[Congressional Record Volume 155, Number 196 (Sunday, December 20, 2009)]
[Senate]
[Pages S13558-S13628]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009

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

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

  Pending:

       Reid amendment No. 2786, in the nature of a substitute.
       Reid amendment No. 3276 (to amendment No. 2786), of a 
     perfecting nature.
       Reid amendment No. 3277 (to amendment No. 3276), to change 
     the enactment date.
       Reid amendment No. 3278 (to the language proposed to be 
     stricken by amendment No. 2786), to change the enactment 
     date.
       Reid amendment No. 3279 (to amendment No. 3278), to change 
     the enactment date.
       Reid motion to commit the bill to the Committee on Finance, 
     with instructions to report back forthwith, with Reid 
     amendment No. 3280, to change the enactment date.
       Reid amendment No. 3281 (to the instructions (amendment No. 
     3280) of the motion to commit), to change the enactment date.
       Reid amendment No. 3282 (to amendment No. 3281), to change 
     the enactment date.

  The ACTING PRESIDENT pro tempore. Under the previous order, the time 
until 1:30 p.m. shall be equally divided and controlled between the two 
leaders or their designees.
  The Senator from Illinois.
  Mr. DURBIN. Madam President, I thank the majority leader for 
designating that I should control half the time between now and 1:30.
  I would like to, first, thank all the people who are here, the staff 
and the pages. This has been a tough session for many but tougher for 
many of them than some Members of the Senate because many times they 
have had to wait until the very last Senator of either political party 
has finished for the day before they go home. I was reflecting on that 
yesterday afternoon in the midst of one of the toughest, historic 
snowstorms in Washington, DC; that hundreds of staff people were 
waiting at their post, doing their jobs on a Saturday, in the middle of 
a snowstorm, when virtually every business around Washington was 
closing down. I wish to thank them and the pages on both sides of the 
aisle for their patience and commitment to this great country and this 
great institution.
  Why are we here on Sunday? Why were we here on Saturday? Why are we 
going to take a vote at 1 in the morning on Monday? Good questions, and 
I am not sure there are satisfying answers. But there are answers. We 
are here because we are trying to finish health care reform. It has 
been a project that has been underway for almost a year now, since the 
President challenged us to do something, and a lot of effort has been 
expended on both sides of the aisle. But I will say I can speak for our 
side of the aisle.
  Senator Max Baucus came to me more than a year ago and sat down in my 
office to talk about health care reform. He was preparing for this 
battle as chairman of the Senate Finance Committee and knew he would 
play a central role, gathering the opinions of members of his committee 
and Members of the Senate.
  Efforts were underway with Senator Kennedy from his remote location 
in Massachusetts, recuperating from surgery and from cancer therapy, 
trying to keep his committee on track toward health care reform. He 
turned over that mantle to Senator Christopher Dodd of Connecticut, who 
did an admirable job with the Senate Health, Education, Labor, and 
Pensions Committee.
  They prepared for and had hearings. They entertained hundreds of 
amendments. In fact, I believe there were over 160 amendments that were 
proposed by the Republicans, and many of them were adopted in the HELP 
Committee.

  Senator Coburn of Oklahoma filed 212 amendments during the HELP 
Committee markup. He offered 38 amendments to the bill. Nineteen of his 
amendments--half of them--were agreed to. Of those that were offered, 
15 were not agreed to--all by rollcall vote. So 13 amendments offered 
by the Senator from Oklahoma were included in the bill that is before 
us today.
  He has questioned whether the current procedure gives him an 
opportunity to offer amendments. The fact is, we are now on our 21st 
day of considering health care reform. Exactly 4 amendments have been 
offered by the Republican side of the aisle, 4 substantive amendments 
to change provisions in this bill of 2,000 pages--in 21 days, 4 
amendments. They offered six motions to stop the debate, send the bill 
back to committee. They were generic motions. They did not ask for 
specific changes. They just take on an issue in the bill and say: Send 
it back to the committee and tell them to solve this problem and then 
bring it back to the floor at a later time. Well, that is kind of a 
procedural and, if I might say, political statement more than a 
substantive statement about a provision in the bill.
  So exactly four amendments have been offered by the Republican side 
of the aisle that deal with substance. Some of their efforts have been 
in protection of the health insurance industry, particularly a program 
called Medicare Advantage, which was created by private health 
insurance companies to prove to government they could provide Medicare 
more cheaply.
  Some did but most did not, and now we are paying up to $17 billion a 
year subsidizing private health insurance companies that told us at the 
start: We will save you money. It turns out they are costing us money--
a lot of money--and many of us think it is wasteful. We would rather 
have that money spent on basic Medicare, making certain there is 
solvency in Medicare and a good, strong future.
  So when you look at the state of the situation, we are now on a 
cloture motion to bring a close to the debate on health care reform, 
after almost 3

[[Page S13559]]

weeks and four Republican amendments--only four were offered. There 
never was a Republican substitute, no Republican proposal for health 
care reform. We have been told this might exist. We have never seen it. 
Of the four amendments they offered, not one was this substitute that 
was going to deal with the health care system. It is a promise that has 
not been kept. They kept saying: It is coming. Pretty soon we are just 
going to put this thing right in the Record. Well, it never happened. 
In 3 weeks, it never happened.
  It is hard work to prepare a substitute. The reason this took so long 
and has dragged on for so long is we had to take every page of this and 
turn it over to the Congressional Budget Office. They sit there with 
their economists, pore over it and say: Well, is it going to add to the 
deficit or reduce the deficit? Is it going to reduce health care costs? 
What is the impact? It takes them some time to do that. The Republicans 
know if they are going to have a substitute, it will have to go through 
the same rigorous appraisal, and they have not done that, I think 
because it is hard. In fact, from their political point of view, it 
might be impossible to try to solve the problems facing health care in 
America without taking the path we have taken.
  What does this bill do? The basics are obvious. First,--and this is 
all backed up by the Congressional Budget Office--it will reduce the 
cost of health care. It will make it more affordable. A health care 
policy for a family of four offered by an employer, on average, cost 
$6,000 10 years ago. Today, it costs $12,000 a year. It has doubled in 
10 years, and in 8 years it will double again to $24,000. We have to 
slow this down or it will reach a point where more and more people will 
be uninsured, fewer businesses will offer health insurance, and more 
individuals will find themselves unable to afford the basic protections 
they need for themselves and their families.
  So the Congressional Budget Office tells us we reduce the growth in 
the cost of health care, and that is a good thing. They came through 
with a dramatic revelation yesterday when they said this bill will 
reduce our deficit as well. If the cost of health care goes down, the 
cost of health care programs offered by government goes down. They tell 
us in 10 years we will save $130 billion from the deficit. That is a 
dramatic savings--the largest in history. But then the news got better. 
They said, in the second 10 years, instead of saving $650 billion from 
our debt and deficit, it could reach double that amount: $1.3 trillion 
in savings in the second 10 years.
  I would say to those who give speeches day after day about our 
deficit, I invite you--in fact, I challenge you to come up with a bill 
that does this, that gives us actual savings of $130 billion in 10 
years and $1.3 trillion in the next 10 years. It is hard to do. It may 
be impossible for some to come up with such a bill.
  This bill also will extend the coverage of health insurance so 94 
percent of Americans will have coverage. Madam President, 30 million 
Americans today who have no health insurance will have health insurance 
under this bill. Half of them are poor enough that they will receive 
Medicaid; the other half will qualify for the insurance exchanges and 
other tax credits to help them pay their premiums so they can have and 
afford health insurance.
  Ninety-four percent of Americans--we have never, ever achieved a 
level of insured Americans that reached that number. Thirty million 
Americans will be receiving health insurance at the end of the day.
  This bill will start giving consumers across America protections they 
need against abuses from health insurance companies. One of the things 
near and dear to my heart about this amendment, which has been 
criticized by some, is this amendment, which was offered yesterday, has 
been on the Internet, for those who are interested to read it, for 24 
hours, and will continue to be available.
  This amendment says that as soon as this is signed, health insurance 
companies across America cannot deny coverage to children, those under 
the age of 18, because of a preexisting condition. That means if your 
son or daughter is diagnosed with diabetes, juvenile diabetes, and you 
find it difficult to get health insurance today because of that 
preexisting condition, they will no longer be able to discriminate 
against your child and your family because of this bill. That is one 
thing. There are many others.
  This whole notion of health insurance companies waiting until you get 
sick and cut you off when you need them the most, that comes to an end, 
under this amendment, in 6 months. So over and over again, we give 
consumers across America a chance to have the coverage they paid for 
when they need it the most. We used to call it the Patients' Bill of 
Rights, and it used to be bipartisan. It was Senator Kennedy and 
Senator McCain who brought it to us, and it failed because the health 
insurance companies were so politically powerful. But we have got them 
this time. If we can pass this bill, we finally have the protections 
the American people so desperately need.
  There are other provisions in the bill. Right from the beginning, we 
provide more help to small businesses. These are businesses with 50, 25 
employees and an average payroll of $50,000 an employee to $25,000 an 
employee or less. For each of those businesses, we say: We are going to 
help you buy health insurance for the owners of the business as well as 
for the employees. Those are the folks who are struggling and losing 
coverage, people such as the realtors in your hometown. Did you know 
one out of four realtors in America has no health insurance. I did not 
know it until they came to see me. Well, this gives them a hand. It 
gives them a tax break as a small business to provide health insurance 
for their people.
  I am going to reserve the remainder of my time. I will tell you, we 
are here today. We are burning the hours off the clock to vote at 1 
a.m. in the morning. It would be more humane to the people who work 
here, to the Members of the Senate and their families, for us to reach 
a gentlemanly and gentlewomanly agreement that we will have this vote 
at a more reasonable time. If we have the 60 votes, which I think we 
have the commitments for, then we can decide how to move forward.

  We have had a long, arduous, and sometimes taxing debate leading to 
this moment. I think it is time for a vote. The sooner we can reach 
that vote, the sooner the American people will know that we will either 
succeed or fail in bringing stability and security when it comes to 
their health insurance, making that health insurance more affordable, 
extending the reach and protection of health insurance to record levels 
of Americans, making sure we have health insurance reform as part of 
this, and at the same time, at the very same time reducing our deficit.
  I reserve the remainder of our time.
  The ACTING PRESIDENT pro tempore. Who yields time?
  Mr. DURBIN. Madam President, how much time do I have remaining?
  The ACTING PRESIDENT pro tempore. There is 1 minute 50 seconds.
  Mr. DURBIN. Madam President, I wish to suggest the absence of a 
quorum and ask unanimous consent that the time under the quorum be 
allotted equally to both sides.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  The clerk will call the roll.
  The assistant bill clerk (Sara Schwartzman) proceeded to call the 
roll.
  Mr. CHAMBLISS. Madam President, I ask unanimous consent the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. CHAMBLISS. Is it correct, Madam President, the minority side has 
the hour from 1:30 to 2:30?
  The ACTING PRESIDENT pro tempore. That is correct. Under the previous 
order, the time until 11:30 p.m. shall be controlled in alternative 1-
hour blocks with the Republicans controlling the first hour.
  Mr. CHAMBLISS. I, then, Madam President, ask unanimous consent 
Senators Cornyn, Graham, Isakson, and myself be allowed to have a 
colloquy during this first hour, from 1:30 to 2:30.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. CHAMBLISS. Madam President, here we are on our 21st legislative 
day, less than 4 weeks, on the most major piece of health care 
legislation ever

[[Page S13560]]

proposed in the history of our great country. That is less than weeks 
that we have been on this bill that seeks to change the way health care 
is delivered in America and also seeks to change the way individuals 
have access both to health care itself as well as to insurance. During 
this period of time--and we are headed, I might say, too, toward 
passage of this bill in the Senate over the next couple of days.
  I do not remember, in my 15 years in the Congress, both in the House 
and in the Senate, any major piece of legislation such as this being 
debated and ultimately brought to a final vote within such a short 
period of time. I have been involved in farm bills that have been on 
the Senate floor for longer than this--any number of other pieces of 
legislation that we deal with on a regular basis that have been on the 
Senate floor for longer than that period of time.
  I heard the assistant majority leader a little earlier talking about 
the fact that we have had the opportunity to amend this bill. The fact 
is, the Republicans have been offered the opportunity to introduce 10 
amendments to this massive piece of legislation for debate on the 
floor. We have a number of other amendments that have been filed. The 
four of us here today have significant amendments that we filed that 
now we are not going to have the opportunity to call up. It is 
extremely unusual for such a massive change in American policy being 
debated and voted upon without not only bipartisan support but without 
bipartisan participation from the standpoint of giving us the 
opportunity to file amendments, to have those amendments debated and 
voted upon.
  The assistant majority leader also referenced amendments by Senator 
Coburn. I am not going to speak for him. He will be on the floor of the 
Senate later today to certainly speak well for himself. But the fact 
is, he and other Members of the HELP Committee offered any number of 
amendments, as well as Members of the Finance Committee offered any 
number of amendments, that were voted down in the HELP Committee and in 
the Finance Committee on a pure partisan vote.
  It was the opportunity for meaningful participation by Republicans, 
who have some pretty good ideas about health care, to participate in 
the development of this bill, and it simply did not happen.
  Let me say what Republicans are for. There have been comments on this 
floor that there has been no substitute bill offered. The fact is, 
Senator Burr and Senator Coburn, who will be on the floor a little bit 
later, have spent hours on the floor of this Senate talking about their 
proposed bill that is not going to see the light of day. It has never 
been allowed to come up in committee, and it is not going to be allowed 
to come up on the floor of the Senate because the majority leader has 
done what we call fill the tree. That is the Washington speak way of 
saying that all amendments are now cut off. There will be no more 
additional amendments debated and brought up for a vote. But that is 
just one of four separate plans that have been filed and laid on the 
table, not just for the last 72 hours but for the last several months. 
They have been available to look at online. There are any number of 
cosponsors to the bipartisan Wyden-Bennett bill. There is also the 
Gregg bill. There is the Coburn-Burr bill. There are any number of 
alternate proposals out there that the majority has simply decided: We 
do not think those bills are worth even debating on the Senate floor, 
so they have not allowed those bills to come up.
  But what are Republicans for? We have said this over and over. Let me 
just say, No. 1, we are for meaningful, affordable access to health 
insurance by every single American. We can do it in a way that does not 
raise taxes. We are for providing coverage for all Americans, including 
those who have had preexisting conditions. We can do it in a way that 
does not raise taxes.
  We are for trending down the cost curve; when it comes to health care 
reform, if we do not turn that cost curve downward, then we have failed 
the American people. Frankly, the independent Congressional Budget 
Office has said health care cost under the Reid proposal is going to 
not only continue to go up but it is likely--not only will it continue 
on its current curve, but it is going to go up and not down.
  The way you can ensure that cost curve turns down, just two 
Republican proposals that we think have an awful lot of merit but are 
not going to be considered and certainly are not going to be included--
are not included in the managers' amendment that has now been filed--
one of those is tort reform. Physicians all across the country have 
been crying for this for years. But, more so, health agencies and 
individuals who have to pay health care bills have been crying for this 
for years. We can do it in a way that will allow every aggrieved 
individual who is injured as a result of negligent health care being 
delivered to have their day in court. Yet we need to provide some means 
of the elimination of the frivolous lawsuits that go so much toward 
physicians having to call for tests that they might not otherwise need; 
and also to prevent the spiraling costs, on the delivery side, of 
health care because of the high cost of malpractice insurance as well 
as other measures.
  The other way we can trend that curve down is to provide preventive 
incentives to individuals across America to live healthier lives. There 
is example after example that we have talked about on the floor of the 
Senate--from health care providers, employers who have provided 
incentives in their program, their health insurance program, that have 
in fact lowered costs. We can do that. There are proposals to do that, 
but they are not included in the managers' package.
  Insurance reform--Republicans have been very strong about the fact 
that, as a part of overall health care reform, we need to reform the 
insurance industry, rein in some measures that have caused the cost of 
health insurance that is provided by employers to, again, not only 
level off but ultimately trend downward.
  How do we do that, and what ideas have been proposed? We have 
proposed the sale of insurance policies across State lines. There is a 
provision in the underlying bill that does that. I am very pleased to 
see that included.
  Another thing we can do is to allow for what is called associated 
health plans that Republicans have been promoting for years. Every time 
it has come up for a vote in this body, the Democrats have opposed 
allowing individuals across State lines to group together and spread 
the risk of health insurance coverage. It would go a long way toward 
reducing the cost of health insurance premiums. But, unfortunately, we 
have not been allowed to move forward with that proposal.

  Let me mention a couple of things, before I turn to my friend from 
Texas, with respect to the changes in the Reid amendment that was filed 
yesterday. Again, there have been a number of individuals who have come 
to the floor since that amendment was filed yesterday to talk about the 
fact that it is online, and as we look through it more and more we are 
finding more and more about it, that is true. But it certainly does not 
meet the test of giving us 72 hours before we vote on it.
  The number of pages in the bill now, the base bill plus the Reid 
amendment plus the Indian health bill, which is now included by 
reference, totals 2,733 pages. The gross Medicare cuts--and these are 
not slowing the growth of Medicare. These are direct Medicare cuts that 
are being used to finance the underlying health care bill--now totaling 
$470.70 billion. The gross tax increases in the Reid amendment now 
total $518.5 billion. CBO says the gross cost of the insurance coverage 
expansion is $23 billion higher under the Reid amendment than it was 
under the base bill. Federal revenues or Federal taxes increase by 
almost $26 billion under the managers' package.
  All told, the amendment reduces the deficit by $2 billion--going from 
$130 to $132 billion. But, boy, is that ever a figleaf. We are going to 
talk about the CLASS Act that provides for that increase in the 
deficit.
  The Federal cost curve, according to CBO, still goes up. I alluded to 
that a little bit earlier.
  There is a slight increase in additional coverage--but still under 
the Reid amendment there will be 23 million Americans left uninsured. 
That is not what we have heard from the other side of the aisle from 
day one about making sure that every single American was covered.

[[Page S13561]]

  Despite the fact the Democrats have said changes in the managers' 
package would improve the delivery system, CBO also says it is likely 
that the amendment would have little impact on premiums.
  As we move toward the cloture votes on this bill over the next couple 
of days, I think it is important for the American people to get some 
understanding of the fact that the deals that have been made, the deals 
that have been cut to get the Democrats to 60 votes on this bill do not 
do what has been said over and over by folks on the other side of the 
aisle.
  I would now like to ask my friend from Texas how it impacts Texas, 
the managers' amendment, as well as the underlying bill and other 
comments he has relative to the bill.
  The ACTING PRESIDENT pro tempore. The Senator from Texas is 
recognized.
  Mr. CORNYN. Madam President, I look forward to engaging with both the 
Senator from Georgia and the Senator from South Carolina, Mr. Graham. I 
have been in the Senate now for 7 years, which is not all that long 
compared to the length of service of a number of Senators. I was and 
have been proud to represent the 24 million citizens of the State of 
Texas here in the Senate and the seat that was first held by Sam 
Houston in 1846.
  Sometimes the Senate is referred to as the world's greatest 
deliberative body. I think that description is a description that 
inspires schoolchildren and lovers of this great democracy of ours to 
admire and respect this body. But I have to tell you, I think the 
world's greatest deliberative body might not apply to this particular 
piece of legislation. It might, rather, be called the world's biggest 
railroad because of the railroading of the legislation that was 
revealed here only yesterday by Senator Reid, cooked up behind closed 
doors with a variety of interest groups negotiating deals on the side, 
deals that are unknown.
  We know some of those pertain to hospitals, some to the 
pharmaceutical companies. Then I heard one of our other Senators from 
North Carolina yesterday say we should call this ``The Price Is Right'' 
because we know a number of Senators held out for various inducements, 
financial inducements, to encourage them to get to the 60 votes.
  So we do not know what kind of deals have been cut behind closed 
doors, what kind of deals individual Senators may have made. But the 
American people need to know what is in this legislation and how it 
will affect them.
  Unfortunately, notwithstanding the fact that the President of the 
United States said, You know what, when I am elected President, we are 
going to have negotiations around a big table and televise it on C-
SPAN, good luck. So much for that broken promise.
  We know other Senators who expressed the same concerns the Senator 
from Georgia did about having at least 72 hours by posting this on the 
Internet so the American people can read it and so we can consult with 
our constituents--the hospitals, the small businesses, the doctors--to 
say how does this affect you?
  We had eight Democratic Senators on October 6, 2009, who said they 
wanted the CBO scores and they wanted them posted 72 hours ahead of 
time before the first vote. So much for that. We know that is going to 
be thrown out the door as well.
  That demand, I suppose, was made more for public relations rather 
than any real desire to find out what is in the bill and share it with 
the American people because we know legislative language will be 
available only 40 hours before the first vote at 1 a.m. this morning, 
literally in the middle of the night. The Congressional Budget Office 
score is available only 37 hours before the first vote.
  What we are talking about is this legislation. The Senator from 
Georgia said 2,700 pages, I believe, when you consider all of the 
legislation we are going to be asked to vote on the first time on a 
cloture vote at 1 in the morning, about 12 hours from now. We have been 
feverishly reviewing this language to find out what is in it. Frankly, 
what we find out is that it makes things worse rather than better in a 
number of key respects.
  For example, we know that America spends near double what any other 
industrialized Nation does on health care. One of the stated goals, one 
which the Democrats and Republicans both agree on, is that this reform 
ought to control those costs rather than make it worse. I have an 
amendment, amendment No. 2806, designed to ensure that health care 
reform achieves the goal we all support.
  We know that private insurance premiums have more than doubled in the 
last 10 years for American families. The Congressional Budget Office 
estimates that taxpayer spending on government health programs will 
rise to 12 percent of our economy by 2050. That will be a debt of 
$322,000 for the unfunded liabilities of Medicare alone. This bill does 
not make things better. It makes things worse, according to the Obama 
administration Chief Actuary.
  I have an amendment which would apply the truth test to the Obama 
administration's own independent Actuary, based on the evidence the 
Reid bill would increase health care costs for the Nation, for American 
families, for American taxpayers. This amendment leaves it up to the 
Office of the Actuary of the Centers for Medicare and Medicaid 
Services. If that office finds the Reid bill does lower health costs as 
advertised, the bill would then proceed to go into effect. But if, in 
fact, it does not, then it will not.
  Advocates of the Reid health bill continue to promise it lowers 
health care costs, but this amendment will apply the truth test to the 
Obama administration's own independent Actuary.
  I see the distinguished majority whip on the floor. I am glad he is 
here because he may have something to say about this.
  I ask unanimous consent that the pending amendment be set aside and 
that I be allowed to call up amendment No. 2806.
  The ACTING PRESIDENT pro tempore. Is there objection?
  Mr. DURBIN. Reserving the right to object.
  The ACTING PRESIDENT pro tempore. The Senator from Illinois.
  Mr. DURBIN. Madam President, this is the 21st day of debate. There 
have been four substantive amendments offered by the Republican side. 
They have had ample opportunity to call for this----
  Mr. CORNYN. I call for the regular order.
  The ACTING PRESIDENT pro tempore. Regular order has been called for. 
Does the Senator object?
  Mr. DURBIN. I object.
  The ACTING PRESIDENT pro tempore. Objection has been heard.
  Mr. CORNYN. Madam President, I ask my colleagues to comment on some 
of the other broken promises. The President made a solemn pledge that 
he would sign a universal health care bill. This bill, as I understand 
it, still leaves 15 million people without insurance coverage. He says 
the costs will be cut by up to $2,500 a year. The reality is the 
average premiums would increase by $2,100.
  I ask perhaps our distinguished colleagues from South Carolina and 
Georgia to comment on the promises that the President has made with 
regard to transparency, the promises he has made with regard to 
premiums going down rather than up, the promises he has made with 
regard to Medicare--promises it appears this bill will not allow him to 
keep.
  Mr. GRAHAM. Everything the 2008 campaign was about has basically been 
discredited and discarded in this whole health care debate. I thought 
it was change we could believe in. I thought there was going to be a 
new way of doing business in Washington, and God knows there needs to 
be. I thought we were going to negotiate the health care bill on C-SPAN 
and everybody would have a seat at the table, including the drug 
companies. I thought we were going to allow reimportation of 
prescription drugs to allow American consumers to purchase drugs 
dramatically cheaper.
  Not only have we not had any negotiations on C-SPAN, you couldn't 
find the room where the negotiations were going on. The old way of 
doing business looks good compared to this process. There was a 
negotiation going on on the biggest proposal we will probably ever vote 
on, one-sixth of the economy, between two people: the Senate majority 
leader and the Senator from Nebraska.

[[Page S13562]]

  The second in command on the Democratic side told Senator McCain: I 
am just as in the dark as you are. We have gone to a promise of being 
on C-SPAN to everybody was in the dark. I don't know how that plays. I 
hope it plays poorly because at the end of the day, what we are doing 
here is absolutely unconscionable. When you thought it couldn't get any 
worse in Washington, when you thought your government had reached a low 
point, well, it has gotten worse. I will be talking about the 60th vote 
here soon, how they got that 60th vote. And if that is OK with the 
American people, which I do not believe it will be, if that is OK with 
our body, then our best days are behind us as a country.
  Mr. CORNYN. May I ask the Senator from South Carolina about this 
other promise? Does he recall the President saying in July of 2009, if 
you like what you have, you can keep it? Is the Senator aware of the 
fact that according to the Congressional Budget Office, between 8 and 9 
million people who would have been covered by employment-based plans 
under the current law would not have an offer of such coverage under 
this bill if passed, and seniors, because of the cuts to Medicare, 
particularly Medicare Advantage, will actually have their benefits cut? 
How do you reconcile those promises with what we see in this 
monstrosity of a bill?
  Mr. GRAHAM. They cannot be reconciled. I hope American seniors are 
paying attention. We are going to take $470 billion out of Medicare in 
the next decade and use that money to create new government programs. 
If you are senior citizens out there, the doctors and hospitals you go 
to--and it is hard to find Medicare doctors right now; a lot of doctors 
are reluctant to take Medicare patients because the reimbursement rates 
are so low. Rural hospitals are on their knees because the Medicare 
rates are so low. Take $470 billion out of the system and see what 
happens to the provider community.
  What does it mean to seniors? It means your chance of finding the 
doctor or hospital to take care of you as a Medicare patient is going 
down, not up. What does it mean to Medicare? It is due to go bankrupt 
by 2017. By taking money out of the system, not reforming Medicare, but 
using it as another purpose has accelerated the problems of Medicare. 
Not only has that promise been broken, we have done something no other 
Congress has ever done to Medicare--take money out of it and give it to 
somebody else. That is not right. We were within inches of expanding 
Medicare to people from 55 to 64 which would put the system at risk.
  My point is simply this. We started this debate as a way to reform 
health care, and a lot of us agree on many things. It wound up being 
what does the Democratic Party need to do to pass a bill. Nobody cares 
what is in this bill anymore. All the objections about the CLASS Act 
and about fiscal responsibility and about the public options being in 
or out have given way to get this thing done before Christmas.
  This is not about health care reform. It is about one political party 
feeling as though they have to pass a bill no matter what is in it. And 
that is sad.
  Mr. CORNYN. I wonder if my colleagues will comment. I have one last 
chart I want to share with them and anybody who might be watching on 
this Sunday afternoon shortly before Christmas.
  Every public opinion poll I have seen says the American people do not 
want us to pass this bill. So one has to wonder: All of us have to run 
for election in our States. Obviously, to win an election, you have to 
get a majority of voters. But 56 percent of U.S. voters in the country 
say they do not want this bill to pass. And yet this thing seems as 
though it is on an unstoppable path toward passage because 60 Senators, 
apparently defying the will of their constituents, seem determined to 
pass the bill.
  Can my colleagues explain to me what they think is going on here?
  Mr. CHAMBLISS. I think it is obvious it is pure arrogance on the part 
of the folks on the other side of the aisle. The American people do not 
want it, but they are saying Washington knows better than the people 
back home know. That is pretty clear.
  I know my colleague from Georgia is like me, when we go back home, we 
get stopped in the airport, in the grocery store, on the streets, all 
around different parts of Georgia. People are not happy about what is 
going on up here with respect to this bill. I wish to ask him about his 
comments with respect to where we are.
  Mr. ISAKSON. Like the Senators from Texas and South Carolina and my 
senior Senator from Georgia, we all represent the people who vote for 
us. And in reference to Senator Cornyn's question about popularity, 
about the way people feel about this legislation, I ask unanimous 
consent to have printed in the Record two letters--one from the Medical 
Association of Georgia and one from a consolidated group of medical 
associations representing 92,000 physicians.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  MAG in Group Representing 92,000 Doctors Opposing Senate Health Bill

       Atlanta.--The Medical Association of Georgia (MAG) is part 
     of a group of state and national specialty medical societies 
     that represents more than 92,000 practicing physicians from 
     across the U.S. that sent a letter to U.S. Senators today 
     urging them to oppose the ``Patient Protection and Affordable 
     Care Act'' (H.R. 3590) because it clears the way for 
     government-controlled medical care.
       MAG President Gary C. Richter, M.D., says, ``We believe 
     that this bill would create a staggering volume of new 
     federal regulatory requirements for medicine, that it isn't 
     sustainable from a budget standpoint, that a `public' or 
     `community' heath insurance option may lead to a single-payer 
     system, that the measure lacks meaningful tort reform and 
     actually discourages proven reforms like limiting attorney 
     fees and malpractice caps, and that the bill does not fix the 
     Medicare Sustainable Growth Rate, or SGR, formula.''
       In the letter, the physician groups ask Senate leaders to 
     ``draft a more targeted bill that will reform the country's 
     flawed system for financing health care, while preserving the 
     best health care in the world.'' The letter states, ``We are 
     therefore united in our resolve to achieve health system 
     reform that empowers patients and preserves the practice of 
     medicine--without creating a huge government bureaucracy.''
       The letter also highlights some of the bill's more 
     ``problematic provisions,'' stressing that it undermines the 
     patient-physician relationship. The correspondence points out 
     that the bill does not provide for the right to privately 
     contract--a ``touchstone of American freedom and liberty''--
     and it stresses that ``patients should have the right to 
     choose their doctor and enter into agreements for fees and 
     services without penalty.'' The letter urges lawmakers to 
     develop legislation that ``allows patients and physicians to 
     take a more direct role in their health care decisions,'' and 
     it points out that decisions surrounding medical care isn't 
     an appropriate role for the government or other third party 
     payers.
       Along with MAG, signatories include the Medical Association 
     of the State of Alabama, the Medical Society of Delaware, the 
     Medical Society of the District of Columbia, the Florida 
     Medical Association, the Kansas Medical Society, the 
     Louisiana State Medical Society, the Missouri State Medical 
     Association, the Nebraska Medical Association, the Medical 
     Society of New Jersey, the Medical Society of South Carolina, 
     the American Academy of Cosmetic Surgery, the American 
     Academy of Facial Plastic and Reconstructive Surgery, the 
     American Association of Neurological Surgeons, the American 
     Society of Breast Surgeons, the American Society of General 
     Surgeons, and the Congress of Neurological Surgeons. Three 
     past presidents of the American Medical Association--Donald 
     J. Palmisano, M.D., William G. Plested III, M.D., and Daniel 
     H. Johnson Jr., M.D.--also signed the letter.
                                  ____

                                                 December 7, 2009.
     Hon. Harry Reid,
     Majority Leader, U.S. Senate,
     Washington, DC.
       Dear Senator Reid: The undersigned state and national 
     specialty medical societies are writing you on behalf of more 
     than 92,000 physicians in opposition to passage of the 
     ``Patient Protection and Affordable Care Act'' (H.R. 3590) 
     and to urge you to draft a more targeted bill that will 
     reform the country's flawed system for financing healthcare, 
     while preserving the best healthcare in the world. While 
     continuance of the status quo is not acceptable, the shifting 
     to the federal government of so much control over medical 
     decisions is not justified. We are therefore united in our 
     resolve to achieve health system reform that empowers 
     patients and preserves the practice of medicine--without 
     creating a huge government bureaucracy.
       H.R. 3590 creates a number of problematic provisions, 
     including:
       The bill undermines the patient-physician relationship and 
     empowers the federal government with even greater authority. 
     Under the bill, (1) employers would be required to provide 
     health insurance or face financial penalties; (2) health 
     insurance packages with government prescribed benefits will 
     be mandatory; (3) doctors would be forced to participate in 
     the flawed Physician Quality Reporting Initiative (PQRI) or 
     face penalties for

[[Page S13563]]

     nonparticipation; and (4) physicians would have to comply 
     with extensive new reporting requirements related to quality 
     improvement, case management, care coordination, chronic 
     disease management, and use of health information technology.
       The bill is unsustainable from a financial standpoint. It 
     significantly expands Medicaid eligibility, shifting 
     healthcare costs to physicians who are paid below the cost of 
     delivering care and to the states that are already operating 
     under severe budget constraints. It also postpones the start 
     of subsidies for the uninsured long after the government 
     levies new user fees and new taxes to cover expanded coverage 
     and benefits. This ``back-loading'' of new spending makes the 
     long-term costs appear deceptively low.
       The government run community health insurance option 
     eventually will lead to a single-payer, government run 
     healthcare system. Despite the state opt-out provision, the 
     community health insurance option contains the same 
     liabilities (i.e. government-run healthcare) as the public 
     option that was passed by the House of Representatives. Such 
     a system will ultimately limit patient choice and put the 
     government between the doctor and the patient, interfering 
     with patient care decisions.
       Largely unchecked by Congress or the courts, the federal 
     government would have unprecedented authority to change the 
     Medicare program through the new Independent Medicare 
     Advisory Board and the new Center for Medicare & Medicaid 
     Innovation. Specifically, these entities could arbitrarily 
     reduce payments to physicians for valuable, life-saving care 
     for elderly patients, reducing treatment options in a 
     dramatic way.
       The bill is devoid of real medical liability reform 
     measures that reduce costs in proven demonstrable ways. 
     Instead, it contains a ``Sense of the Senate'' encouraging 
     states to develop and test alternatives to the current civil 
     litigation system as a way of addressing the medical 
     liability problem. Given the fact that costs remain a 
     significant concern, Congress should enact reasonable 
     measures to reduce costs. The Congressional Budget Office 
     (CBO) recently confirmed that enacting a comprehensive set of 
     tort reforms will save the federal government $54 billion 
     over 10 years. These savings could help offset increased 
     health insurance premiums (which, according to the CBO, are 
     expected to increase under the bill) or other costs of the 
     bill.
       The temporary one-year SGR ``patch'' to replace the 21.2 
     percent payment cut in 2010 with a 0.5 percent payment 
     increase fails to address the serious underlying problems 
     with the current Medicare physician payment system and 
     compounds the accumulated SGR debt, causing payment cuts of 
     nearly 25 percent in 2011. The CBO has confirmed that a 
     significant reduction in physicians' Medicare payments will 
     reduce beneficiaries' access to services.
       The excise tax on elective cosmetic medical procedures in 
     the bill will not produce the revenue projected. Experience 
     at the state level has demonstrated that this is a failed 
     policy. In addition, this provision is arbitrary, difficult 
     to administer, unfairly puts the physician in the role of tax 
     collector, and raises serious patient confidentiality issues. 
     Physicians strongly oppose the use of provider taxes or fees 
     of any kind to fund healthcare programs or to finance health 
     system reform.
       Our concerns about this legislation also extend to what is 
     not in the bill. The right to privately contract is a 
     touchstone of American freedom and liberty. Patients should 
     have the right to choose their doctor and enter into 
     agreements for the fees for those services without penalty. 
     Current Medicare patients are denied that right. By 
     guaranteeing all patients the right to privately contract 
     with their physicians, without penalty, patients will have 
     greater access to physicians and the government will have 
     budget certainty. Nothing in the Patient Protection and 
     Affordable Care Act addresses these fundamental tenets, which 
     we believe are essential components of real health system 
     reform.
       Senator Reid, we are at a critical moment in history. 
     America's physicians deliver the best medical care in the 
     world, yet the systems that have been developed to finance 
     the delivery of that care to patients have failed. With 
     congressional action upon us, we are at a crossroads. One 
     path accepts as ``necessary'' a substantial increase in 
     federal government control over how medical care is delivered 
     and financed. We believe the better path is one that allows 
     patients and physicians to take a more direct role in their 
     healthcare decisions. By encouraging patients to own their 
     health insurance policies and by allowing them to freely 
     exercise their right to privately contract with the physician 
     of their choice, healthcare decisions will be made by 
     patients and physicians and not by the government or other 
     third party payers.
       We urge you to slow down, take a step back, and change the 
     direction of current reform efforts so we get it right for 
     our patients and our profession. We have a prescription for 
     reform that will work for all Americans, and we are happy to 
     share these solutions with you to improve our nation's 
     healthcare system.
       Thank you for considering our views.
           Sincerely,
         Medical Association of the State of Alabama; Medical 
           Society of Delaware; Medical Society of the District of 
           Columbia; Florida Medical Association; Medical 
           Association of Georgia; Kansas Medical Society; 
           Louisiana State Medical Society; Missouri State Medical 
           Association; Nebraska Medical Association Medical 
           Society of New Jersey; South Carolina Medical 
           Association; American Academy of Cosmetic Surgery; 
           American Academy of Facial Plastic and Reconstructive 
           Surgery; American Association of Neurological Surgeons; 
           American Society of Breast Surgeons; American Society 
           of General Surgeons; Congress of Neurological Surgeons.
         Past Presidents of the American Medical Association: 
           Daniel H. Johnson, Jr., MD, AMA President 1996-1997; 
           Donald J. Palmisano, MD, JD, FACS, AMA President 2003-
           2004; William G. Plested III, MD, FACS, AMA President 
           2006-2007.

  Mr. ISAKSON. I want to tell my colleagues what these letters say. The 
first one is to me from Gary Richter, the president of the Medical 
Association of Georgia. He writes in great detail about the 
difficulties and problems they have with this legislation, beginning 
with the stonewall against tort reform by only putting in a 
demonstration project.
  The Senator from Texas is aware of what tort reform can do because 
his State has made a great improvement in medical malpractice costs 
because of tort reform, and we in Georgia have tried to experience the 
same type of thing.
  There are many other reasons in here as well. The interesting thing 
about the letter from the 92,000 physicians represented by their 
medical associations is they talk not only about what is in the bill 
but what is not in the bill. I want to read, if I may, one paragraph to 
demonstrate that point:

       Our concerns about this legislation also extend to what is 
     not in the bill. The right to privately contract is a 
     touchstone of American freedom and liberty. Patients should 
     have the right to choose their doctor and enter into 
     agreements for the fees for those services without penalty. 
     Current Medicare patients are denied that right. By 
     guaranteeing all patients the right to privately contract 
     with their physicians, without penalty, patients will have 
     greater access to physicians and the government will have 
     budget certainty. Nothing in the Patient Protection and 
     Affordable Care Act addresses these fundamental tenets, which 
     we believe are essential components of real health system 
     reform.

  That is a pretty strong statement from 92,000 American physicians 
about this particular piece of legislation.
  To follow up on the point made by the distinguished Senator from 
South Carolina, I have a vested interest. I just got my Medicare card. 
December 1 I became Medicare eligible. When you talk about cutting $470 
billion, it gets personal. It gets personal with all those other 
seniors.
  Think about this. Seniors in America have paid their entire lives, at 
least since 1966 when it was created, They have paid a tax and their 
employers have paid a payroll tax to go into a trust fund to pay for 
their health care after they are 65 years old.
  We are now basically saying, I say to the Senator from South 
Carolina, we are taking $470 billion of the tax money you have paid 
over years of work and we are going to put it in a plan to pay for 
somebody else's health care. That is basically what it does, and that 
is patently wrong.
  One other thing I want to mention that is critical to me. We are all 
professionals at what we do. We all argue from our point of view. I 
understand that and respect that. But something was said earlier today 
which draws me to have a flashback to make the point about how much we 
tried on this side to contribute to improvements in health care and 
better access for all.
  The very distinguished majority whip said he talked with realtors and 
that three in four realtors were uninsured and this would help. The 
reason they are uninsured is they are not able to form risk groups 
together associated and affiliated as a like practice. Because of the 
IRS Code, which this does not amend, a company's employer, who has 
independent contractors working for them, cannot by law provide them 
with medical insurance.
  In 2006 on the floor of the Senate, 57 Republicans and Democrats 
offered and voted for the associated health care bill or the small 
business access to health reform--57 out of 100. We needed 60 like this 
bill needs to get to cloture. That bill would have allowed associated 
professions to join together, compete for insurance nationwide, form

[[Page S13564]]

risk pools that are large enough to mediate and ameliorate high rates 
and have a more competitive rate.
  He was correct in his statement that three in four do not have health 
insurance. I was in that business. I know. The reason they do not is 
because they have to buy on the spot market because they cannot have a 
group plan. When they buy on the spot market, we are talking about 
$1,500, $1,800, $2,000 a month, which is unaffordable and 
unsustainable. But this bill does nothing to address that situation 
which is one of the largest holes in the uninsured problem.
  In fact, when you see the estimates, those who are still left 
uninsured, a great many of them are going to end up being just those 
kinds of people--- independent contractors that the tax laws prohibit 
from associating and affiliating with others. And I was proud to be 
part of that 57, along with the other three distinguished Senators on 
the floor and a number of Democrats.

  There have been lots of efforts made by people on both sides to get 
us better access and affordable health care. But, unfortunately, they 
have been blocked all over this philosophic argument of whether health 
care is going to be government provided or competitive in the private 
sector. Unfortunately, the ship of state is moving toward the 
government provision with this legislation, which is one of the reasons 
I oppose it.
  I turn it back to the distinguished senior Senator from Georgia.
  Mr. CHAMBLISS. I rise to pose a question to the Senator, and I would 
ask my colleagues to comment with respect to their States.
  The Senator served in the State legislature for many years, and is 
very familiar with our SCHIP program, which is called PeachCare, and he 
is also familiar with the rising Medicaid costs that we have seen in 
our State. What this bill does, in seeking to reach out, as I 
understand, is to expand the eligibility for Medicaid. We are all for 
Medicare, but this raises the eligibility level for Medicaid from 100 
percent of the poverty level to 150 percent of the poverty level. That 
will have a huge impact on every single State that is now going through 
very difficult financial times.
  We in Georgia have had a $3 billion shortfall this past year that had 
to be plugged. I saw the other day in the press where we have almost 
another $2 billion our legislature is going to have to deal with next 
month in reducing services around our State. Every State is having that 
same experience. Yet what this bill does is to put a mandate on States 
to increase the amount of money that States put into Medicaid. I know 
the Senator is very familiar with that, and I would ask him to comment.
  Mr. ISAKSON. I appreciate the Senator bringing it up. It is what is 
known in the trade as an unfunded mandate, but I will put some meat on 
that bone.
  This year the State of Georgia had a budget of about $17 billion, and 
the Medicaid portion--just the Medicaid portion in Georgia--was over $2 
billion. So it is approaching, or getting close to, 16, 17, or 18 
percent of the entire budget. If this bill passes raising the 
eligibility from 100 percent to 150 percent, then in 2017--which is the 
trigger date on this Medicaid provision--Georgia would go from $2.15 
billion to over $3\1/4\ billion in its share of Medicaid, and this at a 
time of declining revenues and greater pressure. That is a recipe for 
disaster.
  Our State, like 43 other States in the United States, can't borrow 
money. We have to have a balanced budget. If the Federal Government 
mandates that we spend $3 billion, we have to cut it out of someplace 
else in our State, such as education or our prisons or the park system 
or somewhere else.
  But it is ironic that Senator Chambliss asked me that question 
because this morning, as I was preparing to come over, I had the 
television on, and Arnold Schwarzenegger, Governor of California, was 
being interviewed. He endorsed this provision originally, but he raised 
the question that the provisions in this amendment will raise by $3 
billion the cost of Medicaid, just in the State of California--a State 
that had a $60 billion shortfall last year, and next year, he 
estimates, will have a $20 billion shortfall. If we continue in 
Washington to mandate funding and don't put our money behind it, we are 
pushing our States to the brink of bankruptcy, where a number of them 
already are. It is not fair to say we are covering more people when we 
are bankrupting our States. We are not covering anybody if we are 
pushing the cost off on someone else.
  So I appreciate the senior Senator from Georgia raising that point, 
and I associate myself with Governor Schwarzenegger and his remarks 
this morning about urging us not to force unfunded mandates on our 
States.
  The Senator from Texas.
  Mr. CORNYN. If I can respond to the senior and junior Senators from 
Georgia on this point, my State population is 24 million. Over a 10-
year period of time, this is a $20 billion unfunded mandate--$20 
billion. Of course, we know--or at least we read and hear from some in 
the press--that not all States are going to be treated the same. That 
was, in fact, an inducement on the part of some Senators to vote for 
the bill--to be one of the 60 votes--because they were either going to 
get a sweetener, in terms of being held harmless for at least a portion 
of that, or in the case of Nebraska, I guess all of it.
  That strikes me as fundamentally unfair, but it also demonstrates the 
flaw in the way this bill has been negotiated. In order to try to get 
to the 60 votes, there has basically been a pay-to-play sort of 
approach to this, and it is just repulsive to me, frankly. Certainly, a 
lot of my constituents would wonder: What kind of games are going on 
there?
  I know the Senator from South Carolina has some thoughts about that.
  Mr. GRAHAM. Well, this started out as a noble effort to reform health 
care because it needs reforming. The inflationary cost of the 
government is unsustainable. Medicare and Medicaid, as the Senators 
from Georgia indicated, are becoming huge problems that are 
unsustainable. Medicare is $36 trillion underfunded.
  Now, what does that mean? It means that over the next 75 years, there 
is a $36 trillion shortfall of money to pay the benefits that have been 
promised, and that has to be dealt with.
  What we are doing to Medicare makes the problem worse, not better. 
Medicaid is the largest expense in my State. It is a matching program. 
So listen to this--if you are out there on a Sunday with nothing else 
to do but listen to me. If you don't live in Nebraska, here is what is 
coming your way. Your State will be required to cover more people under 
Medicaid because the eligibility goes up to 133 percent above poverty, 
which is an increase over the current system. So throughout the Nation, 
there are going to be thousands more people enrolled in Medicaid, and 
every State, except one, is going to have to come up with matching 
money.
  I have 12 percent unemployment in South Carolina. My State is on its 
knees. I have a 31-percent African American population in South 
Carolina. Yet how did the majority get the 60th vote on this bill? It 
was the weekend before Christmas, and they were one vote short--here is 
what they did to get that one vote. They had a deal cooked up that no 
one knew about but the two people talking. There was no input from 
anybody other than the majority leader and the Senator from Nebraska. 
After that meeting was over, they came up with a 380-page amendment to 
a 2,000-page bill. They filed it yesterday, and we made them read it. 
We heard it for the first time yesterday. Then the majority leader 
filled up the tree so that there is no ability by any Republican or 
Democrat to amend their work product.
  This is a transparent new way of doing business: you cook up a deal 
in a back room--that is essentially sleazy, in my view--to allow one 
State, in order to get that vote, be held harmless for Medicare 
enrollees, and the rest of us have to go home and hear our constituents 
say: Why can't you in South Carolina and Georgia get that deal? What 
kind of Senator are you?
  Well, I will tell you; this is the kind of Senators we are. We are 
not going to do that. We are not going to put the whole Nation at risk 
and take a broken system and make it worse just to get a vote. No way 
in hell.
  On abortion, you are either for it or against it or you are 
indifferent. You can be whatever you are on abortion and be just as 
good an American as I am. I am pro-life and proud of it. Most of us in 
America, whether you are pro-choice or pro-life, don't want our Federal 
taxpayer dollars to be used to pay

[[Page S13565]]

for abortions. For 32 years, the Hyde amendment has been the law of the 
land, preventing taxpayer dollars to be used for abortion. In this 
health care reform, guess what. That is exactly what is going to 
happen. There is a brave Democrat in the Congress--Bart Stupak, from a 
blue State--who stood up to his Democratic leadership and said: I will 
not vote for a bill that allows Federal taxpayer dollars in the form of 
subsidies to be used to fund abortion because I find that morally 
offensive, and I think most Americans agree with me. He brought the 
House to its knees, saying: You will not pass this bill to use 
federally funded Federal dollars to fund abortion.

  What did he get out of it? Nothing. Not one thing for Wisconsin. He 
got out of that deal the pride of knowing that he stood up for the 
unborn.
  So the bill comes to the Senate, and Senator Nelson from Nebraska 
tries to introduce the Stupak language that would be an absolute bar 
from using taxpayer dollars to fund abortion. He lost that amendment. 
He said he could not vote for a bill that would allow taxpayer dollars 
to be used to fund abortion. But then he gets in a room with Senator 
Reid, and he comes up with a compromise and he claims it solves the 
problem. The problem is, his claim is not accepted by all those who 
follow this. The compromise he has achieved on abortion is a miserable 
failure.
  Congressman Stupak says it is unacceptable. The National Right to 
Life Committee says it is unacceptable. The Nebraska Right to Life 
Committee says it is unacceptable. The Council of Catholic Bishops says 
it is unacceptable. There is not one pro-life group in this country 
that believes Senator Nelson has protected the rights of the unborn. So 
how, in good conscience, do you vote for a bill when that was the big 
issue?
  At the end of the day--one last thought--this bill would make an 
Enron accountant blush. They are talking about how it lowers the 
deficit by $132 billion. But they do not tell you that the $247 billion 
doctor fix is not in the bill. What am I saying? Over the next 10 
years, doctors, under the 1997 balanced budget agreement, will have 
$247 billion taken out of their practices unless Congress acts.
  Since 1997, Congress, every year, has stepped to the plate and 
forgiven that cut, which is double digits. Everybody knows we are going 
to do that. But when it came to health care reform, they left out the 
doctor fix because if you include it, it no longer is revenue neutral. 
It no longer does what they say.
  They say this bill cuts the deficit by $132 billion, but if you 
include the $247 billion, it runs up the deficit in the first 10 years, 
and in the second 10 years it adds $2 trillion to the deficit.
  Long story short, this is what Enron did. People went to jail for 
doing this in the private sector. They took the liabilities of the 
company and they hid them, making their balance sheet look better than 
it actually was. So when you hear this reduces the deficit by $132 
billion, they took out a liability that they know we are going to fund, 
just to cook the books.
  If this is going to be OK for the country, then we have no hope as a 
Nation of ever solving any hard problem. And I would like to say to my 
colleagues: I know you want to be home. I know everybody on the other 
side wants to be home. I know you want to find ways to solve hard 
problems. Troops in Afghanistan want to be home, too. At least they are 
away from home for a noble purpose. We are here trying to stop a 
legislative process that, if it becomes legitimate--if this becomes the 
OK way of doing business, giving one Senator a deal you will not give 
anybody else and putting the whole country at risk just to get one 
vote--then I hope the American people will rise up in righteous 
indignation and throw us all out because nobody should be representing 
the country this way.
  Mr. CHAMBLISS. The Senator from South Carolina raises the point about 
this bill being revenue neutral and it actually decreases the deficit. 
How do they achieve that? They achieve that through some truly Enron 
accounting, as the Senator from South Carolina just said. But here is 
what happens: There is a certain amount of money that is projected by 
CBO to be generated in insurance premiums being paid by young 
individuals across this country under what is called the CLASS Act. The 
CLASS Act is a new health care-generated program, a new entitlement 
program that is included in this bill that is going to provide long-
term care benefits for young, healthy Americans who, ultimately, are 
going to become invalid and need that long-term care.
  Well, the fallacy in the numbers game that is being played is that 
CBO is saying it is true there will be a projection that we are going 
to save--the projection they are using says we are going to generate 
premiums from these young people who are not going to be entitled to 
the benefits under this bill for 20, 30, 40 years from now. But even 
CBO recognizes that when these benefits begin being paid out, there is 
going to be an entitlement created that is going to blow the budget of 
this particular new program all the way out the top.
  In fact, the chairman of the Budget Committee, a Democrat from North 
Dakota whom I admire and respect so much, has even said this particular 
provision in this bill is a Ponzi scheme. It is something Bernie Madoff 
would love. Yet here they are with straight faces on the other side of 
the aisle coming in and saying we are really going to reduce the 
deficit by passing this provision called the CLASS Act. It is beyond me 
how anybody, with a straight face, can say that is actually a fact.
  Mr. ISAKSON. Will the Senator yield?
  Mr. CHAMBLISS. Absolutely.
  Mr. ISAKSON. Isn't it true that is what is wrong with Social Security 
today? We have spent it for years and years rather than putting it in a 
trust fund, and now the baby boomers are going: The money is not there? 
Isn't that the same thing?
  Mr. CHAMBLISS. The Senator is exactly right, and exactly the same 
situation with Medicare.
  Mr. ISAKSON. Just a question on a followup on the fiscal part the 
Senator from South Carolina brought up. It is also still true that the 
taxes on this bill begin in 11 days--January 1, 2010--but the benefits 
begin on January 1, 2014, and in that score of the first 10 years of 
cost, you have years of program that are not costing anything while you 
are raising revenues. So it is a ruse and a masking of the actual 
fiscal effect on the United States of America.
  Mr. CHAMBLISS. The only way Senator Reid could get the score that he 
kept going back and forth with the Congressional Budget Office on was 
to make sure the taxes started immediately. And they will. He has 
increased taxes by $26 billion to come up with a proposal that he says 
is revenue neutral. That is an additional $26 billion. So it makes it a 
total of $518.5 billion in new taxes that are going to be paid by hard-
working, tax-paying Americans, and no benefits under this bill are 
going to start accruing until the year 2014.
  Mr. CORNYN. Will my friend yield for a question?
  Mr. CHAMBLISS. Absolutely.
  Mr. CORNYN. I ask the senior Senator from Georgia, does he remember 
this statement by President Obama? He said he will not sign a plan that 
adds one dime to our deficits, either now or in the future, period. Yet 
David Broder, perhaps one of the most respected journalists here in 
Washington, DC, who has been around a long time, said he has talked to 
all the experts and everybody he has talked to said these bills as they 
stand are ``budget-busters.'' Of course, I am sure the Senator also 
remembers a Washington Post-ABC poll that said 66 percent of those who 
responded to the poll think this bill will make the deficit worse, not 
better.
  In other words, we have a credibility problem between what is being 
promised here by the President and presumably by the proponents of this 
bill and the American people because they simply do not buy it. They do 
not believe it. Maybe that is why that earlier number from the 
Rasmussen poll said a majority of Americans do not want us to pass this 
bill but, rather, want us to start over and take a step-by-step or 
incremental approach.
  Mr. CHAMBLISS. There is just no question but that the American people 
understand this. They get it. When we talk about cutting Medicare by 
$450 billion, do they really not think the quality of care under 
Medicare is going

[[Page S13566]]

to be diminished? Of course it is. Do the American people really think 
we are not going to have an increase in the deficit when we are going 
to have almost a trillion-dollar bill in real, live dollars that is 
going to be passed by this body in the next couple of days, in all 
probability? Surely the American people get that. They know this is 
going to increase the cost of health care and it is going to increase 
the deficit. That is why they are opposed to this.
  Mr. GRAHAM. Will the Senator yield for another question?
  Mr. CHAMBLISS. Sure.
  Mr. GRAHAM. Let's talk about the CLASS Act a little bit more. It is a 
new program that doesn't exist today where the Federal Government, as I 
understand it, will be offering long-term health care insurance to the 
American people. It is a voluntary program at first, just like 
everything else around here. Guess who is going to sign up. It is 
called adverse selection. The sickest people in the country are going 
to sign up.
  Under the bill as it is written, it is just like what Senator Isakson 
said about the underlying bill. You collect taxes for 10 years; you pay 
out benefits for 6. That is the way you get the money to make the 
numbers come out right.
  Guess what happens in this CLASS Act, the new program no one has 
heard much about. You start collecting premiums in 2011, but you don't 
pay any benefits until 2016. Guess what happens. That generates $73 
billion of money to be used to say to the American people that this 
bill is paid for. But when you ask the CBO about what happens after 
2016, they say that by 2029, I think it is, the whole thing falls apart 
because the only people in the program are the sickest folks because it 
is a voluntary program, and at the end of the day, you have created a 
new entitlement, and everybody in this body is going to be rushing to 
subsidize premiums and get more people into this system. It will be 
another entitlement that grows, and CBO says it will be a death blow to 
our fiscal soundness.
  I ask the Senator from Georgia, when Senator Conrad, whom we all 
respect, said this is a giant Ponzi scheme that Bernie Madoff would 
have been proud of, do you think that is what he meant? You collect 
premiums and you make it look as if you have money you really do not 
have and you put off paying out benefits. And at the end of the day, 
would the Senator agree with me--I have a letter from October 23, 2009, 
from Senators Conrad, Landrieu, Lincoln, Warner, Lieberman, Bayh, and 
Nelson to the majority leader saying: Please take the CLASS Act out of 
the bill.
  Would the Senator agree that the CLASS Act is still in the bill and 
that anybody who votes to send this off to the President to become law 
has become a coconspirator to the giant Ponzi scheme?
  Mr. CHAMBLISS. I don't think there is any question about that. The 
Senator is exactly right. It is what we in Washington call fuzzy math--
utilization of money from one pocket to pay for something on the other 
side. At the end of the day, it just does not add up. The Senator from 
North Dakota was exactly right, it is a huge Ponzi scheme.
  I ask unanimous consent to have printed in the Record the letter 
dated October 23, 2009, just referenced by the Senator from South 
Carolina.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


                                                  U.S. Senate,

                                 Washington, DC, October 23, 2009.
     Hon. Harry Reid,
     Majority Leader, The Capitol,
     Washington, DC.
       Dear Leader Reid: We write regarding the merger of the 
     Finance and HELP Committee health reform bills. We know you 
     face a great many difficult decisions now, one of which is 
     whether to include provisions from the HELP Committee bill 
     known as the CLASS Act in the merged bill.
       We urge you not to include these provisions in the Senate's 
     merged bill, nor to use the savings as an offset for other 
     health items in the merger.
       While the goals of the CLASS Act are laudable--finding a 
     way to provide long term care insurance to individuals--the 
     effect of including this legislation in the merged Senate 
     bill would not be fiscally responsible for several reasons.
       CBO currently estimates the CLASS Act would reduce the 
     deficit by $73 billion over ten years. But nearly all the 
     savings result from the fact that the initial payout of 
     benefits wouldn't begin until 2016 even though the program 
     begins collecting premiums in 2011. It is also clear that the 
     legislation increases the deficit in decades following the 
     first ten years. CBO has confirmed that the legislation 
     stand-alone would face a long-term deficit point of order in 
     the Senate.
       Some have argued that the program is actuarially sound. But 
     this is the case because premiums are collected and placed in 
     a trust fund, which begins earning interest, and because the 
     HHS Secretary is instructed to increase premiums to maintain 
     actuarial solvency. We have grave concerns that the real 
     effect of the provisions would be to create a new federal 
     entitlement program with large, long-term spending increases 
     that far exceed revenues. This is especially the case if 
     savings from the first decade of the program are spent on 
     other health reform priorities.
       Slowing the growth of health care costs should be a top 
     priority as we move forward with health reform. Inclusion of 
     the CLASS Act would reduce the amount of long-term cost 
     savings that would otherwise occur in the merged bill. The 
     CLASS Act bends the health care cost curve in the wrong 
     direction and should not be used to help pay for other health 
     provisions that will become more expensive over time and 
     increase deficits.
       Thank you for your consideration. We hope that fiscally 
     responsible measures to improve access to long-term care can 
     be considered in the future.
           Sincerely,
     Kent Conrad.
     Mary L. Landrieu.
     Blanche L. Lincoln.
     Mark R. Warner.
     Joseph I. Lieberman.
     Evan Bayh.
     Ben Nelson.
       U.S. Senators.
  Mr. CORNYN. I am wondering if the Senator would yield for a question 
since we have a unanimous consent for a colloquy.
  The Senator was talking about this a little earlier, but one of the 
things that has not been adequately discussed and because of the way 
this bill has been railroaded and we have been denied an opportunity to 
offer amendments and we will be voting on the bill on Christmas Eve, as 
it is currently scheduled, I want to ask about the impact on 
businesses. You were in the real estate business and employed a number 
of people in your company. You had to meet a payroll and make sure you 
ended up in the black and not in the red.
  One of the things the National Federation of Independent Business 
said was that this bill will actually increase health care costs for 
businesses and the cost of doing business. I can't imagine anything 
worse that we could be doing during a recession, during a time when 
unemployment is at 10 percent, than making it more expensive to do 
business and thus keep people on your payroll. Won't that be the impact 
of this, with higher taxes, with increased health care costs going to 
employers, that it is actually going to make the unemployment problem 
worse rather than better?
  Mr. ISAKSON. I think the Senator from Texas is exactly right. I will 
be the first to tell you, I am in the process of reading the 400-some-
odd page managers' amendment. I haven't read all of it yet. It does 
take out the public option, which, by the way, that was originally in. 
It still may reappear at some date in the future. That was a real 
killer. That raised tremendous costs. In fact, it made it more 
beneficial for a company not to provide insurance and pay the fine and 
put people in the government option. That is not in the bill now, I 
understand that.
  But let me tell you what is in the bill. What is in the bill are a 
number of taxes on small businesses that produce medical devices and 
medical treatments. You know as well as I do that when the government 
raises your taxes, you have to raise your price to the consumer. What 
does that mean? It is not lowering the cost of health care. It is, 
through the tax mechanism, raising the cost of health care, either to 
the insurance company that is in the exchange or to Medicaid or to 
Medicare or to the individual person in terms of their copayments.
  You cannot hide the fact that when you are raising those types of 
revenues--$514 billion; $50 billion a year over 10 years--that money is 
going to ultimately be paid by the consumer of health care. It may be 
paid by the company on its tax return, but it is a pass-through cost 
that they are going to pass through to their consumer, which in turn is 
going to put more pressure on whoever insures that consumer, if, in 
fact, they are insured. So anytime

[[Page S13567]]

the government raises taxes, it raises the cost of living for the 
American people. That is just a common, well-known fact. The Senator is 
exactly correct.
  Mr. CHAMBLISS. We have talked a little bit about the negotiations 
that took place behind closed doors over the last few days. It is 
unfortunate that we have gotten to the point in this body and on this 
particular piece of legislation where the issue of abortion has 
injected itself into meaningful and affordable health care reform 
measures. But that is, in fact, what has happened. Similar to my friend 
from South Carolina, I am pro-life. We all are. I am very proud to be 
and have a strong voting record on that. The law of the land for well 
over 30 years has been that no Federal funds should be used to fund 
abortions. It makes no difference whether you are in one part of the 
country or the other; that is the law. That is the way it ought to be. 
It ought not to be changed.
  We have had any number of votes on abortion issues over the years. In 
every instance, we have failed to pass a law that would provide for the 
use of Federal funds for abortions. That is changing. Irrespective of 
what the Senator from Nebraska thinks he negotiated, that has changed.
  I have three letters I will include for the Record. One is pretty 
interesting because it is from a group of African-American ministers in 
my home State. This group is headed by Bishop Wellington Boone. He 
wrote me a letter yesterday. Here is part of what he says:

       We cannot emphasize enough that abortion is not health 
     care.

