurance premiums are probably part of this 
bill we are dealing with right now. And $60 billion will be passed on 
to every person who has health care coverage right now.
  Here we are, health care reform that is supposed to bring down the 
price of health care so that more people can afford it. And what is the 
first thing we do? It is not to offer a plan. It is not to offer any 
kind of program that would help people who are struggling right now 
because they don't have insurance. It is certainly not going to help 
people struggling to pay their prescription drug prices. We are going 
to raise the price by taxing the manufacturers of drugs, of medical 
devices, and the companies that are giving insurance today.
  It is time that we talk about the high taxes in this bill. What we 
are going to talk about in the Hutchison-Thune proposal, the motion to 
commit, is to say at the very least, the least we can do is not ask 
people to pay taxes for 4 years when you are going to have three 
intervening congressional elections before this bill takes effect. 
Things could change mightily. All these taxes that are going to go into 
place might never bring forward the proposals that are in the 
underlying bill.
  In 2013, 1 year before the bill is to take effect, the taxes on high 
benefit plans go into effect. What is a high benefit plan? A high 
benefit plan is one that is a good plan. Many unions have these, and 
many people who work for

[[Page S13240]]

big corporations have everything paid for. They have all of the 
employer regular, in the order that most companies do, payments, but 
they also allow in these plans to have most of the deductibles also 
paid for. They are very good plans. This bill will excise for those 
plans $149 billion, cut it right out and have an excise tax on those 
good plans, $149 billion. That starts in 2013. That is 1 year before 
the bill takes effect.