  He is absolutely right.
  There is also a letter from Cindy O'Keary, executive director of the 
HOPE Center in Woodstock, GA, who is appalled at the discussions and 
the fact that we now are going to be using Federal money to fund 
abortions, and also a letter from Sadie Fields, State chairman of the 
Georgia Christian Alliance, imploring us not to pass any kind of bill 
that sets the precedent of providing Federal funds for the use of 
abortion.
  I ask unanimous consent to have all three letters printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                  Wellington Boone Ministries,

                                  Norcross, GA, December 19, 2009.
     Senator Saxby Chambliss,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Chambliss: We would like to take the time to 
     thank you for your service to our country and to the citizens 
     of Georgia. We thank you and your colleagues in the Senate 
     who have stood against the terrible healthcare bill which 
     mocks reform and increases taxes, debt and federal power 
     while decreasing the freedom that Georgians value so highly. 
     All of these concerns, however, pale in comparison to fact 
     that the Senate version of the bill opens the door for the 
     federal funding of abortion.
       Those of us who have stood for life over the years have 
     long known that the abortion lobby would never be satisfied 
     with the mere legalization of abortion: they want it to be 
     paid for by taxpayers. Many of your nominally pro-life 
     colleagues have proven that their support of human life has a 
     price: the Manager's amendment does nothing to prevent 
     federal funds from paying for abortion in the federally 
     subsidized healthcare exchanges. The charade that this is 
     some sort of compromise is insulting not only to pro-life 
     activists, but to the overwhelming majority of Americans who 
     don't believe that taxpayer money should pay for abortions.
       Who will be aborted with this federal money? In Georgia, 
     56% of all abortions are performed on black women and 
     nationwide blacks have lost 35% of their population to 
     abortion since Roe v. Wade. The Senate also opened the door 
     for the federal funding of abortion among the indigenous 
     peoples of this country by excluding the Hyde amendment from 
     the reauthorization of the Indian Health Service. Perhaps 
     your colleagues in the Senate are not satisfied with how few 
     American Indians there are left.
       We cannot emphasize enough that abortion is NOT healthcare. 
     It seems some members of the Senate want to take a practice 
     that was supposed to be ``safe, legal and rare'' and make it 
     ``common, legal and subsidized.'' To overturn longstanding 
     policy restricting the federal funding of the destruction of 
     American lives while calling it ``healthcare'' is nothing 
     short of evil.
       We remain strongly opposed to the use of our tax dollars to 
     fund abortion. We ask you, as our Senator, not to let your 
     colleagues forget the line they are crossing if they vote for 
     cloture. Only time will tell if they can escape judgment for 
     their vote in their home states. But there is one Judgment 
     not one of us can escape. Your colleagues who have not yet 
     turned their backs on that Judge would do well to remember 
     this as they cast their votes.
     Bishop Wellington Boone,
       Fellowship of International Churches.
     Dr. Creflo Dollar,
       Creflo Dollar Ministries.
     Dr. Alveda King,
       King for America.
     Mr. Dan Becker,
       Georgia Right to Life.
                                  ____

     From: Cindy O'Leary [[email protected]].
     Sent: Saturday, December 19, 2009, 4:48 p.m.
     To: Harman, Charlie (Chambliss).
     Subject: Senate Discussion and Vote on Health Care 
         Legislation.

       Senator Chambliss, As a registered nurse and the executive 
     director for a pregnancy resource center that helps women and 
     men explore alternatives to abortion as they seek solutions 
     to what are often unexpected or unplanned pregnancies, I am 
     gravely concerned about the potential impact of government-
     subsidized abortions, not only for the unborn, but for their 
     parents who may feel overwhelmingly swayed by economic 
     factors to make the most devastatingly wrong decision of 
     their lives.
       I want to thank you for standing strong tomorrow on the 
     floor of the Senate in expressing the views of your 
     constituents and, according to the recent CNN poll which 
     revealed that six out of ten Americans are opposed to federal 
     funding of abortion, we the people of the United States, as 
     you promote a NO vote on the current health care legislation 
     before the Senate. The only conscionable YES vote will come 
     later for legislation that explicitly excludes the use of 
     federal funds for abortion.
       It is my understanding that the so-called ``compromise'' 
     language included in Senator Reid's Manager's Amendment would 
     actually ensure that, for the first time EVER, federal funds 
     would be made available for the payment of elective 
     abortions. It is also my understanding that the Manager's 
     Amendment rejects other ``compromise'' proposals on abortion 
     that would have codified the House-approved ``Weldon 
     Amendment'' which prohibits government bodies from 
     discriminating against health care providers. Such 
     compromises included an ``individual'' opt-out from abortion 
     coverage, which the Manager's Amendment does not. The 
     Manager's Amendment rejects even the most broadly accepted 
     agreements on this issue.
       Thank you for your courageous support for life and for 
     fighting against allowing the government of the people and 
     for the people to pick up the tab for abortions in America.
                                               Cindy O'Leary, BSN,
     Executive Director, The HOPE Center.
                                  ____



                                   Georgia Christian Alliance,

                                                December 19, 2009.
     Hon. Saxby Chambliss,
     U.S. Senate, Washington, DC.
       Dear Senator Chambliss: The Georgia Christian Alliance and 
     its 65,000-plus supporters in Georgia strongly object to the 
     language contained in the newest version of the Democrat's 
     Health Care Reform bill that ensures, for the first time 
     ever, federal tax dollars will pay for elective abortions.
       If this bill passes, millions of pro-life Americans who 
     believe that abortion is biblically and morally wrong will be 
     forced to fund an act that takes an innocent human life. A 
     Gallup Poll conducted in May 2009 finds 51% of Americans 
     identifying themselves as ``pro life'' on the issue of 
     abortion and 42% identifying themselves as ``pro choice.'' 
     This is the first time a majority of U.S. adults have 
     identified themselves as pro-life since Gallup began asking 
     this question in 1995.
       For weeks, Democrat Senators and Representatives have 
     ensured pro-life Americans they would never vote for a bill 
     that contained federal funding for abortion. It would seem 
     they sold their pro-life position for a bowl of porridge. We 
     are deeply disappointed that they have gone back on their 
     word, and ask you and your colleagues in the U.S. Senate to 
     stand strong for innocent life as this bill moves forward in 
     any Senate vote and in any subsequent conference committee.
           Sincerely,
                                                     Sadie Fields,
                                                   State Chairman.

  Mr. CHAMBLISS. Madam President, in closing, let me say, the Senator 
from South Carolina said it strongly and he is right: We have reached a 
new day in this body. We have had deals cut behind closed doors that 
are going to provide benefits for individual Senators and their 
States--whether Vermont, New Hampshire, Nebraska, Florida, or 
wherever--and that are going to require those of us who didn't have the 
opportunity to participate in the discussions and negotiations on this 
bill to represent to our citizens that they are going to have to pay 
more for services than everybody all across America gets. There is 
nothing right about that. There is nothing fair about it.
  I daresay, I have some relatives who live in Nebraska. They have to 
be embarrassed and ashamed about this. They are going to be getting a 
huge benefit simply because the Democrats needed 60 votes to pass the 
health care bill.

[[Page S13568]]

  Mr. GRAHAM. One last thought, if I may. The Senator mentioned the 
people in Nebraska. I know there are good, hard-working people all over 
the country, particularly in Nebraska. A lot has been said about 
Nebraska. I hope the people in Nebraska will be heard. This is not 
over. They may get 60 votes in the next couple days, but this is not 
over. We are going into the fourth quarter, and the most valuable 
player on our team is the American people. Speak up, speak out. If you 
don't like what is going on, if you don't like the phony baloney 
accounting, if you are upset about your taxpayer dollars being used to 
fund abortions, speak up. If you think there is a better way of doing 
business, let us know about it. There is a long way to go. It has to go 
back to the House. The House has a say. One Senator indicated the House 
better take it or leave it. That is not good government. That is not 
the way it works. Three of us have been in the House. I want you to 
know this is far from over. Public opinion matters to us all. To the 
American people who are concerned about this being a done deal, it is 
not. You can change the outcome. I hope you will get involved. At the 
end of the day, it is your country we are talking about.
  The ACTING PRESIDENT pro tempore. The Senator from Montana.
  Mr. BAUCUS. Madam President, it has been more than a month since the 
majority leader moved to proceed to the health care bill before us 
today. This bill will provide real reform for our Nation's flawed 
health care system. This bill is the product of years of hard work, 
study, and deliberation in both the Finance Committee and the HELP 
Committee--and I mean years--all transparent, all aboveboard, all out 
in the open. In fact, in the Finance Committee, we initiated a new 
requirement that all amendments to the bill would have to be posted in 
advance on the Internet so everybody could know what they were, the 
same with the bill itself. The mark was on the Internet for a couple 3 
days before we even went to markup. It is unprecedented how open and 
transparent the process has been. The same is true in the HELP 
Committee.
  The culmination of these efforts has been the weeks of debate on this 
bill in the Senate. These provisions have been in the public domain for 
a long time. It is true there could be minor changes here and there, 
but most of this has been in the public domain for a long time. We have 
considered numerous amendments. We have engaged in a full and healthy 
discussion. The bill before us is fully paid for. It is important to 
keep reminding colleagues over and over again: This is fully paid for. 
Don't take my word for it. That is what the CBO said. The American 
people trust and realize, according to the Congressional Budget Office, 
a nonpartisan organization, that this bill is fully paid for. It does 
not add one thin dime to the deficit. You are going to hear others who 
don't have their own proposals just want to be negative, want to try to 
shoot holes in this, try to say it adds to the deficit. That is their 
opinion. That is not the opinion of the CBO. CBO says it does not add 
one thin dime.
  This bill will also reduce the Federal deficit in the short term and 
over the long term. It reduces the Federal deficit. We are so very 
concerned about deficits. We in the Congress are and the country is. We 
have to begin as soon as we can to start getting those deficits down 
and the national debt lowered. This health care reform bill not only 
provides health insurance coverage and reforms the insurance industry 
dramatically, it also takes the steps of lowering the deficit and 
lowering the long-term debt.
  Let me quote from the Congressional Budget Office letter of 
yesterday:

       CBO and [Joint Committee on Taxation] estimate that, on 
     balance, the direct spending and revenue effects of enacting 
     the Patient Protection and Affordable Care Act incorporating 
     the managers' amendment would yield a net reduction in 
     federal deficits of $132 billion over the [10-year] period.

  A net reduction of $132 billion. That is even better than the merged 
bill was just before we included the managers' amendment. That was a 
$130 reduction in the national deficit. With the managers' amendment, 
according to the CBO, there is a net reduction in the Federal deficit 
of $132 billion over the 10-year period. What about later? Often people 
say: Gee, I hear you, Senator, you are taking care of things in the 
short term, but you are enacting legislation that will have an adverse 
long-term effect. That is what you guys do back there.
  You hear that often. Let me disclose what the Congressional Budget 
Office says about that. This legislation will reduce the deficit 
markedly in the outyears. Here is what the CBO says in a letter 
released today:

       All told, the [Congressional Budget Office] expects that 
     the legislation, if enacted, would reduce federal budget 
     deficits over the decade after 2019 relative to those 
     projected under current law--with a total effect during that 
     decade that is in the broad range [of] between one-quarter 
     and one-half percent of GDP.

  What are they saying? They are saying that in the second 10 years, 
the deficit will be reduced between one-quarter and one-half percent of 
GDP. That is between $630 billion and $1.3 trillion. That is real 
money. We are going to reduce the Federal deficit by this legislation 
alone. Let's take the between $630 billion and $1.3 trillion--roughly, 
$1 trillion in the next decade. That is important. That is significant. 
That is a good start.
  The legislation before us will extend insurance coverage to more than 
30 million Americans. Think of that, 30 million Americans who today do 
not have insurance will get health insurance. That is so important. I 
have forgotten the exact figure, but I remember there was a Harvard 
study that concluded that 45,000 Americans die every year because they 
have no health insurance. Obviously, people without health insurance 
die earlier, at an earlier age. Just for the sake of their own health, 
it is good those people get health insurance, let alone the benefit to 
hospitals by reducing uncompensated care.
  This legislation will increase insurance coverage to more than 30 
million Americans. I have just been passed a note that people have a 
40-percent higher chance of dying without health insurance. We are 
saying to those folks, those 31 million Americans, we are going to 
figure out a way so you have health insurance so you do not have that 
40-percent higher risk of death.
  Here is what CBO says about coverage:

       By 2019, the CBO and [Joint Committee on Taxation] estimate 
     that the number of nonelderly people who are uninsured will 
     be reduced by about 31 million.

  CBO goes on to say:

       Under the legislation, the share of legal nonelderly 
     residents with insurance coverage would rise from 83 percent 
     currently to about 94 percent.

  That is 94 percent of the folks in our country, excluding seniors, 
because they have insurance under Medicare, excluding them and 
excluding the unauthorized, the total number of Americans who have 
health insurance will rise from the current number of 83 percent to 
about 94 percent.
  This legislation will drive down premium costs for virtually all of 
us. It will drive down premium costs for virtually all. In an earlier 
letter, the CBO indicated premiums would go down for roughly 93 percent 
of Americans under the underlying bill. Premiums would go down about 93 
percent for Americans. I was going to put a table in the record, but 
our rules don't allow us to put tables in, so I summarized. The 
conclusion of that summary is 93 percent of Americans will experience 
lower premiums--not dramatic for some folks but nevertheless down, and 
down is better than not down.
  Insurance costs would go down significantly for those receiving tax 
credits in the new insurance exchanges. It will protect consumers from 
harmful insurance company practices. This is so important. As you know, 
no longer will insurance companies be able to deny coverage for those 
with preexisting conditions. It is an outrage how much insurance 
companies deny coverage based on preexisting conditions. We all hear 
stories many times, if not from direct family members, from friends of 
family who run into this. It is so common, especially in the individual 
market as people buy insurance for themselves. Insurance companies deny 
coverage, deny giving health insurance to somebody because of a 
preexisting condition. It is wrong.

  No longer will insurance companies be able to drop coverage for those 
who are sick. That is very important too. Companies often rescind 
willy-nilly.

[[Page S13569]]

They found something in the background of the person, you didn't tell 
us about that so we are rescinding your policy. That is not right. That 
is just not right. We prevent that from happening in this legislation.
  It will also improve choice and competition in the insurance market. 
We talk a lot about choice and competition. This legislation provides 
more choice in choosing policies and more competition in the insurance 
market. It will also create a true marketplace where plans compete on 
cost and quality rather than on their ability to cherry-pick the 
healthiest among us.
  It will represent the largest tax cut for American families that 
Congress has passed since 2001. This legislation includes the largest 
tax cut for American families that Congress has passed since that tax 
cut bill in 2001, the largest. It is the tax credits people will 
receive to help them buy insurance. That totals up, I think, to $440 
billion. I have forgotten the exact figures. But this is the largest 
tax cut for American families since 2001. It will provide billions of 
dollars in tax credits to help families, workers, and small businesses 
to buy quality, affordable health care insurance. The managers' 
amendment makes this good bill even better. It will provide even more 
consumer protections against harmful insurance industry practices.
  For example, it will hold companies accountable for excessive premium 
rate increases. It will require them to spend more on consumer benefits 
and less on administrative costs and profits. That is new. That is even 
better consumer protection compared with the underlying bill. It will 
restrict the ability of health plans to impose annual limits on 
benefits. That is new, restricting the ability of health plans to 
impose annual limits on benefits. It is wrong if you have an insurance 
policy that, lo and behold, the company says: We didn't know you were 
going to be that sick so we stopped the benefits you can get, annually 
and also lifetime. We do both. We restrict the ability of health plans 
to impose not only annual limits but also lifetime limits on benefits.
  This managers' package will ensure that companies cannot discriminate 
against children with preexisting conditions and do so right away, 
beginning with plans that become effective midyear next year. The 
preexisting condition restriction would ordinarily not take effect for 
a couple years, but for children the preexisting condition prohibition 
will take effect right away. There are other provisions to help people 
between now and 2014. There is high-risk pooling, for example, lots of 
different provisions in this bill which will help people get good 
benefits and protection very quickly.
  This legislation will provide tax credits to even more small 
businesses. The managers' amendment will provide even more tax credits 
than the underlying bill. These benefits will now be available right 
away, in 2010. It is also a concern when will the tax credits for small 
business go into effect--shouldn't they go into effect earlier. Under 
this managers' amendment, these benefits will be available in 2010.
  This will also provide more health insurance choices through a new 
multistate option. That option offers consumers the same health 
insurance Congress has today--no small matter. It will extend extra 
funding for the Children's Health Insurance Program for 2 additional 
years. We are all very concerned about kids' health care. The 
children's health care program has done a pretty good job. This has 
been extended, under the managers' amendment, for an additional 2 
years. It will do even more to control rising health care costs and 
reward even more providers for providing quality care to seniors 
through the Medicare Program. It will invest $10 billion in community 
health centers. They are so important, community health centers, for 
folks who need help right away and don't have insurance, just need the 
care right away. Especially in rural communities, it will provide 
access to critical care where often that care is most needed.
  These are the reforms which Americans have been waiting for, for 
decades. Americans are waiting for these changes. They are waiting for 
these reforms and have been for a long time. Decades may be an 
understatement. Our health insurance system just doesn't do what it 
should for Americans, the people we represent. Finally, we are taking a 
very significant first step to providing those reforms. These are 
reforms American families, workers, and businesses desperately need. 
They are reforms on which our economic stability depends. That is no 
small matter either. If we get our insurance costs under control, that 
is more economic stability for everyone. It is not just for families 
who don't know what the insurance company is or is not going to do, it 
is for small businesses that don't know whether premiums will be up or 
by how much next year. Why? It is more economic stability for families 
and small businesses and soon more economic stability for budgets, 
State budgets, our Federal budget.

  We need to get a little more control over all the excessive costs 
that are going up, and also the volatility, the yo-yo effect that 
premiums have and out-of-pocket cost impositions have on people. This 
will help them very significantly.
  So by and large, to be honest--I know this sounds a little naive, 
perhaps--I do not know why this bill does not get an overwhelming 
endorsement. This is a big vote on both sides of the aisle. Then we 
can, next year, keep going from there; add new provisions that need to 
be added, correct mistakes that probably this legislation is going to 
have, but work together because most Americans want us to work together 
back here. They do not like us being partisan or political.
  I must say, this place is getting a little more partisan over the 
last couple years than it was earlier. It is not what the American 
people want. They want us to do our job, do what is right. This bill 
clearly is in the bounds of reasonableness of what is right and what is 
the right thing to do to get control of our health care system.
  Again, I hope we can get this passed by a large margin. It will pass. 
But I would like it passed by a large margin.
  Madam President, I now yield 20 minutes to the Senator from Rhode 
Island, Mr. Whitehouse.
  The ACTING PRESIDENT pro tempore. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Madam President, I thank Chairman Baucus.
  As we are here in the Senate today, Washington rests under a blanket 
of snow, reminding us here of the Christmas spirit across the Nation, 
the spirit that is bringing families happily together for the holidays. 
Unfortunately, a different spirit has descended on this Senate. The 
spirit that has descended on the Senate is one described by Chief 
Justice John Marshall back in the Burr trial: ``those malignant and 
vindictive passions which . . . rage in the bosoms of contending 
parties struggling for power.''
  Two-time Pulitzer Prize winner Richard Hofstadter captured some 
examples in his famous essay, ``The Paranoid Style in American 
Politics.'' The malignant and vindictive passions often arise, he 
points out, when an aggrieved minority believes that ``America has been 
largely taken away from them and their kind, though they are determined 
to try to repossess it and to prevent the final destructive act of 
subversion.''
  Does that sound familiar in this health care debate? Forty years ago, 
he wrote that. Hofstadter continued, those aggrieved fear what he 
described as ``the now familiar sustained conspiracy''--familiar then, 
40 years ago; persistent now--whose supposed purpose, Hofstadter 
described, is ``to undermine free capitalism, to bring the economy 
under the direction of the federal government, and to pave the way for 
socialism. . . .'' Again, familiar words here today.
  More than 50 years ago, he wrote of the dangers of an aggrieved 
rightwing minority, with the power to create what he called ``a 
political climate in which the rational pursuit of our well-being and 
safety would become impossible''--``a political [environment] in which 
the rational pursuit of our well-being and safety would become 
impossible.''
  The malignant and vindictive passions that have descended on the 
Senate are busily creating just such a political climate. Far from 
appealing to the better angels of our nature, too many colleagues are 
embarked on a desperate no-holds-barred mission of propaganda, 
falsehood, obstruction, and fear.

[[Page S13570]]

  History cautions us of the excesses to which these malignant, 
vindictive passions can ultimately lead: tumbrels have rolled through 
taunting crowds; broken glass has sparkled in darkened streets; 
``strange fruit'' has hung from southern trees; even this great 
institution of government that we share has cowered before a tail 
gunner waving secret lists.
  Those malignant moments rightly earned what Lord Acton called ``the 
undying penalty which history has the power to inflict on wrong.'' But 
history also reminds us that in the heat of those vindictive passions, 
some people earnestly believed they were justified. Such is the human 
capacity for intoxication by those malignant and vindictive political 
passions Chief Justice Marshall described. I ask my colleagues to 
consider what judgment history will inflict on this current spirit that 
has descended on the Senate.
  Let's look at what current observers are saying as a possible early 
indicator of the judgment history will inflict. Recently, the editor of 
the Manchester Journal Inquirer editorial page wrote of the current 
GOP, which he called this ``once great and now mostly shameful party,'' 
that it ``has gone crazy,'' is ``more and more dominated by the lunatic 
fringe,'' and has ``poisoned itself with hate.'' He concluded, they 
``no longer want to govern. They want to emote.''
  A well-regarded Philadelphia columnist recently wrote of the 
``conservative paranoia'' and ``lunacy'' on the Republican right. The 
respected Maureen Dowd, in her eulogy for her friend, William Safire, 
lamented the ``vile and vitriol of today's howling pack of conservative 
pundits.''
  A Washington Post writer with a quarter century of experience 
observing government, married to a Bush administration official, noted 
about the House health care bill, ``the appalling amount of 
misinformation being peddled by its opponents''; she called it a 
``flood of sheer factual misstatements about the health-care bill,'' 
and noted that ``[t]he falsehood-peddling began at the top. . . .''
  The respected head of the Mayo Clinic described recent health care 
antics as ``scare tactics'' and ``mud.''
  Congress itself is not immune. Many of us felt President Bush was 
less than truthful, yet not one of us yelled out ``You lie!'' at a 
President during a joint session of Congress. Through panics and 
depressions, through world wars and civil wars, no one ever has--
never--until President Obama delivered his first address. And this 
September, 179 Republicans in the House voted to support their heckler 
comrade. Here in the Senate, this month, one of our Republican 
colleagues regretted, ``Why didn't I say that?''
  A Nobel prize-winning economist recently concluded thus:

       The takeover of the Republican Party by the irrational 
     right is no laughing matter. Something unprecedented is 
     happening here--and it's very bad for America.

  History's current verdict is not promising.
  How are these unprecedented passions manifest in the Senate? Well, 
several ways.
  First, through a campaign of obstruction and delay affecting every 
single aspect of the Senate's business. We have crossed the mark of 
over 100 filibusters and acts of procedural obstruction in less than 1 
year. Never since the founding of the Republic--not even in the bitter 
sentiments preceding the Civil War--was such a thing ever seen in this 
body. It is unprecedented.
  Second, through a campaign of falsehood: about death panels, and cuts 
to Medicare benefits, and benefits for illegal aliens, and bureaucrats 
to be parachuted in between you and your doctor. Our colleagues terrify 
the public with this parade of imagined horrors. They whip up concerns 
and anxiety about ``socialized medicine'' and careening deficits, and 
then they tell us: The public is concerned about the bill. Really?
  Third, we see it in bad behavior. We see it in the long hours of 
reading by the clerks our Republican colleagues have forced. We see it 
in Christmases and holidays ruined by the Republicans for our loyal and 
professional Senate employees.
  It is fine for me. It is fine for the Presiding Officer. We signed up 
for this job. But why ruin it for all the employees condemned by the 
Republicans to be here?
  We see it in simple agreements for Senators to speak broken. We see 
it, tragically, in gentle and distinguished Members, true noblemen of 
the Senate, who have built reputations of honor and trustworthiness 
over decades being forced to break their word, and doublecross their 
dearest friends and colleagues. We see it in public attacks in the 
press by Senators against the parliamentary staff.

  The parliamentary staff is nonpartisan; they are professional 
employees of the Senate who cannot answer back. Attacking them is worse 
than kicking a man when he is down. Attacking them is kicking a man who 
is forbidden to hit back. It is dishonorable.
  The lowest of the low was the Republican vote against funding and 
supporting our troops in the field in a time of war. As a device to 
stall health care, they tried to stop the appropriation of funds for 
our soldiers. There is no excuse for that. From that there is no 
return. Every single Republican Member was willing to vote against 
cloture on funding our troops, and they admitted it was a tactic to 
obstruct health care reform.
  The Secretary of Defense warned us all that a ``no'' vote would 
immediately create a ``serious disruption in the worldwide activities 
of the Department of Defense.'' And yet every one of them was willing 
to vote ``no.'' Almost all of them did vote ``no.'' Some stayed away, 
but that is the same as ``no'' when you need 60 ``yes'' votes to 
proceed. Voting ``no'' and hiding from the vote are the same result. 
And for those of us here on the floor to see it, it was clear: The 
three who voted ``yes'' did not cast their ``yes'' votes until all 60 
Democratic votes had been tallied and it was clear that the result was 
a foregone conclusion.
  And why? Why all this discord and discourtesy, all this 
unprecedented, destructive action? All to break the momentum of our 
new, young President. They are desperate to break this President. They 
have ardent supporters who are nearly hysterical at the very election 
of President Barack Obama: the ``birthers,'' the fanatics, the people 
running around in rightwing militias and Aryan support groups. It is 
unbearable to them that President Barack Obama should exist. That is 
one powerful reason.
  It is not the only one. The insurance industry, one of the most 
powerful lobbies in politics, is another reason. The bad behavior you 
see on the Senate floor is the last thrashing throes of the health 
insurance industry as it watches its business model die. You who are 
watching and listening know this business model if you or a loved one 
has been sick: the business model that will not insure you if they 
think you will get sick or if you have a preexisting condition; the 
business model that, if you are insured and you do get sick, job one is 
to find loopholes to throw you off your coverage and abandon you alone 
to your illness; the business model, when they cannot find that 
loophole, that they will try to interfere with or deny you the care 
your doctor has ordered; and the business model that, when all else 
fails, and they cannot avoid you or abandon you or deny you, they stiff 
the doctor and the hospital and deny and delay their payments for as 
long as possible--or perhaps tell the hospital to collect from you 
first, and maybe they will reimburse you.
  Good riddance to that business model. We know it all too well. It 
deserves a stake through its cold and greedy heart, but some of our 
colleagues here are fighting to the death to keep it alive.
  But the biggest reason for these desperate acts by our colleagues is 
that we are gathering momentum, and we are gathering strength, and we 
are working toward our goal of passing this legislation. And when we 
do--when we do--the lying time is over. The American public will see 
what actually comes to pass when we pass this bill as our new law. The 
American public will see firsthand the difference between what is and 
what they were told.
  (Mr. FRANKEN assumed the chair.)
  Facts, as the Presiding Officer has often said, are stubborn things. 
It is one thing to propagandize and scare people about the unknown. It 
is much tougher to propagandize and scare people when they are seeing 
and feeling and touching something different.

[[Page S13571]]

  When it turns out there are no death panels, when there is no 
bureaucrat between you and your doctor, when the ways your health care 
changes seem like a good deal to you, and a pretty smart idea--when the 
American public sees the discrepancy between what is and what they were 
told by the Republicans--there will be a reckoning.
  There will come a day of judgment about who was telling the truth. 
Our colleagues are behaving in this way--unprecedented, malignant, and 
vindictive--because they are desperate to avoid that day of judgment. 
Frantic and desperate now and willing to do strange and unprecedented 
things, willing to do anything--even to throw our troops at war--in the 
way of that day of reckoning.
  If they can cause this bill to fail, the truth will never stand up as 
a living reproach to the lies that have been told, and on through 
history our colleagues could claim they defeated a terrible 
monstrosity. But when the bill passes and this program actually comes 
to life and it is friendly, when it shelters 33 million Americans, 
regular American people, in the new security of health insurance, when 
it growls down the most disgraceful abuses of the insurance industry, 
when it offers better care, electronic health records, new community 
health centers, new opportunities to negotiate fair and square in a 
public market, and when it brings down the deficit and steers Medicare 
toward a safe harbor--all of which it does--Americans will then know, 
beyond any capacity of spin or propaganda to dissuade them, that they 
were lied to. And they will remember. There will come a day of 
judgment, and our Republican friends know that. That is why they are 
terrified.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I yield 15 minutes to the Senator from 
Oregon.
  The PRESIDING OFFICER. The Senator from Oregon is recognized.
  Mr. WYDEN. Mr. President, I thank you, and I thank the chair for his 
courtesy as well.
  At this time of the year, millions of Americans are out in the stores 
doing their holiday shopping. That is because we Americans enjoy our 
free markets and our free enterprise system. Whether it is for a 
holiday or we are shopping for a car or food or a house, we Americans 
believe we ought to have quality choices in our marketplace, and 
Americans, our people, ought to be rewarded when they shop wisely.
  The American economy works this way for just about everything except 
health care. Today, American health care is mostly a competition-free 
zone. Insurance companies enjoy extraordinary privileges as monopolies. 
Insurers are exempt from the antitrust laws, and in scores of American 
towns, our people can only get their health care under the heel of just 
one health insurance company.
  Today's health insurance market is essentially dysfunctional, and for 
most Americans, they have no way to hold the insurance companies 
accountable. It has been that way since the middle of the last century, 
since the days of wage and price controls. For literally 60-plus years, 
American consumers have not been in the position to be able to hold the 
insurance companies accountable and to get the value for their dollar 
that they get in every other part of our economy.
  Changing this broken health care marketplace is the heart of real 
health reform. The legislation we will vote on tonight--and, I might 
add, the chairman of the Finance Committee is on the floor, and this 
essentially began with his white paper when we started working on it in 
the Finance Committee--the legislation we are going to vote on tonight, 
in my view, starts the long march to empowering consumers, to turning 
the tables on the insurance lobby, and to getting more value for our 
health care dollar. This can be done through a part of the health 
reform debate that got some discussion in the Finance Committee and 
then, because people liked it and didn't know much about it, has since 
essentially gotten lost in the discussion; that is, the health 
insurance exchanges.
  For folks listening at home today, an exchange is going to be like a 
farmers market. Various types of health plans are going to be marketed 
through the exchange, and for the first time--this was an area in which 
Chairman Baucus and I had a great interest in the committee--it is 
going to be possible for folks to make apples-to-apples comparisons of 
these various health plans.
  There are requirements in the bill that keep the low-quality products 
out of the exchange. Chairman Baucus and I got interested in the need 
for consumer protection particularly early on in programs, back in the 
days after Medicare got established when seniors were buying 15 or so 
private policies to supplement their Medicare and most of them weren't 
worth the paper they were written on. So with these exchanges as they 
are designed, that is not going to happen. People are going to get 
value for their dollar on day one.
  There are also some important consumer protection requirements, and I 
particularly wish to commend the Presiding Officer of the Senate, whose 
work I have been following. These consumer protection requirements will 
ensure that now when a consumer pays a dollar in a premium, they are 
going to get a lot more back in benefits for their dollar. This 
protection is called a loss ratio. People are going to hear a lot about 
that concept. It is new, but it essentially means the insurance 
companies can't walk off with their premium dollar, use it on 
administrative expenses, use it on salaries, but will instead return it 
to the public and the consumer in the form of benefits and premiums. I 
commend the Presiding Officer, the Senator from Minnesota, for ensuring 
this was all put in place. In my view, these ideas ought to appeal to 
both Democrats and Republicans--these market-oriented consumer 
protection principles--simply because they are just common sense.
  So should section 10108 of Senator Reid's managers' amendment on 
which the majority leader, Chairman Baucus, and I worked very closely. 
It is entitled ``Free Choice Vouchers.'' This section creates something 
that has never existed before: a concrete way for middle-income 
Americans who cannot afford their health care to actually push back 
against the insurance lobby and force insurance companies to compete 
for the business of covering those middle-class folks in the insurance 
exchanges. Unlike today, where if a hard-working, middle-class American 
can't afford just the one health insurance policy available to him and, 
thus, is out of luck, with this new provision, there will be a 
different health care marketplace, with free enterprise choices that 
can actually drive down costs for the middle class while ensuring those 
choices are of good quality.
  So the big hurdle, it seems to me, in setting up a new health care 
marketplace, which began with Chairman Baucus's white paper in the 
Senate Finance Committee, is getting these exchanges and getting these 
vouchers in place.
  We are going to be able to build on it. In my view, I think we will 
have additional opportunities to build on these ideas before the 
legislation goes to the President. For example, Senator Collins, our 
Republican colleague from Maine, Senator Bayh, and I have written 
bipartisan legislation that has been endorsed by the influential 
National Federation of Independent Business and we are working to 
include that proposal in this legislation. This bipartisan proposal 
would permit employers who are in the insurance exchange and who 
voluntarily choose to do so--let me emphasize that this is a matter of 
a voluntary choice by employers--if they choose to do so, they could 
give their workers a voucher so that those workers could shop for their 
coverage. What this means is for millions of employers and employees, 
the amendment would provide the opportunity to have a choice of 
American health care plans.
  These are unquestionably challenging days for American employers and 
workers trying to be as competitive as possible in tough global 
markets. For employers who want more ways to help their workers and the 
employers' bottom line and for workers who would like more take-home 
pay and lower health expenses, this bipartisan amendment can be a 
lifeline. We hope our colleagues of both parties will agree and join 
our effort, and this can be part of the legislation that ultimately 
will go to the President.
  Let me close with this. My great hope is that long after 24/7 cable 
TV has moved on to other topics, Democrats and Republicans here in the 
Senate can figure out a new strategy for

[[Page S13572]]

working together, a bipartisan strategy that will let us, together, tap 
the full potential of real health care reform. That potential is for 
holding down costs, getting more value for our health care dollar, and, 
finally, achieving quality, affordable health coverage for all 
Americans.
  I offer this thought because I have long felt both parties have valid 
views on this topic. I believe our party is absolutely right in saying 
you cannot fix American health care unless all Americans get good-
quality, affordable coverage. If you don't do that, too often uninsured 
folks will shift their bills to insured folks, there won't be enough 
prevention, and you won't be in a position to get the most value for 
the health care dollar.
  I continue to believe our colleagues on the other side of the aisle 
have valid points as well. They make valid points about the role of 
marketplace forces, the role of competition, the role of choice.
  There has to be a way in the days ahead--one of the things that has 
pleased me is Chairman Baucus has said we are going to have a lot of 
oversight hearings and a lot of work in the days ahead to actually 
implement this. None of us think we can create a new health care 
marketplace where there hasn't been one for 70 years in a matter of 
minutes. So I am very pleased Chairman Baucus has indicated we will be 
doing a lot of the painstaking oversight work in the days ahead to 
actually implement this transformation in American health care, and I 
think the chairman knows I will be his partner in those efforts to get 
this implemented.
  So after a year of tough financial hardships, let's find a way to 
bring to this Senate floor bipartisanship, common sense, and the good 
will that is public service at its best.
  I close by saying that I look forward to working with the chairman of 
the Finance Committee, who I know shares these views as well.
  With that, Mr. President, I yield the floor.
  Mr. BAUCUS. Mr. President, I wish to thank the Senator from Oregon 
for many reasons, one of which is his kind words, which are really 
appreciated but, much more important than that, his long dedication to 
health care reform. He even worked for the Gray Panthers way back 
before he came here. I remember the name Ron Wyden, Gray Panthers, a 
good number of years ago. Then, lo and behold, both Houses of Congress 
together--we worked together on reforming Medigap coverage. It was an 
outrage. Today we talk about medical loss ratios of maybe 80 percent, 
85 percent, up to 90 percent, and so forth. I can remember back when it 
was an outrage, the degree to which Medigap insurance coverage had 
medical loss ratios of not 80 percent, not 70 percent, not 60 percent; 
it would be below 50 percent. Insurance companies were selling 
insurance to seniors trying to cover that gap between what Medicare 
would and would not cover, and just tragically low, embarrassingly low, 
outrageously low medical loss ratios.
  Senator Wyden and I got together and got legislation passed to reform 
the Medigap market--to make Medigap insurance plans more fair. They 
were ripping seniors off, there was no doubt about it, and we got that 
changed.
  Now, on health care reform, an ardent advocate of more competition, 
more choice in our health care system--it is clear we need more 
competition. It is clear we need more choice. On the competition side, 
in many of our States we find there is only one or two insurance 
companies that dominate the entire State. That is very true around our 
country. There is just not the competition there should be.
  In addition, there is not the choice. A lot of employees would like 
to have more choice among insurance companies in their kinds of 
policies, and so on and so forth. We have a system where most employees 
are tied to their employer; it is pretty much insurance coverage the 
employer offers.
  If we were starting from scratch maybe 20, 30, 40, 60, maybe 80 years 
ago, we may not have had such an employer-based system as we have 
today. Our current Tax Code also tends to encourage excessive insurance 
coverage because of our employer-based system.
  Anyway, I am digressing. Senator Wyden got us thinking a lot earlier 
about the problems that caused, and, frankly, I think he is right. I 
think a lot of Americans think he is right. You can only take things a 
step at a time here, and we are probably not going nearly as far as the 
Senator from Oregon wishes to go. But I thank him. He is there, he is 
dogged, and he works hard on behalf of seniors. He is an advocate of 
American consumers, respected by health insurance companies, not 
letting the companies take advantage of citizens. I thank the Senator 
for that.
  I do not see any Senators on the floor on our side. If there were, it 
would be a good time for them to speak. Pending the arrival of the 
Democratic Senators, let me say a few things about small business.
  Clearly, one of the goals of health care reform is to ensure that 
employees of small businesses have good, quality, affordable health 
care options. We all know that is clear. I have talked to small 
businesspeople.
  I will never forget a conversation I had with a logger who has four 
or five or six people working for him. It was about 2 or 3 years ago. I 
asked him if he had health insurance. He said, yes, for his family--his 
wife and himself.
  I asked: How about your employees? He said, no; he didn't. You could 
tell he wanted to, and he wasn't just blowing smoke. He clearly wanted 
to provide insurance for his employees, but it just pained him because 
it was too expensive.
  We all hear stories like that; they are legion. I can remember 
talking to another small businessman in my State of Montana, a 
contractor, who has 5, 6, 8, 10, people working for him. He is just 
beside himself because the insurance company told him his premiums are 
going to go up 40 percent next year.
  He said: Max, I can't deal with that.
  I asked: Why are they going up 40 percent?
  He said: Well, they found a preexisting condition with respect to one 
of my employees. He said: Max, I was beside myself. I can't afford a 
40-percent increase. They said it would only be a 20-percent increase 
if I let him go. But he has been with me 15, 20 years and is one of my 
best employees. I can't let him go.
  He found another carrier and kept his employee. So he did find 
another insurance carrier, but he had to pay about a 20-percent 
increase in premiums. He was able to keep his employee, but that is 
just wrong. It is so hard for small businesses to provide health 
insurance to their employees. I know it is a trite thing to say, but 
most jobs in our country are created by small businessmen. That is 
where most of the jobs are, and it is where most of the creativity is. 
That is, in many cases, where the greatest need is to help encourage 
entrepreneurism, American ingenuity, and where a small businessperson 
can do a good job with the service he is providing.
  Last year, 62 percent of small businesses did offer health insurance 
to their employees. Compare that with other companies that have, say, 
200 employees. Among all companies in America that have 200 or more 
employees, 99 percent of them have offered their employees health 
insurance. Contrast 62 percent of small businesses offer health 
insurance and 99 percent of businesses with more than 200 employees 
offer health insurance.
  Among the very small businesses in our country it is lower, lower 
than 69 percent. Now it is only 49 percent--a very small number of 
employees--that have health insurance through their small business 
employer. There are clearly very significant reasons for that. There 
are barriers that prevent small businesses from finding affordable 
health insurance options. What are they?
  Small businesspeople tell us the main reason--at least one of them--
is that the premiums are just too high. I mentioned an example of the 
contractor I talked with in my State, who said they are going to charge 
a 40-percent increase in premiums as further evidence that premiums are 
too high. It is understandable that is one of the main reasons small 
businesses can't get health insurance.
  In the past 10 years, premiums have risen 82 percent for single 
workers and 93 percent for families employed by small business--
virtually doubled premiums in the last 10 years if you are a single 
person and work for a very small business. That is not true for big 
business.

[[Page S13573]]

  As health care costs rise, small businesses are forced to make 
workers pay a greater portion of these expensive premiums. In 2008, for 
example, employees at small businesses that did provide health 
insurance paid more than twice what they paid just 8 years earlier--
twice as much.
  The low rate of offering and higher cost-sharing responsibilities for 
employees in small businesses often limit the ability of small 
businesses to attract and retain employees.
  That is why the health care bill before us includes many provisions 
to make quality coverage for small business more affordable not only 
for the businesspeople but for their employees. Before the managers' 
amendment, the bill did include $24 billion in tax credits to help 
small businesses and charitable organizations purchase health insurance 
for their employees.
  The managers' amendment dedicates additional billions to providing 
tax credits to small businesses to make health insurance more 
affordable. The Congressional Budget Office and the Joint Committee on 
Taxation, which I know is near and dear to the heart of the Presiding 
Officer--after all, they are an independent arbiter. They can tell us 
with objectivity what this legislation is or is not--they estimate that 
the tax credit for small businesses will provide $40 billion in tax 
relief to small businesses over their first 10 years.
  In addition, we start the tax credits a year early; that is, we start 
them in 2010. In the earlier bill, it was 2011. In the managers' 
amendment, we start in 2010, right away. This means that in just over a 
week, after the legislation is passed and signed into law, eligible 
small businesses will be able to receive tax credits to help them buy 
health insurance for their employees. This expansion of the tax credits 
means eligible small businesses will now be able to receive up to 6 
years of tax credits. So now starting in 2010, eligible small 
businesses will receive tax credits worth up to 35 percent of the 
employer's contribution to employee health insurance plans--35 percent.
  Then in 2014, it is even better. Eligible small businesses will 
receive tax credits worth up to 50 percent of the employer's 
contribution to employee health insurance plans purchased in health 
insurance exchanges. The employer would get 50 percent of the cost of 
the health insurance, that would be available for credit; that is, the 
employer can credit 50 percent, subtract from his income taxes 50 
percent of the cost of insurance.
  What do you have to do to qualify? Businesses must cover at least 50 
percent of employee premium costs. If you cover half the employee 
costs, you get to subtract your half from your income taxes. The value 
tax credit is based on the size of the business and the average wage 
paid to its employees.
  The managers' amendment strengthens the assistance to small 
businesses by expanding the small business tax credit. In the managers' 
amendment, the tax credit will be available to small businesses with 
fewer than 25 employees and less than $50,000 average annual wages. And 
the full value of the tax credit is now available to small businesses 
with 10 or fewer employees and $25,000 or less in average annual wages. 
It moved up from $20,000 to $25,000 so more small businesses can 
qualify and take advantage of that tax credit. By expanding the wage 
thresholds, which I just described, more small businesses will be able 
to claim the tax credits. And tax credits will phase out more slowly as 
wages increase. This was a high priority for small businesses. We 
recognized that and responded to it.
  The small business tax credit will help make insurance affordable for 
many small businesses. In 2011, 4.2 million Americans will be covered 
by quality, affordable health coverage; 4.2 million Americans will be 
able to take advantage of this. On average, small businesses across the 
country would receive a new tax credit of about $4,900 to help them 
purchase insurance. That is per employee, $4,900 to help them purchase 
insurance for their employees.
  The CBO estimates that the small business tax credit will help lower 
insurance costs by 8 to 11 percent for the employees of small 
businesses receiving the credit. Let me say that again. CBO estimates 
that the small business credit will help lower insurance costs by 8 to 
11 percent for the employees of small businesses who receive their 
credit. Without the small business tax credit, many people would have 
to buy insurance through the exchange on their own without the benefit 
of a contribution from their employer.
  One of the reasons many small businesses are currently unable to 
afford health insurance is because small businesses lack the buying 
power larger companies have to negotiate affordable group rates. The 
Senate bill creates small business insurance exchanges, known as SHOP 
exchanges, where small businesses can band together and pool their 
risks, which will enhance their choice and buying power. These State-
based exchanges will be a critical tool to help small businesses with 
fewer than 100 employees shop for health insurance plans and determine 
their eligibility for tax credits to buy health insurance. Small 
businesses that prosper and grow beyond 100 employees would be allowed 
to continue shopping through the exchanges--pooling. The insurance 
plans sold in SHOP exchanges would be subject to the same transparency 
requirements and consumer protections, so small businesses can feel 
confident they are purchasing high-quality plans that will provide 
quality, affordable coverage for their workers.
  The legislation also institutes reforms in the insurance market that 
will protect individuals and small businesses purchasing plans both 
inside and outside these SHOP exchanges. These reforms will stop 
insurance companies from denying coverage based on a person's 
preexisting health condition or increasing a person's health insurance 
premiums based on health status or on gender and occupation--a practice 
that just has to be stopped.
  These new regulations are essential to helping small businesses keep 
health care costs predictable from year to year. That is one of the big 
problems. Small businesses face this sea of chaos, of volatility, 
uncertainty, unpredictability in knowing what their insurance costs 
will or will not be. That is why insurance companies cherry-pick and 
take advantage for themselves to maximize their profits, but it has the 
opposite effect on small businesses. This will help, frankly, to buy a 
lot more certainty that we desperately need.
  The changes in the managers' amendment will go the extra step and 
ensure this bill provides small businesses with the help they so 
desperately need. Passing health care reform is critical to small 
businesses. Without reform--this is no small matter; I am not blowing 
smoke here--without reform, many small businesses will be forced to 
drop their health insurance coverage they may already have because they 
can no longer afford it. They cannot afford the increase in premiums. 
This will leave many employees to fend for themselves in the individual 
market. We know without this bill passing how unfair the individual 
market is to people.
  Many of the provisions in this bill were designed with small 
businesses in mind. The bill gives small businesses access to a 
reformed marketplace where they will have improved buying power to 
negotiate rates. And the Senate bill provides tax credits to help small 
businesses buy health insurance for their employees.
  Data from CBO tells us that these reforms will make coverage more 
affordable for millions of small business employees. The small business 
tax credit will help reduce health care costs for small businesses and 
their employees. As a result of the larger health reform proposals in 
the bill, there will be an increase in the percentage of small firms 
that offer health insurance coverage.
  We must act to help small businesses access to quality, affordable 
health care options for their employees. Too many small businesses 
around the country are waiting.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Mr. President, I just heard my colleague from Montana 
talk about jobs that are going to be lost, and the jobs are going to be 
lost if this bill passes.
  There was an article in the Wall Street Journal that quoted the 
Federation of Independent Business, a wonderful organization that works 
so well with small businesses in this country. Their prediction is that 
if this passes--if this passes--the mandates in this bill will mandate 
that employers provide

[[Page S13574]]

health care. This is going to cost 1.6 million jobs by 2013.
  Then I got an e-mail from a friend in Dubois, WY, who says that if 
this bill passes, he knows he is going to lay off workers--quite to the 
contrary of what my colleague from Montana says when he says it is 
going to help keep people working.
  At a time when the country is experiencing 10 percent unemployment, 
at a time when the people's No. 1 concern is jobs and the economy of 
this country, we are now embarking on an additional spending spree when 
our national debt is at the highest levels ever.
  I disagree with my colleague from Montana. I think, contrary to what 
he suggested--he said: I am not just blowing smoke--I believe we will 
lose jobs if this passes.
  Mr. BAUCUS. Will the Senator yield for one brief minute?
  Mr. BARRASSO. When I am finished with our comments on this side.
  Mr. BAUCUS. I thank the Senator.
  Mr. BARRASSO. I also heard the majority whip come to the floor and 
say the Republicans have only offered four amendments. I offered 19 
amendments. So I ask unanimous consent that the pending amendment be 
set aside and that I be allowed to call up my amendment No. 3148 to 
protect individuals facing skyrocketing premiums.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. Reserving the right to object.
  Mr. BARRASSO. The purpose of this amendment is----
  Mr. BAUCUS. Reserving the right to object, and I will object, we have 
been----
  Mr. BARRASSO. Regular order.
  The PRESIDING OFFICER. Is there objection to the request?
  Mr. BAUCUS. I object.
  The PRESIDING OFFICER. Objection is heard.
  The Senator from Wyoming.
  Mr. BARRASSO. So we have a 383-page amendment brought to the floor, 
read on the floor yesterday. I worked my way through it, along with my 
staff--383 pages. And the majority whip comes to the floor and says the 
Republicans have not offered amendments. I just tried to offer one, 
unsuccessfully, and it has been objected to.
  So I ask unanimous consent that the pending amendment be set aside 
and that I be allowed to call up amendment No. 3153 to protect young, 
healthy persons from increased insurance premiums.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. Mr. President, clearly this is a stunt. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. BARRASSO. Mr. President, I ask unanimous consent that the 
pending--and these are--I just heard the comments--these are amendments 
that are aimed to keep the President's words that we will get insurance 
premiums under control, people will notice their premiums go down, that 
we will make it better for people, easier for people. The Democrats 
ought to accept all these amendments because they are intended to do 
just that.
  I ask unanimous consent that the pending amendment be set aside and 
that I be allowed to call up amendment No. 3146. This amendment deals 
with individual mandate penalties and creates personal accounts for 
young people who are penalized and they have to pay a fee and a fine if 
they do not obey the individual mandate, and that would go into an 
account for them so they could use that money to buy their own health 
insurance.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. Reserving the right to object, this is the fourth time 
today Senators on the other side----
  Mr. BARRASSO. Regular order.
  Mr. COBURN. Regular order.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. BARRASSO. Mr. President, I understand this is going to improve 
Medicare. I heard the chairman of the Finance Committee say this is 
going to make Medicare stronger. I believe Medicare patients ought to 
have the freedom to contract and the right to privately contract for 
medical services with the physician of their choice.
  If, as the chairman of the Finance Committee has now recommended in 
his statement, it doesn't work out the way it is suggested--I ask 
unanimous consent that the pending amendment be set aside and I be 
allowed to call up amendment No. 2984, Medicare patient freedom to 
contract.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. For the fifth time, I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. BARRASSO. Mr. President, that is why I am not surprised when I 
read polls that say negatives abound in polls about this bill, written 
in secret, brought to us just a little over 24 hours ago with a 383-
page amendment, one that is now not going to be allowed to have any 
amendments offered.
  I just offered four different amendments aimed to strengthen the 
health care system of the country. Each time, the chairman of the 
Finance Committee is not even interested in hearing what the amendments 
are about.
  The people of Wyoming say: Don't cut my Medicare, don't raise my 
taxes, don't make things worse for me, especially in these economic 
times. This is a bill that is going to cut people's Medicare by $500 
billion, it is going to raise their taxes, and it is going to make 
things worse for the people of Wyoming and this country. That is why 
the front page of a local newspaper has a story, ``Doctor Shortage Will 
Worsen.'' Great concerns.
  Even the Actuary of Medicare and Medicaid says that if all of this 
goes through--and this is before we had the 383 new pages--if all of 
this goes through, one in five hospitals is going to have significant 
problems within the next 10 years and one in five doctors' offices may 
have to close. That is why this health bill is scary.
  For anyone who has not had an opportunity to read Dr. Coburn's, 
Senator Coburn's article in the Wall Street Journal, an editorial, 
Thursday, December 17, I recommend the editorial to them. It is titled 
``The Health Bill Is Scary.''
  I ask unanimous consent to have this editorial printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     [From the Wall Street Journal]

                        The Health Bill Is Scary

                            (By Tom Coburn)

       I recently suggested that seniors will die sooner if 
     Congress actually implements the Medicare cuts in the 
     healthcare bill put forward by Senate Majority Leader Harry 
     Reid. My colleagues who defend the bill--none of whom have 
     practiced medicine--predictably dismissed my concern as a 
     scare tactic. They are wrong. Every American, not just 
     seniors, should know that the rationing provisions in the 
     Reid bill will not only reduce their quality of life, but 
     their life spans as well.
       My 25 years as a practicing physician have shown me what 
     happens when government attempts to practice medicine: 
     Doctors respond to government coercion instead of patient 
     cues, and patients die prematurely. Even if the public option 
     is eliminated from the bill, these onerous rationing 
     provisions will remain intact.
       For instance, the Reid bill (in sections 3403 and 2021) 
     explicitly empowers Medicare to deny treatment based on cost. 
     An Independent Medicare Advisory Board created by the bill--
     composed of permanent, unelected and, therefore, 
     unaccountable members--will greatly expand the rationing 
     practices that already occur in the program. Medicare, for 
     example, has limited cancer patients' access to Epogen, a 
     costly but vital drug that stimulates red blood cell 
     production. It has limited the use of virtual, and safer, 
     colonoscopies due to cost concerns. And Medicare refuses 
     medical claims at twice the rate of the largest private 
     insurers.
       Section 6301 of the Reid bill creates new comparative 
     effectiveness research (CER) programs. CER panels have been 
     used as rationing commissions in other countries such as the 
     U.K., where 15,000 cancer patients die prematurely every year 
     according to the National Cancer Intelligence Network. CER 
     panels here could effectively dictate coverage options and 
     ration care for plans that participate in the state insurance 
     exchanges created by the bill.
       Additionally, the Reid bill depends on the recommendations 
     of the U.S. Preventive Services Task Force in no fewer than 
     14 places. This task force was responsible for advising women 
     under 50 to not undergo annual mammograms. The administration 
     claims the task force recommendations do not carry the force 
     of law, but the Reid bill itself contradicts them in 
     section 2713. The bill explicitly states, on page 17, that 
     health insurance plans ``shall provide coverage for'' 
     services approved by the task force. This chilling 
     provision represents the government stepping between 
     doctors and patients. When the government asserts the 
     power to provide care, it also asserts the power to deny 
     care.

[[Page S13575]]

       If the bill expands Medicaid eligibility to 133% of the 
     poverty level, that too will lead to rationing. Because 
     Washington bureaucrats have created a system that underpays 
     doctors, 40% of doctors already restrict access to Medicaid 
     patients, and therefore ration care.
       Medicaid demonstrates, tragically in some cases, that 
     access to a government program does not guarantee access to 
     health care. In Maryland, 17,000 Medicaid patients are 
     currently on a waiting list for medical services, and as many 
     as 250 may have died while awaiting care, according to state 
     auditors. Kansas, the home state of Health and Human Services 
     Secretary Kathleen Sebelius, faces a Medicaid backlog of more 
     than 15,000 applicants.
       Other unintended consequences of the Reid bill could wreak 
     havoc on patients' lives. What happens, for instance, when 
     savvy consumers commanded to buy insurance realize the 
     penalty is the de facto premium? It won't take long for 
     younger, healthier Americans to realize it's cheaper to pay a 
     $750 tax for coverage instead of, say, $5,000 in annual 
     premiums when coverage can't be denied if you get sick.
       OMB Budget Director Peter Orzsag's belief that mandatory 
     health insurance will become a ``cultural norm'' is 
     bureaucratic naivete that will produce skyrocketing premiums 
     and reduced care for everyone. My state's own insurance 
     commissioner, a Democrat, recently confirmed this concern to 
     me in a letter noting that ``the result will be higher 
     insurance rates due to a higher percentage of insured being 
     higher risk/expense individuals.''
       But the most fundamental flaw of the Reid bill is best 
     captured by the story of one my patients I'll call Sheila. 
     When Sheila came to me at the age of 33 with a lump in her 
     breast, traditional tests like a mammogram under the standard 
     of care indicated she had a cyst and nothing more. Because I 
     knew her medical history, I wasn't convinced. I aspirated the 
     cyst and discovered she had a highly malignant form of breast 
     cancer. Sheila fought a heroic battle against breast cancer 
     and enjoyed 12 good years with her family before succumbing 
     to the disease.
       If I had been practicing under the Reid bill, the 
     government would have likely told me I couldn't have done the 
     test that discovered Sheila's cancer because it wasn't 
     approved under CER. Under the Reid bill, Sheila may have 
     lived another year instead of 12, and her daughters would 
     have missed a decade with their mom.
       The bottom line is that under the Reid bill the majority of 
     America's patients might be fine. But some will be like 
     Sheila--patients whose it lives hang in the balance and 
     require the care of a doctor who understands the science and 
     art of medicine, and can make decisions without government 
     interference.
       The American people are opposing this bill in greater 
     numbers every day because the facts of the bill--not any 
     tactic--are cause for serious concern.

  Mr. BARRASSO. Mr. President, here you have it. We have a bill that is 
going to be voted on at 1 in the morning on a Monday morning. Why? 
Because the people who are proposing the bill are scared to let the 
American people know what is in it. That is why public opinion has 
soured on this proposal to the point that it is at the lowest level 
ever, with just 32 percent of Americans in favor, just less than one in 
three. Less than one in three Americans supports what is being 
proposed.
  I believe each one of my amendments would have raised the level of 
support, would have made this better for American taxpayers, for 
American citizens, for American patients, for the patients who depend 
on our health care system, for the providers who give the care, and for 
the people who pay for it.
  I see my colleague from North Carolina ready to rise. I am so happy 
to be joined on the Senate floor by these two wonderful colleagues who 
have a great bill of their own that has gotten very little hearing, 
very little opportunity, certainly no opportunity for a vote on the 
Senate floor.
  As my Senate colleague from North Carolina gets his microphone ready 
to go, I will say that to be held to a false deadline of Christmas Day 
on something as important as a bill that is going to impact the health 
of every person in this country, impact one-sixth of the economy of the 
United States--it is much more important that we get it right than that 
it gets rushed through with speed and secrecy, with not being able to 
offer amendments when a 383-page amendment by Senator Reid is dropped 
on the table yesterday and a vote is going to be held at 1 in the 
morning on a Monday morning.
  It is astonishing that we do not have bipartisan support, people 
working together to find solutions. It is astonishing when you have a 
body such as this of 100 Members, 2 of whom are physicians with 50 
years of experience practicing medicine, working with the system, 
fighting against insurance companies and fighting against the 
government, two physicians who know that you do not want anybody 
between you and your physician, you do not want a government 
bureaucrat, you do not want an insurance bureaucrat, you do not want 
anyone. But what we are looking at is the worst of all possible worlds.
  I ask my colleague from North Carolina if he has some additional 
thoughts.
  Mr. BURR. I do, Mr. President.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. BURR. Mr. President, I look around this Chamber, and I see the 
busts of many Vice Presidents who have served as the leaders of this 
Chamber. It makes me wonder what would they think of the process in 
which we are currently engaged, individuals who, in a time of history 
of our country, took so seriously what went on in this Chamber and the 
effects it had on the American people.
  I look at the process we are going through right now and see the way 
we have trivialized this process--votes in the middle of the night. 
Twenty-four hours ago, there was not a managers' amendment. There was 
not a score. Then yesterday morning we got a managers' amendment, 380-
some pages, and we got a score. Today we get a notice from the 
Congressional Budget Office saying that in their score, they made a 
$\1/2\ trillion error, a $500 billion, $\1/2\ trillion error in the 
projection they sent to Congress. In 24 hours, $\1/2\ trillion.
  Why doesn't this seem to bother those who are the authors of the 
bill? It is because it is not their money. It is the American people's 
money. That is the only way you could rationalize how you could be in 
Washington talking about spending $2.5 trillion at best to stop waste, 
fraud, and abuse, because, let's face it, Republicans and Democrats 
agree: There is no health care reform in here. There is a coverage 
expansion, but there is no health care reform.
  Democrats have walked to the floor and said that we lie. I am not 
lying. Show me the health care reform. Show me where you have 
drastically changed, transformed health care. If you transform health 
care, then you wouldn't have to steal $464 billion from Medicare.
  Mr. BAUCUS. Will the Senator yield so I can show him?
  Mr. BURR. Regular order, Mr. President.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. BAUCUS. He doesn't----
  The PRESIDING OFFICER. The Senator from North Carolina has the floor.
  Mr. BURR. I appreciate that, Mr. President.
  We have gone through this, and we are refused the ability to offer 
amendments. We are refused the opportunity to sit in the back room 
where the legislation was constructed. It is shared with us when they 
are ready. But they use everybody's money. Tell me how it is fair to 
the American people.
  When Nebraska gets a sweetheart deal under Medicaid, and 
Massachusetts and Vermont, in the managers' amendment, when Nebraska is 
told: We are going to expand Medicaid and we are going to hold you 
harmless in perpetuity, you will not have to pay, tell me how that is 
fair to the taxpayers of Virginia, tell me how it is fair to the 
taxpayers of Ohio, tell me how it is fair to the taxpayers of North 
Carolina that they are going to pay for what Nebraskans should be 
obligated to pay. I believe, knowing Nebraska, that the people of 
Nebraska would want to pay their fair share. But, no, to buy a vote, 
they have been given a deal.
  This bill is still $2.5 trillion. It still steals $464 billion from 
Medicare. It still puts a tremendous unfunded mandate on every State in 
this country with the exception of the State of Nebraska. There are a 
number of States that have a grace period for some period of time, 
whatever it took to get their comfort level of their vote, but for 
every other State, at some point they are going to be obligated to pick 
up that difference.
  We cover 3l million Americans who were not covered--that is a 
wonderful thing--and 15 million of them are dumped into Medicaid, the 
worst health care delivery system that exists in this country, a health 
care system that only has the opportunity today to see 60 percent of 
the available doctors because the other 40 percent will not see them.

[[Page S13576]]

  Oh, by the way, what did the Chief Actuary of the Centers for 
Medicare and Medicaid Services say?

       The Reid bill is especially likely to result in providers 
     being unwilling--

  Unwilling--

     to treat Medicare and Medicaid patients, meaning that a 
     significant portion of the increased demand for Medicaid 
     services would be difficult to meet.

  The Chief Actuary went on to say:

       The CMS actuary noted that the Medicare cuts in the bill 
     could jeopardize Medicare beneficiaries' access to care.

  I just heard the Senator from Rhode Island basically come out and say 
that was a fabricated thing on the part of somebody on this side of the 
aisle. I am quoting the Chief Actuary, the President's chief health 
care budgetary person. The Actuary said it ``could jeopardize Medicare 
beneficiaries' access to care.'' He goes on to say that he finds that 
roughly 20 percent of all Part A providers--hospitals, nursing homes, 
et cetera--would become unprofitable within the next 10 years as a 
result of these cuts. Hospitals will close, nursing homes will close. 
This isn't fabrication. This is the Chief Actuary of the Centers for 
Medicare & Medicaid Services, who is part of this administration. The 
CMS's Actuary found that further reductions in Medicare growth, through 
the actions of the independent Medicare advisory board--this is the 
advisory board that is being set up to make determinations about 
coverage in the future--which advocates have pointed to as a central 
linchpin to reducing health care spending, may be difficult to achieve 
in practice.

  In other words, we are making claims that aren't right, it is the 
authors of the bill who are making claims that are not accurate, 
according to the Chief Actuary.
  I yield to the minority leader.
  Mr. McCONNELL. I say to my friend from North Carolina, if that were 
not bad enough--and it may have been referenced here on the floor 
before I came out--we have an announcement from the Congressional 
Budget Office just today. The Senator from North Carolina may have 
referred to this. On the Director's blog today--the Director of the 
Congressional Budget Office--is the headline: ``Correction Regarding 
the Longer-Term Effects of the Manager's Amendment to the Patient 
Protection and Affordable Care Act.''
  CBO has discovered an error in the cost estimate released yesterday--
yesterday--related to the long-term budgetary effect of the manager's 
amendment. They go on to say they were about $\1/2\ trillion off in 
looking at the long-term effects beyond the 10-year window, which 
further illustrates why we ought not to be rushing this thing through, 
and we ought to have further opportunity to discover what other 
problems there are, in addition to the ones the Senator from North 
Carolina has outlined with regard to special treatment for some States 
which all the rest of our States have to pay for.
  Mr. BURR. The minority leader makes a great point. If we waited 
another day to vote, we might save another $\1/2\ trillion. That is 
probably in the best interest of the American taxpayer.
  I will wrap up, Mr. President, because I know Dr. Coburn wants to 
speak. Let me say this. I said earlier this still steals $464 billion 
from Medicare. It also still raises taxes and fees to the tune of $519 
billion. Many of those taxes and fees, by the way, are going to impact 
people well below the $200,000 threshold the President promised he 
would never touch.
  We have just learned in the managers' amendment that we have dropped 
the doctor fix. They should be comforted in knowing that they have a 2-
month extension, but the 1-year extension was dropped in the managers' 
amendment. Dropped. Why? Because they had to pay for what they were 
doling out to get extra votes.
  I ask unanimous consent at this time, Mr. President, to set aside the 
pending amendment, and I wish to call up amendment 3134, which is a 3-
year doctor fix of the SGR and ask for its immediate consideration.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. For the sixth time we are engaged in this stunt, so I 
object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. BURR. Well, Mr. President, my hope is no other Member from the 
other side will come to the floor and say that Republicans haven't come 
up with substantive amendments to this bill.
  Dr. Coburn and I participated in 56\1/2\ hours in the HELP Committee. 
We offered numerous amendments. Some technical amendments were 
accepted. The amendments that meant anything were rejected along party 
lines. We have filed a comprehensive health care reform bill--the first 
one introduced in Congress--in May of this year, I believe. Still, 
Members from the other side come to the floor and say Republicans 
haven't offered anything. We were the first. They may not have liked 
it, but we were the first.
  You know what, it doesn't cost this much and it doesn't raise taxes. 
I think Dr. Coburn will later talk about that bill a little.
  I was glad to see that politics comes from all sides. In the 
managers' amendment we dropped the tax on botox. Hollywood spoke out 
about this tax on one of their health care tools. And what did we 
replace it with? We have now put a 10-percent tax on tanning salons. 
How in the hell does that affect health care? Explain that to me. Are 
we going to tax everything in this country? I can make a tremendous 
case that the 10-percent tanning salon tax gets exactly the person that 
the President said he wasn't going to affect, people who make under 
$200,000--or are we income testing the tanning tax, too?
  Mr. COBURN. Would the Senator yield for a question?
  Mr. BURR. I yield to the Senator from Oklahoma.
  Mr. COBURN. If we are going to tax tanning salons, why don't we tax 
anybody who goes to the beach? Because true sunlight is much worse for 
your skin than a tanning salon. So if the intention was to prevent 
disease, why wouldn't we tax it where most of the disease occurs? Or 
how about kids' sports in the summer. Let's tax kids' baseball. Or 
swimming. Let's tax all the swimming pools because we have exposure to 
UV light.
  This shows the precariousness and the silliness of a large portion of 
this, and I yield back.
  Mr. BURR. The Senator makes a great point, and I am sure we have 
loaded the chairman of the Finance Committee with additional good ideas 
he can go back and think on. I am sure before it is over, we will fine 
parents who don't put suntan lotion on their children--especially if it 
doesn't meet high enough SPF to block everything the Sun might produce.
  This is out of control. This is not the way to write a bill that 
affects one-sixth of the U.S. economy. I mean it is bad enough it is 
done behind closed doors, in a back room, with only a few people there, 
but when the No. 2 Democrat can walk on the floor and say: I haven't 
seen it, either--well, if the No. 2 Democrat hasn't seen it, how many 
people were there? How many people had input into this? Was it just 
Leader Reid and Senator Nelson? Was it the Presiding Officer from 
Minnesota? Nobody knows. Nobody knows. The truth is, and what we do 
know is that the American people don't like the process, and more 
importantly the American people don't like the bill.
  The chairman of the Finance Committee and others have said: But once 
it is out there and they get a taste of this, they are going to like it 
then. Well, let me remind my colleagues: It is too late. The Chief 
Actuary already told us: Hospitals are going to close, nursing homes 
are going to close, doctors are going to quit practicing medicine. They 
will quit seeing Medicare and Medicaid beneficiaries. How do you repair 
that after you have done the damage? Are we willing to risk that for 
the future of this country and generations yet to come?
  Boy, we have a few hours--8 or 10 hours--before we vote. I hope 
people get some sense. I hope they pull back from this. Let's leave for 
Christmas. Let's think about this. Let's go home and talk to people. 
Let's listen to people in this country. If we do, we might come back, 
get a new piece of paper, take some of the things in this bill and take 
some of the things we have talked about on this side of the aisle, take 
some of the things the American people have talked about, and find a 
way for 100 percent of the doctors, nurses, and hospitals to survive; 
find a way for 100 percent of the American people to have coverage, and 
not the 31 million covered in this bill, leaving 24 million outside the 
scope of coverage.

[[Page S13577]]

  You see, when we set out we had three objectives: One was to cover 
all the American people. We flunked. Another was to invest in 
prevention, wellness, and chronic disease management. The doctor and I 
both say we haven't come anywhere close to doing that. The third and 
most important was to make sure it is fiscally sustainable. CBO, CMS, 
wherever you want to go, the only way this is fiscally sustainable is 
if the independent Medicare advisory board continues to cut 
reimbursements, the scope of coverage, to meet how much we are willing 
to spend on health care to say it is affordable.

  I don't believe that is reform. I believe that is legislation that 
picks winners and losers, and that is not the role of the Senate of the 
United States.
  I yield to the good doctor.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. COBURN. I want to raise an issue. It was raised in the Finance 
Committee markup; it was raised in the health care markup. I have 
behind me the Medicare cuts, and I understand they have been slightly 
reduced in home health--in the rebuild--but we are going to cut 
Medicare. We are not going to cut it significantly in the fraud--$2 
billion. That is where the real waste is.
  The Senator from Rhode Island came down here and said we are trying 
to scare people, but when we offered the opportunity for the chairman 
of the committee to prohibit rationing of health care in this country, 
both the chairman and the Senator from Rhode Island voted against it. 
It was simple, straightforward, saying no matter what we do in health 
care, we are not going to do what other countries have done, and that 
is ration health care. Straight up-and-down votes--party-line votes--
against it.
  In fact, we are going to ration health care. That is what this bill 
does. The way we are going to control cost is through the mechanisms 
outlined in this bill that are going to allow government bureaucrats to 
decide what you can get treated for, when you can get treated for it, 
and where you can get treated for it. The rebuttal to that is: In 
Medicare, it is already illegal for them to ration care, so we don't 
need a prohibition. The fact is Medicare is rationing right now. They 
are rationing virtual colonoscopies, they are rationing bone 
densitometry, they are rationing Epogen, they are rationing Neupogen--
two key drugs to maintain survival during the treatment of 
chemotherapy. They are practicing medicine.
  So when given the opportunity to vote and put an absolute prohibition 
on the rationing of health care, what did the chairman of the Finance 
Committee do? He voted against that. Because what he recognizes is the 
ultimate plan. And the answer to Senator Burr's question is: This will 
collapse. It is not going to be sustainable. The Medicare cuts won't be 
made by us. We will put it off on a commission and say: Oh, we had to 
do it, and the result of that will be rationing.
  The other result will be what the Senator from Vermont actually 
wants, which is a single-payer, government-run system. That is why he 
is intellectually honest. He brought it to the floor and said this is 
how I think we ought to solve health care. We ought to have the 
government run it, and we ought to have the government make the 
decisions. He was honest about it. That is where this bill is going. So 
if you are a Medicare patient, you should be concerned. If you are a 
Medicare Advantage patient, you should be concerned.
  I have had criticism leveled at me because I do what the chairman of 
the Finance Committee suggests--I make competitive bidding for Medicare 
Advantage. But there is a big difference. Mine has no cuts in benefits. 
They cut benefits 50 percent, in terms of the Medicare Advantage 
differential.
  There are three things you can do to fix health care in this country: 
You can incentivize prevention and the treatment of chronic disease 
based on outcome; you can create transparency so that purchasers in the 
market can actually make a judgment about value and quality; and you 
can assist those who are on the lower rungs of the economic ladder to 
get the same kind of care we get. Those are the three things you can 
do.
  I readily admit we don't have a great competitive model in the 
insurance industry. I want to change that. We had Senator Wyden come to 
the floor and say that he loves the free enterprise spirit, yet we want 
to put an artificial fix in terms of the insurance company, in terms of 
what you have to have for a return. What if an insurance company came 
up with 20 percent greater efficiency in terms of outcomes and 
benefits? They still have to spend that money? In the name of the free 
enterprise system we are going to kill free enterprise? As a practicing 
physician, I bristle at the way I run into insurance companies. There 
is no question about it. We need to fix that.
  The point Senator Burr was making is this says it is this way or the 
highway, when the option we offered--the Patients' Choice Act--cuts 
taxes, doesn't raise taxes; expands exactly to the level or beyond of 
this bill and it does at in a faster rate. It extends the life of 
Medicare. It gives Medicaid patients the same kind of care we get. But 
it was defeated in committee on a party-line vote. It was filed as an 
amendment here but not accepted. We had 10 amendments voted on from our 
side on 2,400 pages of legislation--10 amendments. So it is not about 
being bipartisan, it is about you have to take this or leave it.
  What the American people ought to pray for is that somebody can't 
make the vote tonight. That is what they should be praying for, so that 
we can actually get the middle--not me, not mine. I understand I am way 
over here. But we ought to get the middle of America and the middle of 
the Senate a bill that can run through this country and actually do 
what we say we all want to do. There is a large difference of opinion, 
and it is not rhetoric that is unfounded, as Senator Burr outlined, and 
as Dr. Barrasso outlined with an estimate by NFIB of 1.6 million jobs 
lost. That may be old data, because who knows what the data is now. We 
haven't had a chance to look at it, because 30 hours after the bill is 
introduced for cloture and the cloture motion is filed, we are going to 
vote on it. I am not sure this is a great way to run the country.
  What is in the bill? There are zero guarantees that taxpayers won't 
finance abortion.
  There are zero prohibitions on the rationing of health care--zero. 
There is not one shred of evidence that we are not going to ultimately 
ration health care under this bill. We are. And the only reason you 
would vote against a rationing amendment is because you intend to see 
rationing carried out.
  There are zero Senators required to enroll in either Medicaid or a 
government-run option, either through OPM or Medicaid.
  There are now 10 new taxes created. There are 71 new government 
programs created. There are 1,697 times that the Secretary of HHS is 
going to write the regulations, and based on CRS calculations there are 
between 15,000 and 20,000 new Federal employees who are going to be 
required to carry out this legislation.
  There are 3,607 times, before we got the Reid amendment, that the 
legislation says the word ``shall.'' ``Shall'' is a very important word 
because the word ``shall'' takes away your options. There is no option 
when the word ``shall'' is used. The word ``shall'' also says whoever 
is directing the ``shall'' obviously has more wisdom, more knowledge, 
more experience than the person the ``shall'' is applied to.
  What we have said is, in all our wisdom, in all our many years of 
practicing medicine and being involved in the care of patients, that 
3,607 times we are going to tell the American people what to do.
  One of the big ``shall also's'' that I do not think will ever hold 
scrutiny before the Supreme Court is, you shall buy an insurance 
policy. That doesn't fit anywhere in the Constitution that I read. If 
you do the legal research on it, as my staff lawyers from the Judiciary 
Committee have done, it is highly unlikely that will ever hold up. So 
the whole premise of a large portion of the taxes collected in this 
bill will be out the window.
  It also will totally change, through adverse selection, all of the 
insurance premiums in this country because, if you do not have an 
individual mandate making people buy insurance, the costs relative to 
the illness and the age, even though we have compressed the ratios, 
will rise exorbitantly.

[[Page S13578]]

  There are still going to be 24 million people left without health 
insurance in this country. There is a $10 billion cost just for the IRS 
implementation of this bill. There is at least $25 billion in mandates 
placed on the States, unfunded mandates. Actually it is much higher 
now. There is $28 billion-plus in new taxes on employers. There is $100 
billion, by conservative estimates, in fraud and Medicare and Medicaid 
a year, and this bill goes after $2 billion over 10 years. So we are 
going to go after $2 billion out of $1 trillion--not $200 billion, not 
$20 billion--we are going after $2 billion.
  There is $118 billion in cuts to Medicare Advantage but only for 
those people who do not live in the State of Florida and a couple of 
other places. If you happen to live in Oklahoma, citizens under the 
Medicare Advantage are going to lose.
  This is now over $500 billion in new taxes on Americans. There is a 
quarter of a trillion dollars not in this in expense that everybody 
knows is an expense. We are going to restore the SGR. We are going to 
fix that. And that quarter of a trillion dollars is based on no 
increase in physicians over the next 10 years. How many in this body 
think we are not going to increase the pay of physicians in Medicare 
under the next 10 years? The assumptions in the CBO report that 
accompanied the Reid amendment, if you read what they said, they said 
it is highly unlikely. So that is a quarter of a trillion dollars even 
though it was not in their numbers.
  It also said if, in fact, the cuts came through, which they thought 
highly unlikely that they would, and if they didn't, then the fiscal 
numbers associated with the bill are out the window. The final number 
everybody ought to be paying attention to is $12.1 trillion; $12.1 
trillion is what our kids owe outside of owing ourselves--$1.1 
trillion. That is going to double in the next 10 years.
  Anybody with a lick of common sense who looked at the numbers on this 
bill would say: Washington, your accounting programs aren't any 
different from Enron. The same fate of those who created the Enron scam 
ought to apply to the Congress of the United States. The very fact we 
are not considering an SGR fix is evidence of that. At least you have 
to add a quarter of a trillion dollars every 10 years to this bill just 
to keep doctors even. And don't forget the fact that 34 million new 
Americans over the next 10 years are going to enter Medicare--are going 
to enter Medicare.
  What are the alternatives? I will not offer other amendments and make 
the chairman object to them because I know his answer. He calls it a 
stunt. It is not a stunt when you do not have vigorous amendments 
offered on the Senate floor. It is not a stunt. The stunt is not 
allowing amendments to be offered. To allow only 10 of our amendments 
to be offered on this bill is beneath the dignity of the Senate--on the 
biggest bill in the last 100 years in this Congress, the only bill in 
the last 100 years that is going to affect every American in a personal 
way but also in a fiscal way, a financial way.
  There was an amendment to be offered, a conscience protection for 
physicians. We didn't get a vote on it. Should we force physicians in 
this country to perform abortions or should we have a vote on whether, 
if they have a conscience protection, they ought to be exempted from 
that? Should that not be a part of health care reform? We are not going 
to get a vote on that.
  How about an amendment to reduce the waste, fraud, and abuse in 
Medicare and Medicaid Programs and protecting Medicare benefits? And 
increasing the fraud and waste from $2 billion to $100 billion over the 
next 10 years, that is just 10 percent of what is there. We are not 
going to get a vote on that. It is not going to be available. The 
American people are not going to get to hear the debate on that. They 
are not going to make up their mind. Why? You don't want them to hear 
the debate on it. If you truly wanted to have a debate on fraud we 
would have a debate on fraud, and we would have an amendment saying put 
your stamp down, or are you for the people who are defrauding? Or are 
you for the status quo? We are for the status quo. We are for the well-
connected.
  The amendment on rationing that I talked about--or an amendment to 
limit the bureaucratic increase associated with this bill, which is an 
amendment I offered, we are not going to get a debate on that. That is 
a very straightforward amendment. It just says we are not going to 
increase the number of bureaucrats to implement this bill. We are going 
to drive efficiency in HHS; that is where this is going to. We are 
going to say: You can't get a net increase in bureaucrats so get more 
efficient. Since we are running $1.4 trillion or $1.5 trillion 
deficits, that is something that everybody else in the country would be 
doing, but we are not going to do that. We are not going to allow an 
opportunity for a vote or debate on that. We are not going to have that 
opportunity.
  I have heard the majority mention several times that we didn't have 
anything to offer. We offered the Patients' Choice Act. CBO said it cut 
long-term costs on Medicaid, that it saved money on Medicare. They said 
it saved $1 trillion over the first 10 years for the State and the 
estimates. Because we couldn't get the commitment that was made to us 
by the chairman of the HELP Committee that he would score the bill, the 
bill didn't ever get scored by CBO--but an outside score says it saves 
at least $70 billion the first 10 years and far in excess of that 
afterwards. It covers more people than this bill, saves personal 
choice, doesn't put somebody between you and your doctor.
  I heard the Senator from Rhode Island say we were lying about that 
happening. It is happening today, both from insurance companies and 
Medicare and Medicaid. So if we really wanted to reform health care we 
would be attacking that. Instead, we are going to make it worse.
  Let me tell you how we are going to make it worse. We are going to 
use cost comparative effectiveness, which is exactly what the U.S. Task 
Force on Prevention Services did. They used cost comparative 
effectiveness, and when they looked at breast cancer, they said it is 
not cost effective to screen women before the age of 50. You know what. 
They are right. It is not cost effective. But it certainly is 
clinically effective, especially if your wife is the one who is 40 and 
has breast cancer and it was found by a mammogram.
  You see, judgment goes out the window. What do we do? We reversed 
that finding, one of the first things we did as we started the debate.
  Are we going to do that every time the U.S. Preventive Services Task 
Force issues a ruling that is cost effective but not clinically 
effective? Are we going to do that every time the cost comparative 
effectiveness panel says: You will do this, and the American people 
say: That isn't right, the American Cancer Society says: That isn't 
right. Every time we get one of those rulings will we have to pass a 
piece of legislation to change it?
  The purpose of the three panels is well intended. The Medicare 
Payment Advisory Commission is well intended. Help us cut costs. But 
the only way you go for cost is through prevention and management of 
chronic disease. You are not going to cut costs any other way because 
75 percent of everything we spend is on five chronic diseases. So 
unless you attack the real problem, the real disease, with our health 
care system, you are not going to solve it.
  The lack of art in medicine will become readily apparent in 2015, 
2016, and 2017. We will see bureaucratic decisions in between a patient 
and their provider. That is not a scare tactic. That is absolute fact. 
We have it now with Medicare. It is there. If I have a woman who is 55 
years of age today and I order bone density testing on her and find she 
has severe osteoporosis, I put her on medicine but am forbidden by 
Medicare to do the followup exam that is clinically necessary to see if 
the medicine is working, and not only that, under Medicare rules, she 
can't even use her own money to buy that test. So 2 years later, we do 
the test, and we haven't corrected her disease. Now we change medicines 
to try to find out, but we can't find out again. So she ultimately 
falls and breaks her hip. There is a 20-percent mortality rate from 
falling and breaking one's hip. But those are the rules we are 
operating under now, right now, that you want to expand.
  Government isn't ever compassionate. It is never compassionate. 
People are compassionate. Thought has

[[Page S13579]]

to be in the middle of the practice of medicine, not distant thought, 
near thought. The very fact that an insurance company tells the doctors 
what they can and cannot do is no worse than what we are getting ready 
to do with the rest of government-run health care. We didn't fix that 
problem. We didn't address that problem with this. We didn't guarantee 
that you could walk with your feet. We said: Here is how much money you 
can earn, but we didn't address that.
  I will give two examples. Two people I have taken care of for over 15 
years, both had no clinical indications that they had anything wrong. I 
contacted the insurance company. I thought they needed an MRI of the 
brain. Both of them were denied. I got friends who are radiologists to 
do their MRI. They both had brain tumors. One is still alive. What we 
are setting up isn't any different than what you have a complaint and 
gripe about now with the insurance industry. You didn't fix that in 
this bill. There is no health care reform in this bill. There is health 
coverage expansion, but there is no reform.
  One of those people is still alive, but had we followed either 
Medicare guidelines, cost comparative effectiveness panel guidelines, 
which would have forbidden doing an MRI, that one person out of the two 
would be dead today. So as we sit here and look at our health care 
system, my biggest worry is, I will be in Medicare. I will get 
rationed. I know that. The way we are going about it, that is what is 
going to happen. We are going to ration care. We will not vote to not 
ration it. You know it is going to be rationed or you would have voted 
for the amendment in committee that provided a prohibition.
  But my real concern is not my generation. My real concern is those 
who will follow us with $12.1 trillion worth of debt and the fact that 
every one of those is 25 years of age and younger today. Twenty years 
from now, they will be responsible for $1 million of both debt and 
unfunded liabilities for which we will have to collect, on average, 
$70,000 a year just to pay the interest on what we are sending them. 
Before they pay the rest of their income taxes, before they pay payroll 
taxes, before they pay unemployment taxes, before they send their kids 
to school, before they buy health insurance, before they buy a home, 
before they buy transportation, the real worry that should be in front 
of this country, which is the No. 1 issue on the public's mind, is: How 
do we get out of this financial mess? That is the No. 1 issue on 
people's minds. It is not health care.
  I have no hopes of convincing my colleagues that through 25 years of 
practicing medicine, dealing with Medicare, dealing with Medicaid, that 
that is of any value to you. Because we are hell-bent on passing a 
health care bill and dealing to make sure we can and creating 
inequities throughout this country and dividing our country.
  We heard the Senator from Rhode Island characterize us as liars, 
birthers, supporters of the Aryan nation. That is what I heard. I sat 
and listened to it. I think he doth protest too much, for he knows that 
is not true. There is nobody on our side of the aisle who cares any 
less than anybody on the other side of the aisle about fixing health 
care. The rub is, you believe the government is the most powerful thing 
and the best way to do it. We don't agree with that. We actually 
believe in the American people. We actually believe in the 
entrepreneurial spirit of the average American making good decisions 
for themselves every day, doing things we never do, which is 
prioritizing where their money is going to go and how they are going to 
spend it and working like heck to advance the cause of their own 
family, their own freedom, and their own liberty. You don't believe 
that because, if you did, you would never put this kind of bill on the 
floor. This bill limits liberty. This bill says you shall.
  Think of the first big step in this bill. In the United States, you 
no longer have the ability to not buy health insurance. If you have 
$\1/2\ million in the bank and you want to put that at risk and say: I 
don't want to, you either have to pay a fine, a tax, or you have to buy 
health insurance. So where is the liberty and where is the commerce 
clause in that and where does that tie in with individual liberty and 
individual responsibility? We say: If you don't want to be responsible, 
then we will make you responsible. We don't say: You have to suffer the 
consequences of your lack of responsibility.
  What built this country was people figuring out if you don't act 
responsibly, it is going to cost you. We are going to put a block on 
that and say: You don't have to act responsibly. You don't have to act 
in your own best economic interest. Don't worry. We will take care of 
it.
  Jefferson warned of that. One of the Founders of this country warned 
us against doing the very thing we are doing today. If you read the 
Federalist Papers, you will see what Madison wrote about the welfare 
clause and the commerce clause. He said, whenever the Senate starts to 
think about claiming it means something different than it does, here is 
what we want you to know. It doesn't. It is very limited in scope.
  I said yesterday in a press conference that this country is at the 
point of a crisis of confidence such as we have not seen in hundreds of 
years. It is true. Whether you are a very liberal individual or a very 
conservative individual, you don't have any confidence in us. The 
reason you don't is because we don't act in the country's best 
interest. We act in our political best interest. Republicans are 
equally guilty. We look at partisan issues rather than principled 
issues. What we miss in all that is the best right thing for the 
country. We are missing it with this bill. We are missing the best 
right thing for the country.
  Mr. CORKER. Will the Senator yield?
  Mr. COBURN. I am happy to yield.
  Mr. CORKER. I was listening to the Senator from Oklahoma. I know he 
cares deeply about his patients and continues to treat patients as he 
serves in the Senate. What he has done is pointed out the fact that 
there will be much interruption, changes in the physicians' and 
patients' relationship. But the big picture is what the Senator is 
concerned about, too; that is, the tremendous indebtedness this country 
has by the fact that--the good chairman of the Finance Committee is 
here today listening patiently, and I know this has to be painful to 
him--half the reform we are talking about is actually putting people in 
Medicaid, a program that 40 percent of physicians will not see and 50 
percent of specialists will not see.

  Mr. COBURN. And the outcomes are poor.
  Mr. CORKER. Last weekend, the New York Times talked about many 
physicians prescribing antipsychotic drugs to young people because they 
don't want to deal with them on Medicaid. So half this reform is people 
going into this type of program and half the money is coming from 
Medicare, which is insolvent.
  We have spent all this time, all kinds of bipartisan meetings. I know 
you spoke about the issue of partisanship. I know the good chairman is 
here. We, early on, said we wanted to join in health care reform. We 
just didn't want to take money from Medicare, which was an insolvent 
program, to fund it. What was the major building block of this program? 
Taking $464 billion from Medicare to fund reform. We were, in essence, 
blocked out on the front end saying something we thought was the wrong 
type of principle to build upon.
  Mr. COBURN. Mr. President, if, in fact, we got rid of 50 percent of 
the fraud in Medicare and Medicaid, we would generate $600 billion 
every 10 years, more than offsetting the cuts that have been outlined 
in this bill.
  Mr. CORKER. So if I understand correctly, of the new patients going 
into Medicaid, 50 percent of the money comes from an insolvent program. 
We are not dealing with the doc fix. Much of the savings they have 
talked about is just like the doc fix that back in 1997, the AMA, both 
sides of the aisle agreed to do something to save money for Medicare. 
As the Senator knows now, the Reid amendment takes out all the doc fix, 
now with a $285 billion gap over the next 10 years to deal with 
physicians. It is another example of how we don't have the courage. We 
put in place cuts. We are not going to do that. We know what damage 
that will cause to patients. In this particular case, we should not do 
that. But the fact is many of these cuts that have been discussed will 
never take place. They will never take place. At the end of the day, I 
come back to the very thing you talked about; that is, we have $12 
trillion in debt, $38.6 trillion in unfunded

[[Page S13580]]

liabilities for Medicare alone, and here we are passing a bill that is 
using up the resources we might otherwise use to make it solvent.
  Instead of doing that, we are leveraging a whole new entitlement. I 
heard some of the pundits this morning parroting some of the things I 
have heard from my friends on the other side of the aisle. Let's pass 
this bill. We know it is not very good, but we will fix it as we move 
along.
  What I fear is the way we are going to fix it, we are going to fix it 
by adding tremendous debt on future generations. My guess is over the 
next very short period--2 or 3 months--the other side of the aisle is 
going to come right back up here with a huge, several hundred billion 
dollar unpaid bill to deal with one of these issues we have been 
talking about. That is the way business is done here.
  Mr. COBURN. The Senator raises a good question. How long have we 
known and how long has Medicare been in trouble that we haven't fixed 
it? We will not fix it. We will do exactly what the Senator says, what 
we always do, what we have done since I have been in this body. We put 
the credit card into the machine and say: Transfer this to your 
grandkids. We take no pain ourselves. What is lacking in our country 
today is moral character to lead on the basis of sacrifice. It should 
start with us as Senators in this body.
  Mr. President, I understand our time has expired.
  The PRESIDING OFFICER. The minority's time has expired.
  Mr. COBURN. Mr. President, I thank the Chair, and I look forward to 
hearing the remarks in the cloakroom of the chairman of the Finance 
Committee.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, just a couple, three points here, and I 
see the Senator from Ohio wishes to speak.
  Several times during this afternoon, Senators on the other side of 
the aisle, in my judgment, put on a little demonstration of trying to 
offer amendments. They repeatedly asked consent to suspend the normal 
working of the cloture rule to offer amendments. Earlier, I note for 
the Record, they slow-walked the process when an amendment was in 
order. They wanted the whole amendment read. And now they are trying to 
offer amendments, again, to slow down the process. This is clearly a 
tactic to slow the process. It is not part of the regular order. That 
is clearly what is going on here. Those were not, despite the 
protestations to the contrary, serious amendments.
  Normally, when a Senator offers a unanimous consent request, they 
allow the other side to speak briefly on the subject, at least on the 
reservation of the right to object. That was not allowed here. My 
colleagues did not allow me that courtesy earlier today, to comment 
with a reservation of the right to object. So I want to take a moment 
now to explain what they are really up to. I could not because they 
would not give me the courtesy to say any words during the reservation. 
That is why I made that statement.
  I heard one Senator from the other side of the aisle complain that 
the majority is holding tonight's vote at 1 a.m. in the morning on the 
cloture motion. Let me set the record straight. The majority would be 
happy to have this vote earlier. We would be happy to have this vote 
maybe in 10 or 15 minutes from now. We would be happy to have this vote 
at a decent time. It does not have to be at 1 a.m. tomorrow. It is the 
other side which is insisting that vote be at 1 a.m. in the morning. So 
it is they who are insisting on enforcing the letter of the Senate 
rules. It is their right, but it is also they who are insisting on 
delay.
  I also want to put to bed some of the assertions that they claim this 
bill does not do real health care reform. Let me mention a few health 
care reform provisions in this bill.
  Mr. President, I do not know if you or any of my colleagues have read 
this second article in the New Yorker magazine by Atul Gawande. The 
first article talks about two towns in Texas, basically. The second is 
basically looking to see whether this bill does reform health care and 
whether it does cut down health care costs. It is an article I highly 
recommend to all of my colleagues in a recent issue of the New Yorker 
magazine.
  But, basically, Dr. Gawande concludes this bill includes all of the 
constructive provisions health care economists, stakeholders, and 
people who have studied this issue suggest should be part of health 
care reform. That is his conclusion anyway. I am happy he said that 
because we worked mightily to make sure we have all the provisions we 
can here to help constrain health care costs.
  What are they? Well, one--although some may disagree with the 
policy--is an excise tax on high-cost plans, so-called Cadillac plans. 
It is a bit debatable. Last night I saw a TV ad where a group was 
advocating passage of this bill: But just not my high-cost plan. Pass 
the bill, but just not my high-cost plan. I understand the tenor and 
import of that TV ad, but the main point is, we do have to begin to 
limit to some degree the excessive cost of some plans, and I think we 
are very fair and modest here in proposing an excise tax on those high-
cost plans. The trick is to set the level at the proper level, not too 
high, not too low. I think this bill does that.
  In addition, all the delivery system reforms this bill enacts with 
respect to Medicare are so important to improving quality and reducing 
excess costs. We all know through history that when we reform Medicare 
and make changes in Medicare, the private sector follows. So the 
private commercial market will follow whatever Congress does with 
respect to Medicare; and that is, make good, positive changes. Why? 
Because Medicare is such a large provider of care, it tends to have a 
real effect on what other providers do.
  What are some of those? Well, basically, we start to change the way 
we pay doctors and hospitals; that is, we start to pay on the basis of 
value rather than volume, that is quality rather than quantity. The 
paradox of that is, when people stop to think about it, we are going to 
both cut down costs and increase value at the same time because we will 
be focused on quality. When you focus on quality--not just quantity, 
not the whole volume of services, but, rather, focus on quality--you 
are going to get better quality, but your costs are going to go down 
because you are not reimbursing things such as excessive MRIs, 
excessive CAT scans, excessive high-cost procedures that do not, in 
many cases, get to the quality of health care but, rather, are very 
expensive, and Medicare pays for them. So we are moving more toward 
reimbursing based on quality and value than quantity.
  What else is reform of the health care industry? One is bundled 
payments and the shared-savings program, which we refer to as 
accountable care organizations. This allows hospitals and groups to get 
together to cut down costs. We have bundling in here, which is another 
idea that moves along the same lines. I might add, too, the CMS 
Innovation Center and the Independent Payment Advisory Board suggest 
some of these.
  The bill makes it easier for employers to offer workplace wellness 
programs. We give employers greater flexibility to offer premium 
discounts for workers who are committed to leading healthier 
lifestyles. There is a lot of emphasis here on wellness and lifestyles. 
We give incentives to employers to have wellness programs and 
preventive programs, which will help, obviously, the worker, but, in 
addition to that, cut down costs.
  There are other provisions here. This bill keeps getting stronger. 
The so-called freshmen package, led by Senator Warner, will give the 
Secretary additional authority to expand delivery system reforms. It 
expands the scope of the Medicare board to the private sector.
  There are many other provisions in here.
  The Nation's employers, through the leadership of the BRT, played an 
important role in developing that package.
  And the manager's amendment included a provision that will provide 
greater access to Medicare data to measure performance.
  It is no exaggeration to say that this bill will revolutionize health 
care.
  But don't take my word for it. The 23 economists who wrote to the 
President agree.
  Mr. President, I ask unanimous consent that letter from these 
economists be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

[[Page S13581]]

                                              Stanford University,


                                     Center for Health Policy,

                                  Stanford, CA, November 17, 2009.
     President Barack Obama,
     The White House,
     Washington, DC.
       Dear Mr. President: On behalf of my colleagues, a group of 
     distinguished economists, I am pleased to transmit this 
     letter regarding essential components of health reform 
     legislation.
           Sincerely yours,
       Alan M. Garber, M.D., Ph.D.
       Henry J. Kaiser, Jr., Professor, Professor of Medicine, 
     Professor of Economics, Health Research and Policy, and of 
     Economics in the Graduate School of Business (courtesy), 
     Director, Center for Primary Care and Outcomes Research and 
     Center for Health Policy Stanford University.
                                  ____

                                                November 17, 2009.
     President Barack Obama,
     The White House,
     Washington, DC.
       Dear Mr. President, As the full Senate prepares to debate 
     comprehensive health reform legislation, we write as 
     economists to stress the potential benefits of health reform 
     for our nation's fiscal health, and the importance of those 
     features of the bill that can help keep health care costs 
     under control. Four elements of the legislation are critical: 
     (1) deficit neutrality, (2) an excise tax on high-cost 
     insurance plans, (3) an independent Medicare commission, and 
     (4) delivery system reforms.
       Including these four elements in the reform legislation--as 
     the Senate Finance Committee bill does and as we hope the 
     bill brought to the Senate floor will do--will reduce long-
     term deficits, improve the quality of care, and put the 
     nation on a firm fiscal footing. It will help transform the 
     health care system from delivering too much care, to a system 
     that consistently delivers higher-quality, high-value care. 
     The projected increases in federal budget deficits, along 
     with concerns about the value of the health care that 
     Americans receive, make it particularly important to enact 
     fiscally responsible and quality-improving health reform now.
       In developing our analysis and recommendation, we received 
     input and suggestions from Administration officials, 
     including the Office of Management and Budget and others, as 
     well as from economists who disagree with the 
     Administration's views.
       The four key measures are:
       Deficit neutrality. Fiscally responsible health reform 
     requires budget neutrality or deficit reduction over the 
     coming years. The Congressional Budget Office (CBO) must 
     project that the bill be at least deficit neutral over the 
     10-year budget window, and deficit reducing thereafter. 
     Covering tens of millions of currently uninsured people will 
     increase spending, but the draft health reform legislation 
     contains offsetting savings sufficient to cover those costs 
     and the seeds of further reforms that will lower the growth 
     of spending. Deficit neutrality over the first decade means 
     that, even during the start-up period, the legislation will 
     not add to our deficits. After the first decade, the 
     legislation should reduce deficits.
       Excise tax on high-cost insurance plans. The Senate Finance 
     Committee's bill includes an excise tax on high-cost health 
     insurance plans. Like any tax, the excise tax will raise 
     federal revenues, but it has additional advantages for the 
     health care system that are essential. The excise tax will 
     help curtail the growth of private health insurance premiums 
     by creating incentives to limit the costs of plans to a tax-
     free amount. In addition, as employers and health plans 
     redesign their benefits to reduce health care premiums, cash 
     wages will increase. Analysis of the Senate Finance 
     Committee's proposal suggests that the excise tax on high-
     cost insurance plans would increase workers' take-home pay by 
     more than $300 billion over the next decade. This provision 
     offers the most promising approach to reducing private-sector 
     health care costs while also giving a much needed raise to 
     the tens of millions of Americans who receive insurance 
     through their employers.
       Medicare Commission. Rising Medicare expenditures pose one 
     of the most difficult fiscal challenges facing the federal 
     government. Medicare is technically complex and the benefits 
     it underwrites are of critical importance to tens of millions 
     of seniors and Americans with disabilities. We believe that a 
     commission of medical experts should be empowered to suggest 
     changes in Medicare to improve the quality and value of 
     services. In particular, such a commission should be charged 
     with developing and suggesting to Congress plans to extend 
     the solvency of the Medicare program and improve the quality 
     of care delivered to Medicare beneficiaries. Creating such a 
     commission will make sure that reforming the health care 
     system does not end with this legislation, but continues in 
     future decades, with new efforts to improve quality and 
     contain costs.
       Delivery system reforms. Successful reform should improve 
     the care that individual patients receive by rewarding health 
     care professionals for providing better care, not just more 
     care. Studies have shown that hundreds of billions of dollars 
     are spent on care that does nothing to improve health 
     outcomes. This is largely a consequence of the distorted 
     incentives associated with paying for volume rather than 
     quality. Health care reform must take steps to change the way 
     providers care for patients, to reward care that is better 
     coordinated and meets the needs of each patient. In 
     particular, the legislation should include additional funding 
     for research into what tests and treatments work and which 
     ones do not. It must also provide incentives for physicians 
     and hospitals to focus on quality, such as bundled payments 
     and accountable care organizations, as well as penalties for 
     unnecessary re-admissions and health-facility acquired 
     infections. Aggressive pilot projects should be rapidly 
     introduced and evaluated, with the best strategies adopted 
     quickly throughout the health care system.
       As economists, we believe that it is important to enact 
     health reform, and it is essential that health reform include 
     these four features that will lower health care costs and 
     help reduce deficits over the long term. Reform legislation 
     that embodies these four elements can go a long way toward 
     delivering better health care, and better value, to 
     Americans.
           Sincerely,
       Dr. Henry Aaron, The Brookings Institution.
       Dr. Kenneth Arrow, Stanford University, Nobel Laureate in 
     Economics.
       Dr. Alan Auerbach, University of California, Berkeley.
       Dr. Katherine Baicker, Harvard University.
       Dr. Alan Blinder, Princeton University.
       Dr. David Cutler, Harvard University.
       Dr. Angus Deaton, Princeton University.
       Dr. J. Bradford DeLong, University of California, Berkeley.
       Dr. Peter Diamond, Massachusetts Institute of Technology.
       Dr. Victor Fuchs, Stanford University.
       Dr. Alan Garber, Stanford University.
       Dr. Jonathan Gruber, Massachusetts Institute of Technology.
       Dr. Mark McClellan, The Brookings Institution.
       Dr. Daniel McFadden, University of California, Berkeley, 
     Nobel Laureate in Economics.
       Dr. David Meltzer, University of Chicago.
       Dr. Joseph Newhouse, Harvard University.
       Dr. Uwe Reinhardt, Princeton University.
       Dr. Robert Reischauer, The Urban Institute.
       Dr. Alice Rivlin, The Brookings Institution.
       Dr. Meredith Rosenthal, Harvard University.
       Dr. John Shoven, Stanford University.
       Dr. Jonathan Skinner, Dartmouth College.
       Dr. Laura D'Andrea Tyson, University of California, 
     Berkeley.

  Mr. BAUCUS. The CMS Actuary agrees that this bill bends the cost 
curve. The folks at the Commonwealth Fund say the bill will save 
families $2,000 per year.
  Mr. President, I ask unanimous consent that an excerpt from Dr. 
Gawande's article from the New Yorker be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               Excerpt From Gawande Article in New Yorker

       There are hundreds of pages of these programs, almost all 
     of which appear in the House bill as well. But the Senate 
     reform package goes a few U.S.D.A.-like steps further. It 
     creates a center to generate innovations in paying for and 
     organizing care. It creates an independent Medicare advisory 
     commission, which would sort through all the pilot results 
     and make recommendations that would automatically take effect 
     unless Congress blocks them. It also takes a decisive step in 
     changing how insurance companies deal with the costs of 
     health care. In the nineteen-eighties, H.M.O.s tried to 
     control costs by directly overruling doctors' recommendations 
     (through requiring pre-authorization and denying payment); 
     the backlash taught them that it was far easier to avoid 
     sicker patients and pass along cost increases to employers. 
     Both the House and the Senate bills prevent insurance 
     companies from excluding patients. But the Senate plan also 
     imposes an excise tax on the most expensive, ``Cadillac'' 
     insurance plans. This pushes private insurers to make the 
     same efforts that public insurers will make to test 
     incentives and programs that encourage clinicians to keep 
     costs down.

  Mr. BAUCUS. Mr. President, the Senator from Oklahoma at one point 
questioned the constitutionality of the mandate to buy health 
insurance. I might say, we thoroughly studied this issue. I believe 
there is ample authority for Congress to enact such a provision under 
the Commerce Clause, and also under the congressional authority to tax 
and spend for the general welfare provided for in the Constitution.
  I might also add, Prof. Mark Hall of Wake Forest University has done 
an excellent survey article on this subject. Mr. President, I ask 
unanimous consent that the conclusion of Professor Hall's article, 
found at www.oneillinstitute.org, be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

[[Page S13582]]

Legal Solutions in Health Reform--The Constitutionality of Mandates To 
                       Purchase Health Insurance

                         (By Mark A. Hall, JD)

                           Executive Summary

                   Prepared by the O'Neill Institute


                              introduction

       Health insurance mandates have been a component of many 
     recent health care reform proposals. Because a federal 
     requirement that individuals transfer money to a private 
     party is unprecedented, a number of legal issues must be 
     examined. This paper analyzes whether Congress can legislate 
     a health insurance mandate and the potential legal challenges 
     that might arise, given such a mandate. The analysis of legal 
     challenges to health insurance mandates applies to federal 
     individual mandates, but can also apply to a federal mandate 
     requiring employers to purchase health insurance for their 
     employees. There are no Constitutional barriers for Congress 
     to legislate a health insurance mandate as long as the 
     mandate is properly designed and executed, as discussed 
     below. This paper also considers the likelihood of any change 
     in the current judicial approach to these legal questions.


                          POTENTIAL SOLUTIONS

       Congress's Authority to Regulate Commerce: The federal 
     government has the authority to legislate a health insurance 
     mandate under the Commerce Clause of the United States 
     Constitution. A federal mandate to purchase health insurance 
     is well within the breadth of Congress' power to regulate 
     interstate commerce. Congress can avoid legal challenges 
     related to the 10th Amendment and states' rights by pre-
     empting state insurance laws and implementing the mandate on 
     a federal level. If Congress wants states to implement a 
     federal mandate, it has the following two options:
       Conditional Spending: Congress may condition federal 
     funding, such as that for Medicaid or public health, on state 
     compliance with federal initiatives.
       Conditional Preemption: Congress may allow states to opt 
     out of complying with direct federal regulation as long as 
     states implement a similar regulation that meets federal 
     requirements.
       Congress's Authority to Tax and Spend for the General 
     Welfare: Congress also has the authority to legislate a 
     health insurance mandate under its Constitutional authority 
     to tax and spend. There are no plausible Tenth Amendment and 
     states' rights issues arising from Congress's taxing and 
     spending power. However, Congress' taxation power cannot be 
     used in a way that burdens a fundamental right recognized in 
     the Constitution's Bill of Rights and judicial 
     interpretations by the U.S. Supreme Court. Since there is no 
     fundamental right to be uninsured, no fundamental rights 
     challenge exists.
       Other Relevant Constitutional Rights: Challenges under the 
     First and Fifth Amendments relating to individual rights may 
     arise, but are unlikely to succeed. The federal government 
     should include an exemption on religious grounds to a health 
     insurance mandate as an added measure of protection from 
     legal challenges based on religious freedom. In the 
     alternative, the federal government can simply exempt a 
     federal insurance mandate from existing federal legislation 
     protecting religious freedom.
       Considerations: To avoid a heightened level of scrutiny in 
     any judicial review, the federal government should articulate 
     its substantive rationale for mandating health insurance 
     during the legislative process.


                     legal issues & applicable law

       Commerce Clause: Congress has the power to regulate 
     interstate commerce, including local matters that 
     substantially affect interstate commerce. Health care and 
     health insurance both affects and is distributed through 
     interstate commerce, giving Congress the power to legislate 
     an insurance mandate using its Commerce Clause powers.
       Taxing and Spending Power: Congress has the power to tax 
     and spend for the general welfare. It can use its taxing 
     power to implement a ``pay or play'' model to tax individuals 
     that did not purchase insurance or provide tax benefits to 
     those that do purchase insurance. Congress can also use its 
     spending powers to influence state action. The taxing power 
     of the federal government can be limited if a tax 
     intentionally and directly burdens the exercise of a 
     fundamental right.
       Federalism: The 10th Amendment and principle of state 
     sovereignty in the Constitution prohibit the federal 
     government from commanding the states to implement federal 
     law or policies that would interfere with state sovereignty. 
     This is referred to as the ``anti-commandeering'' principle. 
     A federal employer mandate covering state and local 
     government workers appears consistent with existing 
     Constitutional decisions but still might be susceptible to 
     challenge under the Tenth Amendment.
       Individual Rights: The First and Fifth Amendment contain 
     provisions that may have some bearing on a health insurance 
     mandate.
       Free Exercise of Religion: The First Amendment's Free 
     Exercise Clause protects the free exercise of religion. In 
     addition, the Religious Freedom Restoration Act (RFRA) 
     prevents the federal government from enacting a law that 
     substantially burdens an individual's exercise of religion, 
     unless the government has a compelling interest.
       Due Process and Takings Clauses: The Fifth Amendment 
     includes two relevant provisions. The Due Process Clause 
     guarantees that no person shall be deprived of life, liberty, 
     or property without due process of law. The Takings Clause 
     states that the government may not take an individual's 
     property without just compensation.


                               CONCLUSION

       The Constitution permits Congress to legislate a health 
     insurance mandate. Congress can use its Commerce Clause 
     powers or its taxing and spending powers to create such a 
     mandate. Congress can impose a tax on those that do not 
     purchase insurance, or provide tax benefits to those that do 
     purchase insurance. If Congress would like the states to 
     implement an insurance mandate, it can avoid conflicts with 
     the anti-commandeering principle by either preempting state 
     insurance laws or by conditioning federal funds on state 
     compliance. A federal employer mandate for state and local 
     government workers may be subject to a challenge; however, 
     such a challenge is unlikely to be successful. Individual 
     rights challenges under the First Amendment's Free Exercise 
     Clause or RFRA are unlikely to succeed, although a federal 
     insurance mandate should include a statement that RFRA does 
     not apply or provide for a religious exemption. Fifth 
     Amendment Due Process and Takings Clause challenges are also 
     unlikely to be successful. The legal analysis presented is 
     likely to endure, as the Supreme Court's current position and 
     approach to interpreting relevant constitutional issues 
     appear to be stable.

  Mr. BAUCUS. I might also say, Mr. President, the Senator from 
Oklahoma said the independent Medicare advisory board would ration 
care. In fact, he even accused us in the Congress--myself included--of 
voting against a prohibition on rationing. But, I might say, I am not 
for rationing care in the sense that the Senator from Oklahoma talked 
about. I do not think anybody in this Congress is. We have to find a 
system that starts to control costs in a fair way, that increases 
quality but also cuts costs. That is the underlying premise of the 
delivery system reforms in this bill. But do not just take my word for 
it. Right here in the bill, on page 1004, the bill says, with regard to 
the advisory board:

       The proposal shall not include any recommendation to ration 
     health care.

  I chuckle a little bit when I say that because the Senator from 
Oklahoma is very concerned about using the word ``shall.'' If he does 
not like ``shall,'' then I suppose he means the board would have 
discretion. But we say ``shall not include any recommendation to ration 
health care.'' That is on page 1004 of the bill. It is right there in 
black and white letters. Read the bill. The prohibition against 
rationing of health care is right there.
  Mr. President, I see the Senator from Ohio, who wishes to speak.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Mr. President, I thank the Finance chairman for his 
leadership.
  I have sat here listening. I was watching the debate in the last hour 
from my office, and then I came over in the last 20 minutes or half 
hour and watched from here. I am incredulous when I hear my colleagues 
on the other side of the aisle talk about ``saving Medicare.'' This is 
the same group of people, with only one exception on the whole 
Republican side of the aisle, in 2003, who rammed through the Medicare 
privatization bill that was written by the drug companies and the 
insurance companies for the drug companies and the insurance companies.
  Two things: One, they never paid for it. There was no discussion, no 
interest, no move to pay for their bill at all. Then they criticize 
that our bill is costing too much and running up the debt, when the 
Congressional Budget Office--which everyone knows is fair--they 
complain about the Congressional Budget Office. It is like at a 
sporting event. The losing team complains about the ref.
  The other side, because they are losing, complains about the 
Congressional Budget Office. We know it plays fair. We cite it. We 
must. We do. It helps us move forward and helps us figure things out. 
But they did not even try to pay for their Medicare privatization bill 
because the drug companies and the insurance companies would not have 
gotten their way so much if they tried to pay for it. But the second 
thing is, their bill shortened the life expectancy of Medicare.
  Our bill increases the life expectancy of Medicare for 10 years. And 
they have the gall to come to the floor and say our bill does not treat 
Medicare right, that our bill is going to ruin Medicare, that our bill 
whatever.
  If you are a senior citizen in our country, understand what this bill 
does

[[Page S13583]]

for Medicare. This bill guarantees benefits, No. 1. No. 2, this bill 
lengthens the life of Medicare for several years, as I said. No. 3, 
this bill helps with the cost of prescription drugs by closing that 
doughnut hole my friends on the other side of the aisle created back in 
2003 with President Bush because the drug companies wanted it that way 
and the insurance companies wanted it that way.
  Last, this bill provides all kinds of services to seniors they were 
not getting before--mammograms, colonoscopies--for free because we 
want--not that we want to do a give-away but we want seniors to be 
healthy and live longer and have healthier lives. We know that is good 
for our country. It is good for them. It is good for our families. I am 
incredulous when I hear them talk about Medicare.
  The second thing I am incredulous about when I hear them, that is 
pretty unbelievable, is how they talk about partisanship. In the 
Health, Education, Labor, Pensions Committee, which Senator Coburn sits 
on and Senator Burr sits on--two of the people who were talking 
earlier--and the Presiding Officer sits on, we accepted 160 amendments. 
I voted for almost all of them. They made sense. Some were minor; some 
were more major. That gave this bill a bipartisan flavor to it.
  But now they say the bill is too partisan and we were not listening, 
they say we are rushing it through--whatever they say. But the reason, 
even with those 160 Republican amendments, they do not want to pass it 
is twofold. One is people such as Senator DeMint said: This is the 
President's Waterloo. If we can defeat this, we can end his presidency. 
So part of their opposition is strict win-at-any-cost partisanship.
  The other reason is, even though there are 160 Republican amendments, 
on the big questions of the day, it is a philosophical difference. Go 
back to 1965. Very few Republicans supported Medicare. On the key vote 
in the House of Representatives, only 10 out of 160 or 170 Republicans 
supported Medicare. Over here, in those days, there were a few sort of 
``Rockefeller Republicans'' who supported it. But, by and large, the 
mainstream Republican party, at least in Congress, opposed Medicare.
  So just like they opposed Medicare because it was a big question, 
they are opposing this bill because it is a big philosophical question. 
That is fine they disagree with us, but do not accuse us of 
partisanship when, one, many of them want President Obama to fail. That 
is a strategy. It is a political strategy. But, second, do not accuse 
us of partisanship when 160 Republican amendments were in this bill in 
my committee, and in Senator Baucus's committee many amendments were 
accepted that were Republican amendments.
  Then to say we have to slow this down because it has gone too fast, 
these negotiations have been going on for months. In the Finance 
Committee, the Gang of 6 started in mid-June officially, and it began 
before that.
  I want to put a human face on this. When they say, let's not move too 
fast, do you know why I want to move, why I want to get this done by 
Christmas? We do not deserve to have Christmas with our families until 
we finish this. Do you know why? Because every day in my State--in 
Defiance and in Williwick and in Warren and in Steubenville--every day 
in my State, 390 Ohioans--lose health insurance.
  Do you know what else? One thousand people every single week in this 
country die because they did not have insurance. So 390 people in my 
State alone--probably 350 in Michigan; probably 250 in Minnesota--every 
single day are losing their health insurance, and in this country 1,000 
people a week are dying because they do not have health insurance. A 
woman with breast cancer is 40 percent more likely to die if she is 
uninsured than if she is insured--40 percent more likely to die if she 
is uninsured than if she is insured.

  So when I see my friends stall and stall, and they have all kinds of 
reasons--they have the clerk read the bill, they try to talk too long--
whatever it is, however they are stalling in so many different ways, 
they should think about those 390 Ohioans who lose their insurance 
every day, think about the 1,000 people a week who die because they 
don't have insurance, and think of the woman with breast cancer without 
insurance who just has more trouble fighting back.
  To further put a human face on this, I wish to share some letters 
from people in Ohio who have written me. These are people who 
understand how important it is because it is important to their 
personal lives, their families, their loved ones, themselves, that we 
take care of this bill by Christmas.
  Sandra from Franklin County writes:

       In December 2008, my partner lost her job. In July of this 
     year she started working part-time in the evening, which 
     didn't offer insurance. In October she found full-time work. 
     We are grateful she is now employed. The job has no coverage. 
     While she was unemployed, it hurt us financially. We are 
     behind on some bills. But we can't afford health insurance 
     for her now. It's a similar story with a friend of mine. He 
     lost his job last year. After looking for a job, he decided 
     to go back to school. He finally found a job and is happy for 
     that. But he also doesn't get insurance.