  In 2013, 1 year before there is any new plan put forward, those who 
have very good coverage--whether it be someone who works for a big 
company or whether it is a union member--will start getting a 40-
percent tax on that benefit. So all of the things that have been 
negotiated are going to have a big 40-percent tax. That starts in 2013.
  In addition, in 2013, 1 year before the bill takes effect, there is a 
limitation put on itemized deductions for medical expenses. Today, if 
you spend more than 7.5 percent of your income on medical expenses, you 
get to deduct everything over that. So if you have a catastrophic 
accident or you have a very expensive disease to treat or you are in a 
clinical trial--something that is expensive--if you go above 7.5 
percent of your income, you can deduct that. In 2013, under the bill 
that is before us, you would have to spend 10 percent of your income 
before you could deduct those expenses. That is another $15 billion 
that will be collected in taxes that are not collected today.
  The new Medicare payroll tax, which impacts individuals who earn over 
$200,000 or couples who earn $125,000 each, would take effect in 2013. 
That is $54 billion in taxes.
  These are all the taxes that take effect before the bill does, before 
there is any plan offered. You would have the tax that starts next 
month on insurance companies, pharmaceutical companies, and medical 
device companies. Then, in 2013, you would have a tax on high-benefit 
plans, a 40-percent tax on that plan. Then, in 2013, the itemized 
deductions will not be allowed until you have paid 10 percent of your 
salary in medical expenses. Then there is the Medicare payroll tax, 
which is going to impact individuals. All of this is before there is a 
program in place.
  In 2014, when the bill does come forward so there are plans to be 
offered to people, then you start the mandates on employers and the 
taxes if people are not covered. So you have $28 billion in taxes on 
employers that start in 2014. These are the employers who cannot afford 
to give health care to their employees or they do not give the right 
kind of health care to their employees, so it is not the right 
percentage, and if it is not the right percentage, then the employer 
pays a fee of $750 to $3,000 per employee. That is their fine.
  Then there is the tax on individuals who do not have health 
insurance, and that is $750 per adult.
  My colleague from South Dakota and I will certainly want to spend 
more time talking about this and hope very much that our colleagues 
will also. I do not think this is what the American people thought they 
would be getting in health care reform. Of course, what we would hope 
the American people would get in health care reform would be lower cost 
options that do not require a big government plan. They would not 
require big taxes. They would not require big fees. If we had a 
lowering of the cost, by allowing small businesses to have bigger risk 
pools, that would not cost anything. It would allow bigger risk pools 
that would provide lower premiums and employers would be able to offer 
more to their employees.
  Most employers want to offer health care to their employees. It is 
just a matter of the expense. The bill we are debating now is going to 
put more expenses and burdens on employers, at the time when we are 
asking them to hire more people to get us out of this recession.
  Everywhere I go in Texas, when I am on an airplane, when I am in a 
store, a grocery store--I have not been able to do any Christmas 
shopping, I must admit, so I have not been in a department store, but 
nevertheless I do go to the grocery store--everyone who I am talking to 
is saying: I can't afford this. What are you all doing? And I am 
saying, of course: Well, we are trying to stop this because we agree 
with you that small businesspeople cannot afford this.
  I was a small businessperson. I know how hard it is because we do not 
have the margins of big business, and it is very hard to make ends meet 
when you have all the mandates and the taxes, and when you are trying 
to increase your business and hire people, which is what we want them 
to do. You cannot do it if you are burdened with more and more 
expenses, as this bill will do.
  What Senator Thune and I are doing is making a motion to commit this 
bill back with instructions, to come back with the changes that will 
assure that when the implementation of this bill starts, that will 
trigger whatever programs are in the bill at the same time as whatever 
taxes and fees are going to be in this bill.
  I would hope there would be fewer taxes and fees. But whatever your 
view is on that issue, it is a matter of simple fairness that you would 
not start the taxes before you start the implementation of the program. 
It would be like saying: I want to buy a house, and the realtor says: 
Well, fine, you can start paying for the house right now, and in 4 
years you will be able to move in. The house might be stricken by 
lightning. It might fall apart. It might blow up. It might have a fire. 
And that is exactly what could happen in this bill.
  This bill may not make it for 4 years, when people see what is in it. 
There will be elections, and I cannot imagine we would establish a 
policy of taxing people for 4 years, raising costs, leading down this 
path that will eventually go to a public plan that will end up doing 
what was originally introduced in the bill; and that is, to end up with 
one public plan. It will take a little longer the way the bill is being 
reconfigured, but it is going to end up in the same place, unless we 
can stop it by showing people that the mandates and the taxes are not 
good for our economy and they are not good for the health care system 
we know in this country.
  We have choices in this country. We have the ability to decide who 
our doctor is and what insurance coverage we want, whether we want a 
high deductible or a low deductible. That is not a choice that should 
be taxed. We should not have someone tell us what procedures we can 
have. We should have the option of deciding that for ourselves with our 
doctors. That is what we want in health care reform. But that is not 
what is in the bill before us.
  I hope we can discuss the Hutchison-Thune motion to commit. We are 
going to work to try to make sure everyone knows we want fairness in 
this bill and that people know what is in it. I hope we will get 
whatever the new version of the bill is very soon so we will have a 
chance to see if maybe there are some changes that are being made. But 
in the bill before us, the taxes start next month, and the bill is 
implemented in 2014. On its face, that is fundamentally unfair. I hope 
our motion is adopted so we can change it.
  Mr. President, I yield the floor.
  Mr. KOHL. Mr. President, today I would like to talk about health care 
costs. We began this endeavor to fix our broken health care system a 
year ago for two reasons: to move toward universal coverage, and to 
reduce the unacceptably high cost of health care that is threatening to 
ruin our country.
  It is vital that in our quest to cut costs, we do not leave money on 
the table that could be going back into the pockets of the American 
people. This process is not over and while we still have time, we need 
to more strongly address the rising costs of prescription drugs. The 
cost of brand-name drugs rose nine percent last year. That is an 
unprecedented, unacceptable hike. In contrast, the cost of generic 
drugs fell by nearly nine percent over the same time period.
  For years, we have tried to make it easier for Americans to have 
access to affordable drugs. We have worked to ease the backlog of 
generic drug applications at the FDA. We support comparative 
effectiveness studies and academic detailing to diminish the influence 
of brand-name drug manufacturers. And we must continue to break down 
the barriers to help generic drug companies get their products on the 
market.
  Therefore it is imperative that we pass legislation to fight the 
backroom deals between brand name drug companies and generic drug 
companies that keep generics off the market and out of reach for 
consumers. The Kohl-Grassley amendment to stop what we call

[[Page S13241]]

these ``reverse payments'' is based on a bill that was passed with 
bipartisan support by the Judiciary Committee last month, and I thank 
Senator Grassley for working together with me on it.
  Let me be clear about what these deals are: brandname drug companies 
pay generic drug companies--their competition to not sell their 
products. The brandname drug companies win because they get rid of the 
competition. Generic drug companies win because they get paid without 
having to manufacture a product. And consumers lose because they have 
been robbed of a competitive marketplace.
  How much do American consumers lose in these backroom deals? Thirty-
five billion dollars over 10 years, according to the Federal Trade 
Commission. And the Congressional Budget Office estimates these 
anticompetitive deals cost the Federal Government nearly $2 billion on 
top of that, because we end up paying more for branded drugs through 
Medicare and Medicaid. We cannot afford to leave this money on the 
table, and our bill--which we hope will be included in the final health 
reform legislation--will make sure we do not.
  We are pleased that the current bill includes a provision that 
Senator Grassley and I hope will slow the rising cost of drugs and 
medical devices. Our policy aims to make transparent the influence that 
industry gifts and payments to doctors may have on medical care. As we 
look to reform the health system, it is imperative that every dollar is 
spent wisely.
  In closing, I urge my colleagues to support my amendment to end these 
collusive drug company settlements and to find additional ways to 
reduce the cost of this bill. This proposal would save billions of 
dollars and reduce consumer costs by billions more. This is what we 
said we would do, and this is what we must do.
  Mr. JOHNSON. Mr. President, I rise today to recognize that the rising 
health care costs plaguing our health care system are 
disproportionately harming small business in South Dakota and across 
the Nation. Over the last decade, health care costs have been rising 
four times faster than wages, eating into the profits of small 
businesses and the pocketbooks of families. Many small businesses avoid 
hiring new employees because the cost of providing benefits is too 
great, and in some cases are forced to lay off employees or drop health 
care coverage entirely.
  A small business owner in northeastern South Dakota shared with me 
the impact of rising health care costs on his business. He cited a 
strong conviction and moral obligation to provide his employees and 
their families with benefits, including quality, affordable health 
insurance. Despite his best intentions, rising health care costs are 
threatening his ability to maintain those benefits.
  As the employees of this small business aged and used more of their 
health benefits, the insurance company steadily raised rates 10 to 20 
percent each year. When the rates were affordable the small business 
owner paid the full cost of premiums, but has since been forced to 
shift more and more of the costs onto his employees. If rates continue 
to rise, he is worried he will no longer be able to afford to offer any 
coverage.
  And he has concrete cause for concern. Current trends paint a bleak 
picture of future health care costs for all Americans, but they have 
particular implications for small businesses. In 2000, employer-
sponsored health insurance in the large group market for a family in 
South Dakota cost on average $6,760. In 2006, the same family health 
insurance plan cost $9,875. That is a 72-percent increase in 6 years 
and, unless action is taken to alter this unsustainable course, it is 
projected this same coverage will cost $16,971 in 2016. Because they 
lack bargaining leverage, small businesses pay on average 18 percent 
more than larger businesses for the same health insurance. Despite 
their best intentions to provide quality, affordable benefits to their 
employees, the unsustainable trends in our current health care system 
have already forced many small businesses to make tough decisions.
  The Senate health care reform bill addresses the main challenges 
facing small businesses--affordability and choice. The Patient 
Protection and Affordable Care Act will increase quality, affordable 
options in the small group market. The Small Business Health Options 
Program, SHOP, Exchange will give small businesses the buying power 
they need to get better deals and reduce administrative burdens. And 
small businesses providing health insurance to their employees will be 
eligible for a tax credit to improve affordability. The bill will also 
end the discriminatory insurance industry practices in the small group 
market of jacking up premiums by up to 200 percent because an employee 
gets sick or older, or because the business hired a woman.
  The Senate health reform bill will give a new measure of security to 
those with health insurance and extend this security to more than 30 
million Americans who are currently uninsured. It will lower premiums, 
protect jobs and benefits, and help small businesses grow.
  Mr. GRASSLEY. Mr. President, yesterday afternoon, a few of my friends 
on the other side made some assertions about congressional history, 
fiscal policy, and the role of bipartisan tax relief for the period of 
2001-2006. The speakers were the distinguished junior Senators from 
Vermont, Ohio, and Minnesota. They are all passionate Members. They are 
articulate voices of the progressive, as they term it, or very liberal 
wing, as those of us on this side term it, portion of the Senate 
Democratic Caucus.
  I respect the passion they bring to their views. But, as one of them 
has said frequently in his early months of Senate service, we are 
entitled to our opinions, but not entitled to our own facts. I couldn't 
agree more with that notion. In order to insure an intellectually 
honest standard of debate, both sides need to correct the record when 
they feel the other side has misstated the facts. It is in that spirit 
that I respond today.
  I won't take this time to debate the merits of the surtax that they 
propose as a substitute revenue raiser in this bill. That can wait till 
we debate their amendment. I am going to focus on their assertions 
about recent fiscal history and the role of bipartisan tax relief.
  Before I address the revisionist fiscal history we heard, I would 
like to set the record straight on congressional history.
  It was said yesterday afternoon that there were 8 years of a George 
W. Bush administration and Republican Congress. If the Members making 
these assertions would go back and check the records of the Senate, 
they would find that during that 8-year period Republicans controlled 
the Senate when it was evenly divided for a little over 5 months. For 
almost half the month of January 2001, Democrats held the majority 
because outgoing Vice President Gore broke ties. For the balance of the 
period from January 20, 2001, through June 6, 2001, the Senate was 
evenly divided, but Republicans held because of Vice President Cheney's 
tie breaking vote.
  On June 6, 2001, the Democrats regained the majority when Senator 
Jeffords, previously a Republican, began caucusing with Senate 
Democrats. For the balance of 2001, 2002, and in early 2003, Democrats 
held the majority.
  For two Congresses, half of President Bush's term, Republicans held a 
majority. For the last 2 years of the George W. Bush Presidency, 
Democrats controlled both Houses of Congress.
  When you add it up, with the exception of a little over 4 months when 
the Senate was equally divided, Democrats controlled the Senate for 
about half the period of the George W. Bush administration.
  When you hear some of our friends on the other side debate recent 
fiscal history, these basic facts regarding political power and 
accountability are obscured. Perhaps it is their opinion that Democrats 
were not exercising majority power during that period, but the fact is 
that Democrats controlled the Senate for almost half the period of the 
George W. bush administration.
  Now let's turn to the fiscal history assertions from my friends on 
the other side. The revisionist history basically boils down to two 
conclusions:
  1. That all of the bipartisan tax relief enacted during that period 
was skewed to the top 1 percent or top two-tenths of 1 percent of 
taxpayers; and
  2. That all of the ``bad'' fiscal history of this decade to date is 
attributable to the bipartisan tax relief plans.