  Maria from Montgomery County writes:

       I work in a school and come in contact daily with 
     struggling families who can't afford basic medical care for 
     their families. Please help. We want an America that sees 
     health care as a right for all.

  Today, I was on ``Face the Nation'' with Senator Landrieu and Senator 
Alexander. A woman I was talking to works there part time as a 
contractor. She has a contracting relationship with them. She helps 
prepare people before they go on the air. She is not employed by CBS; 
she is an independent contractor. She has her small business. She has 
insurance and she pays a whole lot of money for it, and she said: Five 
years from now, I am going to be on Medicare. I look forward to having 
the stability and predictability of real health insurance. That is why 
this is so very important.
  Roberta from Greene County down in Xenia, between Dayton and 
Columbus:

       I am a senior citizen who feels uncomfortable using my 
     fabulous Medicare benefits when others--parents, ill people, 
     the unemployed--don't have any health care at all. Please 
     pass health care reform for all who need and are without 
     medical care.

  Roberta, who is on Medicare, knows and understands, No. 1, how 
important Medicare is to her. She also knows she is going to get more 
from this bill, including free screenings for mammograms, a free 
physical every year, and the cost of prescription drugs will be less 
because we are closing the doughnut hole. She knows this bill--unlike 
when the Republicans tried to privatize Medicare in 2003--actually 
lengthens the life of Medicare.
  Mr. DURBIN. Mr. President, would the Senator yield for a question? I 
am going to be speaking at the end of this hour that has been allocated 
to our side, and I don't want to interrupt the Senator from Ohio but 
for one reason. I don't know if the Senator from Ohio heard or is aware 
of a statement made earlier today by our colleague from Oklahoma, 
Senator Coburn, who came to the floor and said:

       What the American people ought to pray is that somebody 
     can't make the vote tonight. That is what they ought to pray.

  I have been trying to reach Senator Coburn because he is on a 
committee on which I serve and I work with him. This statement troubles 
me. I am trying to reach him to come back to the floor and explain 
exactly what he meant about a Senator not being able to make the vote 
tonight.
  I don't know if the Senator from Ohio is familiar with this 
statement, but I am reaching out to Senator Coburn. I will be on the 
floor in the next 45 minutes, and I hope he will join me.
  I thank the Senator from Ohio for yielding.
  Mr. BROWN. I did not see that quote, but I watched what happened here 
2 nights ago when we were trying to pass the Defense appropriations 
bill to make sure our troops were funded in Afghanistan, Iraq, and 
stateside and in Europe and everywhere else--Korea, everywhere. The 
Republicans wanted to kill that even though it would mean no funding, 
it would mean military layoffs, it would mean we wouldn't be able to 
get the things and supplies we need for the troops, because they said: 
We want to kill health care reform. I don't understand the 
desperation--except maybe I do because everything about this debate is 
protecting the insurance companies. I guess that is more important to 
them than anything else. So I will be interested too. I appreciate the 
assistant majority leader's

[[Page S13584]]

comments on why Senator Coburn said that.
  Let me close with one last letter.
  Valerie from Cuyahoga County, which is in northeast Ohio:

       I thank the Lord that my husband has a job with health 
     benefits. If he didn't have it, I would be knee deep in 
     medical bills. I know how important insurance is. I could 
     never imagine not being able to go to the doctor. I have had 
     many surgeries and had my fair share of doctors' visits. 
     Could you imagine yourself without medical insurance or not 
     being able to go to the doctor?

  She says:

       I bet most Senators and Congressmen never had to worry 
     about that. But many Americans have that worry and it is a 
     scary, scary feeling. The time is now to pass health reform.

  I know my colleagues have good health insurance. Of course they do. 
That is a good thing. But I also know many of my colleagues don't spend 
much time talking to people who don't.
  Most people in our--if you are a Congressman or a Senator making 
$170,000 a year, most people you see and socialize with probably are 
pretty upscale, probably have insurance. Most of us don't spend nearly 
enough time--I know the Presiding Officer does this in Duluth and 
Rochester and all over Minnesota. I know the Senator from Colorado, who 
worked on a lot of these issues with me in the House, when he goes to 
Boulder and when he goes home to Denver, he talks to people who don't 
have insurance.
  I just wish more of my colleagues who oppose this bill would meet 
some of the 390 people in my State or in their States who lose their 
insurance every day. I wish they would talk to a woman who has breast 
cancer without insurance, knowing she is more likely to die. I wish 
they would talk to some of those people whose family members die 
because they don't have insurance. Because most of us dress like this 
and most of us hang around with people who dress like this and 
generally we have good insurance, I think we are a little out of touch. 
I hope we can pass this bill, go back home, and meet some of these 
people for whom this is going to matter because I think it will make a 
difference in how we all look at this.
  I thank the Presiding Officer, and I yield the floor.
  Mr. BAUCUS. Mr. President, I yield 10 minutes to the Senator from 
Colorado, Mr. Udall.
  The PRESIDING OFFICER. The Senator from Colorado.
  Mr. UDALL of Colorado. Mr. President, I thank the Senator from 
Montana for yielding. I thank him for his tremendous leadership on this 
important fight here on the floor of the Senate.
  First, I commend my colleagues for strapping on their snow gear. The 
Presiding Officer comes from the State of Minnesota, where this kind of 
a storm we have had over the last few days is not that unusual a 
development. I like a good 16-inch dusting from time to time. We all 
know what an important issue reforming our health care system is, and 
braving the elements is a small price to pay.
  I have come to the floor a lot over the past few months to discuss 
the challenges that are facing us as we work toward fixing our broken 
health care system. One overarching theme I continue to emphasize is 
just how important this is to putting our economy back on track.
  We have a bloated $12 trillion Federal debt which is being fed daily 
by growing health care costs. Every day, employers, small and large, 
are laying off workers and slashing benefits for their employees. Great 
American businesses, especially in our manufacturing sector, have 
nearly collapsed because of the rising costs of providing health care 
for their workers.
  Those Americans who have coverage lack the peace of mind in knowing 
that their insurance will be there just when they need it. This lack of 
stability and peace of mind is a fundamental problem with the status 
quo today because it takes away one of the things valued most by 
Americans: their freedom. Today, they are reluctant to move to a new 
job, to advance their education, or start a small business for fear 
they won't be able to provide health care for their families.
  As we struggle to mend our economy, we can't afford to tell people to 
stay put. We know from history that encouraging the entrepreneurial 
spirit of Americans is the key to promoting small business, creating 
jobs, and driving our economic recovery. Small businesses have 
accounted for 65 percent of all new jobs created in the past 15 years, 
but today anyone who owns or has ever tried to start their own business 
can attest to why rising health care costs is such a major problem in 
this country.
  Take, for example, the story of a gentleman who just recently 
contacted me from Denver. I will pick up on the theme the Senator from 
Ohio was touching upon. If we listened to the people in our States, 
there would be no question that this reform is necessary. Dave is a 
small business owner. Last year, he saw his insurance premiums 
skyrocket 27 percent for his employees. When he questioned this 
unbelievable increase, his insurance company said all he needed to do 
to save money was just stop offering coverage to his employees. Just 
let them buy their own insurance, his insurance company told him. When 
he looked into that, when he checked it out, he found out that nearly 
half of his workforce would be ineligible for coverage because of 
preexisting conditions and that those who could obtain coverage were 
priced out and couldn't even afford it.
  I hear this story time and time again--small business owners who want 
to do the right thing but end up facing annual double-digit increases 
in their costs. This is so troubling in this economic time because 
small businesses pay on average 18 percent more than large employers 
for the same level of coverage.
  The status quo--and the Presiding Officer has been articulate and 
eloquent and involved in this fight--as he knows, is unacceptable, and 
we can't kick the can down the road any longer. The good news is the 
legislation we are considering contains essential provisions aimed at 
helping small businesses, individuals, and American families across our 
country. Let me touch on a few of the important provisions that are in 
this final package.
  Health insurers will be organized into well-regulated marketplaces 
and finally forced to compete. This would then involve a creation of a 
more transparent process for individuals and small businesses, so, for 
the first time, you can actually compare insurance plans side by side.
  The legislation helps individuals pay for these newfound health 
insurance options. More than half of the cost of reform goes to 
financing tax credits to put money back in the pockets of middle-class 
families to help them purchase a health plan. As Chairman Baucus has 
pointed out, these tax credits represent the biggest tax cut since 
2001.
  In addition, starting in 2010, many small businesses will also 
qualify for new tax credits worth up to 50 percent of the cost of 
providing health insurance to their employees.
  Also in this bill--I can't emphasize this enough--Americans will no 
longer go bankrupt because of health care costs. We are the only 
developed country in the world where citizens go bankrupt because they 
have health care costs they can't afford.
  Insurers will be prohibited from denying access to health care 
because of preexisting conditions, limiting coverage because of age or 
gender, or dropping the insurance someone has already paid for simply 
because they get sick.
  Regardless of what we hear from our friends on the other side of the 
aisle, this legislation saves money, it strengthens Medicare, it 
reduces the deficit, and it puts us on a path to finally addressing our 
growing national debt. In fact, noted MIT economist Jon Gruber 
estimates this bill will save small businesses 25 percent, or about $65 
billion per year, on health insurance. That translates into $30 billion 
in take-home pay and an estimated 80,000 saved jobs.
  While the bill before us makes important improvements, I would also 
like to say a few words about the package of amendments offered by the 
distinguished majority leader. I took some time, as I think we all did 
over the last snowy 24 hours, to familiarize myself with the changes, 
and I wish to touch on some of the most promising revisions that have 
been made.
  I wish to first note my appreciation for including the freshman 
package. These amendments were offered by myself and the freshman 
class, of which the Presiding Officer is a member, and

[[Page S13585]]

they have attracted bipartisan support. They boast the endorsements of 
business, labor, and consumer groups. The provisions inject more cost 
containment in the bill, cut down on regulatory and bureaucratic 
redtape, and push even more aggressively toward a reformed health care 
system.
  I am particularly pleased to see a provision I worked on that would 
expand the scope of a new board designed to strengthen Medicare. The 
amendment would task this board not only to monitor Medicare but to 
look for ways to improve the entire health care system as a whole. I 
believe the independent payment advisory board is one of the best cost-
containment tools in the bill, and I want to acknowledge Senator 
Rockefeller for his work in developing the idea, as well as Leader Reid 
for putting even more bite into the authority of this important panel 
of experts.
  Second, I wish to express how proud I am that Majority Leader Reid 
put so much emphasis in the managers' amendment on improving health 
care in rural America. The difficulty of accessing health care in rural 
communities is a unique struggle I have been increasingly concerned 
about, especially as I have traveled around Colorado's rural areas in 
the past several months. I am glad to see the inclusion of an amendment 
I authored to establish a rural physician pipeline training program 
designed to help bolster our rural health care workforce. Many of my 
colleagues joined me in offering this important amendment which has the 
potential to recruit and train more doctors to practice in rural areas.
  In addition, I also authored an amendment that would establish an 
explicitly rural element to the community transformation grant program 
which is aimed at helping prevent and reduce chronic disease in 
communities across the country.
  My amendment would ensure that rural areas are getting their share of 
this critical prevention and wellness funding, and I was very proud to 
see this important change included as well.
  As I begin to close, I wish to say that although this bill has been 
strengthened significantly by the majority leader's efforts, it is not 
perfect. But I do not think anyone expects Congress to craft a perfect 
piece of legislation. We could never send the President a bill that 
fixes all the problems in our health care system or exactly reflects 
the priorities of every single Member of Congress, including myself. 
But what I am confident of is, this legislation can establish a sturdy 
foundation upon which we will build, improve, and strengthen access to 
health care in America.
  Will there be mistakes made along the way? I do not doubt it. But as 
a lifelong mountain climber, I know from experience that the stumbles 
you experience along the way are a necessary part of reaching any 
mountaintop. Providing insurance and quality care for all our citizens 
is a once-in-a-lifetime opportunity to improve the health and well-
being of every American. These are the goals of our health insurance 
reform and, over the next few days, I look forward to passing a bill 
which modernizes our health care delivery system, increases much needed 
choice and competition in the health insurance industry, and helps put 
our economy back on track, while improving the financial security of 
middle-class working families.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, I yield 10 minutes to the senior Senator 
from Michigan.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Mr. LEVIN. Mr. President, first, let me thank the Senator from 
Montana for the extraordinary work he has put in on this bill for so 
long, so many months, so many years. Thanks also go, of course, to the 
Democratic leader, our majority leader; Senator Dodd; and others who 
have worked so hard to get us here.
  We are in a pivotal moment in the long fight to reform our health 
care system. Everyone should, by now, be well aware of the history--how 
Presidents of both parties have tried and failed to achieve reform and 
how, after months of painstaking review, we have arrived at this 
instant, closer than ever to health care reform.
  It would be impossible to fashion legislation on an issue so massive 
and so complex on which all could agree in every detail. Those seeking 
perfection will have to look outside this Chamber or, for that matter, 
in any piece of complex legislation.
  But when they look outside the walls of this Capitol, Senators will 
also find problems that dwarf the imperfections in this bill. They will 
find a broken health care system, one in which we pay vastly more than 
other wealthy nations for care that is, in many cases, demonstrably 
inferior. They will find Americans struggling to afford the health care 
coverage they have and employers struggling to provide insurance to 
their employees. They will find manufacturers struggling under a costly 
health care burden, from which their international competitors were 
long ago freed. They will find employee and employer alike plagued by 
never-ending uncertainty about the cost and availability of health 
insurance, an instability that haunts families and hinders job 
creation. They will find costs rising so fast they threaten to swallow 
the rest of the Federal budget and sink family budgets. They will find 
astonishing amounts of money spent, not on better care or innovative 
treatments but on overhead and bureaucracy. They will find millions of 
Americans with no coverage at all--a tragedy for the uninsured and a 
source of inefficiency and expense that make health care more expensive 
for all of us.
  So the choice before us now is whether any imperfections we might see 
in this bill outweigh the mountain of evidence that our current system 
is in dire need of repair. It is between moving forward on a 
significant repair of a broken system or quashing yet another attempt 
to reform health care in surrender to the status quo and to the 
rhetoric of distortion and fear.
  To me, this choice is clear: We cannot wait any longer for health 
care reform. The people of my State cannot wait. The people of this 
Nation cannot wait. Now is the time for all those years of frustrated 
effort, all the research and analysis, all the debate and discussion, 
for us to reform a broken system. We must vote for cloture on the 
managers' amendment before us and continue to vote for cloture on the 
endless filibusters that confront us because we cannot wait.
  We cannot wait any longer to reform this system because its costs are 
out of control. In 1990, this Nation, 12.3 percent of its gross 
domestic product on health care. That is $1 in $8. By 2018, the Centers 
for Medicare and Medicaid Services, CMS, estimates that figure will 
increase to 20 percent, and $1 in every $5 will go to health care. CMS 
estimates that after spending about $6,000 per capita on health care in 
2003, we will spend more than $13,000 per capita in 2018, more than 
doubling our per-person expenditures in 15 years.
  This translates directly into unsustainable costs for the American 
people. According to the Kaiser Family Foundation, thousands fewer of 
our businesses are offering insurance than a decade ago, a clear sign 
they can no longer sustain cost increases of 6 percent or more, year 
after year. If we do nothing, these costs will continue to rise at a 
rate which will swallow the budgets of families, businesses, and 
government.
  We cannot wait any longer because, even for those fortunate enough to 
have insurance where they work, they are increasingly unsure it will be 
there when they need it most. Every Member of this body has heard from 
constituents who thought they had solid health insurance, only to find 
out their insurer had wriggled out of paying for desperately needed 
care or found a convenient preexisting condition that voided their 
coverage or capped their coverage, so they faced a crushing choice 
between treatments they had to have and costs they could not afford. 
Even in cases where families have health insurance, medical emergencies 
can leave debilitating costs in their wake. According to a study in the 
American Journal of Medicine, 62 percent of all bankruptcies filed in 
the United States in 2007 involved medical costs; and even more 
compelling, three-quarters of those bankruptcies involved people who 
had health insurance when they got sick. There can be no more clear 
sign of the need to act than the fact that having health insurance is 
no insurance against bankruptcy from medical costs.

[[Page S13586]]

  We cannot wait any longer because so much of the enormous cost at the 
heart of this health care crisis is money spent on that having little 
or nothing to do with quality care. For example, for those who purchase 
insurance in the individual market, roughly 30 percent of the costs 
they pay will stem from the insurance company's administrative 
expenses--on bureaucracy, not medicine. A 2003 study published in the 
New England Journal of Medicine found that, in 1999, Americans spent 
over $1,000 per capita on health care administration costs--more than 
$1,000 for every man, woman, and child in this Nation spent on 
paperwork and redtape. Electronic medical records, which make 
administration more efficient and improve the quality of care, are 
still not in use for most patients.
  Finally, we cannot wait any longer because the inefficiencies of our 
system are crushing us and our budgets and, even more pointedly, 
because so many lives are at stake. One hundred forty thousand 
Americans have lost their lives since 2000 because they lacked health 
insurance. We cannot afford to walk down this road any longer. We must 
change direction. This bill will do it in a positive way.
  An analysis by the Urban Institute, using methodology developed by 
the Institute of Medicine, determined that since 2000, nearly 140,000 
Americans have lost their lives because they lacked health insurance. 
Other studies show that breast cancer patients, stroke victims and 
other patients are, as common sense suggests, far more likely to die 
from their conditions if they lack adequate health insurance. These are 
rigorous studies that bring us to an inescapable conclusion: If we fail 
to act, Americans will continue to lose their lives when they need not, 
simply because they don't have adequate health insurance, or any health 
insurance at all.
  For these reasons and many others, it is long past time to reform our 
system. The question we must then answer is, will we come closer to a 
health care system worthy of this Nation if we pass this bill?
  I believe we will. The legislation before us will reform the 
insurance system in powerful ways, protecting patients from the host of 
abuses they now so often face. We will begin to control spiraling costs 
in many ways, and establish research centers to find new ways to 
improve care and lower costs. We will create powerful incentives to 
reduce administrative burdens and costs. And we will bring millions of 
Americans into the health care system, reducing the number of 
uninsured, and reducing what is both a burden of inefficiency on the 
system and a moral blemish on our Nation.
  We are out of time and out of excuses. Now we must choose. Choose 
between beginning to reform on the one hand and continuing the status 
quo on the other. Our individual problems with this bill cannot be 
allowed to overshadow the much larger problems with our health care 
system. Near the end of this long path toward health care reform, we 
cannot turn back. The Senate needs to move forward.
  Again, I thank my good friend from Montana and the other leaders who 
have made it possible for us to get to this point.
  The PRESIDING OFFICER (Mr. Udall of Colorado). The Senator from 
Montana is recognized.
  Mr. BAUCUS. I yield 10 minutes to the Senator from Illinois.
  Mr. DURBIN. Mr. President, I thank my colleague. I wish to renew my 
invitation to Senator Coburn to please come to the floor but do it soon 
before my time expires. I called his office to make sure he knew I was 
trying to reach him. I have spoken on the floor to alert the Republican 
side that I wished to ask him to explain a statement he made on the 
floor earlier today. The statement of Senator Coburn of Oklahoma said:

       What the American people ought to pray is that somebody 
     can't make the vote tonight. That's what they ought to pray.

  I am troubled by this statement. I want to give the Senator from 
Oklahoma an opportunity to explain it because the simple reality is, I 
don't think we should be wishing misfortune on any of our Senate 
colleagues on either side of the aisle. I don't know if this was an 
innocent statement or something he now wants to clarify. But as stated, 
it troubles me.
  It troubles me because I am afraid it reflects the situation we find 
ourselves in too often in the Senate, where people are literally 
invoking God's name in prayer for political purposes--in this case, to 
wish misfortune on one of our colleagues who would not be able to make 
our 1 a.m. scheduled rollcall. I do not wish misfortune on any of our 
colleagues.
  Mr. BAUCUS. Will my colleague yield on that point?
  Mr. DURBIN. I am happy to yield.
  Mr. BAUCUS. I wish to ask my colleague, who knows the Senate 
procedures so very well, why are we having a 1 a.m. vote? Isn't it 
possible it could be a different time?
  Mr. DURBIN. I thank the Senator because he is exactly right. Under 
the usual business of the Senate, we agree that we will do something 
more thoughtful and humane and a vote at an earlier time. Senator Reid 
has approached Senator McConnell and said we have one of our Senators, 
Senator Byrd of West Virginia, with significant health problems, who 
was been brought to the floor now early in the morning, late at night, 
and in a wheelchair. He looks better than ever, I might add. He is 
being asked to show up at 1 in the morning because we could not reach 
what is usual comity and gentlemanly accord on scheduling a vote.
  It is unfortunate because now we face this 1 a.m. vote and with no 
cooperation on the other side to even change the vote for a very humane 
reason.
  Mr. BAUCUS. The requests on this side for a vote at a reasonable 
hour--now it is 10 after 5 say maybe 5, 6, 7, 8 eight clock--a 
reasonable time, instead of 1 a.m., have been rejected by the other 
side?
  Mr. DURBIN. Unfortunately, the Senator from Montana is correct. What 
the Senator from Oklahoma says is:

       What the American people ought to pray is that somebody 
     can't make the vote tonight. That's what they ought to pray.

  I do not think it is appropriate to be invoking prayer to wish 
misfortune on a colleague. I want him to clarify that. I have invited 
him. I tried to reach out to him. He is my friend and I have worked 
with him. But this statement goes too far.
  The simple reality is this. We are becoming more coarse and more 
divided. It is understandable we would disagree on political issues. 
That happens all the time. But, unfortunately, we have allowed that 
political disagreement to spill over into our personal relationships 
and friendships and that does hurt this institution.
  We rely on one another on both sides of the aisle so much. I would 
say from the start that Senator Reid has offered the Republican side of 
the aisle accommodations and asked we try to do things that might help 
the families and individuals in the Senate, and we have not had any 
luck to date.
  Hope springs eternal. I hope Senator Coburn can make it to the floor 
to explain his statement. Earlier this week, there was a prayercast 
involving several Senators--I did not hear it; I only heard references 
to it--where they were actually in a group praying for the defeat of 
this legislation on health care reform. It is their right to do that.
  I can recall as a high school football player saying a prayer my team 
would win a football game. I don't know if God had any time to worry 
about my little football game. But when it reaches a point where we are 
praying, asking people to pray that Senators won't be able to answer a 
rollcall, I think it has crossed the line. I hope my friend and 
colleague from Oklahoma will come and explain exactly what he meant.
  I wish the bill before us were different. I wish it had a strong 
public option. I wish it offered Medicare to people 55 years and older. 
I wish it eliminated the McCarran-Ferguson antitrust exemption for 
health insurance companies. Unfortunately, it does not do those things.
  My disappointment over those elements should not lead me to conclude 
this bill is wanting or bad. The opposite is true. We have to look to 
the positive side of what this legislation will do.
  This health care reform will extend the reach of health insurance 
coverage to 30 million more Americans. I see on the floor this evening 
my colleague from Arizona. He and I were on a television show early 
this morning. I am sure we got great ratings because the

[[Page S13587]]

public can't wait to hear us, but during the course of that television 
show, the Senator from Arizona expressed concern that 20 million 
Americans would not be covered by our bill.
  Interesting, isn't it? Today 50 million Americans are not insured; 50 
million Americans are uninsured. This bill will provide insurance for 
30 million more, meaning 94 percent of Americans will have coverage, 
the highest percentage in the history of our country. The Senator from 
Arizona says it does not go far enough to include more people.
  We have waited patiently now for 21 days during the course of this 
debate on health care reform for the Republican plan for reforming 
health care. It has never been produced. Promised but never produced. I 
think the reason is obvious. It does not exist. Several times they have 
said on the floor: We have a plan, and they will wave a bill at us. 
When the Republicans had a chance over a 3-week period of time to offer 
their substitute, they never did. In fact, in over 20 days of active 
debate on the floor, there were exactly four Republican amendments on 
health care reform. Four in 20 days, 1 every 5 days. At that rate, how 
long would the Republicans have us stay on the floor waiting for the 
next amendment?
  That is the reality. They offered six motions to stop the debate, 
remove the bill from the floor, and send it back to committee. Of 
course, when it came to actual substantive amendments changing sections 
of the bill, they would not do it. So the Republicans have come up 
empty. They are running on empty when it comes to health care reform 
which means this task of writing a bill is either beyond their pay 
grade or beyond their will and they like the system as it exists.
  I do not. Fifty million uninsured Americans is unacceptable in this 
country. I think we have to reach a point where we move forward with 30 
million now and then find ways to bring in the additional 20 million. 
Remember, when Social Security was enacted into law, with the 
resistance of the Republicans--they resisted it saying it is too much 
government--the safety net extended to widows. We extended in years 
that followed Social Security protection to dependents, survivors, and 
the disabled and we added a cost-of-living adjustment.
  It was not the end of Social Security in the 1930s. In the years that 
followed, we built on the original bill and we will build on this 
original model of health care reform. The same thing is true under 
Medicare. Medicare as originally offered did not cover disabled people. 
It did not provide home health care, therapy, or prescription drugs. 
Over the years, we added those benefits.
  I believe this is an important starting point. I also think it is 
important we provide insurance protection for Americans. When it comes 
right down to it, too many people are denied the therapies, the 
surgeries, the medications their doctors recommend because some clerk 
in an office at a health insurance company is instructed to just say 
no, and they say no repeatedly.
  We also make sure that patients are first, even with our additional 
amendment guaranteeing the right of people to pick their doctor and 
keep their doctor. It is a patient-first approach that we are using on 
this bill.
  We hold the health insurance companies accountable and say if they 
turn around and gouge the patients before they want to be part of the 
insurance exchange, they can be disqualified. We saw what happened with 
credit card reform. When the banks had their way after the passage of 
credit card reform and during the period before it went into law, they 
ran up the interest rates on credit cards. I got letters in the mail 
from American Express and others saying: Incidentally, because of the 
new Federal law, we are going to raise your interest rate on your 
credit card over 20 percent. We know some of these merchants, given 
enough time, will capitalize on that time and try to exploit that 
system. Our bill is going to go after them.
  The medical loss ratio is an important part in the bill. I am sure 
the health insurance companies are not going to be happy with it. It 
says: Stop taking those premium dollars and turning them into 
administrative expenses, advertising, bonuses for CEOs' high-paid 
salaries. Take the money and pay for medical services for the people 
you insure. If you do not, if you take too much of this money for 
profiteering, you are going to have to rebate it to your customers. It 
is changing the balance, giving customers a chance when it comes to 
health insurance--something that is long overdue.
  We extend the health care safety net in this bill. Mr. President, 1.8 
million people in my home State of Illinois will have access to 
affordable health insurance. I have met them. They are hard-working 
people, small businesses, part-time employees, unemployed people--none 
of them has health insurance. Again, 1.8 million in my State of almost 
13 million are going to have the chance to be covered.
  We will have 10,000 more community health centers.
  I cannot tell you what an exciting idea this is. If you visit a 
community health center in Arizona or Illinois, you know what I am 
talking about. This is a clinic in a neighborhood, usually, or small 
town where people can literally walk through the front door and get 
access to primary care physicians who will help them through their 
medical difficulties. They do not have to wait until they are so bad 
they end up in an emergency room where costs are dramatically higher. 
They have a doctor, a nurse, a medical professional, a dentist right 
there in their community. We estimate this bill will add 10,000 more 
community health clinics across the United States. That is going to be 
a dramatic change.
  It also will create the opportunity for 20,000 more primary care 
physicians across America. If there is anything more we need, it is 
family care, internists who can deal with the medical needs of people 
before they are referred to a specialist or before their situation has 
deteriorated.
  This bill is going to provide for all people under 133 percent of 
poverty--that is about $29,000 for a family of four--the security of 
knowing they are under Medicaid protection without health insurance 
costs, without health insurance premiums. We will say to those working 
poor people: You are going to have health insurance. We also believe 
that progress is going to take some time.
  I recall that Senator Teddy Kennedy, who I wish were here for this 
great battle for which he prepared for four decades, said in his book 
``True Compass'' toward the end that real reform is never over. It is 
not. This is a beginning. It is an important beginning. It establishes 
important principles.
  I say to the critics, we don't expect every aspect of this bill to 
work perfectly. It is an imperfect product made by mere humans trying 
to do their best. But some of the things in this bill are going to 
dramatically change health care in America for the better. We are going 
to find ways to deliver quality care to people in a cost-effective way. 
We are going to change parts of our system today which, unfortunately, 
under this current system are out of control. The costs are out of 
control.
  Moving coverage to an additional 30 million people, 94 percent of 
Americans under coverage, something no other bill from either side of 
the aisle has proposed, reducing our deficit--incidentally, we now have 
a CBO statement which makes it clear that the budget savings in the 
second 10 years--the first 10 years is $130 billion; the second 10 
years is up to $1.3 trillion. They qualified it, but it still is the 
most dramatic deficit reduction bill in the history of the United 
States. There has never been a bill that has come before us that 
reduces our deficit so dramatically.
  It reduces it because it works. It brings down the cost of health 
care. As far as Medicare is concerned, this bill will add at least 9 
years of life to Medicare. Medicare, which is going to face serious 
financial problems in about 7 or 8 years, has a new lease on life with 
this bill of 9 or 10 years.
  To say this saves Medicare and puts it on sound footing is a fact 
that has been confirmed by the Congressional Budget Office, all the 
speeches on the floor notwithstanding.
  This bill is also going to move us forward in the whole area of 
looking at ways to deal with medical negligence and medical 
malpractice. We provide incentives and grants to States to find ways, 
without penalizing the true victims of medical malpractice, to reduce 
the incidence of lawsuits, to reduce defensive medicine. That is a 
conscientious and thoughtful way to approach this.

[[Page S13588]]

  I would say, if I were to ask anyone to offer a prayer--and I don't 
do that very often--I would say a prayer for the 50 million uninsured 
Americans, folks who go to bed without peace of mind that they have 
health insurance for themselves and their families. I would say a 
prayer for those turned down by health insurance companies when their 
doctor says they need a certain therapy or a certain medication or a 
certain surgery. Those are the people I think of. I pray good fortune 
for them. I do not pray for misfortune for anyone in the Senate--not 
for any of my colleagues, not for any of my political opponents. I do 
not think that is appropriate use of prayer to do that.
  I am sorry, as I bring this to an end, that the Senator from Oklahoma 
has not been able to come to the floor. I have tried now on several 
occasions through the cloakroom and other ways to invite him to come 
and explain his remarks. I am troubled when he says the American people 
ought to pray that somebody can't make the vote tonight. I pray for 
everybody. I don't pray for misfortune for anyone in the Senate. Let's 
have the vote. Let's have all 100 Senators here voting their 
conscience, voting their heart.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I will be a bit presumptuous here that I 
can speak for most Senators and probably most of the American people. 
One thing in life that is so difficult to deal with is when you are 
working with somebody, irrespective of a situation, and trying to 
resolve an issue, a problem, and the person you are talking to or 
working with is not dealing in good faith. When each side is dealing in 
good faith, then each side will begin to recognize the merits of the 
other person's point of view and each person tends to recognize the 
deficiencies and faults of his own point of view. It is a good-faith 
exchange.
  Not very many things in life are black and white and not many issues 
are black and white. Most of them are some shade of gray. I may think 
that even though my issues--I am not white and the other guy is black, 
I like to think my shade of gray is more light than his shade of gray. 
That is not relevant. What works is when both sides talk to each other 
and try to make an accommodation.
  I think I can safely say most Americans think our health care system 
needs some repair. It is too costly. There are too many cases when the 
insurance industry cherry-picks and takes advantage of people. It is 
not the right thing to do.
  Also, we have to find a different way to pay for doctors and 
hospitals, reimbursing on basic quality, not quantity. Almost all 
doctors agree we should move in that direction.
  A few minutes earlier, one Senator got up and said CBO has made this 
huge error, a $\1/2\ trillion error. He goes on and on about this $\1/
2\ trillion error. To be honest, if we are going to deal in good faith, 
we should mention the pluses and the minuses, and let the Senators and 
the public figure out where all this nets out.
  CBO has made many statements, most of which I think the Democratic 
side has relied on, and CBO has made statements that the Republican 
side has relied on. It is not black and white. It is a shade of gray.
  In this case, it is true that CBO sent a letter, I think it was 
today--in fact, I have it here with me--that said they made a $\1/2\ 
trillion error in the second 10 years. What was the error? I don't 
remember the exact figure, but essentially I think CBO said this 
legislation will reduce the debt in the last 10 years by I think it was 
\1/2\ percent of GDP which comes out to about $1.3 trillion to the 
good. It reduces the debt by $1.3 trillion.
  CBO in a letter to us came back and said they made a mistake. This 
legislation does reduce the Federal budget deficits over the subsequent 
10 years but not by as much. A \1/2\ percent GDP should have been 
between a \1/4\ percent GDP and \1/2\ percent GDP.
  Half the story is CBO said they made an error of \1/2\ percent GDP. 
But the full story is, still, nevertheless, the Congressional Budget 
Office says:

       All told, CBO expects that the legislation, if enacted, 
     would reduce federal budget deficits over the decade over 
     2019 relative to those projected under current law--with the 
     total effect during that decade that is in a broad range 
     between one-quarter and one-half percent of GDP.

  Essentially, they are saying: We made a mistake at CBO, but still 
this is going to reduce deficits between $615 billion and, say, $1.3 
trillion. That is the full story.
  I hope when we debate here that we give both sides of the story. That 
way we can work more toward common ground what is right. Nobody is 
totally right. Each of us is here serving in good faith. We want to do 
what is best for our people in our home States, and we are trying. 
Different States have different points of view. We are going to get 
better solutions in health care reform if we talk to each other in good 
faith and give the whole story, not just part of it.
  The PRESIDING OFFICER. The Republican whip.
  Mr. KYL. Mr. President, I appreciate the comments my colleague from 
Montana made. I think the point my colleague earlier was trying to make 
was that we just got the bill yesterday and have not gotten a full CBO 
or final CBO score; that the correction simply revealed the fact there 
is a lot there to digest, and we ought to have more time to understand 
exactly how the interrelated pieces of the bill work, how all the CBO 
scoring relates, and so on. When CBO can make about a $600 billion 
error, as I understand, that is a big error. So there is probably more 
and a lot we don't understand. It would be helpful if we had more time 
to understand this and how it all works, and that was the point my 
colleague was making, I believe.

  But I do appreciate my colleague pointing out it is better we work in 
good faith and, for the most part, I certainly recall the long 
conversations the ranking Republican, Senator Grassley, and the 
chairman of the committee had. I know they worked in good faith, and it 
would be best if we did that. It is to that end I wish to speak to some 
comments a colleague made earlier today.
  I don't know whether it is frustration or maybe just the lens through 
which partisans view things and their opponents, unfortunately, that 
spawned the remarks earlier today from one of our Democratic 
colleagues, but in either event, his characterization of his Republican 
colleagues, I think, requires response.
  He began by talking about the malignant and vindictive passions that 
have descended on the Senate. Here is what he said, and I am quoting:

     . . . too many colleagues are embarked on a desperate, ``no 
     holds barred'' mission of propaganda, obstruction and fear. 
     History cautions us of the excesses to which these malignant, 
     vindictive passions can ultimately lead. Tumbrils have rolled 
     through taunting crowds, broken glass has sparkled in 
     darkened streets, strange fruit has hung from southern trees.

  I couldn't believe my ears, these references to Kristallnacht, one of 
the first and most vicious attacks on the Jews by the Nazis, and 
hanging of Blacks. The majority leader's remarks last week, comparing 
the Republicans' position on health care to the proslavery movement, 
remain largely ignored as the clumsy, offhand remarks of a partisan, 
but the references earlier today appeared not to be off-the-cuff 
mistakes but prepared text, deliberately delivered by one of the 
brighter minds of the Senate.
  Our colleague went on to acknowledge, and I quote again:

     . . . that in the heat of those vindictive passions, some 
     people earnestly believed they were justified. Such is the 
     human capacity for intoxication by those malignant and 
     vindictive political passions.

  Well, yes, Republican Senators do believe our position is justified--
in fact, correct. There are honorable people on both sides of the aisle 
who obviously have to agree to disagree. But our colleague attributes 
no good motive to Republicans, whose passions are simply ``malignant 
and vindictive.'' He adduces evidence to support his claim. First, an 
unnamed editor of the Manchester Inquirer who wrote that the GOP ``has 
gone crazy'' and an unnamed economist who believes our party has been 
taken over by the ``irrational right.'' A Philadelphia columnist talked 
about ``lunacy on the Republican right.''
  Further quoting now: `` . . . it has gone crazy, is more and more 
dominated by the lunatic fringe and has poisoned itself with hate.''

[[Page S13589]]

  I wonder if my colleagues believe our position is animated by hatred. 
Why else would we oppose this legislation? Well, he answers that 
question too. It is because, he says, first of all:

     . . . to break the momentum of our new young President. They 
     are desperate to break this President. They have ardent 
     supporters who are nearly hysterical at the very election of 
     President Barack Obama--the birthers, the fanatics, the 
     people running around in right-wing militias and Aryan 
     support groups. It is unbearable to them that President 
     Barack Obama should exist. That is one powerful reason. It is 
     not the only one.

  Well, talk about vindictive passions. Does my colleague believe that 
is why I oppose the legislation--or my colleague John McCain? I hate to 
disappoint some folks, but I don't care about the political fortunes of 
the President, at least not right now. I may about 3 years from now. I 
don't like this bill. That is why I oppose it.
  My colleague says there is another reason. He says it is the 
``insurance industry,'' which he proceeded to demonize. I am not one to 
defend the insurance industry, but it is strange to see it so demonized 
by my colleague, whose party brags of getting another 30 million people 
insured by what? The insurance industry. Why subject these folks to 
such awful torture? But the real irony is, the legislation which we 
oppose, the insurance industry supported. It made a deal with the Obama 
administration and key Senate Democrats: You mandate that every 
American has to buy one of our policies, and we will support your bill. 
There was a deal all right, but it was between the insurance industry 
and key Democrats. The insurance industry obviously didn't dictate the 
Republican position, which largely opposes the individual mandate.
  Well, finally, our colleague also accused Republicans of engaging in 
something else. He said we were engaged in a:

     . . . campaign of falsehood about death panels and cuts to 
     Medicare benefits and benefits for illegal aliens and 
     bureaucrats to be parachuted in between you and your doctor.

  He went on to state:

       Our colleagues terrify the public with this parade of 
     imagined horrors. They whip up concerns and anxiety . . . 
     then they tell us the public is concerned about the bill.

  So the reason the public is opposed to the bill is because of the 
power of Republican Senators to terrify our constituents about imagined 
horrors. Let us look at the examples given.
  I don't know of any Republican Senator who has characterized the 
health care rationing as coming from death panels. I heard that phrase 
in another context. We have tried to discuss the provisions of the bill 
we believe do result in rationing. The chairman of the committee and I 
have had a lot of debate on this subject. I wish Senator Roberts and I 
could offer a couple of the amendments we wanted to offer to make sure 
there is no rationing in the bill. I think it is a real problem and 
should be debated on its merits.
  The benefits for illegal aliens, I suspect he was referring there to 
the House debate, but it is still the case that there are completely 
inadequate provisions in the bill to verify eligibility for benefits. 
You can even apply by telephone, so just about anybody could apply for 
some of the benefits.
  Third, the matter of Medicare benefits. I don't think we are 
terrorizing our constituents about Medicare benefits, unless they 
understand the facts, and the facts are that Medicare benefits are 
going to be cut. The Congressional Budget Office says the Medicare 
Advantage benefits are going to be reduced from a monthly actuarial 
value of $135 down to $49 a month. That is CBO saying there is going to 
be reduction in the benefits for those who have the private Medicare 
Advantage policies. That includes dental, vision, hearing, vision care, 
fitness, and a variety of other programs.
  We have had a semantic debate in this Chamber between those who say: 
Well, the fundamental benefits of the Medicare law are not specifically 
eliminated or reduced in the legislative language of the bill. That is 
true. But what is also true is, the additional benefits in Medicare 
Advantage are being reduced. That is unassailable. It is also true--and 
CMS, for example, refers to this--that enrollment is going to be 
reduced because of these reductions in benefits. They talk about the 
lower benchmarks, and they say when it is fully phased in, enrollment 
in Medicare Advantage plans would decrease by about 33 percent. So this 
is not some kind of fantasy. This is taken from the Congressional 
Budget Office and from the CMS Actuary.
  Finally, in addition to the Medicare Advantage, the Actuary says 
simulations by the Office of the Actuary suggest that roughly 20 
percent of party providers; that is, hospitals, nursing homes, home 
health care, would be unprofitable within the 10-year projection period 
as a result of productivity adjustments. That means they would go out 
of business. Obviously, senior care is going to be affected by this 
legislation, and we believe negatively so. That is an honest debate to 
have, and it is one which we would like to have.

  But, finally, my colleague turned the world upside down by arguing 
the only reason we are here the week before Christmas is because of 
Republican bad behavior; that we ruined the holidays for the 
professional staff because we followed the procedures of the Senate 
that require the reading of the bill.
  It is true that requirement is usually waived, but then we usually 
have plenty of time to know what is in a bill. Usually, a bill works 
its way through committee and both parties know what is in it. We both 
help to write the bill. It is transparent. It is usually printed long 
before it comes to the Senate floor so we know what is in it. The 
reason it was read was so our staff would, in fact, have time to read 
it, to advise us--because we didn't all have time to read it 
ourselves--and to advise the public, our constituents, of what is in 
it. Again, we received it yesterday and we are voting on it tonight. 
That is very little time to know everything that is in there.
  The more we learn about what is in there, the angrier a lot of people 
get. The special deals for one State, for example, are simply wrong. 
That is why you take time to see what is in it. The majority of the 
public, according to opinion polls, want us to take more time to 
understand what is in this bill.
  A final point on this. I have to say, the majority leader dictates 
the schedule of the Senate. All Senators are pretty much equal, but the 
majority leader has two things he can do and only he can do. He has the 
right of first recognition, and he has the right to set the schedule. 
By the schedule, I mean when he files a cloture motion, which is what 
brings this bill to the floor or this amendment to the floor. When he 
files the cloture motion, that is what determines when the vote will 
be. He determines when to bring the Senate back in session. Under the 
rules, an hour after he brings us back in session, the cloture motion 
ripens and we have a vote.
  He can set that time at any time. He can say tomorrow morning, at 9 
a.m., the Senate will come back in session and we will vote at 10 a.m. 
The leader could do that. That is his right, and he is the only one who 
has the right to do that. But instead, he says we will come in at 1 
minute past midnight tonight. Therefore, the vote will be 1 minute past 
1 a.m. tomorrow morning. It is his right to do that.
  We didn't do that; he did that. He is the only one who has the right 
to set that schedule. If he wanted to set a schedule that was a little 
more convenient for all the Members--including our dear friend, the 
Senator from West Virginia, who is ill and indeed does have to get out 
of a bed to come in a wheelchair to this Chamber--the majority leader 
has it within his power to say we will do it at a more convenient time.
  Why would he do it in this way? Because he has deliberately decided--
and all majority leaders have not done quite this but have done similar 
things--to set a recess and then work us up against the recess so we 
will have an incentive to finish. It is usually a pretty good 
incentive. Certainly, going home for Christmas is a big incentive. So 
the majority leader figures, if he can schedule this bill and the 
various votes in such a way that we end up voting on it on Christmas 
Eve, that maybe then we will hurry up and try to do it because, as one 
Democratic staffer is quoted as saying: ``We need to hurry up and pass 
this bill because the longer it hangs around the harder it will be''--
meaning to pass it. That is true. The more the public finds out about 
it, the less they like it.
  So the majority leader is trying to get it done as quickly as he can, 
and ``as quickly as he can'' means scheduling us for a vote 1 hour 
after we come

[[Page S13590]]

in. Since there has to be an intervening day--and today is the 
intervening day--tonight, at 1 minute after midnight, we will reconvene 
for the next day and then have the vote at 1 a.m. It is purely the 
majority leader's decision to do it that way. Republicans have nothing 
to do with it.
  If I had my way, we would vote at 10 o'clock in the morning. But that 
is not the way it is going to be. So please don't say it is Republican 
bad behavior that results in having to vote on this bill late at night. 
The process is determined by the majority leader.
  I guess I am going to conclude by saying I don't believe this bill 
can be sold on its merits, and I think that is another reason why we 
have to hurry up and do it--before the public figures out what is in 
it. The public opposes this bill not for the reasons imagined by my 
colleague but because it will cut Medicare benefits, it will increase 
insurance premiums--not cause them to go down--it will raise taxes, put 
the government in charge of too much, it will cost trillions of 
dollars, and it will result in the delay and denial of care. That is 
why the majority of Americans want us to start over and address the 
problems on a step-by-step basis.
  I was amused by my counterpart, the Democratic whip, saying 
Republicans have only offered four amendments. I think it was seven but 
say it is four. Guess who determines how many amendments we get to 
offer? The majority leader. He sets that schedule as well. He says now 
it is our turn to offer an amendment. Then it is your turn. The way he 
managed the schedule, we only got to file either four or seven 
amendments. We have 200 amendments pending. We would love to get as 
many of these pending and voted on as possible. Believe me, it is not 
Republicans who don't want to vote on our amendments. The majority 
leader, again, has set the schedule.
  This is why we oppose the bill. It is why we don't like the process. 
We respect what our constituents are telling us. We believe this bill 
will be bad for them, and it will be bad for our country. Our 
Democratic colleagues have a different position. Neither their position 
nor ours is malignant, nor should they be expressed vindictively.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, we have all been waiting for many weeks 
while the Democratic leadership worked behind closed doors, out of 
public view, to write this new health care reform bill, and this 
process, of course, is very much contrary to what the President 
promised during the campaign--that negotiations on the health care 
reform bill would even be on C-SPAN so everybody in the country could 
see it. So now a very secretly put together bill is out for our 
consideration with just a few days to consider it.
  Last week, they were considering expanding Medicare to people between 
55 and 64 years of age--also, increasing Medicare to cover people up to 
150 percent of poverty--and thirdly, having a government-run plan run 
by the Office of Personnel Management.
  Now we have something entirely different. We have the Reid amendment, 
and it is chock full of special deals. It does nothing to fix the fatal 
flaws in the 2,074-page bill we started with, and now we have a bill 
that is probably 400 pages longer than 2,074 pages.
  What kind of changes does this new amendment make to the original 
Reid amendment? Well, one tax disappears--it was a tax on cosmetic 
surgery--and in its place we have a new tax, a tax on tanning bed 
services. The dial on the Medicare payroll tax is turned up. So the 
first-time marriage penalty in a Medicare tax--one that hits about half 
the two-earner couples--is enhanced. Well over 1 million couples get to 
look forward to that tax hit--can you believe it?--just for being 
married. So the old marriage penalty is back. The dial on the insurance 
fee is also turned up in the back end of the bill.
  But with respect to a few favored insurance companies, the fee is 
turned off. The very limited small business tax credit is expanded--
over $\1/2\ trillion in new taxes, according to the official 
congressional scorekeepers. What kind of tax changes stay the same? 
Basically, the managers' amendment in the underlying Reid amendment 
still imposes new taxes--new taxes on everything from tanning beds to 
insurance companies to wages to heart valves to drugs and even more.
  Contrary to what has been said on the Senate floor this very day, the 
tax burden still rests on many middle-class folks. As has been said, 
there is a sizable subsidy that 12 million tax-filing families and 
individuals receive. We do not dispute that. But what the other side 
does not want to acknowledge is this: There are 42 million tax-filing, 
middle-class families and individuals who will pay higher taxes under 
this 2,000-plus page bill. For every middle-class, tax-filing family 
who receives an insurance subsidy, three middle-class families will pay 
higher taxes.
  I ask unanimous consent to have printed in the Record a copy of a 
corrected version of an article from Congressional Daily, dated 
December 18, of this year.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                 [From CongressDaily AM, Dec. 18, 2009]

         Labor Cites JCT Analysis To Argue Against Cadillac Tax

                            (By Peter Cohn)

       Labor officials Thursday unveiled new ammunition in their 
     fight against a proposal to tax high-cost health insurance 
     plans in the Senate health bill, citing a congressional 
     analysis that found more than 22 million households earning 
     less than $200,000 would see a tax increase by 2019.
       That figure could rise a bit as the Joint Committee on 
     Taxation did not distribute information on tax returns for 
     married couples earning up to $250,000, which is the 
     threshold set by President Obama when he pledged not to tax 
     the middle class. The tax issue could be the most intractable 
     difference between Senate and House-passed legislation--which 
     instead relies on a millionaires' surtax--as Democratic 
     leaders struggle to cobble together a bill that can pass in 
     both chambers next year. Communications Workers of America 
     President Larry Cohen, whose group released the JCT figures, 
     said they demonstrate ``irrefutably that the excise tax--
     which will result in reduced coverage and increased costs for 
     our middle class families--is the opposite of reform.''
       Most House Democrats and union officials are adamant that 
     the final version does not break Obama's pledge and tax those 
     households earning less than $250,000. Obama at one point 
     appeared to endorse the House bill's surtax, which is the 
     single-biggest revenue source in either bill at $460.5 
     billion. There are major problems with that tax in the 
     Senate, however, not least because it is not indexed for 
     inflation. It also could affect about one-third of all income 
     earned by small business owners that file individual tax 
     returns, according to JCT.
       ``This is going to be a major problem, no question about 
     it,'' said a senior Democratic aide. ``The White House is 
     going to have to weigh in and provide some direction.''
       There have been some mixed signals. The president in a July 
     press conference said the House surtax ``meets my principle'' 
     of not burdening ``families who are already having a tough 
     time.'' In a speech to Congress after Labor Day, however, 
     Obama endorsed the Senate excise tax as a ``modest change 
     that could help hold down the cost of health care for all of 
     us in the long run.''
       The 40 percent excise tax in the Senate bill would affect 
     employer-sponsored coverage worth more than $8,500 for single 
     workers and $23,000 for family plans beginning in 2013. Those 
     figures would rise with inflation, plus 1 percent each year, 
     with higher beginning thresholds for older workers and those 
     in high-risk professions. Certain high-cost states would be 
     granted additional room before the tax kicks in.
       In a White House blog post Wednesday, National Economic 
     Council Deputy Director Jason Furman said the Senate bill 
     would not hike taxes on the middle class and actually would 
     provide a net tax cut.
       He noted JCT estimates that only 3 percent of health 
     premiums would be affected in 2013, a figure that rises to 8 
     percent by 2019, as well as the higher wages that would 
     accompany a decrease in costly health benefits.
       One school of thought holds that whatever bill is able to 
     muster 60 Senate votes will form the basis for the final 
     legislation, and House Speaker Pelosi will have to deliver 
     the votes in her chamber. Another says 188 House Democrats 
     that oppose the Senate tax--a broad cross-section led by 
     second-term Rep. Joe Courtney of Connecticut, who requested 
     the new JCT data, and Rep. Sander Levin of Michigan--won't 
     allow the House to be steamrolled.
       ``How did they get into this mess?'' one labor official 
     asked. ``They've set this thing up terribly, and they have a 
     huge problem in their Caucus.''
       The senior Democratic aide said another Senate provision, 
     an increase in the Medicare payroll tax for those earning 
     above the $200,000 and $250,000 thresholds, could meet the 
     House test. Another idea, promoted by Sen. Debbie Stabenow, 
     D-Mich., would apply the Medicare tax to unearned income such 
     as capital gains and dividends and also has some cache in the 
     House.
       But those proposals also have the disadvantage of being 
     prime revenue sources to

[[Page S13591]]

     help shore up Medicare's finances over the long haul, which 
     could be negated if used up to help expand healthcare 
     benefits to younger workers.
       House moderates at one point considered a plan authored by 
     the centrist Democratic think tank Third Way to tax ``excess 
     medical inflation,'' or healthcare premiums that are rising 
     much faster than overall economic growth. Sen. Thomas Carper, 
     D-Del., an honorary Third Way co-chairman, has pitched the 
     idea in his chamber as well. He continues to argue it could 
     be a fallback position; other sources on and off Capitol Hill 
     suggested the train has already left the station and it was 
     too late to inject a new and untested idea into the mix.
       What is striking is the amount of agreement between unions 
     and Republicans on the Senate's excise tax, however. 
     Republicans, including Sen. John McCain, R-Ariz., have long 
     held that taxing employer-provided health coverage is the 
     best way to keep costs down and raise revenues. But in 
     opposing the overall health bill, they have latched on to the 
     fact that the excise tax and other taxes in the bill would 
     hit those middle-class workers Obama wants to protect.
       According to JCT data analyzed by Senate Finance Committee 
     Republicans, the number of households earning less than 
     $200,000 that would be hit with a tax increase number closer 
     to 42 million in 2019, or about 25 percent of all tax filers 
     under that threshold.
       They looked not only at the excise tax but also a scaled-
     back itemized deduction for medical expenses for those with 
     costs not covered by insurance, and those affected by the 
     Medicare tax that have losses bringing their income under the 
     thresholds.
       The numbers factor in those who receive premium tax credits 
     and subsidies to offset the cost of buying health coverage in 
     the bill. Most of those hit with net tax increases earn 
     between $50,000 and $200,000 annually. Of those households 
     earning under $75,000, roughly 12 million would come out 
     ahead, JCT found, including many who earn too little to pay 
     taxes.

  Mr. GRASSLEY. This new compromise does not fix any of the core 
problems in this original 2,074-page Reid bill. It is still that long 
of a bill. It is still a $2.5 trillion massive bill as far as costs are 
concerned. The Reid amendment actually adds 400 more pages.
  These closed-door negotiations did not produce a better product. 
Quite the opposite. It still taxes middle-class families, seniors, and 
veterans. Millions of people still will not be able to keep what they 
have, as the President promised in the last campaign. A lot of people 
who were hoping to pay less as a result of the word ``reform'' will 
still end up paying more.
  I am not just talking about the young and the healthy. It still 
imposes higher premiums for prescription drug coverage on seniors and 
the disabled. It still permanently cuts all annual Medicare provider 
payment updates based on productivity gains outside of health care. 
These cuts still go into effect, even if it means providers will get a 
negative payment update, and these permanent cuts still threaten 
Medicare access to care.
  The bill still cuts $120 billion from Medicare Advantage, cuts that 
will reduce Medicare benefits for 11 million beneficiaries, contrary to 
what the President told us in his speech in September--that nobody is 
going to get cut in Medicare. This bill still creates a new body of 
unelected officials with broad authority to make further cuts in 
Medicare beyond the $40-some billion that are in this bill.
  This bill still unwisely makes the board permanent. This bill still 
requires this board to continue making even more cuts in Medicare and 
to do that forever into the future.
  The damage this group of unelected people could do to Medicare is 
unknown, but we certainly do know how impossible it will be to undo any 
damage that unelected board does, if Congress decides we ought to undo 
it. That is because whatever cuts they make we have to offset, and 
stirring up that money is very difficult for offsets.
  This bill passes a $26 billion unfunded mandate on to the States 
because the Reid amendment even made this problem worse by adding $1 
billion to that unfunded mandate for States under Medicaid. These 
increased costs will cause States to raise taxes, maybe cut education, 
maybe cut transportation, and maybe cut law enforcement. But it is 
still money the States have to dig up.
  This bill still has the CLASS Act in it, even though the 
administration's own Health and Human Services Chief Actuary says it 
runs the risk--a great risk--of being unsustainable.
  It still has a special carve-out for committee and leadership staff 
from having to use the health insurance exchanges. This is a cute move 
on the part of somebody in these closed-door offices. I got an 
amendment through the Senate Finance Committee on a unanimous basis 
that, if the people of this country have to use the exchange, employees 
and Congressmen on Capitol Hill ought to use it. But, no; when you get 
to the secrecy behind doors, just the Congressmen and their permanent 
staffs but not the thousands of people who serve on leadership staff or 
committee staff, they still got the deal they have today. So they are 
not going to know what the American people are going through by using 
the exchange.
  This bill still has special deals for brand-name drug makers that 
will reduce access to generic drugs, making drug costs even higher for 
everyone. What this process has shown is that there is a clear and 
significant philosophical difference between this side of the aisle 
versus that side of the aisle. Those differences are still there, and 
the lines between us on this specific piece of legislation become 
brighter still, even though maybe on 90 percent of the legislation 
going before this body, there is bipartisan cooperation. But on this 
one, restructuring one-sixth of the economy, health care being a life-
or-death issue for 306 million Americans, this is different from 
anything this body has tried before. On something such as this, maybe 
there is a legitimate reason for having differences.
  Republicans tried to reduce the overall cost. They said no. They 
increased the spending in the bill. Republicans tried to reduce the 
pervasive role of government. They said no, and they increased the role 
of government. Republicans tried to make it harder for illegal 
immigrants to get benefits. They said no, and that still has not been 
fixed. Republicans tried to guarantee that Federal funding for 
abortions would not be allowed under this bill. That has been the 
Federal policy since 1976. That has even had bipartisan support ever 
since the Hyde amendment was put in place that year. But they said no. 
They wouldn't agree to apply that policy. That still has not been 
fixed. Republicans tried to allow alternatives to the individual 
mandate and the harsh penalties associated with it. They said no. They 
have subjected even more people to the mandate, and they have raised 
penalties. Republicans tried to raise medical malpractice reform. They 
said no. Real lawsuit reform is still not in this bill.
  We have watched while the other side has expanded government 
coverage. Since this process began, the other side has been working 
hard to move millions of people from private coverage to government-
subsidized coverage. The bill creates new government programs that 
cover families making close to $100,000 a year. When we hear about that 
in rural America, in the Midwest part of the United States, they think 
we have gone bananas in this body by subsidizing families making 
$100,000.
  At the end of the day, after raising billions in new taxes, cutting 
about $\1/2\ trillion from Medicare, imposing stiff new penalties for 
people who don't buy insurance and increasing costs for those who do, 
still 23 million people will not have health insurance. I don't think 
this is what the American people had in mind when we promised to fix 
health care.
  The Reid bill imposes a $2.5 trillion tab on Americans. It kills jobs 
with taxes and fees that go into effect 4 years before the benefits of 
the bill take hold. It kills jobs with that employer mandate. It 
imposes $\1/2\ trillion in higher taxes on premiums, on medical 
devices, on prescription drugs, and yet more. It jeopardizes access to 
care with massive Medicare cuts. It imposes higher costs. It raises 
premiums. It bends the cost curve in the wrong way because people would 
expect you to bend inflation down, but this bill takes it up. This is 
not what people have in mind when they think about health care reform.
  We have been hearing repeatedly from the majority whip from Illinois 
that the Republican side has offered only four amendments. I found this 
to be rather astonishing. The majority whip should know, because they 
are filed at the desk, that Republicans have put forth 214 amendments. 
In addition to striking some of the bad ideas in the Reid bill, these 
amendments also contain Republican proposals that are

[[Page S13592]]

improvements over the Reid bill. But in this rush to get it done, the 
majority has decided they don't want to consider any more of the 440 
amendments filed at the desk.
  Let's be clear. We keep them so people can have access to them 
anytime they want to, the 440 amendments that have been filed, that we 
are accused of not offering any suggestions or improvements. Right here 
in these three binders, any one of the amendments you want, it is 
there.
  Since this happens to be the case, I would like to take them up on 
their interest in considering additional amendments. The majority 
leader and my friend, the Senator from Montana, have both said they 
want this bill to fill the doughnut hole in the Medicare Part D 
Program. I share my colleagues' desire to provide even more protection 
than seniors get under Medicare. I filed an amendment that is in this 
binder, amendment No. 3182, that would use the savings from medical 
liability reform, which happens to be about the second or third thing 
that always comes up at my town meetings that the people in this 
country feel we ought to be working on if we are going to make real the 
word ``reform.'' It would put that $50 billion into savings toward 
eliminating the doughnut hole. The amendment puts the needs of 27 
million seniors ahead of the needs of trial lawyers. I can't speak for 
my colleagues, but that seems like a pretty easy decision.
  To my good friend from Montana, I only have one unanimous consent 
request. I ask unanimous consent to set aside the pending amendment in 
order to offer amendment No. 3182, which is at the desk.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. Mr. President, reserving the right to object, the 
doughnut hole will be filled. I have made that promise. Senator Reid 
has made that promise. The White House made that promise. When the bill 
is presented on the President's desk, the doughnut hole will be filled 
but not in the way suggested by my friend from Iowa. He is one of my 
best friends in the Senate, and it is with regret that I must object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. GRASSLEY. I find it disappointing that we would miss the 
opportunity to forgo $50 billion in savings that could make 
prescription drugs more affordable for 27 million seniors. Even though 
my friend has just said they are filling the doughnut hole, I would 
quickly say it is being filled in a way that the big pharmaceutical 
companies are going to make sure they are selling prescription drugs, 
prescribed drugs, for a long period of time and not have the savings 
that ought to come from using generics to a greater extent. This $50 
billion--actually $54 billion--that CBO says we would save with medical 
malpractice reform would be a better way of filling that doughnut hole.
  I have a parliamentary inquiry of the Chair.
  The PRESIDING OFFICER. The Senator will state his inquiry.
  Mr. GRASSLEY. I want to make a parliamentary inquiry about the 
pending managers' amendment. My inquiry will be whether the pending 
amendment, which everyone agrees is critical to the health care reform 
legislation before us, complies with Senate rule XLIV.
  Senate rule XLIV was adopted as part of major ethics and government 
reform legislation. It was passed in 2007. Its title was the ``Honest 
Leadership and Open Government Act.'' The Democratic leadership made it 
the first bill introduced when they took over the majority in 2007. It 
enjoyed broad bipartisan support. I wish the reform had been tougher. 
The part of the legislation that became Senate rule XLIV dealt with the 
transparency of earmarks. They are technically defined as ``limited tax 
benefits'' and ``congressionally directed spending items.''
  Rule XLIV applies to floor amendments such as the pending managers' 
amendment. Rule XLIV requires the sponsor of the amendment--in this 
case, Senator Reid--to provide a list of these narrow provisions. 
Senator Reid has not provided the list. We received the several-
hundred-page amendment yesterday morning. Republican staff have 
performed a preliminary review. That review finds that some items 
might--I repeat, might--be limited tax benefits. There are press 
reports about narrowly crafted exceptions to the insurance fee.
  I ask unanimous consent to have printed in the Record a copy of the 
Dow Jones article dated December 19, 2009.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                       [From Dow Jones Newswires]

  Senator Nelson Wins Tax Carve-Out for Mutual of Omaha in Health Bill

                          (By Martin Vaughan)

       Washington (Dow Jones)--Insurance giant Mutual of Omaha 
     will see less of a hit from a $10 billion-a-year industry-
     wide tax on health insurance providers, under the terms of a 
     deal worked out between Senate Democratic leaders and Sen. 
     Ben Nelson (D., Neb.).
       Under revised Senate health legislation unveiled Saturday 
     by Senate Majority Leader Harry Reid (D., Nev.), the tax on 
     insurers will begin in 2011 at $2 billion a year, eventually 
     rising to $10 billion annually. The tax is to be divided up 
     based on each company's market share.
       Senate aides who reviewed the legislation said provisions 
     in the revised bill are specifically crafted to protect 
     Nebraska insurers, including Mutual of Omaha.
       The tax carve-out appears to be one of several concessions 
     Nelson won from Democratic leaders before agreeing to add his 
     vote, the final one needed to secure passage in the Senate, 
     to the healthcare measure.
       ``The biggest issue for us was abortion,'' said Jake 
     Thompson, a Nelson spokesman. ``But Sen. Nelson also wanted 
     to ensure that Nebraskans won't face increased premiums as a 
     result of a fee that was going to be imposed.''
       Nelson inserted a provision that will carve out 
     supplemental Medicare insurance from that tax. That provision 
     will benefit Mutual of Omaha, but also other insurers that 
     offer so-called Medigap policies, Thompson said.
       Nelson also won support for a provision ensuring that 
     Nebraska won't have to foot any costs for new Medicaid 
     enrollees. That is important because the Senate bill expands 
     Medicaid eligibility, potentially increasing costs for many 
     states under a cost-sharing system with the federal 
     government.
       Most other states will be required to pick up between 5% 
     and 18% of coverage costs for new Medicaid enrollees, with 
     the federal government picking up the remainder.
       The revised bill introduced by Reid also carves out non-
     profit insurers that meet certain criteria, especially in 
     Nebraska and Michigan, from the new industry-wide tax.
       ``Several states had unique circumstances, and [Reid] 
     thought it was appropriate to provide a narrow exemption from 
     the fee for a couple of states that had unique 
     circumstances,'' a Senate Democratic aide said in a 
     conference call with reporters.
       ``Nebraska also had circumstances that necessitated the 
     relief,'' the aide said, without elaborating.
       ``This legislation is good for our country and good for 
     Nebraska,'' Nelson said in announcing his support for the 
     healthcare bill Saturday.
       One provision in the bill is narrowly tailored to apply to 
     Blue Cross/Blue Shield of Nebraska, Nelson's spokesman said. 
     It says that a company that is a mutual insurance company and 
     had a market share in a state of between 40% and 60% in 2008 
     would be exempt from the tax.
       Senate transparency rules enacted after Democrats took over 
     the chamber in 2006 discourage narrowly crafted tax breaks, 
     also called tax earmarks. Senators are required when offering 
     amendments that include such provisions to publish a list in 
     the Congressional Record, and the amendments could be subject 
     to procedural objections.
       The Senate GOP aide said that carving one insurance 
     provider out of the tax could put it at a distinct advantage 
     with respect to competitors. The Joint Tax Committee has 
     estimated that the tax could result in increased premiums to 
     consumers of between 1% and 1.5%.
       ``If one company is protected from that fee, you're talking 
     about a significant pricing differential,'' the aide said.