[[Page S13242]]

  Not surprisingly, nearly all of the revisionists who spoke generally 
oppose tax relief and support tax increases. The same crew generally 
support spending increases and oppose spending cuts.
  On the first point, two of the three speakers from the other side 
voted for the conference report for fiscal year 2010 budget resolution. 
The third speaker was not a Member of this body at that time the 
conference report was adopted. I am not aware, however, of his 
opposition to that budget which was drawn up by the Senate Democratic 
Caucus.
  That budget was similar to President Obama's first budget. A core 
portion of that budget, much ballyhooed by the Democratic leadership, 
was an extension of the major portion of the bipartisan tax relief 
enacted during the period of 2001-2006. As a matter of fact, roughly 80 
percent of the revenue loss from that legislation, much criticized by 
the three speakers yesterday afternoon, is contained in the budget that 
two of them voted for. Eighty percent is usually a pretty fair 
endorsement of any policy. Again, I have not heard the third speaker, 
the junior Senator from Minnesota, indicate that he doesn't support the 
tax relief included in the Democratic budget. Perhaps I missed 
something. In addition, the three speakers need to pay attention to 
analyses from the nonpartisan Joint Committee on Taxation.
  If they did examine those analyses, they would find that, in terms of 
the burden of taxation, the 2001 legislation redistributed the burden 
from lower income taxpayers to higher income taxpayers.
  Now, I turn to the second fiscal revisionist history point. That 
point is that all of the ``bad'' fiscal history of this decade to date 
is attributable to the bipartisan tax relief plans.
  In the debate so far, many on this side have pointed out some key, 
undeniable facts. We agree with the President on one key fact. The 
President inherited a big deficit and a lot of debt.
  The antirecessionary spending, together with lower tax receipts, and 
the TARP activities has set a fiscal table of a deficit of $1.2 
trillion. That was on the President's desk when he took over the Oval 
Office on January 20, 2009. That is the highest deficit, as a 
percentage of the economy, in Post World War II history.
  Not a pretty fiscal picture. And, as predicted several months ago, 
that fiscal picture got a lot uglier with the $787 billion stimulus 
bill. So for the folks who saw that bill as an opportunity to 
``recover'' America with government taking a larger share of the 
economy over the long term, I say congratulations.
  For those who voted for the stimulus bill, including two of the three 
speakers to which I refer, they put us on the path to a bigger role for 
the government. Over a trillion dollars of new deficit spending was 
hidden in that bill. The Congressional Budget Office concluded that the 
permanent fiscal impact of that bill totaled over $2.5 trillion over 10 
years. It caused some of the extra red ink. Supporters of that bill 
need to own up to the fiscal course they charted.
  Now, to be sure, after the other side pushed through the stimulus 
bill and the second half of the $700 billion of TARP money, CBO 
reestimated the baseline. A portion of this new red ink, upfront, is 
due to that reestimate.
  The bottom line, however, is that reestimate occurred several weeks 
after the President and robust Democratic majorities took over the 
government. Decisions were made and the fiscal consequences followed.
  Some on the other side who raises this point about the March CBO 
reestimate. That is fine. But, if they were to be consistent and 
intellectually honest, then they would have to acknowledge the CBO 
reestimate that occurred in 2001 after President Bush took office. The 
surplus went south because of economic conditions. The $5.6 trillion 
number so often quoted by those on the other side was illusory.
  The three members should go back and take a look at what CBO said at 
the time. According to CBO, for the first relevant fiscal year, the tax 
cut represented barely 14 percent of the total change in the budget. 
For instance, for the same period, increased appropriations outranked 