  Mr. GRASSLEY. Likewise, single State Medicaid provisions might be 
determined to be congressionally directed spending items. Under rule 
XLIV, the determinations are not made by the minority staff.
  In order to ensure transparency of narrow provisions, the burden is 
on the sponsor to provide the list.
  This is my parliamentary inquiry: Does rule XLIV of the Standing 
Rules of the Senate require that if a Senator proposes an amendment 
containing congressionally directed spending or a limited tax benefit, 
that the sponsor of those provisions and the names of the Senators 
requesting them be printed in the Record?
  The PRESIDING OFFICER. Paragraph 4(a) of rule XLIV requires that a 
Senator proposing an amendment containing a congressionally directed 
spending item ensure as soon as practicable that a list of such items 
be printed in the Congressional Record.
  Mr. GRASSLEY. Has the majority leader provided a list of these 
special

[[Page S13593]]

deals and of the Members requesting them for the Record as required by 
the Senate rules?
  The PRESIDING OFFICER. The Chair is not aware of whether that has 
occurred at this time.
  Mr. GRASSLEY. So what is the situation as far as the rule being 
provided, as long as the Senate has not been made aware of this?
  The PRESIDING OFFICER. This part of rule XLIV simply requires that 
the Senator mentioned make a good-faith effort to comply with paragraph 
4(a). It does not impose a condition that would precede the amendment, 
that it could not be heard.
  Mr. GRASSLEY. I yield the floor.
  The PRESIDING OFFICER. The minority whip.
  Mr. KYL. Mr. President, a lot of attention has been paid to the 
position of the senior Senator from Nebraska on this legislation. Page 
98 of the amendment provides that the State of Nebraska is carved out 
from being responsible for paying for additional Medicaid patients 
added under the bill. It is the only State explicitly carved out from 
this requirement.
  I address this as well to the chairman of the committee.
  I ask unanimous consent that the pending amendment be set aside and 
it be in order to offer an amendment to extend to all States the same 
benefit that provides 100 percent Federal funding to the State of 
Nebraska for their expanded Medicaid Program. This would give the same 
treatment to other States that currently only Nebraska would enjoy 
under this bill. If the bill is a good thing for all States, then it 
seems to me it should be applied equally to all States.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. I object.
  The PRESIDING OFFICER. Objection is heard.
  The Senator from Wyoming is recognized.
  Mr. ENZI. Mr. President, since that was the broader context of that 
intent and there are other States that are hurting as well, I ask 
unanimous consent that the pending amendment be set aside in order to 
offer an amendment to the extent that Colorado and Montana and Virginia 
would get the same benefit that provides 100 percent Federal funding to 
the State of Nebraska forever for their expanded Medicaid Program, 
which would give the same treatment to these other States that I have 
mentioned that currently only Nebraska would enjoy under the bill.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. Mr. President, reserving the right to object, as enticing 
as that might sound, I object.
  The PRESIDING OFFICER. Objection is heard.
  The Senator from Alabama is recognized.
  Mr. SESSIONS. Mr. President, following up on that, I happened to see 
Governor Schwarzenegger on television today. He said he had initially 
been inclined to support this legislation until he realized what it 
would do to his Medicaid budget in California--it would cost them $3 
billion and they do not have that $3 billion. Indeed, they didn't have 
the money necessary to meet their current obligations under Medicare.
  Therefore, I ask unanimous consent that the pending amendment be set 
aside and it be in order to offer an amendment to extend to the State 
of California the same benefit that provides 100 percent Federal 
funding to the State of Nebraska for their expanded Medicaid Program. 
This would give the same treatment to California as Nebraska would 
obtain.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. I object.
  The PRESIDING OFFICER. Objection is heard.
  The Senator from Alabama.
  Mr. SESSIONS. Mr. President, I think I would be remiss if I did not 
ask unanimous consent that the amendment be set aside and that these 
provisions be extended to my State of Alabama which is also in a 
serious condition financially and whose Governor has expressed 
unequivocal opposition to the burdens on the State Medicaid Program 
that passing this legislation would impose. I ask unanimous consent 
that the same benefit that provides 100 percent Federal funding to the 
State of Nebraska for their expanded Medicaid Program apply to the 
State of Alabama.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. I object.
  The PRESIDING OFFICER. Objection is heard.
  The Senator from Alabama.
  Mr. SESSIONS. Mr. President, why are we here voting tonight at 1 a.m. 
and probably voting all the way to Christmas Eve? I think the answer 
fundamentally is on the health care matter, that after much talk about 
a bipartisan health reform effort and some work toward that end, the 
President and the Democratic leadership in the Congress decided they 
had the majorities in the House and the Senate and that they would use 
those majorities to pass the legislation that they wanted without 
Republican input. I know that has happened on occasion around this 
Senate, but I don't believe it has ever happened on a matter of such 
significance.
  These major kinds of policy matters have historically been bipartisan 
or had substantial bipartisan support. We are talking about health 
care, involving every American. We are talking about raiding, not 
strengthening, Medicare, a program that is already in deep trouble. We 
are talking about a major governmental intervention into one-sixth of 
the American economy. These are pretty big issues.
  Even more significantly, our Democratic colleagues are concerned 
about the American people, who, by consistent majorities, reject this 
plan. They are fearful of them. So they want to move this bill forward 
now, sooner, faster, quicker, with less discussion and less debate. 
Instead of working together to improve a broken health care system, the 
decision has been reached to railroad this bill through before 
Christmas.
  They say the President promised reform. He was elected and so they 
will just ram it through no matter what the American people, for that 
matter, think.
  Just for example, a recent CNN poll--I do not think that is a 
rightwing entity--61 percent oppose the Senate bill, only 36 percent 
support it. Just a little more than one-third support and over 60 
percent oppose. Those are lower numbers than President Bush received 
for his plan to reform Social Security.
  So, why do they do this? Well, because they think they know better 
than you do, because they want to make history. And if you object--as 
the Senator from Rhode Island said this morning--you and the rabble 
disagree with us, why, you are mean-spirited, coldhearted, and 
fearful--as to whatever those words were--you are just like those great 
unwashed whom you represent. So I think there is an unusual amount of 
disdain here for any political and substantive disagreement about this 
incredibly important legislation and I think a disdain for the concerns 
of the American people, as represented in rallies, in tea parties, and 
in polling data.
  Is this all just illogical fear? Are these people totally 
irresponsible to worry about the future financial condition of their 
children?
  A colleague of mine showed me this great cartoon that showed a man 
standing beside Santa Claus, and Santa said: What would you like? I 
think the man was President Obama. And he said: Health care. And there 
was also a little boy, sitting on Santa's lap, and he said: What do I 
get? And Santa said: You get the bill.
  Well, the people know this is a significant issue for the future 
direction of our country, and I think they are saying that this what 
not what they intended during the last campaign. I remember this 
defining moment--do you not?--when Joe the plumber accosted President 
Obama, and they discussed redistributing the wealth around. And what an 
effort there was to suggest that President Obama did not really believe 
in that idea, but that he believed in freedom and individual 
responsibility and was not going to tax the average person, and those 
kinds of things. So the campaign survived that little dust-up.
  But I think the American people are saying: Fool me once--during the 
campaign--shame on you. Fool me twice, shame on me. They are not happy 
with this bill. Polls show the tea parties are more popular than the 
Republican or Democratic Parties. So I think this use

[[Page S13594]]

of raw power--the idea that we must get this bill done before 
Christmas, and we will pay any price necessary to get the votes to do 
it--is not good.
  I am amazed that people would criticize those of us who do not agree 
with this legislation--and I am prepared to talk at some length about 
the substantive reasons about it--that we are somehow obstructionist 
because we would like to have more than 1 day, really, to consider a 
383-page amendment and see what all was placed in it.
  So my colleagues have been saying the people are misinformed and they 
have been subjected to lies and misinformation. Well, just a few days 
ago, I heard the President declare that if you do not pass this 
legislation, your insurance premiums are going to go up, which is not 
untrue. But what he did not convey--and I think most people understand 
already, however--is that even if the bill passes, premiums will go up 
some, double digits more than they would have gone up if the bill had 
not passed. A few people will see a modest--less than 1 percent, maybe 
some over 1 percent--reduction in the rate of increase in their 
insurance premium, but a lot of people are going to see double-digit 
increases in their premium, particularly the people who are not in 
group plans. Those are the ones for whom insurance premiums are the 
most unfair and who are getting rooked the most by insurance. We ought 
to be taking care of this problem because they are not in group plans 
and they are not in companies that subsidize it. They do not work for 
the government that subsidizes their health care.
  But the President has the bully pulpit. He lectured the whole 
Congress. He hauled us out and talked about it in a joint address to 
Congress. He got $150 million from the big PhRMA drug companies to 
advertise in support of this bill, as it has been reported. Robert 
Reich, a great liberal, Secretary of Labor under President Clinton, 
scathingly condemned that deal that PhRMA made with the White House 
over the doughnut hole and their contribution for advertising.
  I will just have to say, the majority has found no price too high, no 
depth too low in order to get that 60th vote so they can go forward. 
And we have got to get it done now, pass this managers' amendment that 
the majority leader has plopped down--the one that was written in 
secret and we just saw yesterday morning at about 10 o'clock.
  Well, I will just say, how should we judge the overall merits of the 
bill? How should we decide whether to vote for it or against it? I 
would say that one good way is to judge it by its own promises, to 
judge it by what the American people have been told the bill will do, 
how much it will cost, and those kinds of things.
  Well, there are some facts and some fictions here. We just need to be 
frank about it.
  Fiction No. 1: We have been told that the total cost of the 
legislation is $871 billion. That is a lot of money, $871 billion. But 
what are the facts? When the new programs created by this bill are 
fully implemented, the bill will actually cost, over the first 10 years 
of full implementation, $2.5 trillion--three times as much.
  Now, who is giving the best numbers here? Since we know most of the 
benefits do not start until 5 years from now, they score the first 10 
years of the budget, the cost of the bill, and say it costs $871 
billion. But if you take it from the first 10 years of the bill, as we 
would normally score a piece of legislation, it is $2.5 trillion--
$2,500 billion. That is a stunning difference. It just shows what a 
massive piece of legislation this bill is.
  According to the bill, Medicaid will be expanded up to 133 percent of 
the poverty level, but that will not happen until 2014. The insurance 
subsidies funded by the bill do not begin until 2014. So this is how 
they manipulated the numbers. So they say $871 billion. Not so. In 
fact, the managers' amendment increases Federal spending on health care 
to $200 billion rather than $160 billion projected under the original 
bill that came forward.
  So we currently spend one-sixth of our GDP on health care. How much 
more can we afford to pay? And wasn't the original intent to rein in 
health care spending, to reduce the percentage of GDP going to health 
care?
  Mr. President, how much time is left on this side?
  The PRESIDING OFFICER. The Senator from Alabama has 6 minutes 
remaining.
  Mr. SESSIONS. The business community as well as many others are 
expressing concern about the fact that this bill would not actually 
rein in health care spending. I thought the goal and I think most 
Americans thought the goal of the legislation was to figure ways to 
contain the growing cost of health care in America without reducing our 
quality and the magnificent care so many Americans receive. But it does 
not do that. In fact, the numbers show, independent accounts show that 
the percentage of our national wealth, our GDP, that will go to health 
care once this bill is passed--if it is--will be greater than if it is 
not passed. We should wrestle with those issues and do better.
  What about another fiction? The President had promised--you have 
heard him--along with other leaders on this floor: This bill will not 
add one dime to the Nation's surging debt. But by any fair analysis, 
the bill increases both spending and debt.
  First, I just have to say, when you pass 70 new government programs, 
expand Medicaid, and create millions of dollars in new subsidies, how 
can that not increase spending? But the bill is structured in a way so 
that its spending is covered by its new $519 billion in taxes. Well, if 
you raise taxes enough, you can make anything come out to a balance. 
They call some of these taxes fees, but they are still taxes and 
increased cost in the system. They include a $6 billion annual tax on 
the insurance industry as a whole. For the people we want to reduce 
premiums, we raise taxes on them $6 billion. It includes a $2.3 billion 
annual tax on the pharmaceutical industry. We would like to see less 
cost for drugs, not more. It includes taxes on medical device 
companies, $28 billion on employers that do not provide enough coverage 
according to the new standards and a 40-percent tax on plans that 
provide too much coverage, and $43 billion in total taxes raised 
through penalties on employers and individual mandates. All in all, you 
are taxed if you sell insurance, taxed if you buy it at the wrong 
level, and taxed if you do not buy it at all. Yet, contrary to 
promises, the bill does not lower individual family premiums, and for 
many, their out-of-pocket costs will increase. So this is not the kind 
of reform we were promised.

  But one more thing. Always a part of health care reform was the 
acknowledged necessity to do something about the reductions in 
payments, reimbursements to doctors. This bill proposes cutting 
physicians' pay 21 percent. That is what it does--they ignore a $250 
billion cost, and act as though they can use that money for the bill's 
new programs. But doctors were promised from the beginning that their 
payment reimbursements would be fixed. They cannot sustain a 21-percent 
reduction in pay. Doctors will quit doing Medicare work all over the 
country if that occurs.
  Mr. ENSIGN. Will the Senator yield?
  Mr. SESSIONS. I will be glad to yield.
  Mr. ENSIGN. So let me ask the Senator, from what I understand about 
the so-called doctors fix, there is around a $250 billion cost to that. 
In this bill, there is no fix to that, from what I understand. Is that 
correct?
  Mr. SESSIONS. That is correct.
  Mr. ENSIGN. So the bill is either dishonest as far as the deficit is 
concerned because if you put the doctors fix in there, this thing 
actually hurts the deficit, or we are actually seriously hurting 
doctors because this bill will require a lot more doctors in the 
country to take care of those new people who will now have health 
insurance in the country. Is that correct?
  Mr. SESSIONS. Exactly correct. What we are doing, I think you can say 
fairly--boil it down to this--we are raising taxes over $500 billion, 
we are cutting Medicare nearly $500 billion--so, around $1 trillion 
total. And we are using none of that money to fix the doctor payment 
deficit we know has to be fixed. Instead that money is going to new 
programs. We cannot cut the doctors 21 percent. Congress has filled 
that money in every year for nearly 10 years now, and we have to fill 
it in in the future. Any good health care reform would do what it 
promised to do from the beginning, which was to eliminate this cut.

[[Page S13595]]

  One proposal has been to do it simply by adding, throwing it to the 
debt.
  Mr. ENSIGN. Will the Senator yield further?
  Mr. SESSIONS. I will be pleased to.
  Mr. ENSIGN. So would the Senator describe this almost as a shell 
game?
  Mr. SESSIONS. Absolutely.
  Mr. ENSIGN. The doctors fix would be the pea. Where are they hiding 
the pea? Because we know this is going to be fixed. It is always fixed. 
Every year, we fix the doctors' pay. And yet, to hide the true costs of 
the bill, then, the doctors' fix is really the pea in that little shell 
game and they are just hiding it. Is that correct?
  Mr. SESSIONS. Exactly. The President looked the American people in 
the eye and he said: This legislation will not add one dime to the 
national debt.
  The PRESIDING OFFICER. This block of the minority's time has expired.
  Mr. SESSIONS. Mr. President, if I could ask for 30 seconds to finish.
  The PRESIDING OFFICER. Is there objection?
  Mr. HARKIN. How much time did he ask for, Mr. President?
  The PRESIDING OFFICER. The Senator asked for 30 seconds.
  Mr. HARKIN. No objection.
  Mr. SESSIONS. So the President promised to end the doctors coming to 
Washington every year to try to make sure they don't get cut 21 
percent, but he has not done it. This bill's promises simply do not add 
up. This bill, when you assume the doctor fix, clearly adds to the 
debt. It must be added as part of the reform. There are a number of 
reasons to oppose the legislation, and I urge my colleagues to do so.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. I understand now the Democratic side has 1 hour, from 
6:30 to 7:30?
  The PRESIDING OFFICER. The Senator from Iowa is correct.
  Mr. HARKIN. Mr. President, I yield myself the time from 6:30 to 7.
  Mr. President, I was in my office a little bit ago, and I was 
watching the comments made by the distinguished minority whip, the 
Senator from Arizona, Mr. Kyl. He went on at some length about how this 
vote at 1 a.m. we are going to be taking is tough on some Members. He 
mentioned specifically our distinguished colleague, Senator Robert 
Byrd, who is not up and about at those hours, and they would have to 
drag him out of bed and bring him down here for this vote. Senator Kyl 
felt very sorry for Senator Byrd that we would do that at 1 a.m.
  He said the majority leader has the power to put this vote back. We 
could do it at 9 a.m. in the morning. Well, he is absolutely right; we 
could do it at 9 a.m. in the morning. But because of the intransigence 
of the Republican side, because they are not willing to let us have 
these votes without expending the 30 hours under the rules--under the 
rules--the cloture motions have been filed and, of course, the 
Republicans, which is their right, can burn up 30 hours.
  Well, after the first vote at 1 a.m., the clock starts ticking on the 
next 30 hours for the underlying substitute. And then after that 30 
hours, there is the underlying bill itself, and that gets 30 hours. So 
if the Republicans really want, they can burn up 90 hours. I ask, to 
what end? To what end? We have the 60 votes. No one doubts that. There 
are 60 votes now to pass this bill. So to drag this out and to cause 
people to come in at 1 a.m. in the morning is not on the Democratic 
side, it is on the Republican side.
  So when I heard the distinguished Senator from Arizona pleading to 
put the vote off, I thought to myself: Well, if that is what the 
Republicans would like to do, there is a simple way to do that. You 
simply move the vote we are going to have at 1 a.m. to 9 a.m. tomorrow 
morning, and then you have the intervening hours from 1 a.m. to 9 a.m. 
count toward the 30 hours for the next vote. It is simple, very simple.
  So I took that to heart, and I asked our staff to type up a unanimous 
consent request, and we have given a copy to the other side. So that is 
what my unanimous consent will do. It will ask that the vote occur at 9 
a.m. tomorrow morning, but that the intervening hours from 1 to 9 would 
count toward the 30 hours for the underlying substitute.
  So, Mr. President, I ask unanimous consent that the cloture vote 
scheduled to occur at 1 a.m. Monday, December 21, occur at 9 a.m. 
Monday, December 21; and that if cloture is invoked, the postcloture 
time be considered to have begun at 1 a.m.
  The PRESIDING OFFICER. Is there objection?
  Mr. ENZI. Mr. President, reserving the right to object, we are not 
the party that spent 8 weeks putting this together to delay everything. 
We are not the party that spent all the time putting this amendment 
together that we are trying to do without any input from the 
Republicans. We are trying to have time to both review this and let 
America know what is happening. We know the Democrats have kept people 
from going home now for 3 weeks so they wouldn't have to listen to the 
voters at home who are really upset with this bill.
  So we would agree to the request to set the vote at 9 a.m. if the 
Senator will modify and strike the retroactive cloture time. We want 
the time.
  Mr. HARKIN. My initial request stands, Mr. President.
  The PRESIDING OFFICER. Is there objection?
  Mr. ENZI. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. HARKIN. So, Mr. President, here we go again. There they go again. 
You know, they want to delay, delay, delay, delay; obfuscate, 
obfuscate, obfuscate, and try to kill this bill by delaying it ad 
infinitum. They would be happy to delay this through Christmas, through 
the New Year, and January and February. Why? They would be happy to 
delay this bill for 10 years or more because they don't want it to 
happen. That is really what is going on.
  I say to my good friend from Wyoming--and he is my good friend; he is 
a great Senator--I thought--we did--in our committee, we got the bill 
through open and aboveboard. I think the reason we are here at this 
time is because we Democrats bent over backwards to accommodate the 
minority. We did in our committee, and I can say that Senator Baucus 
went the extra mile--no, he went the extra 10 miles. He went the extra 
100 miles on the Finance Committee to involve and to get the minority 
side involved. In the end, only one Republican would vote for it, and 
we know who that was, the Senator from Maine.
  We could have emulated the Republicans. We could have emulated what 
they did when they were in the majority in 2001. I was here. I remember 
it well. When they came up with this crazy tax package that cut taxes 
for the wealthiest in our country, stole the surplus we had built up 
under President Clinton by the year 2000 where we were looking at 
surpluses on into the future, and they came up with all of these big 
tax cuts for the wealthy, guess what they did. They didn't involve us 
at all. They did reconciliation where they only needed 51 votes. Under 
reconciliation, under the rules of the Senate, as the Presiding Officer 
knows, there is no filibuster. You cannot filibuster a reconciliation 
bill under the rules.
  So if they had done their tax bill in 2001 like we are doing this, we 
could have delayed. We could have had some input into that, but they 
said no. They just went right to reconciliation. We could have done 
that with this bill. We could have done that with this bill.
  I remember having discussions with members of our caucus and others 
saying: No, no. And the President, President Obama, wanted to do this 
as bipartisanly as possible to involve the minority in a constructive 
process. So that is what we decided to do, to do it in a very 
constructive, open process. What it has gotten us is total--total--
obfuscation and delay and trying to kill the bill by the minority. But 
we will persevere. We started this open process, and we are going to 
finish this open process. The die is cast.
  We have a vote at 1 a.m. I wish it could be 9 a.m., but you just 
heard the Republicans object to that because I just asked that the 
intervening hours be counted toward the next 30 hours, and they 
wouldn't even do that. So the reason we are here is not because of the 
Democrats. We are here because the Republicans simply don't want this 
bill to pass.

  That is really the reason.
  So we are going to vote. We are going to vote at 1 a.m. On the face 
of it, it is

[[Page S13596]]

really a technical, procedural vote, but it is something more than 
that. With that vote at 1 a.m. on the managers' package, on cloture on 
the managers' package, we will have reached a pivotal point at 1 a.m., 
a pivotal point in a decade-long quest to pass comprehensive health 
care reform. We have reached a crossroads, a kind of a point in time 
just as the Senate did in 1935 when we passed Social Security, or in 
1965 when we passed the Medicare bill. Each of those bills was a giant 
step forward for the American people, but each was bitterly opposed in 
this body by defenders of the status quo, the Republicans.
  In each case, Senate opponents waged a strident campaign of fear, 
warning that the passage of the legislation would lead to socialism. 
Senator Robert Taft from Ohio kept calling it socialism. We are going 
to ``Sovietize'' America. You can read it in our history books. But in 
the end, a critical mass of Senators rose to the historic occasion. 
Senators ignored the dark warnings and the demagoguery. They voted 
their hopes and not their fears. As we know now, in retrospect they 
passed laws that transformed America in profoundly positive ways.
  The Senate has arrived at another one of those rare historic moments. 
This time, we are attempting to pass comprehensive health care reform, 
a goal that has alluded Congresses and Presidents going back to the 
administration of Roosevelt. People think I am talking about Franklin 
Roosevelt. No. I am talking about the administration of Theodore 
Roosevelt.
  Once again, advocates of reform faced bitter opposition, including 
the filibuster we are seeing now and that has been going on for weeks 
by defenders of intense interests in the status quo. Once again, each 
Member of this body must make a choice: fear or hope; stick with the 
broken status quo or embrace bold change with all of its uncertainties.
  The other side is saying what about this? What is going to happen 
here? I keep talking about this bill we are passing. It is not like the 
Ten Commandments carved in stone. It is a bill. It is a law. Laws 
change as times and conditions change, as we get different information. 
So there are uncertainties in the future. The future is uncertain. But 
we can lay down a good start toward bringing people into a health 
insurance system and stopping some of the most horrible practices of 
the health insurance industry, moving us toward more of a health care 
system rather than a sick care system.
  So, yes, there are uncertainties, but we know one thing: The 
certainty of the status quo leads to too many people not having any 
kind of health care whatsoever. It leads to people dying younger than 
they should because they don't go in for their checkups and their 
screenings, children and others.
  We know the other side made clear sometime ago they wanted to 
obstruct and delay and filibuster and kill this bill. As far as my 
friends on the other side of the aisle are concerned, this floor debate 
is not about offering amendments to improve the bill. It is really not 
about allowing more time to fully read it and understand the bill. That 
is nonsense. It is not about playing a constructive role to pass a 
better bill. All the other side wants to do is kill this bill. Period.
  All this yakking that is going on--I was home this afternoon and I 
turned on C-SPAN and I was listening to the debate. And I thought, you 
know, people are at home. They are getting ready for Christmas. The 
trees are up. People are feeling good. Here we are going back and 
forth, back and forth, back and forth, but people have tuned this out.
  They really have. It is Christmastime and people have tuned this out. 
Yet we are here.
  We are here for a good reason. We are here because we are determined 
to pass meaningful health care reform for America, and we need to do it 
before Christmas.
  Well, again, in the defense of the broken system and the status quo, 
the Republicans joined at the hip with the health insurance companies. 
They use the same talking points, the same distortions, the same bogus, 
cooked-up studies, the same outrageous stories about death panels and 
pulling the plug on grandma. We have heard all that from the other 
side, week after week, month after month. Every step, as I said, we on 
this side have acted in good faith. We did not go the reconciliation 
route. In our futile quest for bipartisanship, we have repeatedly given 
the Republicans more time.
  In the Senate HELP Committee, under the great leadership of Senator 
Dodd, we spent nearly 3 weeks marking up the bill. No amendments were 
denied. Republicans could offer any amendment they wanted. It took 13 
days, a total of 54 hours of meetings. We went out of our way to 
accommodate our Republican colleagues. We accepted 161 of their 
amendments, either by vote or just by accepting them. After all that 
time, all that goodwill on our side, accepting 161 of their amendments, 
every Republican on the committee voted against the bill.
  Now, every time I have told this story in Iowa or wherever I have 
been, people shake their heads. They say: What? They offered 161 
amendments? Surely, they would have been kind of happy with that. They 
might have voted for the bill. They don't understand that. Every single 
Republican voted against it after all of those amendments.
  In the Finance Committee, deliberation on the bill stretched out for 
months solely to accommodate the wishes of the Republican members of 
the committee. Yet after all that time, despite the fact that Senator 
Baucus had bent over backwards to pursue bipartisanship and to 
accommodate the minority's requests--he acted in good faith at every 
step of the way--all but one Republican on the committee voted against 
the bill.
  Now, today, Republican Senators say they are opposing the cloture 
motion because they need more time. They say we are rushing things, 
rushing things, there is a big rush going on. Good grief. This bill has 
been on the Senate floor for 21 days. We have been deliberating about 
health care reform for almost the entire year. Congresses and 
Presidents, as I have said, have been trying to get this done since 
Theodore Roosevelt.
  So Republican colleagues say: Slow down. You are moving too fast. 
Well, that is absurd and disingenuous. We have to ask ourselves: Are 
our Republican friends going to be more constructive, more willing to 
act in good faith after the Christmas or New Year's break? Of course 
not. Their aim, understand, is not to improve the bill or to even 
understand it; it is to kill health care reform. Period. That is all it 
is. They just want to kill it.
  Now, because they don't have enough votes to kill it outright, they 
have opted for a course of delay and obstruction and filibustering. But 
let's be clear. They are not only delaying and obstructing the Senate; 
they are delaying and obstructing the millions of Americans who 
desperately need the reforms in this bill. They are delaying and 
obstructing the 31 million Americans who will finally get health 
coverage. They are delaying and obstructing the underinsured, millions 
of Americans who know they are just one serious illness away from 
bankruptcy and financial catastrophe. They are delaying and obstructing 
millions of Americans with preexisting conditions who can't get 
insurance. They are delaying and obstructing women in this country who 
face systematic discrimination by health insurance companies. They are 
delaying and obstructing Americans who fear if they get cancer or heart 
disease, their health insurance company will cancel their coverage.
  Let's be clear. Again, Republicans are not only trying to kill health 
care reform, in doing so they are killing the hope for millions of 
Americans who are desperate for reform of the current broken system. 
Too many Americans are literally dying because they do not have health 
coverage and proper access to a doctor.
  All told, nearly 45,000 Americans die each year because they lack 
meaningful health insurance. A Johns Hopkins study found that children 
without health insurance who are hospitalized are 60 percent more 
likely to die than those with insurance. Why? It is obvious. Kids 
without health insurance are much less likely to get preventive care or 
to be taken to a doctor in the early stages of their illness--60 
percent more. Think about that. Children without health insurance who 
are hospitalized are 60 percent more likely to die than children who 
have health insurance. So that is the real cost of delay and 
obstruction on the floor of the Senate.

[[Page S13597]]

This is our job. We are here. We are going to finish this job. But it 
is a tragic human cost. And these victims can be found in every one of 
our cities, our farms, our rural communities.

  I refuse to allow any obstacle to stand in the way of the Senate 
addressing the needs of these Americans. I have, along with my friends 
on this side, opposed the Republicans' filibuster. Likewise, I have 
been willing to disappoint many whose views I respect by agreeing to 
painful compromises in order to keep this bill on track. I agreed to 
those compromises not because I lacked passion or fight--I think my 
colleagues who know me know well enough that I can fight--I did so 
because of the harsh but unavoidable reality that because of the 
Republicans' obstructionism, we need 60 votes to pass this bill, and 
the only path to securing 60 votes was by making necessary compromises. 
But I add, that is also the way our predecessors in this body were able 
to get the votes to pass Social Security and Medicare, both of which 
had big gaps in coverage when they were first enacted. What they did is 
they passed bills that were sort of a half a loaf. Then they came back 
for the remainder of the loaf in the following years.
  Despite these compromises, make no mistake, this remains a profoundly 
progressive bill. One analyst put it this way:

       This legislation will be the most important social policy 
     achievement since the Great Society.

  That is exactly why the rightwing in this country is pulling out the 
stops to kill it. This bill will usher in three huge reforms. First, 
this bill will be the biggest expansion of health coverage since the 
creation of Medicare. Some 31 million Americans who do not have 
coverage now will get it, thanks to this bill. This is a monumental 
achievement. We do this by expanding Medicaid and by providing 
subsidies to low-income, modest-income families.
  In addition, if you are a small business owner, this bill will offer 
tax credits of 35 percent of employer contributions toward premiums in 
order to make it more affordable for small businesses and their 
employees to have health insurance. That 35 percent will go up to 50 
percent. But the 35 percent starts next year. That is why I have said 
many times in my State of Iowa, and around it, that actually the 
biggest winners under this bill, aside from the totally uninsured, are 
small businesses and the self-employed. Small businesses and the self-
employed are the big winners in this bill.
  What is more, our bill will end the discriminatory practice of 
jacking up premiums for businesses because an employee is older or has 
a preexisting condition. They will not be able to do that anymore.
  Through these new health insurance exchanges, small businesses and 
people currently without access to affordable coverage will be able to 
shop and choose from a menu of quality health plans, much in the same 
way Members of Congress do.
  This bill does much more than extend health coverage. The second 
great reform in this bill is an array of provisions cracking down on 
pervasive, outrageous abuses by the health insurance companies, abuses 
that currently leave most Americans just one serious illness away from 
financial catastrophe.
  Right now, the health insurance industry in this country is 
extraordinarily profitable. But these profits come at a staggering 
human cost. Think about it. When Americans get a diagnosis, let's say, 
of cancer or some other grave illness, they fear two things: First, 
they fear the illness and, second, they fear the health insurance 
company. They wonder, is my company going to authorize treatment and 
pay the bills or will I have to go to war to prevent it from sticking 
me or rescinding my policy?
  I always tell people: Look at your policy. Is there a rescission 
clause in there? I have had so many people say: What is a rescission 
clause? It is a little clause in there, probably in the fine print, and 
it says that when your policy is up for renewal, the insurance company 
can terminate you. They do not have to renew your policy. This is what 
happens. Someone gets a very serious long-term illness such as cancer 
or heart disease. When their policy is up for renewal, the insurance 
company says, no, they will not renew your policy. Now you are out in 
the cold with a preexisting condition. Now you can't get insurance 
anywhere. This bill will end that practice.
  Health insurance companies now employ whole armies of claim adjusters 
just to deny requests. In fact, the health insurance companies give 
bonuses--they reward people for denying claims, saying no to 
policyholders. In the State of California, the largest insurers deny 
one out of every five requests for medical claims, even when 
recommended by the patient's doctor. One large insurer, PacifiCare, 
denies medical claims nearly 40 percent of the time. Think about that. 
That is almost one out of two. CIGNA denies claims 33 percent of the 
time. So if you get a terrible illness and you are insured by 
PacifiCare, good luck in getting them to pay for your medical 
treatment.
  Republican Senators give us all the scare talk about a government 
bureaucrat standing between you and your doctor. Right now, we have 
corporate bureaucrats standing between you and your doctor, and they 
earn good evaluations and bonuses and money for denying you coverage.
  I can remember a town meeting I had in Mason City in August, one of 
those famous town meetings. Toward the end of it--it was OK. There was 
a lot of contention there, people voicing their concerns, as they ought 
to do, as they have a right to do. But at the end, there was a man 
sitting down in the front. I thought, this will be my last one. I 
called on him. He stood up and he said: You know, I have been a doctor 
here for over 40 years in Mason City--40 years.
  He said: I can say honestly during those 40 years, I have never once 
had a government bureaucrat come between me and my patients on Medicare 
or Medicaid. He said: However, I can't tell you how many times during 
those 40 years I have had insurance bureaucrats come between me and my 
patients.
  This is a doctor, practicing for 40 years, and never once did he have 
a government bureaucrat come between him and his patients.
  Nearly 62 percent of bankruptcies in the United States are linked to 
medical bills. And here is the kicker: Nearly 80 percent of those are 
people who had health insurance.
  When is the last time you ever heard of a health insurance executive 
claiming bankruptcy? I would like to find one someplace.
  The American people have lived in fear and under the heavy hand of 
these health insurance companies long enough. But help is on the way.
  Let me mention a few of the ways this bill immediately cracks down on 
abuses by the health insurance industry. First, if you are uninsured 
with a preexisting condition, the bill would give you access to 
affordable coverage without discrimination. Our bill immediately bans 
those rescissions I talked about where the insurance company can 
rescind your policy. We stop that right away.
  We prohibit insurers from imposing lifetime limits on benefits, and 
we impose and restrict the use of annual limits.
  Our bill ends discrimination against women. As I said, currently they 
pay as much as 48 percent more for the same coverage a man has.
  Our bill requires insurers right away, next year, to let children 
stay on their family's policy until they are age 26. Those are a few of 
the things.
  But there is a third area in this bill I have championed for many 
years, and in many ways I think it may be the most profound part of the 
bill, and that is a whole array of provisions promoting wellness and 
prevention, turning America into a general wellness society.
  To this end, at the clinical level, the bill requires reimbursement 
for proven, cost-effective preventive services such as cancer 
screenings, nutrition counseling, and smoking cessation programs. This 
means health professionals will be able to offer these services to you 
before you get diabetes or cancer or emphysema.
  For essential screenings and annual physicals, there are no copays, 
no deductibles. We encourage people to do this so they will not have to 
pay a copay or deductible.
  Our bill makes major new investments in community wellness and public 
health, and we help businesses both large and small create workplace 
wellness programs for their employees.

[[Page S13598]]

  One thing I do not think has been mentioned before, our bill requires 
large chain restaurants to post basic nutritional information right on 
the menu so consumers, when they are going out to eat, can make healthy 
choices.
  What we are trying to do is change the paradigm from our current sick 
care system to a true health care system--one that keeps people out of 
the hospital in the first place. Our aim is to recreate America as a 
wellness society focused on healthful lifestyles, good nutrition, 
physical activity, and preventing the chronic diseases that take such a 
toll.
  As a proud progressive, I make no bones about my enthusiasm for the 
three great reforms in this bill--vastly expanding coverage, cracking 
down on the abuses by the health insurance companies, and making robust 
investments in wellness and disease prevention.
  Today we are closer than we have ever been to making Senator Ted 
Kennedy's dream of universal health insurance a reality. This bill has 
many authors. We have all been involved in it. But in a very real 
sense, this is Senator Kennedy's bill.
  I urge Senators, when the vote occurs at 1 a.m., to vote their hopes, 
not their fears. Seize the moment. Let's move ahead. Let's vote for 
cloture. At long last, let's give every American access to the quality, 
affordable health care they need and they deserve.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Ms. STABENOW. Mr. President, before my friend from Iowa, the 
distinguished Chair of the HELP Committee, leaves the floor, I thank 
him for his wonderful leadership and friendship in so many capacities 
and passion for what we are doing now. We are all here together knowing 
that in the process of legislating, you don't always get every idea you 
want. But you come together and you work for something that is good for 
the American people, and that is what we have done. I thank him very 
much for all of his leadership.
  I wish to take a few moments to talk about how we actually got to 
this point on a Sunday evening--we are voting at 1 o'clock in the 
morning--and, frankly, what has been happening all year. I want to take 
a few minutes to talk about what has happened this entire year, the 
first year of President Obama's presidency, our first year in the 
majority, and then to speak a little bit as well about the very 
important legislation that is in front of us.
  I do think it is important that we take a moment to recognize and 
address a very unfortunate milestone, look back on the year on what we 
have accomplished in spite of that milestone.
  In April, the media celebrated President Obama's first 100 days in 
office. But here in the Senate, we can measure our progress by 
something else--not 100 days, but 100 objections from the minority 
party. Actually, 101 as of yesterday; objections, filibusters, delays, 
stalling tactics designed to stop us from helping the American people 
who are hurting in these tough economic times. That is more true in my 
State than any other place in this country. Our people, the great 
people of Michigan, have been hurting longer, have been hurting much 
more deeply than other places in the country because of the major 
economic transition, as well as the recession in which we are involved.
  There is good news because while the Republicans were stalling and 
wasting time, we were working hard doing what the people of America 
sent us to do. I want to talk about what we have done in spite of the 
stalling. But I also want to take a brief moment to explain something 
hard to explain about Senate rules because people look at us and say: 
They objected, but why does that matter? Why does that matter?
  Mr. President, as you know, when there is an objection, in order to 
overcome it--and it is called a filibuster--it involves invoking 
motions called cloture and it takes time. It plain takes time. So 101 
times we have not been able to move forward because of an objection or 
we have had to go through this long process we are involved in right 
now.
  I think it is important to briefly explain it because when 
Republicans object, as they are now, as they have been on so many 
occasions, our leader has to file what is called a cloture motion, and 
then you wait 2 days. You cannot do other business for those 2 days. We 
have done that over and over, wasting time while people in my State 
want us to be focused on jobs, on lowering their health care costs, on 
making sure we are doing the things that matter to them every day. But 
we stop and we wait 2 days. Then we vote on stopping the filibuster. 
Then we wait 30 hours, which is what we are doing right now. Then we 
vote on whether to proceed to the item. There are filibusters again. 
Then we file a cloture motion on the amendments or the bill. We wait 2 
more days. Then we vote on closing a filibuster, and then we wait 30 
hours, and then we vote on the amendment, which we will do tonight, and 
then we have to wait another 30 hours. In this case, another 30 hours.
  It does matter when we say there have been 101 objections that have 
either stopped us or forced this process. It does matter. It matters 
because it has slowed down the ability to move to get things done.
  The good news is that we have gotten things done anyway. We have 
gotten things done anyway because we are focused and committed to 
getting things done. We know the American people have waited too long. 
The last 8 years were about taking us in the wrong direction, with 
things that did not help most people, that put us in a huge deficit 
hole, that did not address health care or health care costs or jobs, or 
policies that made it worse.
  We know that even though there have been 101 objections so far this 
year--and there will be more; there will be more--we are going to get 
things done for the American people.
  It is amazing the stalling actually happened on the very first day of 
the 111th Congress on January 6 when Republicans objected to moving 
forward with an important public lands bill, something we had been 
trying to do for some time to protect and preserve our national parks, 
forests, and wilderness areas. But we passed that important bill anyway 
over their objections and three different filibusters, as the chart 
showed. Three different times we had to wait, wait 2 days, wait 30 
hours, wait 2 days, wait 30 hours. But we passed it.
  Since then, nearly every single week we have been in session, every 
single week but 4 out of 41 weeks, we have had to go through this 
process or have had objections. They have found something to object to 
or something to filibuster.
  As I said, yesterday they objected for the 101st time, this time with 
a filibuster against providing affordable health insurance for over 30 
million Americans. They have misused longstanding Senate rules and 
traditions to stall everything that might give this President and this 
Congress a victory.
  I think it hurts all of us when the Senate breaks down as it has. 
Everybody is hurt by that--to stall everything that would help get 
Americans back to work or that would help 15.4 million Americans who 
are looking for work, and now to stop us, as I said, from extending 
health insurance coverage to over 30 million Americans. Their 
objections are about policy. They are about politics.
  Earlier this year, objection 74, they stalled the unemployment bill, 
and their delaying tactics caused nearly 200,000 Americans to lose 
their unemployment benefits a couple of months before Christmas. They 
objected to the bill twice. They filibustered not once but three times 
before they voted unanimously. They voted unanimously for the bill. Why 
would you filibuster something three times and then vote for it 
unanimously? Not because you are concerned about the policy. The only 
explanation is that Republicans were trying to waste time--time that 
cost 200,000 Americans their unemployment benefits; the difference 
between paying the mortgage, keeping the heat on, putting food on the 
table, and possibly trying to keep health care going with a COBRA 
payment or in some other fashion.
  Objection 4 was the Republican filibuster of the Lilly Ledbetter Fair 
Pay Act to make sure women get equal pay for equal work. Republicans 
filibustered and held up that bill, but we pushed forward. We passed 
it. We passed a very important equal pay for equal work bill in spite 
of it.
  Objection 6 was to the American Recovery and Reinvestment Act which

[[Page S13599]]

has been absolutely critical to creating jobs, keeping our economy out 
of a depression. They filibustered that bill three times as well. But 
we overcame the objections, passed the Recovery Act, and made critical 
investments in transportation, in our schools, in our police officers, 
and in clean energy technology and manufacturing.
  And, yes, we are seeing the difference in Michigan right now. Mr. 
President, $2 billion was part of the Recovery Act. I am pleased to say 
we have received a large part of that in Michigan to develop new 
battery technology manufacturing. We have at least six different firms 
that have announced and begun to develop manufacturing facilities for 
advanced battery development. Those manufacturing facilities are going 
to put thousands of people back to work. That was in the Recovery Act 
that was filibustered three times.
  Objection 20 was to Senator Kennedy's Serve America Act, which we 
passed despite their filibuster, to help young people give back to 
their country through voluntarism and community service.
  Objection 24 was to the Fraud Enforcement Recovery Act which cracked 
down on predatory lending and abuses by banks and mortgage companies. 
That bill was held up for nearly a month. But we passed it, giving real 
relief to millions of American homeowners.
  We passed the credit card bill, Republican objection 32.
  We passed the Helping Families Save Their Homes Act, Republican 
objection 33.
  We gave the FDA the authority, finally, to regulate tobacco to help 
keep kids from smoking. That was Republican objection 38.
  We passed the Travel Promotion Act which will help stimulate the 
suffering tourism industry across the country. That was objection 45.
  We passed a true funding bill to make sure our soldiers in Iraq and 
Afghanistan had the support they needed despite having to file cloture 
to stop a filibuster--objection 47.
  We passed the Defense authorization bill that included a pay raise 
for our troops and other help for our military and their families 
despite repeated filibusters and objections. And these were objections 
54, 56, 57, and 58. Can you imagine? This was a Defense bill.
  We passed the veterans health care bill, despite Republican stalling, 
to help caregivers of disabled veterans, women veterans, rural health 
improvements for veterans, mental health care for veterans, and support 
for homeless veterans. This was Republican objection 89.
  Objection 98 was another filibuster against those pay raises for our 
troops just 9 days before Christmas.
  Despite all of those objections, 101, we have been doing what we were 
sent here to do. We have focused on actions to help create jobs and 
strengthen our economy and focus on the things that families struggle 
with and care about every day to make people's lives better, not just a 
few, not just investment bankers on Wall Street, not just the wealthy 
folks who got the tax cuts in the last 8 years, but middle-class 
families every day who are trying to figure out: What about them? What 
about us? That is what we have been focused on.
  We passed an extension of the Children's Health Insurance Program to 
provide health and dental care to nearly 10 million children. We passed 
legislation to reform government contracting and protect taxpayer 
dollars. We passed legislation to invest in health care, energy, and 
education. We passed the cash for clunkers bill, as you know, that I 
was proud to lead in the Senate that moved over 650,000 fuel-efficient 
cars off dealer lots and brought thousands of laid-off manufacturing 
workers back to work.
  We passed legislation to support the growth of small businesses and 
to extend the first-time home buyers tax credit. And now, just a few 
days before Christmas, we are working to pass this critical, historic 
health insurance reform legislation. We are committed to getting it 
done.
  Republican colleagues can object 100 times or 1,000 times, but we are 
not wavering in our commitment to do the right thing. Even though 
inaccuracies abound, even though misinformation has been said over and 
over about what this bill would do, we are committed to overcoming what 
has been the tidal wave of opposition from the special interests who 
control the status quo, who like it the way it is right now. We are 
determined to get beyond that and do the right thing for American 
families. Whether our Republican colleagues work with us or not--and we 
sincerely hope they do, and we have spent a tremendous amount of time 
this year reaching out to get bipartisan support--whether they stall or 
object, our job is to do everything we can to move America forward, and 
that will continue to be our focus.

  As the distinguished Presiding Officer knows because we both sit on 
the Finance Committee, we have spent months reaching out with 
committees, with processes to get bipartisan support. But, as my dad 
used to say, it takes two to tango. It takes both sides to want to work 
together. Unfortunately, it appears the strategy that was put in place 
back at the beginning of the year, the very first day of session, with 
the very first filibuster, was just to stop us from being able to move 
America forward, to stop this great new President, to stop the majority 
in the Congress. But we have moved forward despite that.
  I think often of what we could do if we hadn't had to deal with 101 
filibusters, what we could have done in creating a clean energy bill, 
which would create more jobs in my great State, or dealing with other 
critical issues we need to deal with and we will deal with. As we slog 
through filibuster after filibuster in the coming year, we will do 
that. But now we have the opportunity in front of us to pass historic 
health insurance reform that, frankly, people have talked about for 100 
years.
  This legislation is not perfect, but nothing ever is when you start. 
It is a great framework, however, for putting in place the value, the 
principle that every American should be able to have affordable health 
insurance and that we are going to tackle the explosion of costs that 
have hit businesses large and small, that have hit taxpayers, and to 
bring those costs down over time. That is what we are involved in right 
now, and we are going to get it done.
  We could have voted much earlier, rather than keeping our staff here 
until 1 a.m., and we will vote again after we run the next 30 hours, 
which will be, I believe, Tuesday morning. We could vote and be done 
with the final passage at that point. We know where the votes are. We 
have the votes to pass this. But it appears we will be here until 
Christmas Eve. Mr. President, I do not mind for myself. I, of course, 
want to be home with my family, as I know you do. But I think about my 
brother, who drives for UPS, and I know he will be working on Christmas 
Eve, as a lot of Americans will be working on Christmas Eve. And if we 
need to be here until Christmas Eve to do something that will 
positively affect every American, I am willing to do that. I am willing 
to do that if that is what we need to do.
  Let me take a moment to talk about the bill in front of us. The bill 
in front of us literally saves lives, saves money, and saves Medicare, 
and I am very proud that in the managers' amendment, the amendment we 
will be voting on at 1 a.m. today, we have made it even better.
  I am very pleased to have helped to lead a section related to small 
business tax cuts. Along with our chair of the Small Business 
Committee, Senator Landrieu, and another strong advocate, Senator 
Lincoln, we have been working on provisions that will make sure there 
are small business tax cuts that start immediately--next year--after 
the bill passes, $40 billion in tax cuts in total to help small 
businesses afford health insurance for themselves and their workers.
  In our amendment, we also provide even tougher insurance reforms.
  In the underlying bill, we lay out a whole health care bill of 
rights. I remember coming here in the year 2000, and the Patients' Bill 
of Rights was the major thing we were trying to get done. We were in 
the minority, the Democratic minority, but we were working hard to do 
that. It was my first opportunity to work with Senator Kennedy. We 
believed strongly that we needed to take insurance company bureaucrats 
out of the middle--from between doctors and patients. That is in this 
bill. Those kinds of reforms are in this bill and only one of many 
things that are in this bill.

[[Page S13600]]

  We have toughened it up so that if insurance companies, between now 
and when the new group insurance pool takes effect, are raising their 
rates too high, spending too much on profit and administration, then 
taxpayers, ratepayers, will get a refund. And we hope that will put 
pressure on them not to continue to raise rates or try to do what the 
credit card companies have done before the bill takes effect--raise 
their rates. So we have put new protections in and other protections as 
well to make sure that the majority--the vast majority--of every dollar 
a family puts into premiums actually goes for their medical care rather 
than for profits and administration.
  In total, we have $430 billion in tax cuts to create affordability 
for families and for individuals, to help them afford health insurance. 
With that, overall, this is a tax reduction--this bill is--for the 
American people, and it is a reduction for taxpayers because it lowers 
the deficit in the first 10 years and on into the future.
  I am going to take just a moment to give a sense of what is in the 
bill as it relates to new coverage and the benefits.
  We know the majority of us have health insurance already. In 
Michigan, it is about 60 percent of the people, and in other places it 
is 50 or 55 percent. But we have what is called an employer-based 
health insurance system. So we have started from the basis that people 
should be able to keep what they have, and we have built on that. The 
majority of people have either employer-based insurance or they have 
Medicare or Medicaid or veterans services or other public services. So 
we started from the basis that we want to make current health insurance 
more secure, more stable. The insurance reforms we are putting in place 
for those plans that take effect--or new plans after this takes 
effect--will include the elimination of preexisting conditions, the 
elimination of what is called rescissions--the ability to drop someone 
if they have gotten sick--and the elimination of discrimination.
  One of the things I was surprised to learn about, in terms of how 
extensive it is, as we went through this process is that women are 
paying, on average, 50 percent more than men for the same coverage in 
the individual insurance market or maybe even less coverage. Because a 
woman is in her childbearing years or perhaps has been pregnant and may 
be viewed as having a preexisting condition, some women might not be 
able to find health insurance.
  So those who have insurance today, as they attempt to get new plans, 
will be able to take advantage of all of the insurance protections--our 
health care insurance bill of rights--in the bill. And this is very 
important.
  Also, people with insurance today will actually, over time--and it 
will take some time for this to happen--but as others who do not have 
insurance now are able to afford health insurance and become able to 
get health care, there will be fewer people using emergency rooms. 
There will be fewer people needing other kinds of services that 
actually end up coming back, in terms of cost, to all of us who have 
insurance today because when someone walks into the emergency room 
sicker than they otherwise would be if they had seen a doctor, they get 
treated, as they should, but then the hospital has to make up the cost, 
so they put it on people who have insurance today. That is estimated to 
be about $1,100 in hidden costs for individuals. So we are going to see 
those kinds of costs come down and other changes and efficiencies and 
quality that will help people with insurance today. So coupled with the 
insurance reforms, we will see more stability and more quality for 
people who have insurance today.
  The major area of new coverage is in what is called the insurance 
exchange. For the 15 to 20 percent of the people who can't find 
affordable insurance today--and most of them, as our Presiding Officer 
knows, are small businesses or people who are self-employed or people 
who have lost their jobs and then lose their insurance--we set up a new 
group pool, which is a way for people to use the same leverage a big 
business does or the Federal Government does, just as the insurance 
policy for Members of Congress uses a pool. Then everyone can choose 
the insurance coverage they want within that pool and get a better 
deal. That is what we are setting up in the insurance exchange, with 
helpful tax cuts for families and for businesses and individuals to 
help them afford health insurance.