the tax cut by $6 billion. So, spending above baseline, together with 
lower projected revenues, accounted for 86 percent of the change in the 
budget picture. Let me repeat that. Bipartisan tax relief was a 
minimal, 14-percent factor, in the change in the budget situation.
  Over the long term, the tax cut was projected to account for 45 
percent of the change in the budget picture. Stated another way, the 
10-year surplus declined from $5.6 trillion to $1.6 trillion. Of that 
$4.0 trillion change, the tax cut represented about $1.7 trillion of 
the decline.
  Let's take a look at the fiscal history before the financial meltdown 
hit. That conclusion is, again, in this decade, all fiscal problems are 
attributable to the widespread tax relief enacted in 2001, 2003, 2004, 
and 2006.
  In 2001, President Bush came into office. He inherited an economy 
that was careening downhill. Investment started to go flat in 2000. The 
tech-fueled stock market bubble was bursting. Then came the economic 
shocks of the 9/11 terrorist attacks.
  Add in the corporate scandals to that economic environment. And it is 
true, as fiscal year 2001 came to close, the projected surplus turned 
to a deficit. I referred to the net effects of some of these unforeseen 
events on the projected $5.6 trillion surplus.
  Now, yesterday afternoon's three speakers may so oppose bipartisan 
tax relief that they want to attribute all fiscal problems to the tax 
relief. The official scorekeepers show the facts to be different.
  Those on this side of the aisle have a different view than the 
revisionists. In just the right time, the 2001 tax relief plan started 
to kick in. The fiscal facts show as the tax relief hits its full force 
in 2003, the deficits grew smaller. They grew smaller in amount. They 
grew smaller as a percentage of the economy. This pattern continued up 
through 2007.
  If my comments were meant to be partisan shots, I could say this 
favorable fiscal path from 2003 to 2007 was the only period, aside from 
6 months in 2001, where Republicans controlled the White House and the 
Congress.
  But, unlike the fiscal history revisionists, I am not trying to make 
any partisan points. I am just trying to get to the fiscal facts.
  So, let's get the fiscal history right.
  In this decade, deficits went down after the tax relief plans were 
put in full effect. Deficits did start to trend back up after the 
financial meltdown hit. I doubt the fiscal history revisionists who 
spoke yesterday would say that bipartisan tax relief was the cause of 
the financial meltdown. So, aside from that unrelated bad macroeconomic 
development, the trend line showed revenues on the way back up.
  But that is the past. We need to make sure we understand it. But what 
is most important is the future. People in our States send us here to 
deal with future policy. This budget debate should not be about 
Democrats flogging Republicans and vice-versa. The people don't send us 
here to flog one another, like partisan cartoon cut-out characters, 
over past policies. They don't send us here to endlessly point fingers 
of blame. Now, let's focus on the fiscal consequences of the budget 
that is before the Senate.
  President Obama rightly focused us on the future with his eloquence 
during the campaign. I'd like to take a quote from the President's 
nomination acceptance speech:

       We need a President who can face the threats of the future, 
     not grasping at the ideas of the past.

  President Obama was right.
  We need a President, and I would add Congressmen and Senators, who 
can face the threats of the future. The legislation before us, as 
currently written, poses considerable threats to our fiscal future. It 
is too important to dodge. It is a bill that restructures one-sixth of 
the economy. It affects all of us and, more importantly, all of our 
constituents.
  Grasping at ideas of the past or playing the partisan blame game will 
not deal with the threats to our fiscal future. Let's face the honest 
fiscal facts. Let's not revise fiscal history as we start this critical 
debate about the fiscal choices ahead of us. The people who send us 
here have a right to expect nothing less of us.

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