  We are also giving a choice to States. For lower income working 
people, a State may choose to provide a basic health insurance plan 
rather than people getting a tax cut to go into the exchange. They can 
set up their own basic health insurance plan and bring down costs as 
well through the State.
  For young workers--and this is one of the things I wish had been 
around a couple of years ago--we will be allowing parents who have 
their children on their insurance policies--after the effective date of 
the act, they will be able to keep their children on their insurance 
policies until the age of 26. That will give young people a chance to 
get a start in that first job knowing they have insurance until they 
are 26. And there are a number of other provisions in the bill for 
young people as well.
  We are making Medicaid a true safety net for low-income people up to 
133 percent of poverty. We are truly going to be able to say: If you 
lose your job, you won't have to lose your insurance. What an important 
thing to be able to say in terms of taking away that fear of losing 
your job and having nowhere to turn.
  Improving Medicare. We are going to stop what have been overpayments 
to for-profit insurance companies and put that money back into closing 
the gap in prescription drug coverage under Medicare. It has been 
called the doughnut hole. We are going to close that. We are going to 
provide preventive care for seniors without out-of-pocket costs and 
lengthen the Medicare trust fund so that it is stronger for a longer 
period of time.
  I am very proud to have worked with Senator Kerry to develop a way to 
provide support and help for companies that pay for the health 
insurance of early retirees, to lower their costs so that, in fact, we 
will be able to help those who have retired, voluntarily or 
involuntarily, so they will have the insurance they need until they can 
qualify for Medicare.
  Let me close by saying this legislation is very much about saving 
lives. Forty-five thousand people lose their lives every year because 
they can't find health insurance they can afford. That is 45,000 
families who will have one less person at the dinner table over the 
holidays because of lack of health insurance. Surely we can do better 
than that in our great country.
  We will be saving money for small businesses, for families, for 
taxpayers, and bringing down the deficit--beginning to turn those costs 
downward rather than keeping them going upward in such an 
uncontrollable way.
  Saving Medicare. We will be making sure Medicare is stronger out into 
the future and that our seniors have more help paying for their 
prescription drugs and preventative services as well.
  When you get through all of it, we know it is hard to change the 
status quo because those who benefit from the current system don't want 
it changed.
  The PRESIDING OFFICER (Mr. Wyden). The Senator's time has expired.
  Ms. STABENOW. But we do.
  I thank the Presiding Officer.
  The PRESIDING OFFICER. The Democratic block of time has expired.
  The Senator from Utah, Mr. Hatch, is recognized.
  Mr. HATCH. Mr. President, after weeks of closed-door clandestine 
negotiations, Senator Reid finally emerged with a 383 page manager's 
amendment yesterday to the 2,074 page, $2.5 trillion tax-and-spend 
Washington takeover of our health care system.
  Despite all the promises of ushering a new era of accountability and 
transparency in Washington by the President and the Democratic Party, 
the Reid amendment represents everything that Americans hate about 
Washington right now Chicago-style backroom buy-offs at the expense of 
American taxpayers.
  At yesterday's press conference, when Democrats were asked about the 
Nebraska earmark for Medicaid funding, the majority leader simply 
replied, ``A number of States are treated differently than other 
States. That's what legislation is all about. That's compromise.''
  So in addition to the Medicare Advantage deal to grandfather only 
Florida's seniors and the $300 million give-

[[Page S13601]]

away known as the Louisiana Purchase, we now know what the Democrats' 
version of compromise really looks like. In the Reid amendment, 
released yesterday, Vermont gets a 2.2-percent increase for 6 years in 
its Medicaid Federal match rate while Massachusetts gets a 0.5 percent 
increase for 3 years for its entire program. But the deal for the State 
of Nebraska takes the cake. Now we all know that any one Congress can't 
bind future Congresses but somehow Nebraska will receive a special 
carve out that would have the Federal Government pay for every dollar 
of its Medicaid expansion. The total cost of these Medicaid special 
deals--$1.2 billion.
  So the next logical question is pretty straightforward--who will pay 
for these special deals? Well, the answer is simple. Every other State 
in the Union, including Utah, which are collectively facing $200 
billion in deficits and are cutting jobs and education services to 
survive; our States will now pay to support these special deals for 
Nebraska, Massachusetts and Vermont.
  According to the Congressional Budget Office, the Medicaid expansion 
in the Reid bill creates a $26 billion unfunded mandate on our cash-
strapped States. Coincidentally, only one State avoids this unfunded 
mandate--Nebraska.
  Let me now focus my attention on over a $\1/2\ trillion worth of new 
taxes, fees, and penalties on individuals, families, and businesses 
imposed by the Reid bill. The new fees begin in 2010, while the major 
coverage provisions do not start until 2014. Almost $57 billion in new 
taxes are collected before any American sees the major benefits of this 
bill, which are largely delayed until 2014. It is no wonder why this 
budget gimmickry creates an illusion of this bill reducing our national 
deficit.
  Based on data from the Joint Committee on Taxation--the nonpartisan 
congressional scorekeeper--this bill would break President Obama's 
campaign promise by increasing taxes on 42 million individuals and 
families making less than $250,000 a year. This is even after taking 
into account the government subsidies provided to low- and certain 
middle-income individuals and families.
  The Reid bill not only increases payroll taxes by nearly $87 billion 
but also imposes $28 billion in new taxes on employers who do not 
provide government approved health plans. These new taxes will 
ultimately be paid by American workers in the form of reduced wages and 
lost jobs.
  According to a recent study of similar proposals by the Heritage 
Foundation, these new job killing taxes will place approximately 5.2 
million low income workers at risk of losing their jobs or having their 
hours reduced and an additional 10.2 million workers could see lower 
wages and reduced benefits.
  So with nearly $\1/2\ trillion in Medicare cuts and more than $\1/2\ 
trillion in new taxes, does the Reid bill actually do anything to 
control our Nation's skyrocketing health care costs? The answer, 
according to the Congressional Budget Office, is no. In fact, it will 
actually increase our national health care spending. I quote: ``Under 
the legislation, Federal outlays for health care would increase during 
the 2010-2019 period, as would the Federal budgetary commitment to 
health care. The net increase would be about $200 billion over that 10-
year period.'' So what is the bottom-line? More taxes, more spending 
and bigger government.
  Let me a take a moment to talk about the so-called abortion 
compromise in this bill. The language to prevent taxpayer dollars from 
being used to fund elective abortions in the Reid amendment is 
completely unacceptable. The new abortion provisions are significantly 
weaker than the amendment I introduced with Senator Ben Nelson to 
ensure that the Hyde amendment, which prohibits Federal dollars from 
paying for elective abortions, also applies to any new Federal health 
programs created by Congress. The Hyde amendment has been public law 
since 1976.
  The Nelson-Hatch-Casey amendment, which is almost identical to the 
Stupak amendment that was included in the House-passed health reform 
bill in early November by a vote of 240 to 194; it is important to note 
that 64 of those Congressmen voting for the amendment were Democrats. 
Let me repeat that--the Stupak amendment was supported by 64 House 
Democrats. And, despite that vote and the support of seven Senate 
Democrats, the majority decided not to include this language in the 
Reid bill or the Reid managers' amendment. I find that absolutely 
outrageous.
  Moreover, the Reid conscience protections are much weaker than those 
included in the House passed health reform bill. The House bill 
included the Hyde-Weldon conscience protections that have been included 
in the HHS appropriations bills since 2004; the Reid health reform 
legislation does not. The Hyde-Weldon language ensures that strong 
conscience protections are in place for medical providers who oppose 
abortion. These strong protections, which are currently Federal law, 
should also apply to the new programs created through the Reid 
managers' package.
  The so-called abortion compromise does not stop there. The Reid 
amendment also creates a state opt-out charade. As noted by Cardinal 
Daniel DiNardo, the Archbishop of Galveston-Houston and the Chairman of 
the U.S. Catholic Conference of Bishops' Committee on Pro-Life 
Activities, allowing ``individuals to `opt-out' of abortion coverage 
actually underscores how radically the underlying Senate bill would 
change abortion policy. Excluding elective abortions from overall 
health plans is not a privilege that individuals should have to seek as 
the exception to the norm. In all other federal health programs, 
excluding abortion is the norm. And numerous opinion polls should that 
the great majority of Americans do not want abortion coverage.''
  Additionally, this provision does nothing to prevent one State's tax 
dollars from being used to fund abortions in other States. In other 
words, tax dollars from Nebraska or Utah could be paying for abortions 
in California or New York.
  The Reid amendment also creates a new public option that will be run 
by the Office of Personnel Management, OPM, which, for the first time, 
creates a federally funded and managed plan that will cover elective 
abortions. Should this legislation be signed into law, the Federal 
Government will be funding elective abortions for the first time in 
over 30 years, against the will of the vast majority of Americans. For 
these reasons, I believe that the Senate health reform legislation is 
far inferior to the House passed bill when it comes to protecting the 
sanctity of life. It should come as no surprise to anyone that pro-life 
organizations from the U.S. Conference of Catholic Bishops to the 
National Right to Life Committee and the Family Research Council have 
expressed their strong opposition to this so-called compromise.
  Finally, let me take a moment to talk about the individual mandate 
tax which has almost doubled from $8 billion to $15 billion in the Reid 
amendment. I have long argued that forcing Americans to either buy a 
Washington-defined level of coverage or face a tax penalty collected 
through the Internal Revenue Service is unconstitutional. The 
Constitution empowers Congress to do many things for the American 
people. Just as important, however, is that the Constitution also sets 
limits on our power. We cannot take advantage of the power without 
recognizing the limits.
  We hear a lot about how Senators on this side of the aisle are 
supposedly defending the big, evil insurance companies while those on 
the other side of the aisle are the defenders of American families. 
This insurance mandate exposes such partisan hypocrisy. Let me ask one 
simple question: who would benefit the most from this unprecedented 
mandate to purchase insurance or face a penalty enforced by our friends 
at the Internal Revenue Service?
  The answer is simple. There are two clear winners under this 
draconian policy and neither is the American family. The first winner 
is the Federal Government, which could easily use this authority to 
increase the penalty, or impose similar ones, to create new streams of 
revenue to fund more out of control spending. Second, the insurance 
companies are the most direct winners under this insurance mandate 
because it would force millions of Americans who would not otherwise do 
so to become their customers. If you do

[[Page S13602]]

not believe me, then just look at the stock prices of the insurance 
companies that have recently shot to their 52-week highs.
  Right now, States are responsible for determining policies that best 
meet the particular demographic needs and challenges of their own 
residents. Massachusetts, for example, has decided to implement a 
health insurance mandate while Utah has decided not to do so. This bill 
would eliminate this State flexibility so that the Federal Government 
may impose yet another one-size-fits-all mandate on all 50 States and 
on every American. I cannot think of anything more at odds with the 
system of federalism that America's founders established--a system 
designed to limit government and protect liberty.
  As I have said all year long, ensuring access to affordable and 
quality care for Americans is not a Republican or Democrat issue--it is 
an American issue. Unfortunately, the majority's arrogance of power has 
forced us down a path where ideology has trumped policy and big 
government has trumped American families.
  Town hall after town hall and poll after poll tell us that Americans 
want us to step back, start over and reform our healthcare system in a 
step-by-step, fiscally responsible manner. This is a moment for courage 
and leadership. All we need is one Democrat to listen to a growing 
chorus of concerns from Americans across this great nation and stand up 
against this bill. I am going to do everything possible to make sure 
that the voice of Utahns and Americans everywhere is heard loud and 
clear in this Senate Chamber.
  A vote to move this bill forward will be one of the most important 
votes this body has ever taken--a vote that is bigger than our parties 
or our ideologies; a vote that will fundamentally change the American 
landscape for generations to come and restructure one-sixth of our 
economy; a vote that will determine if we will give our future 
generations the same opportunities and the same sense of pride that has 
been our privilege. Make no mistake, our actions on this vote will not 
be without consequences. History and our future generations will judge 
us on this vote.
  Despite the harsh realities of skyrocketing deficits and an exploding 
national debt, the majority's insatiable appetite to spend has not 
changed. Last weekend was a perfect example. At a time when we are 
already debating a $2.5 trillion tax-and-spend Washington takeover of 
our health care system, the majority jammed through a $1.1 trillion 
appropriations bill with a 12-percent year-over-year increase in 
Federal spending. But this is only the tip of the iceberg. There is 
already talk of raising our Nation's debt limit by almost $2 trillion 
to accommodate Washington's out of control spending habits.
  Enough is enough. It is time to stand up and do what is right and 
there is no better time to do it than to vote against moving forward on 
this health care bill. The time for courage is now.
  The historic blizzard in Washington yesterday was a perfect symbol of 
anger and frustration brewing in the hearts of the American people 
against this bill. I urge the majority once again to listen to the 
voices of the American people. My Republican colleagues and I are 
united with the American people in our fight against this $2.5 trillion 
tax-and-spend bill. There is still time to step back and start over.
  One last thing. When you have one-sixth of the American economy 
involved, it deserves a bipartisan vote. To be honest, almost every 
major reform we have ever passed--in fact, every one I can think of--
had a huge bipartisan vote. In this particular case, I don't know of 
one Republican who is going to vote for this. If you can't get 75 to 80 
votes on something this important, this much of a reform, then we 
should start over and do it the right way.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. BENNETT. Mr. President, I have been interested in the 
conversation that has gone on this afternoon and this evening. I have 
heard, once again, the statement made on the floor about the number of 
people who die every year because they don't have insurance and how 
that is an absolutely essential reason why we have to pass this bill 
and indeed pass it now; we have to pass it before Christmas; we have to 
pass it immediately because there are tens of thousands of people who 
are dying because they don't have insurance; we have to pass this bill 
so it will provide insurance for them in January of 2014; we have to 
pass this bill because people are dying right now, but we are not going 
to have any of the things that will take care of them available for 4 
years. So we can't take an extra week--we can't take an extra 10 days--
because people are dying. But we can take an extra 4 years before we 
give them anything. I have had a very hard time understanding that 
logic. The mathematics do not add up for me. Delaying everything for 4 
years--why?
  We know why. The reason they are delaying the implementation of this 
bill for 4 years has nothing whatever to do with people's health or the 
fact that some people are dying. The reason the implementation date of 
this bill is delayed 4 years is entirely due to the computers in the 
Congressional Budget Office which say, if you started this program 
immediately, it would bankrupt the United States. It would blow the 
budget right out of the water. How do we make it look as if this bill 
is budget neutral? The way we make it look as if the bill is budget 
neutral is tell the computers--which cannot think, they can only add--
we will start the revenue in this bill, the taxes in this bill, the 
increased premiums in this bill right away. But we don't start spending 
on any of the things we are giving the people to save their lives for 4 
years. So the computers will say: All right, you will accumulate 
revenue for 4 years and that will be a big pot of money. Then, in the 
remaining 6 years of the 10-year term, which is all the computers are 
allowed to look at, you will have enough money over a 10-year period to 
pay for 6 years' worth of benefits. I will grant that. Actually, it 
isn't 6 years' worth of benefits because the money coming in will not 
be enough. So in order to make it look even better, they will project. 
The computers--which don't think, just add--say: Yes, this is right. We 
will project taking roughly $\1/2\ trillion out of Medicare and putting 
it into the same pot of money that is coming in, in the 4-year period, 
when nothing is going out.
  But wait a minute. If we have 4 years of money coming in and nothing 
going out and we take $\1/2\ trillion out of Medicare and put it in the 
same pot of money, the unthinking computers can add that very well. 
They can come up and say: You know, this is going to be revenue 
neutral. Anybody who thinks this is going to be revenue neutral does 
not understand reality, certainly does not understand history.
  Let's look at the CBO record of projecting health care costs. I 
remember when the Congress passed Medicare. There were very firm costs 
associated with Medicare. It was going to cost so much. We look back on 
Medicare, it has cost 20 times what was projected. In the first year, 
it cost more than was projected. This is in constant dollars, not in 
inflation-adjusted dollars. In constant dollars, Medicare costs 20 
times what we were told. I remember during the debate in 1994, Joe 
Califano, the father of Medicare, the member of the White House staff 
who wrote the bill, wrote an op-ed piece in the Washington Post. He 
said: Congress, pay attention to our experience with Medicare. He said: 
We put Medicare together, but we got the cost projections. We put the 
whole thing together. We knew within months after it had passed we were 
wrong. We knew within months the costs were going to go way out of 
sight. We went to the Congress and told them and at that point it was 
too late. This thing had taken root. It had its followers. It had 
people who were solidly behind it. It was too late to fix it. It has 
ended up costing us 20 times.
  Let's look ahead and see what we are doing if we pass this bill. No. 
1, we are doing nothing for people who need coverage for 4 years. But 
we are locking into the Federal budget situation a brandnew 
entitlement. That is a word we use in Washington. Many of my 
constituents don't understand what it means. Let me do my very best to 
try to help people understand. First, as the word implies, the people 
who are receiving the money under an entitlement are entitled to it, 
whether we have the money to give it to them or

[[Page S13603]]

not. They are entitled to it whether they need it or not. They are 
entitled to it whether it makes any sense for them to get it or not. It 
is an entitlement that they will receive this money.
  When Medicare was passed, the only entitlement we had was Social 
Security. Now we have Social Security, Medicare, and Medicaid. Along 
with the other entitlements built into the Federal budget, how much of 
the Federal budget goes out in entitlements? If we look at the budget 
for 2010, here is the cautionary lesson. The budget in 2010 on which we 
voted--I didn't vote for it--listed the projections out of the 
Congressional Budget Office as to how much revenue the Federal 
Government was going to have in 2010. The answer was $2.2 trillion. 
That is a lot of money. Then it said, next line, entitlement spending 
or mandatory spending, $2.2 trillion, which meant that in 2010, with 
the economy on its back and the revenue coming down as a result, every 
single dime we received out of the economy in 2010 was already 
committed.
  So people would say: Senator, why don't you balance the budget? I 
would say: How am I going to balance the budget? How am I going to 
balance the budget with every dime that is coming in already committed 
and going out as an entitlement and outside the appropriations process?
  Vote against an earmark.
  Pardon me. The entire government, all the Embassies overseas, the 
Defense Department, Transportation, Education, national parks, name it, 
whatever it is, every dime to keep the government going had to be 
borrowed, not because we didn't have any revenue. We had $2.2 trillion 
worth of revenue which, by itself, would have covered the cost of 
keeping the government open. But we couldn't touch a single dime of 
that $2.2 trillion because all of it was tied up with entitlements. So 
what are we doing in the face of that experience? We are creating a new 
entitlement to add to those we already have.
  The realities of Federal budgeting are these, and they are not unlike 
the realities of running a business. I have run a business. I 
understand how the very best projections, the very best forecasts can 
go awry. You have a new product. You think it is going to do well and 
you forecast X millions of dollars in revenue from this new product. 
You look at what the product is going to cost you and you forecast that 
cost and you put the two together and you say: All right, we will have 
X in revenue and we will have Y in costs. As a result, we are going to 
have Z in profit. So you go out and you build the product. You commit 
for the raw materials. You pay the people in your factory to produce 
it, and you put it on the shelves. Now you are at the mercy of the 
customer, because if the customer decides he doesn't like the product, 
your projections of the amount of revenue will not save you from the 
enormous loss that will come.
  Yes, you are right on the Y you are spending, but you were wrong on 
the X you thought you would get in. Instead of having the Z you planned 
to have as profit, you have a huge loss on your hands. Conversely, I 
have this happen, too. I have done my forecasting. I have laid down the 
plan for how much of the product we are going to produce. I have done 
my forecasting of how many will sell, and the product went crazy. It 
jumped off the shelves. All of a sudden, I was stuck with empty shelves 
and had to scramble to produce more and more and more in order to meet 
demand.
  In the Federal Government, we don't have a product but we have 
expenses, just the same as doing a manufacturing operation. We don't 
have sales, but we have taxes. Our taxes are dependent upon the 
viability of the economy. The one fundamental lesson we all should 
learn is this: We can accurately predict the expenditures that are 
going out, just like in the business I could predict what it would cost 
me to produce the product, but we cannot accurately predict the revenue 
that will come in, just like I can't accurately be sure what the sales 
will be. We did a spending pattern based on revenue when the economy 
was strong. Suddenly, the economy turned weak and the revenue dropped 
off to $2.2 trillion. We were stuck.
  Does this make any sense in the face of that reality? We can 
determine the spending, but we can't determine the revenue. Does it 
make any sense in the face of that reality to build in increased 
spending in the form of another entitlement in the hope that the 
revenue will be there? The only way the majority leader is able to make 
this bill look as if the revenue will be there is with a series of 
budget gimmicks the likes of which I have never seen, some of which I 
have already discussed.
  The first budget gimmick is to say the revenue will be there because 
we will have 10 years of it and only 6 years of expenditure. The 
revenue will be there because we will be able to find $\1/2\ trillion 
worth of waste, fraud, and abuse in Medicare. I will stipulate there is 
probably $\1/2\ trillion worth of waste, fraud, and abuse in Medicare 
over the period of time we are discussing in this bill. We have been 
looking for it for more than 10 years and have been unable to find it. 
This bill, instead of trying to take a scalpel to Medicare and cut out 
the areas of waste, fraud, and abuse, uses a sledgehammer to smash 
Medicare and say we are going to knock $\1/2\ trillion out of it and 
hope that in the process of doing so, we will hit the waste, fraud, and 
abuse without hitting anything else.
  We have 4 years on the timetable laid down by the majority in which 
to get this right. The majority has decided that if, indeed, people are 
dying because they don't have health care, they can continue to die 
because they don't have health care for 4 more years. I think in the 
face of the smoke and mirrors we are seeing with respect to this 
budget, we can afford, during that 4-year period, at the front end of 
that 4-year period, to take a few more weeks to do this right. That is 
why I am here and that is why my Republican colleagues are here, not 
because we don't say there is a problem, not because we don't have any 
ideas as to how to deal with the problem, not because we don't want to 
join hands with our friends across the aisle to solve the problem but 
because we know this bill is the wrong solution. Our constituents are 
pleading with us. They know this bill is the wrong solution. Every poll 
shows that. They are pleading with us: Don't let it happen. Don't let 
it happen. No matter what you have to do, don't let it happen.
  It may well be that all our efforts are in vain. It may be we are 
washed aside in a tide of 60 votes. But we will not be washed aside by 
complacency or the desire to get along because the stakes are too high.
  I conclude with this one last analogy. There was another very large 
organization that handed out a large series of entitlements to people 
with whom it was connected. These entitlements were not directly 
involved with the business of that organization, but they got bigger 
and bigger and bigger, and, ultimately, this organization suddenly 
discovered it could not function because of the financial drain of the 
entitlements it faced. The organization is now owned by the Federal 
Government. It is called General Motors. They discovered they could no 
longer be a car company because they were buried by the kind of 
entitlements they had built into their own situation.
  Let us take a lesson from General Motors. We do not want the Federal 
Government to go bankrupt the way that company did. If we do, there is 
no other organization to bail us out the way the U.S. Government 
ultimately felt forced to bail out General Motors. It is a cautionary 
tale we all need to heed.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. VITTER. Thank you, Mr. President.
  I, too, rise to voice my very strong concerns about this latest 
version of so-called comprehensive health care reform. I will speak of 
my strong concerns starting with the process we are in the midst of 
because I am still digesting the particulars of this latest megabill.
  As you know, it was divulged yesterday, a 383-page amendment to the 
underlying bill. The amendment references another bill which is 286 
pages. The underlying bill is 2,074 pages. It makes for the seventh--
count them--the seventh version of so-called comprehensive health care 
reform, Obamacare for short, in a few weeks. That grand total would be 
2,733 pages. So, certainly, I am still digesting this latest version. 
My staff is helping me,

[[Page S13604]]

but I wish to rise to begin to express my concerns.
  The first concern is what I just referenced, this process we are in 
the midst of. When I went around Louisiana and when I continue to go 
around Louisiana--have townhall meetings--of course, health care comes 
up first and often. The themes I hear over and over are: This is too 
important to rush. This is too important to have some arbitrary 
deadline, whether it was last summer or Christmas. We need to get it 
right, not have arbitrary deadlines, and we need to know what we are 
voting for or against. That is what I hear about the right process to 
use over and over and over.
  Well, unfortunately, clearly, this process we are in the midst of 
does not honor those wishes of Louisiana citizens, of American 
citizens. Before this latest megahealth care bill was unveiled 
yesterday, everyone it seems--including Members of the majority party 
who, at least, were involved in the negotiations, unlike Republicans--
was in the dark.
  Let me mention a few statements Democratic Senators made over the 
last week or so before yesterday's unveiling.
  Senator Durbin, in the leadership, said:

       I would say to the Senator from Arizona, that I'm in the 
     dark almost as much as he is. And I'm in the leadership.

  Senator Schumer of New York, also in the leadership:

       I can't say what there is, because we're not allowed to 
     talk about what's submitted to CBO.

  Senator Bayh of Indiana:

       We're all being urged to vote for something and we don't 
     know the details of what's in it.

  Senator Bill Nelson of Florida:

       I don't know what the deal is.

  My colleague, Senator Landrieu, of Louisiana:

       There's no specific compromise. There were discussions. . . 
     . Until the package that was sent is scored, we really don't 
     even know what's in it.

  Senator Casey of Pennsylvania:

       Any big agreement is progress . . . even if we do not know 
     any of the details.

  Senator Feinstein of California referred to a meeting on the majority 
side recently:

       There was no explanation. It was sort of go team, go.

  Senator Ben Nelson of Nebraska, talking about a similar majority 
meeting:

       General concepts, but nothing very specific at all.

  Then, at least yesterday, this new megabill--this 383-page amendment, 
referencing another 286-page bill, attached to an underlying 2,074-page 
bill--was unveiled. That finally happened yesterday morning.
  Well, that is some progress. But I am afraid it is not progress 
enough. It is not time enough, considering we are set to vote on this 
new megabill in just a few hours, starting at 1 a.m. tomorrow morning.
  Listening to American citizens all over the country, several 
Senators, including myself, have advocated we need at least 72 hours of 
final bill text on the Internet before we take any votes about this 
sort of major legislation. We need at least 72 hours of the official 
Congressional Budget Office cost estimate being on the Internet before 
we start any of those votes. I have certainly advocated that. Many of 
my colleagues on the Republican side have advocated that, listening, 
responding to American citizens who say: No arbitrary deadlines. Know 
what you are voting on. Get it right.
  Perhaps even more importantly than my advocating it or other 
Republicans advocating it, at least eight Democrats have specifically 
demanded the same thing. In fact, on October 6 of this year, eight 
Democrats wrote a very clear, strongly worded letter to the majority 
leader, Senator Reid, and they demanded exactly the same thing: 72 
hours of final legislative language on the Internet before any vote on 
the matter, a full Congressional Budget Office cost estimate on the 
Internet for at least 72 hours before any vote on the matter. I applaud 
these Senators for demanding that: Senator Lincoln, Senator Landrieu, 
Senator McCaskill, Senator Pryor, Senator Bayh, Senator Lieberman, 
Senator Ben Nelson, and Senator Webb.
  But, again, this process we are in the midst of certainly does not 
honor that minimal demand. We are set to vote on this in just a few 
hours. When we do, we will have only had the final legislative language 
for about 40 hours. We will have only had the full Congressional Budget 
Office cost estimate for about 37 hours. That is 56 percent or less of 
this minimum timeframe that so many of us, including eight Democrats, 
have demanded.
  Again, this rush to judgment, this rush to beat an arbitrary 
Christmas deadline, is clearly ignoring the common sense of the 
American people, the common sense I heard in my dozens of townhalls all 
across Louisiana: no arbitrary deadlines. Know what you are voting on. 
Get it right. Do not rush to judgment.
  I have strong concerns about this process. Where are the 72 hours? 
Where is the opportunity for Members and the American people to know 
what is in this latest version of a megabill on so-called comprehensive 
health care reform? Where is the 72 hours' notice of a Congressional 
Budget Office cost estimate?
  Given that rush to judgment and arbitrary timeline, I am rushing to 
digest this latest version of the bill. But certainly, already, I have 
other very strong substantive concerns. I will be coming back to the 
floor within the next few days to more precisely outline those concerns 
as I digest more of the details of this latest megabill. But let me 
mention at least six of the big Louisiana-based questions I am focused 
on in terms of this latest megabill, this latest so-called 
comprehensive health care reform or Obamacare.
  No. 1 is the impact on the Louisiana State budget. There has been a 
lot of discussion about that because of the particular language 
included in the bill pertaining to Louisiana that apparently gives 
Louisiana a $300 million benefit. The problem, from the Louisiana 
perspective, is in the Medicaid system, and that $300 million is 
directly related to Medicaid. In Medicaid, there is a much greater 
additional burden put on all States, including Louisiana. In 
Louisiana's case, apparently, that is going to far surpass $300 
million.
  So I am concerned about the overall, the net, impact on the Louisiana 
State budget, particularly because of the dramatic expansion of 
Medicaid. Medicaid is the health care program for the poor. It is 
dramatically expanded in the bill. Every State--except perhaps Nebraska 
because of special language put in for Nebraska--every State pays a 
match for both existing Medicaid and Medicaid expansion. That is going 
to put a big extra burden on the Louisiana State budget, and that big 
extra burden is apparently going to be much more than the $300 million 
of benefit that has been so widely talked about. I am looking, right 
now, at the details of that.
  My second big Louisiana-based concern has to do with the Louisiana 
seniors--Louisiana seniors who have paid into Medicare, the health care 
system for retirees, for years and have assumed it would be there for 
them, as they paid in, as they followed the rules every step of the 
way. I know from the study I have done already that this new, latest 
version of the megabill, so-called comprehensive health care reform, 
involves a $464.6 billion cut to Medicare. That is going to impact 
every Louisiana senior, and it is going to impact tens of thousands of 
Louisiana seniors on Medicare Advantage particularly onerously.
  My third big Louisiana-based concern is the Louisiana taxpayer 
because this bill contains massive tax increases to pay for all these 
new entitlements. Apparently, the total figure of tax increases in the 
bill is $518 billion--over $\1/2\ trillion--more tax increases than in 
any of the six previous megabills, the six previous versions of 
Obamacare. A lot of these taxes are clearly going on individuals who 
earn less than $200,000 per year, families who earn less than $250,000 
per year. A lot of Louisiana taxpayers are going to be hit. That is a 
big concern.
  Fourth, I am concerned about Louisianians who have health care now 
and who pay premiums because those premiums, by all accounts, by all 
independent estimates, are going to go up because of the taxes and fees 
and other burdens in this bill.
  Fifth, what about Louisiana small businesses, businesses that are 
struggling right now in a serious recession, the most serious recession 
since the

[[Page S13605]]

Great Depression? We are in the midst of an extremely serious 
recession, and we are putting new mandates, new burdens, and new taxes 
on Louisiana small business. By all accounts, that is going to cost 
jobs, pure and simple, as we are in the midst of a very serious 
recession. I am concerned about that impact on Louisiana small 
business.
  Sixth, and finally, Louisiana defenders of life. I am very proud to 
say Louisiana is one of the most pro-life States in the Nation--very 
strong values which hold up life and the defense of life in all its 
forms. Apparently--it is clear to me--this bill has taxpayer funding of 
abortion, the first time ever in Federal legislation, breaking 
tradition from the Hyde amendment, which has been the law since early 
1977.
  I am very concerned about that radical, truly radical departure from 
the past.
  So in closing, let me say I hope we can adopt a different process, 
one that reflects the common sense of the American people and 
Louisianans when they say no arbitrary deadlines, no rush to judgment, 
and know what you are voting on. Also, I hope we will adopt a different 
approach that doesn't involve all of the downside I have mentioned, 
those six major categories.
  I am still digesting this latest megabill. I will return to the 
Senate floor in the next few days to talk more and in more detail about 
those concerns I have laid out. But I hope all of my colleagues, 
Democrats and Republicans, look hard at those and similar concerns, 
look hard at the process and resolve to not just do this quick, not 
just do it before Christmas by some arbitrary deadline, but to do it 
right and to honor the American people in our work.
  Thank you, Mr. President. I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. LeMIEUX. Mr. President, I am new to this Chamber, and as I have 
sat here today and listened to my distinguished colleagues speak about 
this bill, watching some of my other colleagues on television in my 
office this evening, I can't help but think how fortunate I am to be 
here, to be a part of this process. It makes me think back also to the 
Founders who put together this great constitutional system of democracy 
that we have in this country, with the three branches of government, 
and here in the Senate, the sober and reflective legislative body that 
thinks through the great issues of the day to make sure we get them 
right for the American people.
  In listening to this great debate, I wonder what they would think 
about what we are doing here. Putting aside the substance, what would 
they think of the procedure? Because I am new to this Chamber, I think 
I still have fresh eyes as to what is normal as compared to perhaps 
what is a little bit departed from normal. Would they think it was 
within their intentions as the Founders that we would be coming here to 
vote at 1 o'clock in the morning? Would they think it would be within 
their intention of how things would work in the Senate that we would 
get an amendment to the bill that is 400 pages long, we would get it 
yesterday and would have just a little time to consider it before we 
try to vote on it? Would it be what they intended, that we would press 
this vote up against Christmas, and we would try to get it done quickly 
while most of the people in our country are off with their families and 
preparing for the holidays? Would that be what they intended, the 
process of this great deliberative body, arguably, it is often said, 
the greatest debating institution in the world? Is that the way they 
would want us to achieve policy that is going to affect one-sixth of 
our economy? I don't think so. In fact, I don't think the American 
people think so either.
  That is why they are so bewildered as to what we are doing here in 
the Senate and why we are, as my friend and colleague from Louisiana 
said, rushing to judgment; why we must get this done before Christmas. 
If it is such a good bill, why do we have to get it done so quickly? If 
it is such a good bill, why can't we take some more time to evaluate 
it? If it is such a good bill, why can't we offer more amendments to 
it?
  So I am sure the American people, if they are home watching this--and 
they are probably watching Sunday night football--but if they are 
watching this, they would say: Of course, my Senator from Florida or 
the Senators from the other States can now offer amendments to try to 
improve the bill. But that is not the case because the leader of the 
Democratic Party, the majority leader, has done something called 
filling the tree.
  Now, look, I am new here, too, so this is all new to me, but it is a 
process by which no other amendments are allowed. So if we want to 
change the bill, if we have ideas to improve it, that is not allowed. 
Is that what the American people want from us? Is that what our 
Founders intended? I don't think so.
  So we have this new amendment. It is 400-some pages long. I guess it 
is the amendment to fix the problems that were in the bill, or at least 
to get 60 votes. And what do we know about this amendment? What does it 
do, for example, to Medicare cuts? We know the previous bill before the 
Senate cut nearly $\1/2\ trillion out of health care for seniors. What 
does this amendment do? Well, it still cuts health care for seniors. It 
actually cuts a little bit more, but it is still around that same 
number: $\1/2\ trillion.
  We know also that it raises taxes. Does it raise taxes $\1/2\ 
trillion as the previous measure did? Yes, it does. In fact, it raises 
taxes a little more. Now it is $518 billion.
  Well, what about the question that is the most pressing on the minds 
of most Americans, the very reason we are here, according to the 
President of the United States, which is to impact the cost of health 
insurance for most Americans. What does it do about that? Does the 
amendment do something about that? We know the underlying bill does 
nothing to impact the cost of health insurance for most Americans. We 
are here about to change one-sixth of the U.S. economy, and this bill 
does nothing to impact the cost of health insurance for folks who 
already have health insurance in this country. That is not me saying 
it; that is the Congressional Budget Office.
  If you are one of the 170 million Americans who already have health 
insurance, this bill is not going to lower your costs. In fact, for 
some Americans, it is going to increase your costs over the next 10 
years.
  Well, does this amendment fix it? No. So we are still in the same 
situation--cutting $\1/2\ trillion out of health care for seniors, 
raising taxes by $\1/2\ trillion, with nothing in it for most Americans 
in terms of the cost of their health insurance.
  How is this going to affect the American people? Well, if you have 
Medicare, if you are a senior who has been paying into it, it is going 
to affect you.
  My friends on the other side of the aisle will say: Look, the nearly 
$\1/2\ trillion that we are going to take out of Medicare is just 
waste, fraud, and abuse. We will get that money out. Well, the 
Congressional Budget Office says the measures that are in the bill will 
take out $1\1/2\ billion worth of waste, fraud, and abuse, not $500 
billion. So where is the rest going to come from? It is going to be 
decreased benefits. It is going to be decreased access to doctors.
  We know right now in Medicare, nearly 24 percent of medical health 
care providers--your doctors, for example--will not take Medicare 
anymore, 24 percent, one in four of them. In Medicaid it is 40 percent.
  What is going to happen when you reduce the amount of money you are 
paying into Medicare? You are going to reduce the amount of money that 
is being paid to providers, which means providers are not going to see 
their patients. If the doctor is not in, it is not health care reform.
  This really impacts my State of Florida. We have the highest number 
of seniors per capita, 3 million seniors, on Medicare, and they are 
going to be impacted.
  I wish to read from a letter that was sent to me by Mr. Richard 
Mullaney. I received it at the end of November. It says:

       Dear Senator LeMieux. I thought you might like to see this 
     letter I received from my cardiologist.

  It attaches that letter from the Palm Beach Cardiovascular Clinic in 
Jupiter, FL, down in southeast Florida.
  I ask unanimous consent that this letter be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


[[Page S13606]]




                             Palm Beach Cardiovascular Clinic,

                                                      Jupiter, FL.
       An Open Letter to our Patients: The 2010 Medicare Fee 
     Schedule mandates that on January 1, 2010 severe cuts in 
     cardiology physician fees will begin. This cut is being 
     phased in over four years because the government used flawed 
     data to make their calculations. In addition, there are 
     Congressionally mandated cuts of more than 20 percent to all 
     Medicare physician fees, regardless of specialty. The result 
     of these combined government policies are that our practice 
     is facing payment cuts ranging from 25 to almost 50 percent.
       Such drastic reduction in fees are going to seriously 
     hamper our ability to continue to see you, our patients, as 
     we do today. We feel the need to warn you that these 
     reductions will translate into much longer waiting periods 
     for you to schedule an appointment or a procedure with your 
     doctor, longer telephone response times to you, and not 
     having the convenience of in-office Nuclear and Echo 
     diagnostic testing available to you. Making sure you have the 
     best quality of care will always be our number one priority. 
     Caring for people is why we all dedicated our lives to heart 
     patients. In the very near future--it is going to be a 
     difficult climate to operate in our current manner.
       We have built our office facility and trained our staff to 
     best take care of each patient. We believe that the care you 
     receive is critical to your quality of life. Wish these cuts 
     we may not be able to provide some of the services that 
     patients have come to depend on and in the long run; if the 
     current policies are not changed, we may be forced to close 
     our doors.
       As a cardiovascular patient we urge you to contact our 
     lawmakers (see attached for their information) about the 
     impact of our changing practice on you. The law is clear--we 
     face cuts unless Congress acts. In advance we thank you for 
     understanding our changing environment.
           Sincerely,
     Gabriel E. Breuer.
     Chauncey W. Crandall IV.
     Augusto E. Villa.
     Agustin A. Vargas.
     Gonzalo J. Loveday.
     Burton H. Greenberg.
     Sidney M. Richman.

  Mr. LeMIEUX. Mr. President, it is an open letter to patients, and it 
is signed by some seven doctors who are in this cardiovascular clinic 
practice. I will read portions of it. It says:

       Drastic reduction in fees are going to seriously hamper our 
     ability to continue to see you, our patients, as we do today. 
     We feel the need to warn you that these reductions will 
     translate into much longer waiting periods for you to 
     schedule an appointment or a procedure with your doctor, 
     longer telephone response times to you, and not having the 
     convenience of in-office Nuclear and Echo diagnostic testing 
     available to you.

  The letter goes on to say:

       With these cuts we may not be able to provide some of the 
     services that patients have come to depend on and in the long 
     run, if the current policies are not changed, it may force us 
     to close our doors.

  So these are doctors, real doctors, and this is a letter from their 
real patient saying: If these cuts to reimbursements to doctors and 
providers aren't addressed, then we are going to have an inability for 
doctors to perform health care.
  Those are real-world problems that are going to occur if this bill is 
passed.
  So this is no great shakes for seniors. This isn't health care 
improvement for seniors. Those that we already have on a government 
entitlement program, those who have already paid into the program are 
going to have a cut in their benefits. That is exactly what the Chief 
Actuary, we found out last week from the Center for Medicare and 
Medicaid Services, said. He said it is plausible, even probable, that 
there will be shortages for Medicare and Medicaid beneficiaries because 
there is not going to be doctors who are available to see them.
  Let's talk about the taxes: $518 billion in tax increases. What is 
that going to do to the cost of health care? We are going to tax 
medicine. We are going to tax lifesaving devices. Those taxes, of 
course, will be passed along to you, the consumer. So for you, your 
cost of health care will go up, taxes on health insurance of almost $60 
billion; taxes on medical devices, $19 billion; taxes on medicine, $22 
billion. If you don't have health insurance now and you don't get it, 
you will be taxed. If you are a small business and you don't provide 
health insurance to your employees, you will be taxed.
  I had a telephone townhall meeting this week, and I talked to a 
gentleman from central Florida who had been laid off from his job at a 
restaurant. He said to me: The reason I got laid off is because the 
restaurant couldn't afford the health care benefits. So when health 
care benefits went up, the restaurant raised its prices for its food, 
people stopped coming to the restaurant, and the restaurant went out of 
business. Then there wasn't health care for any of the employees.
  You can't get blood from a stone. While the benefits of this plan as 
laid out by my Democratic colleagues may sound great--33 million more 
Americans who are going to have some kind of health insurance--you have 
to look at the details. How are you going to pay for it, and what is 
the effect going to be? When you raid nearly $\1/2\ trillion out of 
Medicare, you are going to decline the quality of health care for our 
seniors. When you raise taxes by $\1/2\ trillion, you are going to pass 
those costs along to consumers who already have health insurance, and 
their prices are going to go up. You are going to pass them along to 
small businesses that would not be able to afford them, that will let 
people go.
  We have 11.5 percent unemployment in Florida. When small businesses 
can't afford this, they are going to let people go or, like that 
restaurant, close their doors. That is not good for a country that is 
fighting through the worst recession since the Great Depression.
  Now we find out there are a bunch of special deals in this bill. We 
find out that the Senator from Nebraska has been able to get a special 
fix for his State.
  See, another thing this bill does is it puts a big unfunded mandate 
on the States. What do I mean by that? An unfunded mandate is a 
requirement that the States must fulfill that they don't get paid for. 
This time it comes in the form of Medicaid, which is health care for 
the poor. Medicaid, under this proposal, is going to be increased. We 
are going to put 15 million more Americans into Medicaid.
  If you think Medicare recipients are having a tough time finding a 
doctor, in Medicaid, 40 percent of health care providers will not take 
it; 50 percent of specialists will not take it. Now we are going to put 
15 million more Americans into it.
  What it does to the States, in a State such as Florida, it is going 
to cost us in 10 years nearly $1 billion to accept this unfunded 
mandate. The Senator from Nebraska apparently got a fix for this so his 
State would not have to pay the $1 billion. Well, Florida would like 
that same fix. If it is good for Nebraska, it is good for Florida. I am 
sure Iowa would like that fix as well. I am sure all the States would.
  So I ask unanimous consent that the pending amendment be set aside 
and it be in order to offer an amendment to extend to the State of 
Florida the same benefits that provide 100 percent Federal funding to 
the State of Nebraska for their expanded Medicaid Program.
  The PRESIDING OFFICER. Is there objection?
  Mr. HARKIN. Objection.
  Mr. LeMIEUX. For the folks who are watching at home, the reason my 
distinguished colleague from Iowa objected to this is because this deal 
would not go through if they provide it for every State. So some States 
are going to get it better and some States are going to get less, and 
that is not fair. But that is the process that has put this bill 
together, to cobble together 60 votes.
  So at the end of the day--may I ask how much time I have remaining?
  The PRESIDING OFFICER. Fifteen seconds.
  Mr. LeMIEUX. At the end of the day, I have 15 seconds left. I will be 
back to the floor to speak about this again. But this is not a good 
bill for America, and that is why my colleagues on this side of the 
aisle have been debating and showing our objections so the American 
people can understand.
  I yield the floor.
  The PRESIDING OFFICER. The Republicans' block of time has expired.
  The Senator from Massachusetts.
  Mr. KIRK. Mr. President, I rise to, first, commend my distinguished 
colleagues, Majority Leader Harry Reid of Nevada, Senators Ben Nelson 
of Nebraska, Barbara Boxer of California, Bob Casey of Pennsylvania, 
and Chuck Schumer of New York for the principled and practical 
compromise they reached on the difficult issue of abortion. Their work 
allows the U.S. Senate to now march with our House colleagues toward 
the forward edge of history and the enactment of The Patient Protection 
and Affordable Care Act, and I congratulate them for that important 
contribution.

[[Page S13607]]

  I would also like to commend my colleague, the assistant majority 
leader, Dick Durbin of Illinois, for bringing to the Senate's attention 
during yesterday's debate an op-ed that appeared in the Washington Post 
this morning written by our dear friend Victoria Reggie Kennedy 
entitled ``The Moment Ted Kennedy Would Not Want to Lose.''
  Vicki Kennedy was Senator Kennedy's partner in all things, including 
his final efforts to move health reform forward even as he valiantly 
fought his own battle with cancer.
  In more than 17 years of marriage, Ted and Vicki were inseparable, 
bonded by the love of friends, family and most obviously by their love 
for one another. Vicki displayed inspirational grace in leading us all 
in our grief and in the memorable celebration of his life on the 
occasion of Senator Kennedy's death.
  And today, she continues as his partner paying tribute to Ted's 
legacy by respectfully urging his colleagues to move forward on the 
health reform he would have wanted.
  I feel certain that Vicki's voice and his will make us more 
determined than ever to complete Ted's work for the American people. We 
thank you, Vicki.
  Mr. President, I would now like to respond to an argument made in 
another op-ed in Thursday's Washington Post and in an interview on 
``Meet the Press'' this morning by my friend, and a former Democratic 
Party chairman, Howard Dean.
  Chairman Dean said in his opinion piece: ``If I were a Senator, I 
would not vote for the current health-care bill,'' because it does not 
bring ``real reform.''
  With all due respect, before anyone swallows Howard's faulty 
prescription, as they say in the field of health care, ``It's time for 
a second opinion!''
  As a former national chairman of the Democratic Party myself, I'll 
take my equal time to offer my opinion and say I am a U.S. Senator, and 
I will vote for the current health care bill precisely because it does 
bring ``real reform.''
  Is it all the reform for which our friend and colleague Ted Kennedy, 
``the Father of Modern Health Care Reform'', fought so valiantly and 
tirelessly throughout his legislative career? No.
  Is it all the reform for which I and many of my distinguished 
colleagues advocated so passionately here on the floor of this Chamber 
throughout this intense debate? No.
  But, is it a quantum leap forward that will bring ``real reform'' to 
a broken, discriminatory, bankrupting, deficit-busting health care 
system that will only get worse without immediate action and passage of 
this legislation?
  The answer is clearly: Yes.
  One of the reasons history will record that Ted Kennedy was the 
greatest legislator of our time was that he respected the need and the 
art of compromise.
  And he would argue that a choice between a solid, sound, significant 
and long overdue start at ``real reform'' of our health care system and 
the choice of leaving American families to continue to fall behind 
because we refused to seize the historic moment before us--is the 
easiest choice and, perhaps, the most historic vote we may ever cast as 
U.S. Senators.
  Does anyone in this Chamber--or in Massachusetts--or anywhere else 
for that matter, doubt Ted Kennedy's commitment to legitimate, 
credible, real reform of our system in order to make affordable, 
quality health care accessible to the greatest number of Americans? The 
answer is clearly: No.
  Is this a bill of ``real reform'' that Ted Kennedy would champion and 
vote for? Absolutely, yes!
  Ted Kennedy knew real reform when he saw it, and so do I.
  Here are the real health care reform measures of this Senate bill, 
many of which Senator Kennedy helped to craft. Think about this.

  It will save money and save lives; expand coverage and bring over 30 
million uninsured Americans into the community of the insured; It will 
control costs and lower premiums; stimulate competitive choices so 
consumers can choose the best policy at the most affordable price; 
relieve the costly health care burden on the small businesses of 
America through tax credits; provide a discount to countless seniors 
like my own sister Maud, who are squeezed by the cost of prescription 
drugs under Medicare D's so-called doughnut hole.
  The real reforms in this bill will strengthen Medicare and Medicaid; 
reduce the deficit by hundreds of billions of dollars; attack waste, 
fraud and abuses; eliminate lifetime limits on needed care; reward 
wellness and preventive practices; increase transparency and insurance 
company accountability; promote flexibility, innovation and best 
business practices; reward the quality and value of care instead of the 
quantity and volume of procedures.
  This bill will eliminate unjust discrimination against women or those 
afflicted with preexisting conditions; it will provide the elderly and 
disabled a voluntary choice to self-fund a plan that will provide 
financial security to purchase long-term services when they are needed 
most; it will require insurance companies to cover children and 
dependents up to age 26; and prohibit insurance companies from dropping 
coverage for Americans who get sick--the very reason they buy health 
insurance in the first place!
  In these and many other ways, this Senate bill is real reform--for a 
senior citizen who cannot afford the drugs she needs; for the 31 
million people who will now have the health insurance they deserve; for 
families who worry that hospital bills will wipe out their life 
savings; and for a system that presently fails to serve the needs of 
the American people, this is real reform.
  For those well-meaning progressives who say they oppose this bill 
because it does not go far enough and to my colleagues on the other 
side of the aisle who want to defeat this bill and start over, I say 
they are both mistaken.
  We need to win this fight now and we need to win this fight together! 
Will there be more to do after its enactment?
  Mark my words. There will always be more to do. But this historic 
piece of legislation will be a giant step forward toward a health care 
system that truly begins to serve the needs of the American people.
  President Kennedy offered two profound observations that have helped 
me keep things in perspective throughout my life, and they have 
particular application at this moment in our time. He once said:

       Wisdom requires the long view.

  And on another occasion, he said:

       Democracy is never a final achievement; it is a call to an 
     untiring effort.

  John Kennedy's words apply so well to the work of health care reform 
before us this evening and to the legislation that will pass this 
Senate within the next several days.
  We are all called upon to exercise our wisdom and to take the long 
view of history. We must understand that passage of this legislation 
will not be a final achievement. It will be a compelling first call to 
an untiring effort to continue with our responsibility to do what the 
American people deserve--provide affordable, accessible, quality health 
care for them as a matter of right.
  I am old enough to recall the Civil Rights Act of 1960, and the Civil 
Rights Act of 1964, and the Civil Rights Act of 1968. With the passage 
of each of those laws, there was always more to do. But each began the 
march of progress toward equality under our laws. And each created a 
responsibility to assure that our country's laws more aptly reflected 
our national character and our principle of equal justice.
  The same is true of this moment in our national history. The bill 
before this Senate is not perfect, nor will it be the final product. 
But make no mistake, it is real reform, and it will provide enormous 
benefits to America's workers, America's seniors, and America's 
families.
  I urge my Republican colleagues not to be held hostage by the raw and 
divisive politics of the moment, not to be the captives of those who 
may threaten with some meaningless political litmus-test score cards, 
but to step back and to think about the positive difference these 
reforms will make in the lives of the millions of American families you 
represent--and, finally, to reflect wisely upon the long view of 
history and decide that this is the moment to join the majority of this 
U.S. Senate in moving toward history's enlightened edge by voting for 
this landmark legislation.

[[Page S13608]]

  I yield the floor.
  The PRESIDING OFFICER. Who seeks time? The Senator from Connecticut.
  Mr. DODD. Mr. President, before he leaves the floor, let me commend 
our colleague from Massachusetts, Paul Kirk, who has only been with us 
a brief amount of time under circumstances he has said on numerous 
occasions over the last several weeks he would much prefer to have 
avoided. I commend him.
  Many of my colleagues know that Paul Kirk is no stranger to this 
institution, having worked as a member of the staff in Senator 
Kennedy's office for many years. He has had a distinguished career in 
his own right in Boston. We welcome him here under those very sad 
circumstances. But his remarks this evening are evidence of the value 
he has placed in coming to this Chamber and filling a gap here and 
articulating a view our colleague from Massachusetts would be 
expressing were he here these days and tonight.
  Said so well, if it has not been printed in the Record, I ask 
unanimous consent to have printed in the Record an editorial piece 
written by Senator Kennedy's wife Vicki Kennedy.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               [From the Washington Post, Dec. 20, 2009]

             The Moment Ted Kennedy Would Not Want To Lose

                      (By Victoria Reggie Kennedy)

       My late husband, Ted Kennedy, was passionate about health-
     care reform. It was the cause of his life. He believed that 
     health care for all our citizens was a fundamental right, not 
     a privilege, and that this year the stars--and competing 
     interests--were finally aligned to allow our nation to move 
     forward with fundamental reform. He believed that health-care 
     reform was essential to the financial stability of our 
     nation's working families and of our economy as a whole.
       Still, Ted knew that accomplishing reform would be 
     difficult. If it were easy, he told me, it would have been 
     done a long time ago. He predicted that as the Senate got 
     closer to a vote, compromises would be necessary, coalitions 
     would falter and many ardent supporters of reform would want 
     to walk away. He hoped that they wouldn't do so. He knew from 
     experience, he told me, that this kind of opportunity to 
     enact health-care reform wouldn't arise again for a 
     generation.
       In the early 1970s, Ted worked with the Nixon 
     administration to find consensus on health-care reform. Those 
     efforts broke down in part because the compromise wasn't 
     ideologically pure enough for some constituency groups. More 
     than 20 years passed before there was another real 
     opportunity for reform, years during which human suffering 
     only increased. Even with the committed leadership of then-
     President Bill Clinton and his wife, reform was thwarted in 
     the 1990s. As Ted wrote in his memoir, he was deeply 
     disappointed that the Clinton health-care bill did not come 
     to a vote in the full Senate. He believed that senators 
     should have gone on the record, up or down.
       Ted often said that we can't let the perfect be the enemy 
     of the good. He also said that it was better to get half a 
     loaf than no loaf at all, especially with so many lives at 
     stake. That's why, even as he never stopped fighting for 
     comprehensive health-care reform, he also championed 
     incremental but effective reforms such as a Patients' Bill of 
     Rights, the Children's Health Insurance Program and COBRA 
     continuation of health coverage.
       The bill before the Senate, while imperfect, would achieve 
     many of the goals Ted fought for during the 40 years he 
     championed access to quality, affordable health care for all 
     Americans. If this bill passes:
       Insurance protections like the ones Ted fought for his 
     entire life would become law.
       Thirty million Americans who do not have coverage would 
     finally be able to afford it. Ninety-four percent of 
     Americans would be insured. Americans would finally be able 
     to live without fear that a single illness could send them 
     into financial ruin.
       Insurance companies would no longer be able to deny people 
     the coverage they need because of a preexisting illness or 
     condition. They would not be able to drop coverage when 
     people get sick. And there would be a limit on how much they 
     can force Americans to pay out of their own pockets when they 
     do get sick.
       Small-business owners would no longer have to fear being 
     forced to lay off workers or shut their doors because of 
     exorbitant insurance rates. Medicare would be strengthened 
     for the millions of seniors who count on it.
       And by eliminating waste and inefficiency in our health-
     care system, this bill would bring down the deficit over 
     time.
       Health care would finally be a right, and not a privilege, 
     for the citizens of this country. While my husband believed 
     in a robust public option as an effective way to lower costs 
     and increase competition, he also believed in not losing 
     sight of the forest for the trees. As long as he wasn't 
     compromising his principles or values, he looked for a way 
     forward.
       As President Obama noted to Congress this fall, for Ted, 
     health-care reform was not a matter of ideology or politics. 
     It was not about left or right, Democrat or Republican. It 
     was a passion born from the experience of his own life, the 
     experience of our family and the experiences of the millions 
     of Americans across this country who considered him their 
     senator, too.
       The bill before Congress will finally deliver on the urgent 
     needs of all Americans. It would make their lives better and 
     do so much good for this country. That, in the end, must be 
     the test of reform. That was always the test for Ted Kennedy. 
     He's not here to urge us not to let this chance slip through 
     our fingers. So I humbly ask his colleagues to finish the 
     work of his life, the work of generations, to allow the vote 
     to go forward and to pass health-care reform now. As Ted 
     always said, when it's finally done, the people will wonder 
     what took so long.

  Mr. DODD. Mr. President, she said it very well, as Senator Kirk has, 
that this is far from a perfect bill. We all know that. It is far from 
a finished product in terms of health care. The Presiding Officer spent 
a good part of his career as well working on this issue and would be 
the first to acknowledge as well that we have a lot more work to be 
done.
  Congresses long after all of us who serve in this Chamber are gone 
will be grappling with the issue of how we can better deliver health 
care services, create greater access, and reduce the cost of health 
care while extending quality of life for our fellow citizens and 
removing the fear so many families feel when they discover that a loved 
one--a child, particularly--is suffering from some illness or disease 
that requires attention and yet to be informed that the costs of 
providing that attention, that care is so prohibitive that they cannot 
afford to do it and wondering why they, because they lack the economic 
circumstances, cannot take as good care of their children as someone 
with access to greater economic power can.
  That is what we are trying to achieve, to create that availability. I 
don't know anybody who disagrees with the statement that health care in 
America ought to be a right, not a privilege. And if it is a right--
then, just as other rights are extended to every citizen regardless of 
their economic circumstances, their ethnicity, their background, their 
gender, certainly this right ought to be no different in that regard 
and available to all of our fellow citizens regardless of their 
financial circumstances. That is what we are starting to do here. It 
does not achieve that goal perfectly, but it puts us on that path to 
achieving that equity, that ability for families and individuals to 
take care of themselves and their families when afflicted by a medical 
crisis or medical problem.
  Having been deeply involved in this issue now for not quite a year 
but almost a year, since it became very difficult for my friend and 
colleague from Massachusetts to conduct the kind of daily and hourly 
efforts he would have been involved in but for his health condition, we 
have come to a moment now to decide whether we go forward, whether we 
accept the responsibility as being Members of this body to do the best 
we can when trying to design something written by 100 people, not to 
mention 435 in the other body, not to mention an administration and all 
of their interests, not to mention all of the stakeholders who are 
involved in health care, which is so voluminous that it would be 
impossible, even in the time remaining this evening, to mention 
everyone who has a stake in the outcome of this discussion.
  Taking all of those elements and trying to bring them together to 
fashion an ideal or set of ideas to go forward has defied, as I have 
said on so many occasions in this Chamber over the past number of 
months, has defied every administration and every Congress since this 
first challenge was posed by--well, going back to the days of Theodore 
Roosevelt but more recently since the time of Harry Truman. Every 
Congress, Republican and Democratic, every President, Democratic and 
Republican, has at least thought about doing this. Some have actually 
tried. President Nixon actually tried. President Clinton actually tried 
to come forward. Those who remember those days, for a variety of 
reasons, some that seem more clear today than the hour they were being 
debated, those efforts failed. We are now that third administration, 
that third effort that has come this far, if you will.

[[Page S13609]]

  My hope is that this evening and in the ensuing few days, we will 
complete our task in this body and continue the effort by working with 
the House of Representatives to fashion a final product for the 
signature of the President of the United States to allow us to begin 
what will be a long journey to make sure that right of health care is 
available to all of our citizens.
  Many of us here may never see the benefits of that just because of 
life expectancy, I suppose. But to know you are leaving a health care 
system in place for the coming generation where they can look back on 
these wintry days in the Senate and be reminded that there was a 
Congress at the outset of the 21st century willing to face up to the 
challenges, with all of the accusations, all of the barbs, all of the 
ad hominem arguments hurled at people, and make an effort to correct a 
wrong, to right a wrong, to make a difference and improve the quality 
of life for all of our fellow citizens--that is something I hope coming 
generations will recognize as a result of the efforts we have made 
here.
  Let me take a few minutes to wrap up this part of the debate with my 
views as to where we stand at this hour.
  When this body began the process of writing health care reform over a 
year ago, we knew it would represent a mammoth undertaking, and we knew 
it would get more difficult as we got closer to the goal line, as every 
major effort I have been involved in for three decades here has 
certainly evidenced. As you get closer to the goal line of major 
undertakings, it gets harder and harder to cross that finish line.
  This issue involves one-sixth of our economy, affects 100 percent of 
our fellow citizens, and has been the center of American public policy 
debate since before many of us were even born.
  Our path has been long and winding and has been difficult. It has 
been illuminated by a torch lit long ago in the days of Harry Truman 
and those who even preceded him and sustained for decades by very good 
people--Democrats, Republicans, and others--who believe that in a 
nation founded on freedom and sustained by unimaginable prosperity, no 
one--no one--in our country ought to have to go to sleep on a night 
such as this feeling that if they get sick or a loved one does, they 
will go broke or, worse, be unable to afford the care they or that 
loved one needs to get well.
  As I said so many times before, the person who carried this torch as 
long and proudly as anyone since this debate began so many years ago is 
not here with us tonight, but he is here in spirit and good conscience. 
I speak, of course, of our colleague from Massachusetts, Ted Kennedy. 
He never expected that he or we would cure all our ills in one fell 
swoop, in one massive bill that would, once and for all, right this 
problem of health care. Progress, he would argue, is hard, and the 
simple mathematics of the Senate make it harder all the time.
  I know our Republican leadership has basically advised their fellow 
members of their caucus not to vote for this bill no matter what is in 
it. I regret that. I think it is a sad moment but one with which we 
have to grapple. We cannot quit because of that political conclusion. 
We have to move forward. In fact, they went so far as to write a 
playbook for how to disrupt, delay, and obstruct progress on this 
issue. I know they do not like the bill and many parts of it. I also 
know many of them like many parts of this bill, and they acknowledge 
that when they talk about greater access, cost reductions, and the 
quality of health care. As one who conducted the hearings and the 
markup on health care over the last year, I heard over and over that 
members of that committee, Republicans and Democrats, speak of the very 
same goals we all seek with health care reform. I know, as a matter of 
fact, that many of them wrote major provisions of this bill. This bill 
is not devoid of the involvement and participation of members of the 
minority party this evening as we come close to voting on a final 
choice. But I regret it has come to that. I think our best efforts do 
emerge when we work together as citizens of this great country, 
regardless of the political labels we bear.
  My hope will be in the coming days that those doors may open and 
participation may, in fact, flow and we will end up with a product 
coming back from conference that is even stronger than the one we are 
being asked to make a decision on this evening.
  Someday we will look back on this moment in our Nation's history, and 
many of those not part of this decision will wish they stood in the 
arena instead of lobbing rhetorical grenades and cheap shots at a bill 
that deserves so much better. There is still time for my colleagues to 
stand and do what is right. I hope they will before the process is 
over.
  As it is, our caucus had to work at finding compromise language we 
could all stand behind, and we have tried to do that over these days. 
The resulting bill is not one that any one of us would have written on 
our own given that opportunity. And that goes for me as well, as I know 
it does the Presiding Officer. We have fought for a strong public 
option in our committee. I fought to have it included in the bill the 
majority leader brought to the floor, and I would have happily been 
fighting for it even today given that opportunity. But as I have said, 
it is always easier to envision the legislation you want than to pass 
the legislation we can get.
  Our country badly needs this legislation, even as imperfect as it may 
be in some aspects. The preferred outcome of our Republican friends we 
have in the Senate--deadlock within our caucus and a resulting failure 
to pass a reform bill--will result in more family bankruptcies, more 
deficits, and, sadly, more deaths that could have been prevented if 
everyone had access to decent health care. We do not have to let that 
happen. In fact, we will not let that happen. We have to be better than 
that.
  Yesterday, the majority leader offered a managers' amendment to the 
original Patient Protection and Affordable Care Act which we have been 
debating since prior to Thanksgiving.
  It toughens accountability policies for insurance companies, 
requiring them to spend more on health care and less on administrative 
costs and profits, holding them accountable for jacking up premiums, 
and prohibiting them from excluding coverage of preexisting conditions 
for children, effective immediately.
  It provides American families with more health care choices, 
guaranteeing that in addition to a variety of private sector options, 
families can choose from at least two national plans similar to the 
ones we receive right here in the Senate, one of which will be a not-
for-profit plan.
  It strengthens affordability provisions in the bill, starting a tax 
credit for small businesses in 2010, giving families more information 
to shop for better deals, and helping to spread cost-saving innovations 
across the country.
  It builds on the bill's protections for seniors, children, rural 
communities, and other vulnerable populations.
  It preserves the bill's core commitments that no American should go 
broke because they get sick and no American should die because they 
cannot afford the care they need to get well.
  After more than a year of legislating and more than 60 years of hard 
work on the part of advocates across the Nation, we have an 
unprecedented opportunity, both later this evening as well as the 
remaining days of this week. We are standing on the floor of the Senate 
with a chance to pass legislation that puts our focus on preventing 
disease, not just treating it, a bill that insures those 31 million of 
our fellow citizens who today lack any health insurance at all, a bill 
that guarantees every American access to quality health care at a lower 
cost.
  Senator Ted Kennedy always believed we would someday have this 
chance, and I think he knew this year might be the best and for our 
generation the last chance. These opportunities do not come around very 
often. We fought for reform in the 1970s and failed. We fought for 
health care reform in the 1990s and failed as well. If we fail this 
time, if we let partisanship triumph over progress, if we lose sight of 
the goal in the face of political gamesmanship, we who stand here today 
may never get that other chance.
  We came here to make this country a better place. I believe every 
person who serves here believes they came to the Senate to make our 
country a stronger and a better place. We have before us a

[[Page S13610]]

bill that saves lives, lowers costs, and frees tens of millions of our 
fellow Americans from the fear that grips them, as I address this 
Chamber on this evening. Let's do our jobs. Let's pass this bill. Let's 
make America stronger and a better place because this Congress and this 
administration rose to the challenge to grapple with a magnificent 
issue that deserves our attention and our support.
  I urge our colleagues to support this bill.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Kirk). The Senator from Illinois.
  Mr. DURBIN. Mr. President, let me first acknowledge the Senator from 
Connecticut, who played a critical role in not only the inspiration but 
the preparation of this important landmark legislation. Senator Dodd 
has been given some tough assignments in his career. He has been handed 
some of the toughest, and this was one. His Health, Education, Labor, 
and Pensions Committee met, I understand, 54 hours, if I am not 
mistaken. I think that is what he said earlier on the floor. It 
considered hundreds of amendments with the notion that we could create 
a better, more effective health care system in America. I have yet to 
hear anyone criticize his chairing that committee. He was evenhanded 
and fair. He entertained and accepted some 150 or 160 Republican 
amendments to this bill in an effort to try to build some bipartisan 
support for it. He went the extra mile with extra hearings. His 
committee was weary at the end, but he proved that his experience in 
the Senate had taught him valuable lessons about what it took to be 
respectful to the other side of an issue. He was not rewarded with a 
final vote in committee. Not a single Republican Senator would vote for 
the bill. It was not for any lack of effort on the part of Senator 
Dodd.
  When this bill passes--and this bill will pass--he deserves special 
credit for it, and I am going to be one of the first to applaud him. He 
included a provision in this bill near and dear to me on congenital 
heart research that will save lives and will spare suffering to 
families across America. I will forever be indebted to him for it.
  In just 4 hours, in the early morning hours of Monday, December 21, 
2009, one of the most significant votes in the history of the Senate 
will take place. It is hard for us in the midst of this debate, after 
all that has come before us and all that is likely to follow, to 
properly put this in historical context. For those of us who were 
honored by the people of our State to be here at this moment in 
history, it is humbling to know we will be called on to cast a vote 
that can change a nation.
  It has happened here before but only rarely. It happened 75 years ago 
when other Senators, in a much different era, battling through the 
worst depression in our Nation's modern history, were called on by a 
President in a wheelchair to rally and stand for the elderly of 
America. He asked to create Social Security, an insurance plan 
primarily for widows. President Franklin Roosevelt came to this Senate 
in this Chamber asking each and every one of the Senators to be mindful 
of the plight of our parents and grandparents in that time.
  I can recall, in my family, it was not uncommon for grandparents to 
end up living in the same home as their children because after they 
reached the point where they could no longer work for a variety of 
reasons--physical, retirement, whatever it happened to be--their 
savings were meager and the chance of living independently was limited. 
So their children took them in in that spare bedroom, made them part of 
the family and welcomed, but understood that was the only way mom and 
dad were going to have the dignity they deserved in life.
  Franklin Roosevelt had a different vision. He thought if workers 
throughout their worklife paid a little bit of money each week into a 
fund, they could be ensured there would be a check waiting for them at 
retirement that would allow them independence and dignity. He 
prevailed, and Senators stood up in that era of the 1930s and gave him 
the votes that were needed to change our Nation when it came to the way 
we treat the elderly.
  Those on the other side of the aisle--Republicans--were skeptical. 
They were fearful of government; fearful of a new program. They argued 
we were headed down a path we would regret--echoes of many arguments we 
are hearing today in opposition to health care reform. When their time 
came later, even as recently as a few years ago, they tried to 
dramatically change and rewrite the Social Security Program. They 
called for privatizing it, saying we would be much better off if the 
Social Security trust fund were actually in the stock market. Thank 
goodness the wisdom of America rejected that idea. Within months of the 
suggestion, it was proven to be totally false, as life savings were 
lost with the recession that we now are enduring.
  It is an indication of the bravery of a President, the courage of a 
Senate, and the fact that they rejected the pleas of those who would 
say: ``Do nothing. Don't touch it. Leave that problem alone.''
  It was about 45 years ago when another great President had another 
great idea, and that idea was to create Medicare, and with the creation 
of Medicare to say to those same elderly: It isn't enough to give you a 
check to get by each month. We want to make sure you have access to 
doctors and hospitals when you need it. Lyndon Baines Johnson, the 
master of the Senate, then President, managed to engineer the passage 
of that legislation against critics who once again said: It is too much 
government. It is a program that will cost too much money. It is not 
needed. We shouldn't do it.
  Their counsel was rejected. Medicare was created. It wasn't the 
Medicare we know today. It didn't reach the disabled. It didn't provide 
some of the basic services that many seniors now desperately need, and 
it didn't cover prescription drugs, but it was a start. It was a 
critical decision made to move forward. The same Republican Party that 
objected to the creation of Medicare has been critical of the program 
ever since. They have argued that it is wasteful, that it is doomed, 
that it should be allowed to wither on the vine. That was actually a 
quote from a leading Republican not that long ago.
  They suggested there was a better way--let's privatize Medicare. They 
love the notion of privatizing. Get government out of the picture. They 
came up with this theory, with the health insurance industry, of 
something called Medicare Advantage. This was where those flinty-eyed 
entrepreneurs would teach government a lesson. They would offer the 
benefits of Medicare and show how to do it at a lower cost. Well, we 
accepted their challenge and gave them their opportunity, and what we 
found was: They failed. Oh, some succeeded, but by and large when the 
final count took place, those private insurance companies couldn't help 
but have the urge to maximize profits at the expense of Medicare. So 
now we spend about $17 billion a year out of Medicare subsidizing 
private health insurance under the so-called Medicare Advantage 
Program. The experiment has failed.
  The basic idea of Medicare was proven right. It gave to our seniors 
something that we had promised and hoped we could deliver--longer 
healthier lives. It also triggered the creation of a medical health 
establishment across America--the building of hospitals and medical 
schools and more medical professionals than our Nation had ever seen--
because of Medicare, because of a President, Lyndon Baines Johnson, and 
his courage, and because of a Senate that could rise to the challenge 
of passing it, despite the critics.
  Well, in the early hours of Monday, December 21, 2009, our generation 
of the United States Senate will face our rendezvous with destiny, our 
opportunity to change this Nation, to make such a significant change in 
the way health care is delivered in America that we can say to future 
generations: We had our moment, and we seized it. To think that we 
will--with the passage of this bill in perhaps just a few days in the 
Senate, and a few weeks on Capitol Hill--enlarge the percentage of 
Americans with the security of health insurance from 83 percent to 94 
percent--the highest percentage of Americans ever insured in the 
history of our Nation. Of 50 million uninsured Americans today, 30 
million of those people will finally be able to rest at night knowing 
they are covered; that they have health insurance.
  It will be Judy, a worker in Marion, IL, at a hotel, making $8 an 
hour, working 30 hours a week, $12,000 in annual wages. She is a 
diabetic. She has

[[Page S13611]]

never had health insurance in her life. She goes to work every day. She 
is 60 years old. She will have health insurance because of this bill. 
She will be covered by Medicaid, and she won't have to pay for it 
because Judy's wages are at the low end of workers in America.
  I said to her: If you had health insurance, Judy, what would you do?
  She said: Senator, I have a few lumps I have been worried about a 
long time, and I can't afford to go to the doctor. I would go to the 
doctor.
  Thank God she can. Thank God for a lot of others--those who have lost 
their jobs, who are unemployed, who have exhausted their savings, who 
stand to lose their homes--who will at least have the peace of mind 
they will have health insurance. That is going to come too.
  If you have a child with a health problem, as many people do, 
something they call a preexisting condition, this bill will tell the 
health insurance companies immediately: You can no longer discriminate 
against that child. You can't turn down the family or that child for 
coverage. As someone who has been through that experience, I can't tell 
you what that means, to know that you have that kind of coverage; that 
your child, with that health care challenge, can go to the doctor they 
need to see and the hospital they need to be in.
  When my wife and I were first married and had our first baby, I was 
in law school, and we had no health insurance. When our baby had a 
problem, I had to go to Children's Hospital here in Washington and sit 
in a room filled with people who had no health insurance. I took a 
number, and we waited for a doctor. Every time we went, it was a 
different one. I felt like I had let my family down. At a time when my 
family needed health insurance, I had not delivered. I know that 
feeling personally, and I know what it must mean to 50 million 
Americans who face it today. For 30 million of those Americans, this 
bill will give them the peace of mind that they have health insurance.
  It also says to companies across America, we are going to change the 
terms of this relationship between health insurance companies and the 
people they insure. We are going to finally step in on the side of the 
consumers of America--the families of America, the ones that are so 
often turned down because of preexisting conditions, turned down 
because companies canceled their insurance when they started running 
into high medical bills. For the first time, these people will have 
legal rights created by this bill to stand up and be covered and to be 
confident at the end of the day that they will have the coverage they 
paid for their whole life.
  It is an amazing thing we are considering. In the middle of it, with 
all these speeches and all the press releases and all the charts and 
all the time, it is sometimes difficult to focus on the historical 
impact of what we are about to do at 1 a.m. on December 21, 2009. But 
if we do this, and do it right; if 60 Senators step forward, as I think 
they will--commitments have been made--we will make history. It will be 
reported across America that for the first time in memory, the United 
States Senate has voted for comprehensive health care reform.
  The critics will still be there, and they will say the same thing 
they did about Social Security and the same thing they did about 
Medicare: It is too much government. It is not going to work. We 
shouldn't do it.

  Thank God, that counsel was rejected in the 1930s and the 1960s, and 
it should be rejected on December 21, 2009. We need to stand together 
for people who otherwise have no voice--the uninsured, many of whom 
have low-wage jobs, or maybe no jobs at all, and their children, who 
really can't afford the best lobbyist in Washington. It is time for us 
to lobby for them.
  I know there are a lot of critics of this plan. We have heard them. 
They have talked about Medicare and what this will do to this bill. But 
we know what the professionals have told us. This comprehensive health 
care reform legislation will add 9 or 10 years of solvency to Medicare, 
put Medicare on sound financial footing. And that is exactly what we 
should do.
  The bill has a bonus. The bonus is that, at a time when we are facing 
deficits and debt, which have to be taken seriously, this bill charts a 
path for us to start retiring that debt. The Congressional Budget 
Office says that over the first 10 years, $130 billion in debt will be 
relieved by this bill; then in the second decade of this bill's 
existence and changes, we are going to find up to $1.3 trillion in 
deficit reduction.
  There has never been a bill considered on the floor of the Senate 
that has had that kind of impact on our Nation's debt. It is going to 
change life not only for uninsured families but even those with 
insurance. For some, it will give the luxury that we have as Members of 
Congress.
  I think we are the luckiest people on Earth when it comes to health 
insurance. We team up with 8 million Federal employees and their 
families, and each year we have an open enrollment. If we don't like 
the way we are treated by our health insurance company in the previous 
year, we can go shopping, just like you would shop for a car or a 
refrigerator, and pick the right one for your family. We pick the right 
health insurance for our families. Every American should have that 
luxury, and we move toward creating that in this legislation.
  It was several years ago that I teamed up with Senator Blanche 
Lincoln of Arkansas and Senator Olympia Snowe of Maine. We tried to 
create a program for small businesses in America called the SHOP Act. 
This program would give those small businesses the same shopping 
opportunities for health insurance as Members of Congress and Federal 
employees. I came up with an unlikely ally in the National Federation 
of Independent Businesses. They decided they wanted to join us.
  When their lobbyist called and said he wanted to meet with me, I 
said: I can't wait to meet you. His organization had done everything in 
their power to defeat me in every election I had been in, and I wanted 
to see what he looked like.
  He came in and sat down and said: We have to do something about 
health insurance for small business. We ended up creating an unlikely 
but powerful alliance of the National Federation of Independent 
Businesses, the realtors, the Service Employees International Union, 
Families USA--from both sides of the political spectrum--standing 
behind the SHOP bill.
  The SHOP bill, with some changes, is now part of health care reform. 
It is an idea that has been endorsed, and it is one that I think is 
going to make a big difference for individuals. The bill also contains 
help for small businesses to pay for the premiums. Critics on the other 
side of the aisle say: Oh, the taxes go up, but the benefits don't 
start for years. They have missed it because initially we are going to 
be offering tax assistance to small businesses with 50 employees or 
fewer. Those who have an average payroll of $50,000 a worker are going 
to get a helping hand to buy health insurance not only for their 
workers but for the owner of the company.
  I have seen this in my own life. I have friends who run a small 
business who have lost their health insurance because one employee's 
wife had a very sick baby. That is exactly what happened to my friend. 
They went out shopping for insurance on the open market and it was 
brutal. My friends were in their early sixties, and they couldn't buy 
insurance. Everything they could buy was loaded with exclusions and 
deductibles and copays.
  Well, we are going to make sure that businesses have a helping hand 
with a tax credit, and that helping hand is going to allow them to buy 
good insurance that covers their employees.
  Those on the other side talk about the tax increases in this bill. 
Let's be very blunt what they are. There is a .9 percent payroll tax 
increase for individuals making over $200,000 a year and families 
making over $250,000 a year. What it means is this: Roughly $2,000 a 
year for families making over $250,000 will have to be paid to make 
sure that Medicare is solvent and that this program is funded. That may 
affect some Members of Congress, with their spouses working. But I 
don't think it is unfair. It is a tax we should be willing to pay to 
solve major problems in this country.
  There will be taxes on high-end health insurance policies, and it is 
a very controversial provision with some of my friends in organized 
labor. But I

[[Page S13612]]

hope we have hit the right number of $23,000 and I hope our escalator 
clause to try to keep up with inflation is a reasonable one. If it is 
not, we will revisit it. The only law ever written that didn't need 
amendment might have been the Ten Commandments, and I don't think this 
bill, as good as it is, will rise to that level. We are prepared to 
return to it if we need to, to make sure it works and works well, and 
we have the time to do that.

  This is critical. I also know this bill is going to change--you will 
be able to see the change across America with the construction of 
community health clinics. One of our great Senators here, Bernie 
Sanders of Vermont, has been a clarion voice on behalf of community 
health clinics. He knows, as we all do, that these clinics, placed in 
cities and towns across America, are a lifeline to low-income people so 
that they have primary care at a fraction of the cost of a visit to an 
emergency room--good care. I have seen it. I have visited the Erie 
Clinic in Chicago, Alia Clinic in Chicago. These are good, clean, 
modern clinics, with people dedicated to health care and dentistry who 
are helping these people.
  We envision 10,000 more community health clinics as a result of this 
bill, at least, and thousands of primary care physicians to be there to 
help. That will mean we will be creating, across America, a network of 
care and peace of mind for people who otherwise have few places, if 
any, to turn.
  I think the day will come soon when this bill, after it is passed, 
will become evident to America in terms of what we set out to do and 
what we achieved. If history serves, as it has in the past, many of 
today's critics will not dwell on the fact that they voted no, but 
rather say I had some problems with it. I guess it worked out OK. They 
may be afraid to acknowledge that now. I think ultimately they will 
have to.
  This is clearly an idea whose time has come, and it has come because 
we have a President with the courage, the political courage, to step up 
and make sure that we not back away. As Franklin Roosevelt did in 
Social Security, as Lyndon Johnson did with Medicare, Barack Obama, 
with health care reform, has challenged this Congress not to ignore a 
problem that has haunted the Presidencies of seven great men who have 
previously served in that office.
  We need to do our historic duty in the early morning hours so that 
Americans across this Nation can wake up to the stories on the news 
that, finally, hope is on the way.
  I said the other night when I was talking about this--Senator Dodd 
put Vicki Kennedy's Washington Post column in the Record, and I am glad 
he did so--that this has been called many things. It has an official 
name. I am going to call it ``Kennedy Care.'' I hope some others will 
too, because we do it because of the inspiration of a great friend, a 
great Senator, and a great statesman, Edward Kennedy, who I am sorry 
cannot be here to enjoy this historic moment. But he led us to this 
moment. As he said in one of his last columns he wrote about health 
care: We are almost there. In four hours, we will be there.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. HARKIN. Mr. President, first, I commend Senator Durbin for his 
great leadership--he is our assistant majority leader--and for all of 
his handiwork on this bill. He has been one of our strongest proponents 
for making coverage more affordable for small businesses. He just spoke 
about that.
  In fact, under the managers' amendment, we have expanded, even more 
than what we did in the original bill, credits for small businesses. 
These credits now start in 2010. They start next year. They are 
available to more small business firms than we had in the original 
bill--all of that, thanks to the hard work and intervention by Senator 
Durbin.
  I might note we have a provision also in the managers' amendment 
relating to cardiac care, congenital heart disease. I know Senator 
Durbin had a personal tragedy in his own family because of that. So we 
now have a new program to track the epidemiology of congenital heart 
disease; it is section 10411, in case anyone is taking notes. It 
expands on research at NIH on congenital heart disease. We are grateful 
to Senator Durbin for including that.
  Basically, of all the things we have for consumer protection, 
consumers of America have no more dogged champion here in the Congress 
than Senator Durbin of Illinois. No matter what it is we are passing 
here, Senator Durbin always looks to see how consumers are affected. He 
has done that also on this health care bill, by making sure that 
consumers have better protections and health care is more affordable. I 
personally thank Senator Durbin for all of his hard work on this bill.
  As Senator Durbin said, and as our leader, Senator Dodd, said, in 
about 4 hours--a little less than 4 hours now--the historic vote will 
take place in the Senate. It will be the defining vote of my Senate 
career. That has been about 25 years, I guess, I have been here. It 
will probably be the defining vote for all of us during our tenure here 
in the Senate. It will be the cloture vote on the managers' package. 
From that we move forward.
  I hope after that cloture vote, and after we take that cloture vote, 
the minority side would see fit, then, since we have the 60 votes, 
after we have crossed that hurdle, that perhaps they would be willing 
to close up the debate a little bit sooner than ending on Christmas 
Eve. But if that is their desire--I mean, they have the rules. We will 
abide by the rules. If the Republicans want to exercise every single 
right they have under the rules, they can keep us here until Christmas 
Eve. There is no doubt about it. But to what end, I ask? To what end?
  We are going to have the vote at 1 o'clock that is going to require 
the 60 votes. Then why stay here until Christmas Eve to do what they 
know we are going to do, and that is to have the 60 votes on the 
managers' amendment, on the substitute, and on the underlying bill? I 
hope our Republican leader and others on the other side would perhaps 
see that it is not in the best interest of the Chamber, it is not in 
the best interests of the country.
  I know one of the Senators on the other side was talking about waste 
today. I am thinking, you know, this is kind of a waste, that we are 
here yakking about this and doing it up until Christmas Eve, when we 
could collapse all these votes and get it done tomorrow. We could 
actually be done here tomorrow with this whole bill if the Republicans 
would see fit. Like I say, it is up to them. They can keep us here if 
they want to. But the managers' amendment we are going to vote on at 1 
o'clock--again, I keep hearing all day today from the Republicans that 
they have not had a chance to read it, we are rushing it, and it just 
came out the other day. The Republicans had it read word for word. The 
few times I came on the floor during the reading, I didn't see many 
Republicans over there listening to it. You have to wonder, did they 
all go home and read it? They made the clerk read it. Why didn't they 
sit here and listen to it? They would have found out what was in it if 
they were so interested.
  Anyway, this is all gamesmanship around here right now. People of 
America understand that, too. They know we are going to pass health 
reform, and the first vote is going to be at 1 a.m. this morning. I 
heard the Senator from Arizona earlier today talking about why should 
we have it at 1? Why can't we have it at 9 a.m. in the morning? He said 
the majority leader, Senator Reid, has the power. He could move it to 9 
a.m. in the morning and we would not have to bring people here at 1 
a.m. He referred to the Senator from West Virginia, Senator Byrd, by 
name--elderly, frail, but he shows up here to vote. But dragging him 
out of bed at 1 in the morning to come here? He said, Why don't we do 
it at 9 in the morning?
  I thought that was a pretty good idea. When I got to the floor a 
couple of hours ago, I asked unanimous consent at that time that we 
have the vote at 9 a.m. but that the hours from 1 to 9 be counted for 
purposes of the 30 hours. The Republicans objected. So much for their 
concern for the Senator from West Virginia.
  We are on the cusp. We are going to expand small business credits. We 
are going to reduce administrative costs. We are requiring insurance 
companies to spend 80 to 85 percent of their income on health care--on 
health care, not fancy corporate offices, not high, expensive CEO 
salaries of millions of dollars a year, not fancy jets, but 80 to

[[Page S13613]]

85 percent must be spent on health care and paying medical claims.
  As Senator Durbin said, we make major investments in community health 
centers--10,000 more community health centers in America. We are 
investing in the National Health Service Corps to get more young people 
to serve in the National Health Service Corps. We have new protections 
for patients, access to a primary care provider of their choice, and an 
important provision championed by the Senator from Maryland--I think 
Senator Cardin--to provide access for women in their choice of an OB-
GYN. In other words, they get to pick who their OB-GYN is, not their 
primary care provider, not the health insurance company, not anyone 
else. The individual woman can pick her own OB-GYN.
  The amendment we have before us immediately allows children to stay 
on their parents' health insurance until they are age 26. The managers' 
amendment also prohibits insurance companies from imposing preexisting 
conditions on children up through the age of 18 right away, next year. 
Think about that. Think about what that means to a family who has a 
child who maybe was born with a defect--something that is chronic. The 
insurance companies tend to exclude them. Our bill says that beginning 
next year they cannot do that anymore to children. That is a big deal 
for so many families in this country who have kids who have been 
afflicted with a birth defect or maybe something happened, maybe they 
had an accident, maybe they had an illness early in life that has 
turned chronic. This is a very big deal for those families.
  Last, for someone like me who represents a lot of rural areas and 
small towns, we have increased, in the managers' amendment, more 
workforce. We are going to have more people for rural and underserved 
communities. We will increase the funding in the training programs for 
rural health providers, so small towns and rural areas of the country 
have a big boost in the managers' amendment.
  We are going to put more money and more loan repayments for people 
who want to serve in underserved areas, in rural areas, to make sure 
they do not have to go someplace where they get a lot of money to pay 
back their debts for medical school. We are going to be providing some 
of those payments if they serve in a rural area, an underserved area.
  I know we have now another hour to listen to the Republicans tell us 
why we ought to put this off for another century or so, I suppose. The 
people of America know the time has come now. We are committed to this. 
At 1 a.m., we will have the 60 votes, and we will get this passed 
before Christmas. It will be one of the best Christmas presents this 
Congress has ever given the American people.

  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, the reason I wasn't on the floor for a large 
part of yesterday is I was wading through this amendment and also the 
CBO score and also the Joint Tax score. Then I had to talk to experts 
who could interpret what is in there. The American people don't have 
that privilege. They have to rely on the stuff they are hearing on the 
floor. I can tell you, they are pretty upset. I get letters and calls 
from all over the country saying: Stop this bill any way you can. Make 
them get it right. I have to tell you, some of those from other States, 
they are saying: My Senator is not listening to me. I am counting on 
you.
  I rise to speak on the issue of the health care reform. I rise with a 
great sense of disappointment as I reflect on the debate that might 
have been. From the very start, I have said we need to reform our 
health care system. Everyone agrees we need real changes that will 
allow every American to purchase high-quality, affordable health 
insurance. Not a single one of my Senate colleagues on either side of 
the aisle supports the status quo. The argument that Republicans 
support the status quo is simply false. We understand the current 
system fails too many Americans. We want to support reforms that will 
provide real insurance options to all Americans and help lower the cost 
of that insurance. I have said from the start of this year--and, 
frankly, throughout my 13 years in the Senate--that true reform should 
be developed on a bipartisan basis so the legislation will incorporate 
the best ideas from both sides and will have the broad support of the 
American people. That should be a prerequisite to any proposal that 
will affect nearly 20 percent of our Nation's economy and the health 
care of every single American.
  Unfortunately, that was not the process followed in developing this 
bill. Instead, we have the Reid bill, which was developed in secret 
without the input of a single Republican. This morning an adviser to 
President Obama was asked about the partisan nature of this bill and 
the overwhelming opposition of the American people. His response spoke 
volumes of what is wrong with Washington today. He essentially 
responded that the American people don't understand what is in this 
bill and that once it is implemented, they will come to support it. In 
plain English, the White House is saying: Washington knows best. That 
attitude is part of the reason why support for Congress is at a 
historic low and why public support for this bill is so weak.
  Instead of having a bill that will provide greater choices and reduce 
costs, we have a bill that will do the opposite. The Reid bill will 
deny consumers the ability to make choices and instead substitute the 
judgment of government bureaucrats who will decide what kinds of 
insurance you will be allowed to purchase. The bill also fails to 
address the most important issue for the majority of Americans. It 
fails to do anything to help reduce the cost of health care. President 
Obama promised the American people that health care reform would reduce 
health care costs. Yet this bill fails to deliver on the President's 
promise.
  According to the President's own independent Medicare Actuary, this 
bill will actually increase how much we spend on health care. According 
to Rick Foster, the person from the administration who keeps track of 
all Medicare and Medicaid spending, the bill increases health care 
costs $234 billion more than if we did nothing. That is a huge cost.
  In addition to increasing total costs, the Reid bill will increase 
our national debt and threaten the health care provided to millions of 
Medicare beneficiaries. Some of my Democratic colleagues are going to 
come down to the floor and argue that the Reid bill will reduce the 
deficit and extend the solvency of the Medicare Program. They have been 
doing that for days. They will even cite the Congressional Budget 
Office to support their arguments. I hope every American hears those 
arguments and remembers a few inconvenient truths my Democratic 
colleagues are going to forget to mention. The way my colleagues on the 
other side of the aisle were able to force CBO to conclude that the 
Reid bill will not increase the deficit was by requiring them to use 
budget gimmicks and assumptions that would make Bernie Madoff blush.
  Every time you hear one of my Democratic colleagues argue that the 
bill reduces the deficit, you should ask that Senator if he believes 
that Medicare will cut physician payments by 21 percent in March. That 
is right. While the Reid bill cuts over $470 billion from the Medicare 
Program, it will also require that every doctor treating Medicare 
patients have his or her payments cut by 21 percent in just 2 months. 
That is what CBO had to assume when they did their estimate. If you 
believe Congress will never allow this to happen--and we never have--
you cannot believe this bill will actually reduce the deficit. The 
truth is Congress has never allowed that level of cut. Senate 
Democrats, however, chose to ignore this reality and relied on the 
promise of a cut to make their bill add up. You should also ask my 
Democratic colleagues if they believe that Medicare payments to doctors 
will be cut more than 45 percent over the next decade.
  Again, that is what the Reid bill required CBO to assume. If you 
don't think that will happen, then you cannot believe this bill reduces 
the deficit.
  You should also ask my Democratic colleagues if they think that 
within a decade one out of every five hospitals, nursing homes, and 
home health agencies will be operating at a loss because of the 
unsustainable payment cuts in this bill. We just got a revised CBO 
estimate that says there was a little error there, and so there will be 
less savings by $600 billion. According to

[[Page S13614]]

the administration's Actuary, Rick Foster, that is exactly what is 
going to happen if the Reid bill is enacted. He said if these policies 
have to be modified, such changes would likely result in smaller actual 
savings. This means this bill will not reduce the deficit.
  Finally, you should ask anyone arguing that this bill reduces the 
deficit whether they believe Medicare patients will not be able to get 
the care they need. Again, the administration's own Actuary says 
payment cuts in the Reid bill could jeopardize access to care for 
beneficiaries. I do not know if my colleagues believe these things will 
happen. Taking note of these facts pushes up the total cost of the bill 
well over $1 trillion and destroys any pretense of budget balance. 
Unless all the things CBO was required to assume actually happen, this 
bill will actually increase the deficit.
  Health care reform has to be truly paid for. Why? Because the Federal 
Government has maxed out its credit cards. Our out-of-control spending 
is now even driving down the value of our money. As the government 
borrows more money to finance even more spending, the devalued dollar 
will drive up the cost of goods. Oil is a good example. Take a country 
such as Saudi Arabia, which is already raising prices for their oil to 
compensate for the lower value of our dollars. This means every 
American will end up paying more for a gallon of gas because of our 
failure to address growing deficits. If we are going to enact real 
health reform, we need to use honest accounting and not budget gimmicks 
and fake assumptions that we all know will not happen.
  We should pay for expenses such as fixing doctors' Medicare payments, 
and we should not delay the start of spending 4 years after the start 
of the new taxes just to make the bill look good over 10 years.
  The problem for the President and my Democratic colleagues is their 
bill is being sold on the strength of accounting tricks that make it 
appear that it will not add to the deficit. In case they have not 
noticed, they are not fooling the American people. It showed up in 
August. It showed up every time since then. That is why we are not 
getting to go home on weekends. We don't want the Democrats to hear 
from the people at home who are upset about this.
  In a recent poll, 68 percent of Americans said they believe the 
Democrats' health reform bill will increase the deficit. They are 
right. The American people understand that if the Reid bill is enacted, 
deficits will increase. They are right. The same is true for the claims 
that the Reid bill will extend the solvency of the Medicare Program or 
reduce beneficiary premiums. That can only happen if you make all the 
assumptions I previously described. If you don't believe those things 
will actually happen, then this bill will do nothing to extend Medicare 
or lower premiums.

  Besides driving up the deficit, the Reid bill will also eliminate 
more than 1 million jobs. The mandate that employers offer health 
insurance or pay a penalty will be a massive new job-killing tax. Our 
national unemployment rate is at 10 percent. The majority leader is 
attempting to cut off debate on a bill and force its passage before 
Christmas, again, because he doesn't want the people to hear what is 
happening, but we are going to see that that does happen--that will 
force employers to eliminate jobs and reduce wages. Businesses do not 
deny health care to their employees because they are cruel or mean-
spirited. They do it because they can't afford it.
  Most businesses that do not provide coverage do so because they 
cannot afford health insurance. They can't afford it for their 
employees or for their own families. They have looked at the cost and 
figured out they cannot pay for health care and still stay in business. 
The Reid bill fails to do anything to actually lower the cost of health 
insurance, which might mean these businesses could actually afford 
health insurance. Instead, it will place a new tax on these businesses, 
which the CBO has said will lead to these businesses reducing wages for 
their workers and eliminating jobs. That is why the National Federation 
of Independent Business, which represents small business across 
America, estimated the Reid bill would cause 1.6 million jobs to be 
eliminated. That is why they said the Reid bill will create a reality 
that is worse than the status quo for small business.
  The worst thing about the Reid bill is not how it will increase the 
deficit or kill 1 million American jobs. The worst thing about the Reid 
bill is it will reduce the quality of health care we all receive. No 
longer will you and your employer be able to choose the health 
insurance that best meets your needs. The government will tell you what 
kind of insurance you have to buy, and if you don't, you are told the 
government will place a fine on you. Under the Reid bill, the 
government will tell your health plan which types of doctors they have 
to contract with, irrespective of whether that is a doctor you want or 
need to see. The Reid bill also traps 15 million Americans in the worst 
health care program in America. Approximately half the people who get 
the promised health care coverage under the Reid bill will get it 
through the broken Medicaid Program.
  States already use price fixing to limit how much they have to pay 
doctors under the Medicaid Program. That is why as many as 40 percent 
of all doctors will not see Medicaid patients. I have said, if you 
can't see a doctor, you don't have health care. Yet that is exactly 
what the Reid bill will do: Promise 15 million people coverage but trap 
them in a system where we know they will not be able to get the care 
they need.
  If anyone doubts what effect the Reid bill will have, they only need 
to look at Massachusetts. The Massachusetts plan was the model for many 
of the reforms in this bill. The problems they are encountering give us 
a good indication of what will happen to us all if the Reid bill is 
enacted.
  To make the Massachusetts reforms work, they now have a 10-member 
commission trying to impose a global payment system. Under this system, 
doctors and hospitals will be forced to join large networks and be paid 
at a set rate for each patient. This is the same kind of government 
control we already see with Medicaid. The results of these changes are 
equally predictable. Fewer doctors will be willing to see people at the 
exact time when the number of people seeking care is increasing.
  These are just some of the more serious problems with this bill. 
Because many of my colleagues want to be able to discuss the problems 
with this bill, I have limited my remarks for now. Because the bill was 
drafted behind closed doors and thrust upon the American people without 
time to consider all the ramifications, I am sure we will find more 
problems with the legislation after this rushed vote.
  Over the next few days, I plan to lay out specific and concrete 
alternatives to how we could do better. I have been doing that for a 
long time, but they have not been accepted. Republicans have many ideas 
on how to make this bill better, including several that have bipartisan 
support. However, if Senator Reid is successful in cutting off debate, 
we will never get the chance to discuss any of these ideas.
  Health care reform is too important for too many Americans to be 
rammed through the Senate with little or no debate on the weekend 
before Christmas. It appears my colleagues understand how deeply 
unpopular this bill is with the American people, and they want to force 
it through when they believe most Americans are not paying attention. I 
wish to assure my Democratic colleagues that the American people are 
watching, and the voices of August will only grow louder. They will 
remember the vote to cut off debate on this bill for a long time 
because they understand what it will mean for their health care and the 
future of this country. The person with whom I served in the Wyoming 
Legislature sent me a little note and said: If it is broken, don't 
break it more. That is what we are doing.
  I have some articles I wish to include in the Record. One is by 
Howard Dean that suggests this reform falls short. Of course, he is the 
former chairman of the Democratic National Committee. Another is an 
editorial by Matthew Dowd, a political analyst for ABC News, who talks 
about the danger of success and where the polls are on this and says:

       If this legislation passes, Democrats will be held 
     accountable for any failures or problems in the system. So if 
     any Americans' insurance premiums rise, they will blame the 
     Democrats. If patients have to wait in line at

[[Page S13615]]

     emergency rooms, it will be seen as the Democrats' fault. If 
     health care costs don't drop, the Democrats will face the 
     wrath of the electorate.

  I also have an editorial by E.J. Dionne, Jr., about Democratic 
fratricide and an article by George Will, where he says ``More talk, 
less support.'' The more we talk, the less support there is for this 
bill.
  Finally, I have an editorial by David Broder, of December 18, 2009.
  I ask unanimous consent to have these articles printed in the Record.
  There being no objection the material was ordered to be printed in 
the Record as follows:

               [From the Washington Post, Dec. 17, 2009]

                        Reform That Falls Short

                            (By Howard Dean)

       If I were a senator, I would not vote for the current 
     health-care bill. Any measure that expands private insurers' 
     monopoly over health care and transfers millions of taxpayer 
     dollars to private corporations is not real health-care 
     reform. Real reform would insert competition into insurance 
     markets, force insurers to cut unnecessary administrative 
     expenses and spend health-care dollars caring for people. 
     Real reform would significantly lower costs, improve the 
     delivery of health care and give all Americans a meaningful 
     choice of coverage. The current Senate bill accomplishes none 
     of these.
       Real health-care reform is supposed to eliminate 
     discrimination based on preexisting conditions. But the 
     legislation allows insurance companies to charge older 
     Americans up to three times as much as younger Americans, 
     pricing them out of coverage. The bill was supposed to give 
     Americans choices about what kind of system they wanted to 
     enroll in. Instead, it fines Americans if they do not sign up 
     with an insurance company, which may take up to 30 percent of 
     your premium dollars an spend it on CEO salaries--in the 
     range of $20 million a year--and on return on equity for the 
     company's shareholders. Few Americans will see any benefit 
     until 2014, by which time premiums are likely to have 
     doubled. In short, the winners in this bill are insurance 
     companies; the American taxpayer is about to be fleeced with 
     a bailout in a situation that dwarfs even what happened at 
     AIG.
       From the very beginning of this debate, progressives have 
     argued that a public option or a Medicare buy-in would 
     restore competition and hold the private health insurance 
     industry accountable. Progressives understood that a public 
     plan would give Americans real choices about what kind of 
     system they wanted to be in and how they wanted to spend 
     their money. Yet Washington has decided, once again, that the 
     American people cannot be trusted to choose for themselves. 
     Your money goes to insurers, whether or not you want it to.
       To be clear, I'm not giving up on health-care reform. The 
     legislation does have some good points, such as expanding 
     Medicaid and permanently increasing the federal government's 
     contribution to it. It invests critical dollars in public 
     health, wellness and prevention programs; extends the life of 
     the Medicare trust fund; and allows young Americans to stay 
     on their parents' health-care plans until they turn 27. Small 
     businesses struggling with rising healthcare costs will 
     receive a tax credit, and primary-care physicians will see 
     increases in their Medicare and Medicaid reimbursement rates.
       Improvements can still be made in the Senate, and I hope 
     that Senate Democrats will work on this bill as it moves to 
     conference. If lawmakers are interested in ensuring that 
     government affordability credits are spent on health-care 
     benefits rather than insurers' salaries, they need to require 
     state-based exchanges, which act as prudent purchasers and 
     select only the most efficient insurers. Sen. John Kerry (D-
     Mass.) offered this amendment during the Finance Committee 
     markup, and Democrats should include it in the final 
     legislation. A stripped-down version of the current bill that 
     included these provisions would be worth passing.
       In Washington, when major bills ear final passage, an 
     inside-the-Beltway mentality takes hold. Any bill becomes a 
     victory. Clear thinking is thrown out the window for 
     political calculus. In the heat of battle, decisions are 
     being made that set an irreversible course for how future 
     health reform is done. The result is legislation that has 
     been crafted to votes, not to reform health care.
       I have worked for health-care reform all my political life. 
     In my home state of Vermont, we have accomplished universal 
     health care for children younger than 18 and real insurance 
     reform--which not only bans discrimination against 
     preexisting conditions but also prevents insurers from 
     charging outrageous sums for policies as away of keeping out 
     high-risk people. I know health reform when I see it, and 
     there isn't much left in the Senate bill. I reluctantly 
     conclude that, as it stands, this bill would do more harm 
     than good to the future of America.
                                  ____


                         The Danger of Success

                           (By Matthew Dowd)

       President Obama needs an exit strategy. I am not referring 
     to Afghanistan or Iraq (though there are quite a few 
     similarities be- tween the situation Obama is in on health-
     care reform and the political difficulties President George 
     W. Bush faced on Iraq). Congressional Democrats and Obama are 
     headed toward a ``catastrophic success'' politically if they 
     pass health-care reform in its current legislative form. And 
     catastrophic success was a term then-President Bush used on 
     Iraq when he acknowledged the great initial victory but 
     didn't take into account the long-term calamity and costs.
       I am not seeking to argue the substance of health care and 
     the merits or demerits of the bills, and will leave that to 
     experts in policy and its effects. I am talking about the 
     politics of the legislation and the effect it is likely to 
     have on Obama and Democrats in Congress.
       Unlike many other pundits and political experts in both 
     parties, I think that passage of a bill by the Democrats at 
     this point will be politically damaging to both the president 
     and congressional Democrats. Conversely defeat of the 
     legislation is much more likely to hurt Republicans in 
     Congress.
       The latest Post-ABC News poll shows the president's overall 
     approval rating at a new low of 50 percent--about the rating 
     President Bush had going into the November 2004 election, 
     when Democrats said Bush was ripe for defeat.
       There are many reasons for this drop in support for Obama. 
     The stagnant economy is the biggest factor, but close behind 
     is the fact that the administration is pushing health-reform 
     efforts that have polarized the electorate, and that 
     independent and swing voters have moved against in large 
     measure.
       As Wednesday's Post-ABC poll shows, a majority of Americans 
     believe that if this bill passes, their healthcare costs will 
     rise, the federal deficit will increase, the costs of the 
     overall health-care system will climb, and their own care 
     would be better if the system stays as is. Democrats 
     (including former president Bill Clinton) claim that they 
     need this bill to pass for political reasons. But let's 
     examine that. At present, a majority of Americans are against 
     the effort, the legislation lacks bipartisan support, the 
     costs of the reforms are upfront, and the benefits won't kick 
     in until after the 2012 elections. When has that ever been a 
     formula for political success?
       If this legislation passes, Democrats will be held 
     accountable for any failures or problems in the system. So if 
     Americans' insurance premiums rise, they will blame the 
     Democrats. If patients have to wait in line at emergency 
     rooms, it will be seen as the Democrats' fault. If health-
     care costs don't drop, the Democrats will face the wrath of 
     the electorate.
       Many Democrats, including people in the administration, 
     blame poor marketing for their difficulties in passing health 
     reform. They say they haven't gotten the message out. But 
     advocates of reform have spent millions on advertising and 
     lobbying this year. And Obama, who many say is the best 
     orator ever to occupy the White House, has pushed for this 
     legislation constantly over the past six months. In that 
     time, support for Obama's handling of heath-care reform has 
     dropped by more than a net of 30 points.
       Yet before Republicans cheer that they may defeat this 
     effort, they should beware what they wish for. A vast 
     majority of Americans still believes that we need fundamental 
     health-care reform. If the legislation fails, Democrats can 
     blame Republicans by saying reform was in sight and the GOP 
     blocked it without offering a real alternative to decrease 
     costs and increase access.
       The dominant issues today are the economy and jobs, and the 
     public doesn't see either party making these a real priority. 
     Further, polls show trust in government handling of domestic 
     issues remains at historic lows. What most voters hear from 
     Washington these days is squabbling over health reform 
     involving a government role they don't trust and don't want.
       My advice? Leaders in Washington ought to concentrate on 
     what matters to Americans, not on what they think should 
     matter to voters. Come up with a heath-care bill that draws 
     real bipartisan support. And before pushing a bigger role for 
     government, begin to restore trust in the government's 
     ability to do even small things. Democrats pushing so hard 
     for success on health care could find themselves in a 
     situation resembling President Bush's situation on Iraq. They 
     could topple the statue and win the day, but lose politically 
     over the coming months and years.
                                  ____


                         Democratic Fratricide

                         (By E.J. Dionne, Jr.)

       Here's what Democrats need to ponder: Can they prosper in 
     the absence of George W. Bush?
       His presidency was a tonic for Democrats and led to a 
     blossoming of political creativity on the center-left not 
     seen since the 1930s. No tactic, no program, no leader ever 
     did more to catalyze the party than the rage Bush inspired.
       The whole effort was summarized nicely by the party's 
     slogan in 2006, ``A New Direction for America.'' There was no 
     need to specify north or south, east or west, up or down. 
     Compared with Bush, any alternative destination seemed 
     appealing. And by becoming the apotheosis of the fresh and 
     the new, Barack Obama emerged as the most attractive guide to 
     this unknown promised land.
       The consequence is that Democrats must govern in one of the 
     most difficult periods in American history while managing a 
     sprawling coalition and working though a political structure 
     near the point of breakdown--

[[Page S13616]]

     largely because of the dilapidated state of that 
     dysfunctional and undemocratic partisan hothouse, the United 
     States Senate.
       Especially if you take into account the scope of the 
     problems confronted, Democrats could argue they are doing 
     pretty well. It's no small thing to save the economy from 
     collapse. Winding down two wars is no picnic.
       But politically, the Democrats are in trouble. They are at 
     one another's throats over healthcare legislation that should 
     be seen as one of the party's greatest triumphs. They are 
     being held hostage by political narcissists and narrow 
     slivers of their coalition.
       When Democrats make deals, they are accused of selling out. 
     When they fail to make deals, they are accused of not 
     reaching out. Moderates complain that their party has gone 
     too far left. Progressives chortle bitterly at this, asking: 
     What's left-wing about policies that shore up banks and 
     protect drug companies?
       Rural-state centrists insist on more fiscal discipline--as 
     long as it doesn't affect farmers and small-town hospitals. 
     Progressives ask why debt should be the priority when so much 
     more needs to be done to relieve unemployment.
       This is a recipe for political catastrophe. An increasingly 
     bitter and negative Republican Party may not be able to win 
     the midterm elections, but Democrats definitely can lose 
     them.
       Their fractiousness is dispiriting to their supporters, 
     which set off this urgent warning bell in the latest Post-ABC 
     News poll: For the first time in his presidency, more 
     Americans strongly disapprove of Obama's performance in 
     office (33 percent) than strongly approve (31 percent).
       Putting aside margins of error and the fact that the Dec. 
     10-13 poll showed a sudden bump in Republican identification, 
     that might be a statistical anomaly. The point is that the 
     trend is perilous. In June, strong approvers of Obama 
     outnumbered strong disapprovers 36 percent to 22 percent. 
     Ardor and energy are switching sides.
       There are no instant cures, but there is one thing that 
     must be done fast: Democrats need to agree on a health bill 
     and sell it with enthusiasm and conviction. Their own turmoil 
     and back-stabbing are making what is a rather good plan look 
     like a failure while convincing political independents that 
     they are a feuding gang rather than a governing party.
       They have to focus in 2010 on immediate job creation and 
     long-term economic mobility while explaining how aggressive 
     measures to boost the economy now go hand in hand with 
     eventual deficit reduction.
       Congressional moderates must understand that their fate is 
     linked with the party's ability to govern, and grass-roots 
     progressives have to be less on a hair trigger to shout 
     betrayal. (I wish I knew what to do about Joe Lieberman.)
       For his part, Obama has not appreciated until recently how 
     closely he has been tied to Wall Street and the banks. He has 
     been too reluctant to underscore how much of Washington's 
     dysfunction has been pushed to new levels by the Republican 
     Party's decision to grind the Senate to a halt. He has tried 
     to make clear the size of the mess he inherited from Bush, 
     but has not sold the country on the extent to which he has 
     begun to clean it up.
       Americans may not be sold on anything until unemployment 
     starts dropping. Even then, Democrats will have a tough time 
     making the sale if the process that produced the health-care 
     bill comes to define the image of how they govern the 
     country. Democrats have every right to blame Bush for the fix 
     we're in. They can't blame him for the problems they're 
     creating for themselves.
                                  ____


                        More Talk, Less Support

                          (By George F. Will)

       Rushing to lock the nation into expensive health-care and 
     climate-change commitments, Democrats are in an 
     understandable frenzy because public enthusiasm for both 
     crusades has been inversely proportional to the time the 
     public has had to think about them. And the president pushing 
     this agenda has, with his incontinent hunger for attention, 
     seen his job approval vary inversely with his ubiquity. 
     Consider his busy December--so far.
       His Dec. 1 Afghanistan speech to the nation was followed on 
     Dec. 3 by his televised ``jobs summit.'' His Dec. 8 televised 
     economics speech at the Brookings Institution was followed on 
     Dec. 10 by his televised Nobel Peace Prize acceptance speech, 
     which was remarkable for 38 uses of the pronoun ``I''
       And for disavowing a competence no one suspected him of. 
     (``I do not bring with me today a definitive solution to the 
     problems of war.'' Note the superfluous adjective) And for an 
     unnecessary notification. (``Evil does exist in the world.'') 
     And for delayed utopianism. (``We will not eradicate violent 
     conflict in our lifetimes.'' But in someone's.) And for 
     solemnly announcing something undisputed. (There can be a 
     just war.) And for intellectual applesauce that should get 
     speechwriters fired and editors hired. (``We do not have to 
     think that human nature is perfect for us to still believe 
     that the human condition can be perfected.'' If the human 
     ``condition'' can attain perfection anyway, human nature 
     cannot be significantly imperfect.)
       Then on Dec. 13, he was on ``60 Minutes'' praising himself 
     with another denigration of his predecessor, a.k.a. ``the 
     last eight years.'' (Blighted by ``a triumphant sense about 
     war.'') When Attorney General Eric Holder announced last 
     month that five suspected terrorists would be tried in 
     federal courts, he said: ``After eight years of delay. . . 
     .'' When the US. Preventive Services Task Force made the 
     controversial recommendation that women should get fewer 
     mammograms, Secretary of Health and Human Services Kathleen 
     Sebelius said: This panel was appointed by the prior 
     administration, by former President George Bush.'' In 
     congressional testimony, Treasury Secretary Timothy Geithner 
     almost deviated from the script. He said the Obama 
     administration began after ``almost a decade''--slight 
     pause--``certainly eight years of basic neglect.''
       Abroad, the fruits of the president's policy of 
     ``engagement'' have been meager: Witness Iran continuing its 
     nuclear program and China being difficult about carbon 
     emissions. Here is a history lesson for an administration 
     that, considering itself the culmination of history, is 
     interested only in the past eight years of it:
       At a Vienna summit in June 1961, President John Kennedy, 
     fresh from his Bay of Pigs fiasco, was unnerved by the brutal 
     disdain of Soviet Premier Nikita Khrushchev, who considered 
     Kennedy callow. Britain's Prime Minister Harold Macmillan 
     astutely noted that Kennedy had ``met a man who was 
     impervious to his charm.''
       A person can be a novelty only once, and only briefly, and 
     charm, like any commodity, when used uneconomically, becomes 
     a wasting asset. All this is pertinent to the Senate health-
     care debate, now coming to a curious climax amid another glut 
     of careless grandiosity.
       Supporters of the Senate bill say it will insure the 
     uninsured. The Congressional Budget Office says 24 million of 
     the 46.3 million uninsured will remain so. Supporters say it 
     will lower aggregate and individual health-care spending. The 
     government's Centers for Medicare and Medicaid Services says 
     the nation's health-care spending and insurance premium costs 
     will increase.
       Today there are more independents than Democrats, more 
     independents than Republicans, and according to a recent 
     Gallup poll, independents approval of the Democratic-
     controlled Congress (14 percent) is lower than Republicans' 
     approval (17 percent). This is partly a function of the 
     majority party's health-care monomania. Consider what 
     happened recently in Kentucky.
       There a Republican candidate succeeded in nationalizing a 
     state Senate race. Hugely outspent in a district in which 
     Democrats have a lopsided registration advantage, the 
     Republican, by 12 points, won a seat in Frankfort by running 
     against Washington--against Nancy Pelosi, Harry Reid and 
     their health-care legislation.
       A CNN poll shows 36 percent of the public in favor of what 
     the Democratic Senate is trying to do to health care, 61 
     percent opposed. It is clear what the public wants Congress 
     to do: Take a mulligan and start over.
       So Republicans can win in 2009 by stopping the bill or in 
     2010 by saying: Unpopular health-care legislation passed 
     because of a 60-40 party-line decision to bring it to a 
     Senate vote. Therefore each incumbent Democrat is responsible 
     for everything in the law.
                                  ____


                     Dishing Out Some Shock on Debt

                           (By David Broder)

       The 34 names are familiar to anyone who has followed 
     economic policy in Washington for the past generation, one-
     third of them former chairmen or members of key committees of 
     Congress, seven of them former comptroller generals of the 
     United States, seven of them former directors of the 
     Congressional Budget Office and one of them--Paul Volcker--
     the former chairman of the Federal Reserve System and now an 
     adviser to President Barack Obama.
       Both political parties are well represented in their 
     number. But they came together this week as signatories of a 
     nonpartisan manifesto, essentially a stark warning to the 
     president and Congress and a plea for action on behalf of the 
     next generation.
       The United States, they unanimously said, is facing ``a 
     debt-driven crisis--something previously viewed as almost 
     unfathomable in the world's largest economy.''
       Under the impact of the worst economic calamity since the 
     Great Depression, the federal government ran a deficit of 
     $1.4 trillion this past year. The rescue effort was 
     necessary, but in 2009 alone, the public debt grew 31 percent 
     from $5.8 trillion to $7.6 trillion, rising from 41 percent 
     to 53 percent of gross domestic product (GDP).
       Unless strong remedial steps are taken, the debt is 
     projected to rise to 85 percent of GDP by 2018 and 100 
     percent four years later. Barely a dozen years from now. 
     these deeply experienced folks say, the American economy will 
     likely be in ruins.
       All of us have become accustomed to hearing lamentations 
     about the changes in the annual budget deficits, the gap 
     between federal revenues and spending in a particular year. 
     But this commission deliberately shifted its focus from the 
     deficit to the underlying debt.
       The reason was explained to me by Alice Rivlin, formerly a 
     director of both the Congressional Budget Office and the 
     Office of Management and Budget. ``Previously, when we were 
     worried about deficits, we could take comfort in the fact 
     that the debt was not very high relative to the economy,'' 
     she said. ``But now that debt has shot up. The cushion has 
     gone. If the same thing (a severe recession) happened again, 
     we wouldn't be able to borrow to deal with it.''

[[Page S13617]]

       In addition to robbing us of the flexibility to deal with 
     future crises, the rapidly rising debt level could push up 
     interest rates, threatening economic recovery, slow the 
     growth of wages, depress living standards, make the United 
     States even more dependent on foreign lenders and leave us 
     vulnerable to a shock wave if those lenders lose confidence 
     in our ability to repay the loans.
       These experts--writing under the auspices of the Peter G. 
     Peterson Foundation, The Pew Charitable Trusts and The 
     Committee for a Responsible Federal Budget--suggest a series 
     of steps.
       First, they want Obama in his State of the Union address to 
     urge Congress to join in a pledge to stabilize the debt, at 
     no higher than 60 percent of GDP, by 2018. This would require 
     actions by both Congress and the administration to start 
     reducing the projected annual deficits, which add to the 
     debt, That would make debt-management an economic priority 
     once the effects of the current severe recession have eased. 
     To assure the pledge is kept, those who signed this report 
     would ask Congress and the president to set up an enforcement 
     mechanism that would automatically reduce spending or 
     increase taxes when the debt target is missed in any year 
     between 2012 and 2018.
       This is stiff medicine, but the message of this report is 
     that temporizing on this issue poses such perils to the 
     nation's future that the risk is unacceptable.
       When Congress this week ducked its responsibility again by 
     deciding to enact a temporary, two-month increase in the debt 
     ceiling, the need for a shock treatment like this report 
     could not be plainer.

  Mr. ENZI. I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. CORNYN. Mr. President, I thank the Senator from Wyoming for his 
important leadership. He is absolutely right. As much as we would all 
like to be home with our families, especially at this time of year, 
this battle to inform the American people about what is about to happen 
to them is too important for us to simply give up or acquiesce to what 
the Senator from Iowa seems to think is inevitable.
  There is nothing inevitable about this. The only thing I think 
inevitable about it is, in light of the unpopularity of what is being 
jammed down the throats of the American people, there will be a day of 
accounting. We do not know when that day of accounting will be. Perhaps 
one of the first days of accounting will be election day 2010. I do not 
understand how people who are elected to represent their constituents 
can try to impose something that is so obviously unpopular with their 
constituents and expect somehow to be patted on the back and told: 
Well, you are right, you are smarter than we are. You do know better 
than we do what is better for our families and what we ought to be 
limited to when it comes to health care choices.
  I think that is an upside down way of looking at the world. Maybe 
that is the reason why we have such disparate views of what we are 
engaged in here. Clearly, on the other side of the aisle, they believe 
that government is the answer. They believe government can do a lot 
better than the private sector in providing choices and providing cost 
controls. Well, the only way government can do that, of course, is by 
price controls, which we have seen happen in Medicare and Medicaid, 
which have not worked very well. Here we are 5 days before Christmas, 
and we are going to be having a vote tonight at 1 a.m. on a 2,733-page 
health care bill that we got yesterday morning. We do not know what is 
in the bill. We are still reading, and apparently the Congressional 
Budget Office is still trying to figure out the impact of the bill. 
They have already had to correct one mistake because they are being 
asked to rush to judgment on this bill that will affect one-sixth of 
our economy and all 300 million Americans.
  But we do know this: We do know it will cut Medicare by $470 billion. 
Medicare is paid for by employers and the workers into a trust fund, 
and that trust fund is going to be pilfered, robbed, in order to create 
a brandnew entitlement program that the beneficiaries of that 
entitlement program never paid for as did the beneficiaries of 
Medicare. That is one part of this. We also know it is going to 
increase taxes by $518 billion.
  We already know President Obama's promise as to people making less 
than $250,000 a year will not be kept under this bill, and that this 
bill, according to the National Federation of Independent Business, 
will impact small businesses and their ability to create jobs and 
retain workers during one of the worst recessions we have had in this 
country.
  Then, of course, we know this bill--without the phony accounting 
gimmicks, such as implementing a bill 4 years into a 10-year budget 
window--will actually fail in universal coverage. It will leave 23 
million people uninsured, and it will cost roughly $2.5 trillion, and 
it will increase the cost of premiums for people who already have 
insurance.
  What is so disgusting about this process is, this exactly confirms 
the most cynical view that the American people have about Congress and 
Washington, DC. Rather than a change in that process--one that is more 
transparent, one in which everybody's views are considered, and where 
we try to come together in a bipartisan consensus for a solution--this 
is going to be passed strictly along party lines by a political party 
and by their leadership who apparently care more about chalking up a 
victory, albeit a Pyrrhic victory, rather than listening to their 
constituents. The American people want Washington to start over again. 
Fifty-six percent of voters in this most recent poll said they want us 
to stop this bill and start over.
  We know this process is a product of deals struck behind closed doors 
with special interest groups and their lobbyists. The pharmaceutical 
industry got 24 Democrats to switch their votes on reimportation. What 
is that all about? To preserve a special deal cut behind closed doors? 
The insurance industry will get $476 billion of tax money from this 
bill. Then other parts of the health care community are going to be 
exempted from cuts by the payment advisory board because they cut their 
deal behind closed doors. We know this bill is being attempted to be 
jammed through when most people are spending time with their families 
because of the Christmas season.
  Even the distinguished majority whip, last week, said: I am in the 
dark almost as much as other Senators are. He said: I am in leadership. 
So this bill has been written with a small group of people behind 
closed doors, including the Senator from Nebraska, who spent 13 hours--
13 hours--on Friday behind closed doors with Democratic leadership and 
White House officials. In the meantime, we are left completely in the 
dark as to what is in this bill other than what we could glean in the 
limited time we have been given.
  After the ill-fated stimulus bill passed in the first part of the 
year, I remember we got that bill about late Thursday night, and then 
we were asked to vote on it less than 24 hours later--less than 24 
hours later. We--like that--spent $1.1 trillion, including the 
interest, in this stimulus bill that was supposed to keep unemployment 
below 8 percent. Well, we know how well that worked with unemployment 
going as high as 10.2 percent and now at 10 percent. One thing the 
American people told us after that is, they want us--well, I almost 
hate to say it, it seems so simple and straightforward--they want us to 
read the bill. They want us to understand the bill. They want to be 
able to read it and understand it before they give their consent to our 
voting for it. They want to know what the impact is going to be on 
their coverage. Is it going to raise their taxes? Is it going to raise 
their premiums? Is it going to cut into their Medicare benefits? If you 
are a Medicare Advantage beneficiary, we know it will for 11 million 
Americans, including half a million in Texas.
  Then there was this discussion, and I guess this is all for show too. 
This was not, obviously, a sincere effort where we had eight Democrats 
who wrote a letter on October 6 to the majority leader and said they 
want the bill 72 hours before the first vote. Well, guess what. This 
historic vote we are going to have at 1 in the morning will occur 40 
hours, roughly, after we got the bill. So much for 72 hours. We know 
the CBO, the Congressional Budget Office, score, the cost, their 
estimate, even with the phony assumptions that are included in this 
bill, will only be available for 37 hours.
  Then we find out there are other sweetheart deals which makes this 
begin to stink to high heaven--things such as special legislative 
language saying the State of Nebraska--the State of Nebraska--gets a 
special pass from new Medicaid mandates. Vermont and Massachusetts have 
special deals. Then there is a $100 million earmark

[[Page S13618]]

for an unknown hospital. Boy, I cannot wait to find out what that is 
about. Those are just some of the sweetheart deals we know are in these 
bills, and I am sure there are more we will find out about.
  This process has gone too fast and gone too far off track. It reminds 
me of what Rahm Emanuel, the President's Chief of Staff, said when they 
jammed through the stimulus bill earlier this year. He said: A crisis 
is a terrible thing to waste.
  It is one thing if we were acting in response to a crisis in a 
responsible manner, but what this is going to do is make it even worse, 
as the Senator from Wyoming pointed out.
  I think people listening--the 56 percent and growing number of 
Americans who are concerned about this deal--are wondering: Are the 
politicians in Washington more interested in jamming this through or 
getting it right?
  Senator Olympia Snowe from Maine, a member of the Finance Committee--
the one Republican to vote for the Finance Committee bill--said she 
will not vote for cloture on this bill at 1 this morning because this 
is simply an arbitrary deadline. Oh--and guess what--most of the 
provisions do not kick in for 4 years. So why are we doing this 
literally in the dead of night on a phony timetable?
  We know according to experts, such as the dean of the Harvard Medical 
School--he said:

       In discussions with dozens of health-care leaders and 
     economists, I find near unanimity of opinion that, whatever 
     its shape, the final legislation that will emerge from 
     Congress will markedly accelerate national health-care 
     spending rather than restrain it.

  You do not have to go to Harvard to figure that out. Just go to 
Houston, TX. A small business owner in Houston wrote to me and said:

       The proposed Health Care bill is going to have a negative 
     impact on my business because the cost of employee health 
     insurance will go up.
       . . . I don't believe what some are saying that costs will 
     go down. . . . This bill does not make economic common 
     sense.

  Those are true words from a small business owner in Houston, TX, who 
I suspect has a greater understanding of what this bill will be than 
some of the so-called experts here inside the Beltway.
  We know from the Congressional Budget Office, though, that the 
premiums for an average American family under this bill will go up 
$2,100 a year for those purchasing insurance on their own in the so-
called individual market.
  An independent study talked about premiums in Texas specifically and 
said premiums in Texas, for those who purchase insurance on their own, 
will go up for 61 percent--61 percent--of Texans purchasing insurance 
on their own, that their premiums will go up under this bill. What in 
the world are we doing? Under the Reid bill, a family of four in 
Houston would see their premiums more than double to $1,352 a month.
  I find it supremely ironic that perhaps the next vote we will have 
here on the Senate floor, after this health care bill, is going to be a 
vote to increase the statutory debt limit because Congress has maxed 
out its credit card. Currently our credit limit is $12 trillion, and 
now that is not enough because of unwise and reckless spending such as 
that reflected here in this bill. I find that supremely ironic. But I 
suspect there are a lot of Americans who find it very sad and even 
scary.
  We know in a time when people are struggling to keep their job, when 
businesses are struggling to keep their employees rather than have to 
lay them off and make the unemployment statistics even worse, when 
people are losing their home because they no longer have a job, this 
bill will be a job killer.
  The only way this is going to be paid for--the pay-or-play mandates 
put on businesses--is for businesses to take some of the money they 
would have used to hire new employees and pay this new punitive tax 
being imposed by the Federal Government.
  Businesses in Texas know this is true. The Lubbock Chamber of 
Commerce said:

       An employer mandate would be a ``job killer'', raising the 
     costs of maintaining a workforce. . . .
       . . . small businesses and our consumers will be the ones 
     who suffer. . . .

  Then there is this Medicaid expansion that Senator Enzi from Wyoming 
talked about. There is an unfunded mandate here because Texas did not 
get the sweetheart deal that Louisiana or Nebraska or Vermont or 
Massachusetts got--an unfunded mandate of $21 billion over 10 years. So 
not only are people's Federal taxes going to go up, they are going to 
wreck the State budget too by pushing aside other priorities such as 
public education and the like--totally irresponsible.
  Then there is a so-called Nelson amendment on abortion that was 
supposed to strike a ``compromise.'' Well, one of my other 
constituents, Cardinal Daniel DiNardo, who leads Texas' largest 
archdiocese and is chairman of the U.S. Conference of Catholic Bishops' 
Committee on Pro-Life Activities, said this:

       [T]he legislation will be morally unacceptable ``unless and 
     until'' it complies with longstanding current laws on 
     abortion funding such as the Hyde amendment. . . .
       . . . .This legislation should not move forward in its 
     current form. It should be opposed unless and until such 
     serious concerns have been addressed.

  I am staggered at what we are about to witness here, at the sheer 
irresponsibility of the way this is being done, with artificial 
deadlines, votes in the dead of night, bills cooked up behind closed 
doors as special deals jammed down the throats of the American people 
who do not want it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. THUNE. Mr. President, I appreciate the comments of my colleague 
from Texas, and my colleague from Wyoming prior to that. Many have come 
down here, as our colleagues on our side have, day after day, time 
after time, and continue to point out what we believe is wrong with the 
approach that is being taken by the majority, and also pointing out 
where we would do things differently.
  Remember, this is the first bill: 2,100 pages long; $1.2 billion per 
page; $6.8 million actually per word. Then yesterday, we got the 
managers' amendment: another 400 pages. You add yet another amendment 
that is going to go on this stack, and you are talking about 2,700 
pages of bill language.
  What I think is interesting--and I see a pattern emerging here almost 
every single day--it is like deja vu all over again. The other side 
comes down here and talks about the need for health care reform, which 
we all concede. We all believe we need to reform health care in this 
country. We all hear from our small businesses. We all hear from 
individuals and families who are having a difficult time keeping up 
with the high cost of health care. So that is something on which there 
is broad agreement on both sides. Yet that seems to be sort of the MO 
for the other side, to come down here and talk about how we need to do 
health care reform. We agree with that.

  The other strategy is to come down here and attack Republicans for 
not having their own ideas. We have been trying to offer amendments to 
this bill forever. We had several amendments offered today. We asked 
consent to bring up amendments, to get them pending, to get them voted 
on. They were blocked by the other side. We have full alternatives to 
the current bill. Senator Burr and Senator Coburn have an alternative, 
a comprehensive alternative they would like to offer, being blocked by 
the other side.
  So the recurring pattern that has emerged day after day in the debate 
in the Senate is Democrats come down here and talk about how bad the 
current system is and point out examples of those who are falling 
through the cracks in the current system. Exactly. We agree with that. 
We have acknowledged there is a problem. They come down here and attack 
Republicans for not having alternatives. In fact, the Senator from 
Rhode Island this afternoon essentially said that Republicans have been 
coming down here and telling lies.
  What the Republicans have been doing day after day after day is 
coming down and talking about the bill and the impact the bill would 
have on health care delivery, the impact the bill would have on the 
economy, the impact the bill would have on small businesses and their 
ability to create jobs. We have been talking about the Congressional 
Budget Office report that describes the cost of the bill and goes into 
great detail about how it will impact individual families as well as 
the overall cost of health care in this

[[Page S13619]]

country. We have come down here day after day to talk about the CMS 
Actuary's report, the Center for Medicare Services, about the cost of 
the bill and how it would impact the cost of health care in this 
country. So we continue to come down here and talk about the bill.
  The other side--the one thing they don't do is they don't come down 
here and talk about the bill. I don't hear Democrats coming down here 
and offering full-throated defenses for this bill, because the bill is 
indefensible. It is 2,700 pages, and it doesn't do anything to lower 
the cost of health care, according to the Congressional Budget Office.
  So we come down here day after day and talk about the Congressional 
Budget Office report, come down here and talk about the CMS Actuary's 
report. They come down and talk about how bad the current system is, 
say this is going to fix it, but then when they are challenged on the 
CMS Actuary's report and the Congressional Budget Office report, they 
can't defend that.
  What they should be doing instead of accusing the Republicans of 
telling lies and attacking Republicans is accusing the CMS Actuary and 
the Congressional Budget Office. They ought to be coming down and 
attacking them because all we are doing is pointing out the facts as 
they pertain to the current bill that is before the Senate, this 2,700 
pages right here.
  What I would like to point out are some of the promises that have 
been made by the President and by Democrats with regard to this bill.
  The President made it very clear, when he was running for President:

       I can make a firm pledge: Under my plan, no family making 
     less than $250,000 will see their taxes increase--not your 
     income taxes, not your payroll taxes, not your capital gains 
     taxes, not any of your taxes.

  Yet the Joint Committee on Taxation analysis--by the way, that is 
another report, and maybe they ought to be coming down here and 
attacking that report rather than attacking Republicans who are quoting 
from the report. The Joint Committee on Taxation analysis shows those 
people earning less than $200,000 a year will see a tax increase under 
the Reid bill. Even after you account for taxpayers who are going to 
receive the premium tax credit, 24 percent of tax returns under 
$200,000 will, on average, see their taxes go up. There are 42 million 
Americans who are going to see higher taxes who make less than 200,000 
a year. So the no tax increase for the middle class we would have to 
say is a broken promise.
  The second thing they say is that it will lower health care costs. We 
all know--and the President said this as recently as June 23:

       And I've said very clearly: If any bill arrives from 
     Congress that is not controlling costs, that's not a bill I 
     can support. It's going to have to control costs. It's going 
     to have to be paid for.

  So the Democrats have shifted the benchmarks about what that means 
and what impact it is going to have on America's health care premiums.
  The President's first promise, going back to the campaign, was that 
the typical family's premiums would go down by $2,500 per year--a 
$2,500-per-year reduction, according to the President when he was 
campaigning--and that everybody would be covered. Well, we all know 
that even this bill, which is touted as expanding coverage--well, it 
does expand coverage. It puts 15 million more people on Medicaid; that 
is one way it expands coverage. But under this bill, there are still 23 
million Americans who don't get health insurance coverage. So the 
President's promise that he was going to cover everybody, that he was 
going to lower health care costs, again, you would have to say it is a 
broken promise.
  I want to show my colleagues how this would impact a typical family's 
insurance costs. If you are a family who is paying $13,300 today and 
you are getting your insurance in the large employer market--in other 
words, if you work for a large employer, you get it in the large group 
market--and you are looking at the year 2016, you are going to be 
paying over $20,000 a year for insurance. That doesn't lower health 
care costs; that increases health care costs.
  What they will say is: Well, this is better than it would have been 
if we had done nothing. The honest truth is that if we do nothing, we 
still would have 5 percent to 6 percent increases year over year in the 
cost of health insurance for most Americans whether you get your 
insurance in the large group market or the small group market. You are 
still going to have a 5- to 6-percent increase in the cost of your 
health insurance if this bill is passed. You don't see any improvement. 
The best you can hope for is the status quo, which is year-over-year 
increases that are twice the rate of inflation. That is the impact on 
an average family. So the whole notion that this is going to lower 
health care costs just doesn't pass the truth test, according to the 
Congressional Budget Office.
  The next promise that was made is that it would bend the cost curve 
down. What is interesting about that--and, of course, this was the 
President in the joint session of Congress on September 9 of this year:

       The plan I am announcing tonight . . . will slow the growth 
     of health care costs for our families, our businesses, and 
     our government.

  Well, according to the Congressional Budget Office, again--and if my 
colleagues want to attack us, let's have them attack the Congressional 
Budget Office, the CMS Actuary, the Joint Tax Committee, because 
everything I am saying tonight I am quoting from those reports. 
According to the Congressional Budget Office analysis of the Reid 
amendment, the cost curve bends up, not down. In fact, in the first 10 
years, the net increase would be about $200 billion a year in overall 
health care costs.
  This is an outdated chart, I have to say, because this is the chart 
we used before this amendment was added. This is the managers' 
amendment, the 400-page amendment I alluded to earlier that was just 
added to the 2,100 page bill. In the 2,100 page bill, the Congressional 
Budget Office said the cost of health care in this country is going to 
go up, not down, by $160 billion.
  So what is the cost of doing nothing? The blue line represents the 
cost of doing nothing. That is Federal health care spending today and 
what it is projected to be into the future if we do nothing. The red 
line, according to the Congressional Budget Office, represents what 
health care costs would do if the Reid bill passes. The ironic thing is 
that with the 400-page amendment that was added yesterday, this number 
gets bigger, not smaller.

  I said this is an outdated chart. This only represents a $160 billion 
increase in the cost of health care. According to CBO's analysis on the 
amendment, it increases the cost of health care by $200 billion. The 
CMS Actuary came to a slightly different conclusion. They said health 
care costs would go up in the next 10 years by $234 billion. So you 
have all the experts--the Congressional Budget Office, the CMS 
Actuary--all coming to the same conclusion; that is, health care costs 
go up, not down. So we would have to say that is yet another broken 
promise.
  The other thing that has been said throughout the course of this 
debate is that you could keep the insurance you have. In his joint 
session of Congress address on September 9, the President said:

       Nothing in our plan requires you to change what you have.

  Well, interestingly enough, according, again, to the Congressional 
Budget Office, between 9 million and 10 million people who would be 
covered by an employment-based plan under current law would not have an 
offer of such coverage under the proposal, the Reid proposal. So we 
have 10 million people, according to CBO, who are going to lose their 
employer-based coverage, and you also have the 11 million people who 
get Medicare Advantage which is being cut. They aren't going to be able 
to keep what they have. You can argue that maybe their benefits are too 
rich today. That has been the argument made by the other side. But you 
can't say they are going to be able to keep what they have. If you are 
going to cut $118 billion out of Medicare Advantage, the 11 million 
people in this country who get Medicare Advantage are going to see 
their benefits cut. They are not going to be able to keep what they 
have.
  In fact, the Senator from Pennsylvania, Mr. Casey, said recently on 
these Medicare Advantage cuts:

       We are not going to be able to say if you like what you 
     have you can keep it, and that basic commitment that a lot of 
     us around here have made will be called into question.

  Eleven million people who get Medicare Advantage aren't going to be 
able

[[Page S13620]]

to keep what they have, nor are the 10 million people, according to the 
CBO, who are going to lose their employer-based coverage if this plan 
passes--another broken promise.
  No cuts to Medicare--we all know about that. We talked about that for 
about a week here and offered amendments to get rid of the Medicare 
cuts.
  The President said when he was running for office:

       I want to assure [you] we're not talking about cutting 
     Medicare benefits.

  He reiterated that in his State of the Union Address.
  This bill, as we know, cuts $470 billion out of Medicare in the first 
10 years, and when it is fully implemented, it cuts over $1 trillion 
out of Medicare. In the first 10 years, $135 billion out of hospitals; 
$120 billion, as I said earlier, out of Medicare Advantage; $15 billion 
out of nursing homes; $40 billion out of home health care; and $7 
billion out of hospice care--these are all Medicare cuts. These are all 
going to affect people in a very real way whether you get Medicare 
Advantage or whether you are a provider.
  These are just the facts of this legislation. I am talking about the 
bill. I am talking about the bill, and I am talking about what the 
experts have said about the bill. So we would have to say, another 
broken promise.
  The first of the last two here: open and transparent process.
  We all know that when the President campaigned, he said:

       We'll have the negotiations televised on C-SPAN so that 
     people can see who is making arguments on behalf of their 
     constituents and who is making arguments on behalf of the 
     drug companies or the insurance companies. And so that 
     approach I think is what is going to allow people to stay 
     involved in this process.

  That was what the President said when he was campaigning.
  We all know this bill, almost in its entirety, has been written 
behind closed doors. We just saw this 400-page amendment yesterday. It 
was interesting; earlier--it was last week, I guess--in a discussion on 
the floor between Senator McCain and Senator Durbin, Senator Durbin, 
the No. 2 Democrat in the leadership on the Democratic side, said:

       I would say to the Senator from Arizona that I am in the 
     dark almost as much as he is and I am in the leadership.

  Even some of the leaders on the other side--there are only three 
people, four people sitting in a room writing this bill, and what is 
the most offensive thing about this came out yesterday when we found 
out that the Senator from Nebraska had carved out a special sweetheart 
deal with a goody for his State that all the rest of the States get to 
pay for. He gets his Medicaid for his State paid for entirely by the 
Federal taxpayers, and no other State gets that particular arrangement. 
So the Federal taxpayers in every other State, in my State of South 
Dakota--Nebraska borders South Dakota. I think the people in our part 
of the country are going to say this really smells. This is the way 
they are doing business in Washington, DC? This is business as usual.
  The final thing I will say is this: The argument was that it won't 
add a dime to the deficit. Well, here I give the Democrats a little bit 
of credit because they did raise taxes enough and cut Medicare enough 
that they could actually raise quite a bit of revenue. But saying it 
won't add a dime to the deficit assumes there isn't going to be any 
payment to physicians. The physicians' fee fix, which takes about $250 
billion, was completely cut out of here. They are going to have to fix 
that at some point. So we are not counting that.
  We are counting $72 billion from a program called the CLASS Act which 
the chairman of the Senate Budget Committee, the Democrat from North 
Dakota, Kent Conrad, called a ``Ponzi scheme of the first order,'' 
something Bernie Madoff would be proud of. The CBO says of the CLASS 
Act:

       The program would add to future budget deficits in large 
     and growing fashion.

  Even the Washington Post has editorialized about this, and they came 
to the same conclusion:

       The CLASS Act is a gimmick designed to pretend that health 
     care is fully paid for.

  It goes on to say:

       The money that flows in during the 10-year budget window 
     will flow back out again. These are not savings that can 
     honestly be counted on the budget sheet of reform.

  Then we all know we have 10 years of revenue coming in, with only 6 
years of spending in the first 10 years. Phony budgeting, gimmicks--all 
of these things are used to mask the true size of the cost of this 
program: $2.5 trillion over 10 years when it is fully implemented.
  So if you do not use the gimmicks, if you do not use the CLASS Act, 
if you discount the doc fix and don't count that in there, sure, you 
can make it look like it doesn't add to the deficit, but the American 
people know better, and they have come to the conclusion this is going 
to add to the deficit. Even David Broder, who is the Pulitzer Prize 
winner for his commentary, said:

       While the CBO said that both the House-passed bill and the 
     one Reid has drafted meet the test by being budget-neutral, 
     every expert I have talked to says that the public has it 
     right. These bills, as they stand, are budget-busters.

  This is going to add to the deficit. These are all broken promises. 
That is why this bill needs to be voted down. We need to vote it down 
tonight. I am hoping there is a courageous Democrat or two who will 
join us and defeat this bad legislation and move forward to something 
we can pass that will meaningfully lower health care costs for the 
American people.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas is recognized.
  Mr. BROWNBACK. Mr. President, I appreciate the chance to hear my 
colleague from South Dakota speak and talk about the bill. Statements 
he has made I am in agreement with. This is a huge bill the American 
public doesn't want. Gallup polling finds 61 percent of the American 
public oppose the Senate Democratic health care bill. In Kansas, I find 
widespread opposition--much higher than that. You can look at these 
numbers and quickly see why. Just one of the pieces of it--the Medicare 
cuts--will hurt Kansas. There is a 63.7-percent cut in Medicare 
Advantage. The benefits will affect more than 1 in 10 of Kansas 
Medicare beneficiaries. Those cuts are to the point that the program 
will no longer exist.
  There is $1.5 billion in cuts to Kansas hospitals--many of our rural 
hospitals operating on the margins, on the edge. They get cuts. There 
is $239.8 million in cuts to home health agencies. This is going to put 
over 60 percent of them out of business in a 10-year timeframe. They 
don't like this. Great Christmas present.
  There is an 11.8-percent cut in hospice payments. Hospice? Of all 
things to cut. It is a program that has been helpful to so many people 
late in life, and it is being cut. There is $124.2 million in cuts to 
skilled nursing facilities. All of those are things being cut directly 
to Kansans, directly to people who benefit under current programs, and 
this is all to start a new entitlement program--cuts Medicare and 
raises taxes, neither of which we can afford. Medicare is already 
scheduled to go bankrupt, as we well know, so this is like writing a 
big fat check on an overdrawn bank account and saying we will come up 
with the money. It is not going to work. It is going to take money from 
Medicare. It is going to raise taxes in a weak economy. It is going to 
hurt overall.
  One of the issues that has come down to be one of the final pieces of 
this that the Democrats have put forward is the issue of funding of 
abortion. We have had 30 years of agreement in this body and in this 
Capitol that the Federal Government would not fund abortions other than 
in cases of rape, incest, and saving the life of the mother. That was 
it.
  Thirty years ago, the Hyde amendment was put in place. It said we 
would not fund abortions. There was a big debate in the country about 
abortion, but there has been no debate about funding of abortion. We 
said we are not going to fund it. Taxpayers should not be funding 
abortions. If people want to do that, that is their choice on elective 
abortion. We are not going to fund it.
  In this bill, we are going to break that amendment for the first time 
in 30 years.
  What the President said in the joint session of Congress is no longer 
true. This will not be true if this passes in this bill. What the 
President said in the joint session of Congress:

       One more misunderstanding I want to clear up.

  I was listening.


[[Page S13621]]


       Under our plan no Federal dollars will be used to fund 
     abortions, and Federal conscience laws will remain in place.

  I point out that he said ``no Federal dollars'' and ``Federal 
conscience laws will remain in place.'' He said he wanted to clear up 
the misunderstanding. This is not the case.
  We just got the managers' amendment recently, so this has been 
feverishly where we have had to go through what is actually in the 
managers' amendment. What you will find is that all the major pro-life 
groups are opposed to the managers' amendment because it does fund 
abortion. I will go through the specifics.
  Bart Stupak a Democratic Member on the House side. He has been the 
lead guy on the House side to say we should continue with the Hyde 
language. There are disputes about abortions. There is not a dispute 
about the funding of it by taxpayer money. So Bart Stupak has led a 
group of Democratic Members on the issue overall and said we are going 
to pull it out. It is not in the House bill, but now it is in the 
Senate bill. He says:

       Not acceptable . . . a dramatic shift in Federal policy 
     that would allow the Federal Government to subsidize 
     insurance policies with abortion coverage.

  That is what Bart Stupak says about it. What do some of the other 
pro-life groups say about what is in the managers' amendment. These 
groups track this stuff. The U.S. Conference of Catholic Bishops, which 
wants a health care bill--I think they are a pretty fair reviewer of 
this because they want a health care bill to go through, but they are 
committed to life. They do not want taxpayer money to go to end a 
child's life. They are opposed to that--completely opposed to that on 
moral grounds, saying this is the highest moral order that has to be 
protected. Human life has to be protected, and they say, of this 
legislation, the managers' amendment:

       This legislation should not move forward in its current 
     form. It should be opposed, unless and until such serious 
     concerns have been addressed.

  This is on the abortion language. Now let's look at the National 
Right to Life Committee. The National Right to Life Committee--they are 
the gold standard of review. They have been looking at this issue and 
tracking it since Roe v. Wade was passed. They are committed to life at 
all stages, in all places, believing that life is sacred; it is unique; 
it is beautiful; and it should be protected. What do they say about the 
managers' amendment? They say:

       Light years removed from the Stupak-Pitts amendment that 
     was approved in the House of Representatives on November 8 by 
     a bipartisan vote of 240-194.
       The new abortion language solves none of the fundamental 
     abortion-related problems with the Senate bill, and it 
     actually creates some new abortion-related problems.

  Let's go through the specifics, because I think what we should do is 
go through the specifics of this bill and look at what are the specific 
areas of concern. Many of the abortion changes that Senator Reid 
smuggled into his managers' bill behind closed doors make the bill 
worse than ever before. It violates the Hyde amendment and Hyde 
principles set in precedent through all other Federal administered 
health programs like Medicare and Medicaid. It preempts State laws and 
conflicts with some existing laws on abortion.
  Third is the so-called firewall. There is a firewall provision 
between Federal and private funds. That is inconsistent with the Hyde 
and Stupak-Pitts amendment. The firewall language is not very 
fireproof. It is a mere accounting gimmick, where they put the money in 
one pocket and pay for abortions from the other. It is still money that 
goes through the Federal Government to the Federal Government to pay 
for abortions.
  Fourth, it departs from the way the Federal Employee Health Benefit 
Program is governed with respect to private plans covering abortion, so 
it changes that.
  Fifth, it allows executive branch officials to require private health 
plans to cover abortions simply by defining them as ``preventive 
care.''
  We have debated this piece calling abortions preventive care in 
committee and on the Senate floor. Both times we have tried to take 
that out and say preventive care does not include abortions, and we 
have not been able to get that definition to the point where abortion 
can still be called preventive care. This is the Mikulski amendment, 
which mandates that all plans cover abortion by defining abortion as a 
preventive service. If you just define it as a preventive service, you 
can pay for it. But it is still being paid for then, and that is in 
this bill.
  No. 6, it inserts text of the Indian health reauthorization bill. 
That passed last year and didn't get signed into law. It passed this 
body. That does not contain the Senate-passed Vitter amendment to 
permanently prohibit coverage of elective abortions in the federally 
funded Indian health programs.
  And, No. 7, basic conscience protections, like the Weldon language, 
are not included in the Senate version. There are other problems, but 
these are just seven of the most egregious. I can't imagine that people 
across the country--certainly people across my State and other places, 
such as Virginia, Missouri, California, Wisconsin, or anyplace else 
would agree that the Federal Government should break with longstanding 
policy against federally funded abortions, but that is exactly what has 
happened and what is in this bill.
  Abortion is not health care. Why is it even in this bill at all? The 
President himself said that at the joint session of Congress.

  At the end of the day, the vote for cloture is an affirmative vote 
for the Federal funding of abortion. There is no way around that fact. 
Some people on the Democratic side, particularly Senator Nelson of 
Nebraska, with whom I have been working closely on this issue, want to 
keep abortion out of this bill. I believe there are huge flaws still in 
it. He has been fighting to keep abortion out of it. He said this:

       Taxpayers shouldn't be required to pay for abortions.

  That is his statement on the issue. He says it should not be in 
there. He worked to try to get this out. I think there are still 
enormous flaws and holes in this.
  If we start the funding of abortions, the last time we did fund them, 
over 300,000 were paid for by the Federal Government in a 1-year period 
of time through Medicaid Programs; 300,000 annually were funded from 
1973 to 1976. How many are we looking at now if we start down this 
road?
  We need one Democrat in the Senate who will stand and say this is not 
taking care of the unborn. This is breaking the Hyde language that many 
on the other side have supported for years, saying they are pro-choice, 
but they don't think the Federal Government should fund abortions. This 
breaks the Hyde language in the six ways I mentioned and, seven, it 
does not provide for conscious clause protection so someone, maybe they 
are in a Catholic hospital and they do not agree with providing 
abortion services. They would be required to do things in certain 
circumstances--maybe that is not one of them--but certain circumstances 
to which they would not agree.
  This is a big part of this debate, and it has certainly elevated it 
here. The American public does not want the abortion language in the 
bill. Mr. President, 6 in 10, in a CNN survey, say they do not want it 
in this bill. In fact, one-quarter of House Democrats voted for the 
Stupak-Pitts amendment. That is the compromise that continued on the 
Hyde principle and said we will not fund this.
  National Right to Life, I mentioned earlier, goes through some of the 
specifics on this language.
  I will just say, where we are right now all seems so odd to me. We 
are in the final days of Advent season. We are here when we should be 
home with our families. I am missing a lot of the celebration of the 
Christmas season. This is the final days of Advent. Advent is the 
season of anticipating the birth of a child. It is a season of joy, a 
season of happiness. You are looking forward to the day of the birth of 
Christ, December 25. That is the season we are in right now. It is a 
season of joy. How sad we might see the end of lives of children in 
this bill, in this season of joy. It does not have to be that way. It 
should not be that way.
  But now this is, I believe, the central issue in this health care 
debate. If this body passes this bill--and I do not think it should--it 
goes back to the House of Representatives, where Congressman Stupak and 
a group of others

[[Page S13622]]

have said they will not support the language if it has the abortion 
language.
  The issue of funding abortion has now become a central issue in the 
health care debate. It should not be there. It is wrong. It is opposed 
by the American public. I ask my colleagues on the other side, please, 
please, please take this out. It does not belong here. It is not the 
thing to do. It is harmful. It is hurtful to the country, and it does 
not belong anywhere near the health care bill.
  I yield the floor.
  Mr. McCAIN. Mr. President, much has been spoken about the need for 
Americans to access safe and affordable drugs and therapies. We know 
that the pharmaceutical industry has cut numerous deals to protect 
their interests and line their pockets at the expense of the taxpayers, 
including seniors and the uninsured. I don't think it is a secret that 
PhRMA cut a deal with the White House to block legislation allowing for 
the importation of safe and affordable prescription drugs from Canada 
and other approved countries. And it seems that PhRMA cut a deal to 
line their pockets by locking in more expensive brand drugs in the 
Medicare Part D doughnut hole. Finally, it appears that PhRMA made sure 
that their profitable biologic medicines are protected for 12 years 
from competition from FDA-licensed safe and affordable biosimilars.
  This legislation has so many sweetheart deals that we probably 
haven't even found them all yet.
  Today, I am filing an amendment that improves the biologic pathway in 
the bill. It creates a fair pathway for competitive biologics that 
balances incentives for innovation with patient access to safe and 
affordable biosimilar medicines.
  It is a fact that the cost to discover biologic therapies can be 
astronomical. That, unfortunately, leads to some patients being unable 
to afford the needed therapies. Patients benefit from continued 
innovation but they also benefit from safe and affordable competitive 
biologics that may not occur under the proposal in the Reid bill. My 
amendment ensures that incentives to innovate remain in the law.
  It is accepted that biologic therapies are different than chemical 
medicines. That is why there needs to be a unique structure for the 
approval and licensure of biosimilar medicines.
  In creating a pathway to competitive biologics we need to strike a 
balance that provides patients greater access to more affordable, safe 
biologic therapies and ensures innovation continues to thrive.
  Today, biologics have a monopoly for years and years. I am worried 
that the underlying legislation would allow biologics to game the 
system and block competition beyond the 12 years provided in the bill. 
Some have argued that brand biologic companies will be able to stack 
12-year periods of exclusivity on top of each other. My amendment 
addresses this issue.
  My amendment also addresses patient safety issues. FDA has very 
specific recommendations that I wanted to recognize in this pathway. 
Access to safe, competitive biologics is only as good as the therapies 
are safe. My amendment seeks to ensure the pathway for generic biologic 
therapies is as safe and effective as the original product.
  Highlights of my amendment include 10 years of initial data 
exclusivity for the original product--a decade is enough. Reid--Hatch/
Enzi/Hagan, has 12 years of data exclusivity. It also includes two 
extra years of data exclusivity if the manufacturer conducts additional 
research and finds new indications for the original medicine. My 
amendment also incentivizes additional innovation and encourages second 
generation therapies to come to market as soon as possible rather than 
companies waiting until the end of the initial exclusivity period to 
introduce new versions. Additionally, prescribing physician must 
authorize therapeutic appropriateness for a biosimilar and finally, the 
competitive biologic manufacturer is required to ensure the biosimilar 
medicine is safe and effective through clinical studies.
  My goal in introducing this amendment is to ensure patient access to 
safe and competitive biosimilar medicines, to guarantee innovation 
thrives and to bring down cost while ensuring safety and innovation.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, in a few hours, we in the Senate by our 
votes will be able to clear the way for the United States at long last 
to join every other industrial nation in the world and declare that 
health care is a right.
  I thank our leader, Senator Reid, for his extraordinary courage and 
leadership during these many weeks as we have been able to bring 
together the necessary votes to move this legislation forward.
  I thank Senator Baucus, Senator Dodd, and many of my colleagues who 
have worked on so many provisions that are in the managers' amendment 
and are in the underlying bill.
  For 23 years, I have been in Congress, and for 23 years I have been 
supporting universal coverage. I believe every American should have 
access to affordable, quality health insurance and health care. By our 
votes later on this evening, we will have a chance to take a giant step 
forward in accomplishing that goal.
  As I pointed out, the United States, although we spend more than any 
other nation in the world by far on health care, whether you want to do 
it in absolute dollars or on a per capita basis, we spend more than any 
other nation. Yet we are the only industrialized nation in the world 
that does not provide universal insurance and universal care.
  Americans have to make a difficult choice. If someone happens to be 
walking on the ice tonight and does not have health insurance and they 
fall and hurt themselves, they have to make a decision whether their 
arm or leg hurts badly enough to go see a doctor or perhaps to have an 
x-ray to see whether a bone has been broken because they do not have 
the money to pay for that type of care.
  Many people go without checkups because they cannot afford the cost 
of seeing a doctor today. They do not have insurance or their insurance 
does not cover what they need.
  Many people who are on medications have to decide whether they can 
split their pills to make their dollars last a little bit longer 
because they literally are choosing between taking their medicines or 
having food on the table in the United States of America in 2009, the 
wealthiest nation in the world.
  We have a chance to change that situation. One can argue this issue 
on many grounds, and I have. One can argue we need to bring down the 
growth rate of health care costs, and I certainly believe that or one 
can argue that we need to provide more people with health insurance or 
we need to take on the health insurance industry. But I think the most 
persuasive argument for passing this legislation is the moral argument. 
It is the right thing to do. It is what America stands for.
  I met with some students this week, and we were talking about the 
bill. These were high school students. They said it is the right thing 
to do, and they are right. This is the right thing for our Nation to 
do, to make sure everybody has access to affordable health care.
  In Maryland, this takes on a special note because I know my 
colleagues have heard me talk frequently about Deamonte Driver, a 12-
year-old who lived in Prince George's County, MD, just 7 miles from 
here. His mom tried to get him to a dentist because he had a toothache. 
They did not have insurance. No dentist would see him. After many 
efforts to try to get him to a dentist, he ultimately went to an 
emergency room. They operated on him because the tooth had become 
abscessed because of the delay in getting care. He needed emergency 
surgery. It went into his brain, and he lost his life because in the 
United States of America, we could not provide someone who was poor 
access to see a dentist. Tonight we can change that by our votes on 
this bill.
  At long last, we have a chance to do something about that. In the 
last Congress, I introduced a bill that provided universal care by 
saying each of us has a personal responsibility to make sure we have 
health insurance. I did that because I think the first thing we need to 
do as a prerequisite to health care reform is to be sure everyone is 
covered, everyone is in the system.
  This bill and the managers' amendment not only provides for universal 
coverage but makes it affordable for every person in this country.

[[Page S13623]]

  We use the Congressional Budget Office as the objective scorekeeper. 
Everybody agrees to that--Democrats and Republicans. They are the 
professionals who tell us whether our numbers add up. The Congressional 
Budget Office tells us the bill with the managers' amendment will mean 
3l million more Americans will have health coverage as a result of the 
enactment of this legislation. That will take our under 65 group from 
83 percent coverage to 94 percent coverage, and for all Americans we 
will attain 98 percent. Sure, we want to get to 100 percent, but we are 
making a giant step forward for universal coverage.
  The Congressional Budget Office tells us that for the overwhelming 
majority of Americans, they will either see no increase in their health 
insurance premiums from what it would otherwise be or they will see a 
decrease, a decline, a reduction in the cost of the health insurance 
premiums they would otherwise have to pay. For all Americans, they are 
going to have a better insurance product that is going to cover more. 
They are going to have less out-of-pocket costs than they would 
otherwise have. That is what the Congressional Budget Office tells us. 
Why is that true? The legislation provides for prevention and wellness. 
It provides that preventive services will be required to be covered in 
your insurance plan.
  We even do that for our government programs by providing an enhanced 
match for States that expand the Medicaid program for our poor to cover 
the preventive services. It covers oral health for our children as a 
required part of a required essential coverage package and provides 
additional help to help people through education and demonstration 
programs.
  I could give many examples, but let me give one example from the 
point of view of trying to expand preventive services, and that is 
colon cancer. We know that if you have colon screenings, you actually 
can discover a polyp before it becomes cancerous. You can avoid cancer. 
The test costs a couple hundred dollars. If you do not have a test and 
you have cancer and need an operation, that costs tens of thousands of 
dollars.
  Prevention and wellness works. It brings down the growth rate of 
health care costs. It saves us money. This bill invests billions in 
prevention and wellness directly and through required coverage in our 
private and public insurance programs.
  We bring down the growth rate of health care costs by managing 
complex diseases. We know we spend most of our health care dollars 
because of major diseases. This bill helps us manage those diseases so 
people can get the care they need in a more cost-effective way.
  The legislation invests in health information technology so we can 
reduce the administrative costs of health care. I was surprised to find 
that Maryland, similar to most States, if you go into an emergency 
room, it is very unlikely they will have your medical records. If they 
do not have your medical records because their information technology 
is not sophisticated enough to get those records, then surely they are 
going to do tests they would not otherwise have to do, which ends up 
costing us all more money.
  By using health information technology, we can not only take better 
care of you, we can do it in a less costly way. By reducing the number 
of uninsured dramatically, we save money. How? Because someone who is 
uninsured who should see a doctor or go to a clinic instead goes to an 
emergency room which is much more expensive. By the way, they sometimes 
do not pay their bills.
  Each of our families, if you live in Maryland and you have insurance, 
you pay an extra $1,100 a year on your health insurance because you are 
paying for people who do not have health insurance and they access the 
system in a more costly way. This bill brings down the cost. You bring 
down the cost of health care because of competition. We believe in 
competition, market forces. That is what made America great.
  If you live in Maryland and you have private insurance, 71 percent of 
Marylanders are insured by two companies. That is not competitive. I 
have talked with more and more business owners who tell me they have no 
choice. There is one plan they can get. If they do not like that plan, 
there is no insurance they can get. That is not competition.

  This bill brings competition by the exchanges that will invite more 
insurance companies to participate in our States and by the program 
that is in the managers' package that allows us, for the first time, to 
have plans available across State lines. That will be particularly 
helpful for a State such as Maryland, where many of our employers 
employ people who not only live in Maryland but live in Virginia, live 
in Pennsylvania, live in Delaware, live in West Virginia. That will 
certainly help us.
  This legislation also reduces our Federal budget deficit. That is a 
challenge. Let me tell you why it is a challenge. There are two 
different issues. Reducing health care cost growth and reducing Federal 
spending are two different issues because to get everybody insured, 
which will help us bring down health care costs, we need to provide 
subsidies so people can afford their health insurance and provide 
businesses some help.
  As more and more people become insured, they can use our tax 
advantages and pay less income taxes by using before-tax dollars rather 
than aftertax dollars. All that costs revenue to the Federal Treasury, 
so it is a challenge to bring this in without adding to the deficit, 
but we knew we had to do that. The Congressional Budget Office, again 
our objective scorekeeper, tells us that in the 10-year budget window, 
it will reduce the Federal budget by $131 billion, but in the next 10 
years, which all of us will admit is difficult to predict, they tell us 
we can reduce Federal spending by one-half percent of our GDP, which 
can translate to over $1 trillion.
  My point is, we are reducing the deficit while we are reducing the 
growth rate of health care costs.
  The Congressional Budget Office does not score us for a lot of the 
results from our prevention programs. They cannot assume less people 
will get cancer and, therefore, the preventive services will save us 
money. I am convinced the dollar savings will be a lot greater than 
that for health care costs, for our economy, and for the taxpayers of 
this country.
  This legislation protects consumers. That is why the consumer union 
supports moving this bill forward. The insurance reform that is in the 
underlying bill is well known. I tell you, the people of Maryland want 
that. I am sure the people of Massachusetts also do.
  The insurance reform says: Look, let's get rid of preexisting 
conditions. Let's not let insurance companies pick and choose whom they 
want to insure. They should insure everyone. The managers' package 
makes that available immediately for our children. We eliminate the 
lifetime caps, put restrictions on the annual caps. We make immediately 
available coverage for children under the age of 26 and provide a 
reinsurance program for those between 55 and 64.
  We provide for an independent appeal from an insurance company's 
decision on coverage. Too many insurance companies have an internal 
mechanism to determine coverage which is stacked against the 
policyholder.
  The managers' amendment provides for loss ratios. Loss ratios mean a 
certain amount of the insurance dollar must go back to pay benefits. We 
know a large amount is spent on advertising, spent on salaries, spent 
on profits. For the first time, the consumers will know how much of 
that is actually going to their benefits, and we start to put into law 
that a certain amount must be returned to the policyholders in benefits 
and important consumer protection information.
  I am particularly pleased the Patients' Bill of Rights, an amendment 
I offered, is included in the managers' package. I thank the leader for 
including that.
  In the Balanced Budget Act of 1997, a provision that I authored 
included a lot of the Patients' Bill of Rights in the Medicare and 
Medicaid Programs. President Clinton, in 1998, by executive order, 
extended it to all the government programs.
  We passed that bill in the House and it passed in the Senate, but we 
never passed it in both bodies and sent it to the President the basic 
Bill of Rights for patients. We are making a giant

[[Page S13624]]

step forward in the managers' package to cover those Bill of Rights. 
Let me give an example. Access to emergency care that I authored is now 
in this bill. There are insurance companies today that tell you, you 
have to get preauthorization before you can go to an emergency room. 
Think about that. You are having chest pains and sweating and you try 
to find your insurance card to call your insurance company? That is not 
what a doctor tells you to do. You go to an emergency room.
  Suppose the closest emergency room is not in your network. Does that 
mean you will not get full coverage? Some insurance companies say that 
is the case. We put in the prudent layperson standard: If it is prudent 
to go to the emergency room to get care, the insurance company must 
cover your bill.
  I cannot tell you the people I talked with on both sides--I had chest 
pains, sweating, et cetera; I went to the emergency room, found out I 
did not have a heart attack and almost had one when my insurance 
company refused to pay the bill. I did what the doctor told me to do, 
and now they are not covering it. This provision will make sure that 
person's bill is covered.
  Frankly, we have had people who delayed treatment who should have 
gone to an emergency room whose circumstances became much worse and 
some actually died. We cover access to emergency care in the managers' 
package, an important consumer protection.

  We also allow you, as the subscriber, to determine whom you want your 
primary care provider to be. We give you protection as you make your 
decision as to whom your primary care provider will be. If you have a 
child, the pediatrician can be the primary care provider. If you are a 
woman, the OB-GYN can be your primary care provider. Many insurance 
companies deny you that today. That protection is in this bill for 
everyone.
  I am also pleased to have joined Senator Brown in a matter I worked 
very closely on when I was in the House for clinical trials. A lot of 
insurance companies today will not cover the cost of clinical trials, 
even though it might be the best care option available for an 
individual and, by the way, sometimes compromises the integrity of the 
clinical trial if they can't get a representative group to participate. 
Well, we provide protection in this bill to cover you for clinical 
trials that your insurance company has to cover.
  So there is a lot in this bill for consumer protection--the bill of 
rights. Mr. President, there is a long list of organizations that 
support the patients' rights amendment that I offered, from the AARP, 
to the Consumers Union, Families USA, National Women's Law Center--all 
the different specialists. It is an important amendment, and I am glad 
to see it is in the managers' amendment.
  I am proud of a major new effort that has been included in the 
managers' amendment. I want to talk about minority health for one 
moment, and I particularly want to thank a member of my staff, 
Priscilla Ross, who has been working on this issue for many years. She 
has pointed out to me the vulnerability of minority populations in 
America. Let me give a couple of examples.
  The life expectancy for an African American is 5.3 years less than 
someone who is White. Minorities are two times more likely to have 
diabetes. African Americans have 33 percent higher death rates for 
heart disease than the White population. And the list goes on and on.
  Access to care in the minority communities is much less than in the 
general communities at large. So we needed to do something about this, 
and the amendment I offered, which is included in the managers' 
package, elevates minority health in our government agencies. It 
provides statutory authority for the Office of Minority Health at the 
Department of Health and Human Services. It codifies the network of 
minority health offices located within the Centers for Disease Control 
and Prevention, the Centers for Medicare and Medicaid Services, the 
Food and Drug Administration, the Substance Abuse and Mental Health 
Services Administration, and the Health Resources and Services 
Administration.
  Mr. President, it elevates the Office of Minority Health at the 
National Institutes of Health from a center to an institute. That is 
making a commitment to attack this disparity that currently exists in 
health care in America.
  Let me talk about one other issue in this bill that I am proud to 
work with Senator Sanders on which involves the community health 
centers and primary care. Senator Sanders was able to get $10 billion 
in the managers' package so that we could dramatically expand access to 
care. You see, if you are a Latino in America, there is a 35-percent 
chance you have no dependable source of health care, compared to 15 
percent in the White community. We need more federally qualified health 
centers. You can have universal health coverage, but if you don't have 
facilities, it will be difficult to get access to care. The community 
health center expansion will provide access in underserved areas. 
Maryland needs this help, and there is substantial investment in 
primary care in this legislation.
  This bill will help. It will help those who have good insurance 
coverage today by protecting that coverage and making sure it is 
available tomorrow and stopping the erosion that is taking place today 
with insurance companies cutting back on what is covered and employers 
putting more of the cost on the employee. This legislation will help. 
It will help small business owners who today have very little choice as 
to what insurance plan they can get. They are paying 20 percent more, 
on average, than a large company pays for the same insurance 
protection. This will offer choice.
  We also offer tax credits to help small businesses in order to make 
it easier for small businesses--which are the economic engine of 
America--to be able to provide health benefits for their employees. It 
will help individuals who cannot find insurance today by having large 
pools they can enter without being discriminated against by the way the 
actuaries work and will provide subsidies for low-wage workers so they 
can afford the coverage.
  The bill will help our Medicare population by starting to close the 
doughnut hole on prescription drugs, making prescription medicines much 
more affordable for our seniors, and providing preventative services, 
such as annual physicals so that seniors can stay healthy. And it 
provides sustainability to the Medicare Program.
  Most importantly, this legislation reflects the values of our 
Nation--affordable, quality health care for all Americans. I am proud 
to support this legislation, the managers' package, and the underlying 
bill, and I urge my colleagues to be on the right side of history. I 
support moving forward with health care reform.
  With that, Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Alaska is recognized.
  Mr. BEGICH. Mr. President, thank you for the opportunity to be here 
this evening. I thank Senator Cardin for a great presentation on the 
real facts behind this bill.
  You know, being from Alaska, we see a lot of storms. We saw a great 
blizzard here which brought a lot of snow. I see a lot of blizzards and 
storms in Alaska. But I have to be honest with you, I have never seen 
anything like the blizzard of misinformation I have seen in Washington 
regarding this bill.
  Over the course of the next few minutes, I want to talk about the 
general bill and what it means for all Americans, including Alaskans, 
and then specifically about the effect on Alaska.
  First, I want to walk through a couple of large issues. I know people 
watching are hearing this over and over while we are on this bill, and 
the details of it, but I think it is important that we repeat it enough 
for people to be reminded of the positive impacts the bill will have on 
America and my State of Alaska. It is not a perfect bill. There are 
pieces I would like to have improved, and I am sure everyone in this 
Chamber feels the same. But it is a step in the right direction--a 
significant step.
  On the financial end, in the first 10 years, the bill reduces our 
deficit by $130 billion. In the next 10 years, with the improvements in 
the managers' amendment and what it did for the deficit reduction, it 
is now $1.2 trillion--a significant impact on the national debt.
  People call my office and say: How does it reduce the debt? I remind 
them that between Medicare, Medicaid, the VA, Indian Health Services, 
and many

[[Page S13625]]

other health care programs that we deliver, anything we do to improve 
the system will mean taxpayers will save money. So, again, $130 billion 
in the first 10 years, and the next 10 years, $1.2 trillion in deficit 
reduction.
  The other issue--and again these are broad sweeps--is stronger 
medical loss ratios. This is important because this starts now, 2010, 
once this bill is passed, a few months after implementation. Health 
insurers will be required to spend more of their premiums--which really 
are your premiums--on clinical services and quality activities, with 
less going to administration--advertising, profits, excessive pay 
packages. If they do not adhere to the new limits, they will have to 
pay rebates to the policyholders. These stricter limits will continue 
even after the exchange starts in 2011 and apply to all plans, 
including grandfathered plans. That is a significant benefit to the 
individual--the person who has to pay the premium.
  Accountability for excess rate increases: The health insurer's 
participation in the exchange will depend on its performance. Insurers 
that jack up their premiums before the exchange begins will be 
excluded--a powerful incentive to keep premiums affordable.
  There is an immediate ban on preexisting conditions for children 
under the age of 18. This is in the managers' package. To me, this is 
unbelievable. Many families struggle, and sometimes the parents will 
forego their health care in order to make sure their child is as 
healthy as possible. But when a child has a preexisting condition, just 
to get coverage for them is sometimes almost impossible. So this makes 
sure that no insurance company can ban or deny them access to health 
care with preexisting conditions.

  Ensuring the needy have access to care: The use of annual limits on 
benefits will be tightly restricted, ensuring access to needed care. 
And those limits will be prohibited completely by 2014. Starting in 
2010, new policies will eliminate the lifetime caps.
  Also, on the broader scheme, there will be innovation. Medicare will 
be able to test new models. I can't tell you the number of times I have 
had a public hearing or a public meeting in Alaska, or I have had phone 
calls come in from people who have asked me: Can we do something 
different? How can we improve Medicare? This creates some new 
incentives to move forward on innovation within our Medicare system.
  When you look at the small business end of it, the package improves, 
including starting the health insurance tax credit in 2010, with almost 
$40 billion of tax credits. Tax savings to small business will be 
available.
  Transparency: New requirements will ensure that insurers and health 
care providers report on their performance, allowing patients to make 
the best possible choice.
  The next issue--multistate options. This is something during my 
campaign I talked a lot about--a program we all have in Congress, and 
so do almost 4 million Federal employees and their dependents. How do 
we replicate that to give a benefit to the taxpayers of this country, 
if they want to access something similar? Well, now we have the 
multistate option. Health insurance carriers will offer plans under the 
supervision of the Office of Personnel Management, the same entity that 
oversees the health plans of Members of Congress and for Federal 
employees. At least one plan must be a nonprofit, and the plans will be 
available nationwide. This will truly promote competition and choice 
for individuals.
  Another new idea, which Senator Wyden had sponsored for many months 
and talked a lot about, is free choice vouchers, giving more choices to 
individuals with their money.
  As mentioned earlier, the community health centers: It is estimated 
this bill will now be able to put in place almost 10,000 community 
health centers throughout this country, providing easy and affordable 
access for folks.
  On the small business end, I want to again just broadly sweep on 
this. The credits will be available on a sliding scale to small 
businesses, those small businesses with fewer than 25 employees, and 
average annual wages of less than $50,000. All small businesses will 
truly benefit, but if you are a small business with 50 or less 
employees, you will be exempt. If you want to provide insurance to your 
employees, and you are in a small group of 25 employees or under, there 
will be credits available for you.
  The bill also clarifies part-time because we have so many part-time 
employees who work within the seasonal businesses in Alaska--retail, 
fishing, tourism. It makes sure that small businesses are not hampered 
by this legislation but enhanced. Again, 96 percent of the small 
businesses will be exempt from this law, unless they decide to provide 
health care, and then they can get some benefits through tax credits--
up to $40 billion available.
  I am a member of a group of freshmen who came to Washington this 
cycle. We came with all kinds of ideas on how we wanted to change 
Washington in short order. We sat down with this bill in mind, and as a 
group of freshmen, we put together a cost containment package with many 
ideas--very technical in a lot of ways, but just in the broader sense, 
it creates administration simplification. It helps ensure we go after 
health care fraud. With regard to Medicare system upgrades, we make 
sure that as we develop new systems for Medicare and for the providers, 
we do some pay-for-performance testing, which will save individuals, 
save Medicare, and save the Medicare system over time.
  The freshmen spent many weeks on the cost containment package we put 
together, and I want to give credit to Senator Warner for leading the 
charge, though everyone participated to try to make a difference and 
bring cost containment to the issue of health care.
  I want to go through a quick list on this broader perspective of the 
legislation and what happens now, because we hear always from the other 
side that so many things are delayed way out; that they will not happen 
right away. Let me walk through several items that happen right away.
  The Senate bill will make it illegal for insurance companies to drop 
coverage for Americans who are sick--basically, they call them 
rescissions--beginning 6 months after the date of enactment. Insurance 
companies will be barred from limiting the total benefits Americans can 
use over the course of a year--otherwise known as lifetime caps--
beginning 6 months after the date of enactment. Affordable insurance 
coverage options will be made available for high-risk pools of 
Americans who have been uninsured and have been denied coverage because 
they have preexisting conditions, effective 90 days after enactment.
  Early retirees between 55 and 64: I hear from a lot of them who are 
trying to figure out, as they are now retired and still have some 
coverage from their former employer, but it is expensive. What this 
does is set up a new program, and access to a program that will reduce 
their premiums beginning 90 days after enactment. Insurance companies 
will be required to start posting their overhead costs on a public Web 
site so consumers can better compare the deal they are getting 
effective July 1, 2010.
  Insurance companies will have to start providing external review 
processes beginning 6 months after the date of enactment. Dependents 
will be able to receive coverage up to the age of 26 on their parents' 
policy, beginning 6 months after the date of enactment.
  This is one again I hear so much when I am back home and from e-mails 
and letters, people wanting to keep their kids on their policy. Again, 
coverage up to the age of 26.
  The insurance companies will be required to begin covering preventive 
services and immunization without copays on payments beginning 6 months 
after the date of enactment. Seniors will have access to dramatic 
discounts in the purchase of name brand prescription drugs in the 
Medicare Part D Program beginning July 1.
  As I said earlier, children under age 18 cannot be denied for 
preexisting coverage.
  There will be free preventive services for seniors--$500 reduction in 
the doughnut hole for seniors.
  Again, the issue with Medicare, I want to say, when we started this 
effort to reform health care, Medicare was in trouble and could be in 
serious trouble by 2017. This legislation adds 10 more years to 
Medicare.
  To be specific to Alaska--and I will be brief on this but I think it 
is important--many of these issues I laid out

[[Page S13626]]

are important to Alaska, but there are quite a few very specific. 
First, I remind folks what the impact is currently in Alaska--133,000 
Alaskans do not currently have insurance; 27,000 residents who now buy 
expensive individual premiums will now get affordable coverage. We 
double enrollment in Alaska's Kid Care, what we call here in Washington 
SCHIP, to more than 15,000 young people, ending the hidden tax on 
families. About $119 million is spent on uncompensated care, averaging 
about $1,900 per year. By creating a larger program as we are doing 
here, we can eliminate that cost.
  I have heard over and over about Medicare Advantage. Let me tell you 
how that works for Alaskans. What we will be doing, we have 60,000 
Medicare beneficiaries paying a price for excessive overpayments in 
higher premiums, even though 99 percent of our Alaskan seniors do not 
participate in Medicare Advantage.
  What you hear when you hear about Medicare Advantage--and those who 
have it I am sure enjoy it--but in my State we are subsidizing that 
even though 99 percent of Alaska seniors do not take that program. So 
we pay an extra approximately $90 to subsidize that program for those 
extra things they claim they have. The reality is that was supposed to 
be run by the private sector, saving money to Medicare. It is now 
costing us more, it is costing my State $90 per Medicare family.
  About 10,600 Alaskans hit the doughnut hole in Alaska through the 
Medicare drug coverage, which can cost some of our seniors up to $4,000 
additional a year. They will see a 50-percent reduction.
  As I mentioned under early retirees on the national program, 7,300 
Alaskans will be affected in a positive way; 8,600 Alaska small 
businesses could be helped by the small business tax credit. Again, 
Alaska is benefiting a great deal from this legislation.
  Even more specific--and these are items I added specifically in the 
bill to focus on Alaska's specific issues. I thank Senator Harkin on 
this next one, which is important. It is providing more primary care 
providers. It is a loan repayment program. I know he has been an 
advocate of getting more primary providers within the system--
physicians, nurse practitioners, physicians assistants--from $3,500 to 
$5,000 for the National Health Service Corps in this country. It serves 
health professional shortage areas, including 77 in Alaska.
  In part, because of this, and due to other major expansion, the 
Senate HELP Committee has estimated the bill will attract 24,000 new 
primary care providers. If you want to make a difference to the health 
care system, this is one critical piece. Again, Senator Harkin, I know, 
has been an advocate for this for many years. To see us get to this 
state and be able to move this forward is significant. It will have a 
positive impact.
  Another one which is a program that is a great benefit for hospitals 
in Soldotna, Juneau, and Sitka, is an amendment which reauthorizes a 
Medicare project supporting hospitals in rural communities in smaller 
States, extending that for an additional 5 years, moving it from 10 
States to 20 States and creating another 15 hospitals that can 
participate.
  Alaska health care task force--specifically in this legislation, to 
deal with our Medicare provider issue in Alaska but also our TRICARE, 
making sure we deliver the right kind of hospital and medical care to 
our veterans.
  More physicians assistants--we inserted specific language to make 
sure we allow loan repayments for physician assistant teaching faculty, 
to be also included in loan forgiveness. Last year we had 375 PAs who 
handled 1.2 million office visits in Alaska.
  After 21 years, the Indian Health Service is now in this bill to be 
reauthorized. For 21 years it has not been reauthorized.
  There are many great things in this legislation, from a broader 
perspective, as I mentioned earlier in my comments, but also very 
specific to Alaska.
  Could it be better? Absolutely. But do we think we have a piece of 
legislation that is going to make an impact on people's lives? Yes, we 
do. If we want to keep it the same old business as usual, I guarantee, 
in 5 years or 10 years from now we will be in this hall, trying to 
figure out what to do at a bigger crisis.
  This is the right decision. It will be an honor for me later this 
evening to make a vote in the affirmative to move past the cloture 
vote, getting on to voting for this bill.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. HARKIN. Mr. President, first I thank the Senator from Alaska for 
all of his hard work on this bill. I think it is fair to say the 
Senator from Alaska, a new Member of the Senate, I might add, has been 
very much involved in this bill and his focus has been on rural health 
and better health care for native Alaskans. As the Senator knows, the 
Indian Health Care Improvement Act, which also covers Native Alaskans, 
is included in this bill. I thank the Senator from Alaska for insisting 
on that and for being a strong supporter of making sure we do help 
primary care practitioners, both doctors but also nurse practitioners, 
physicians assistants, other health care and primary health care people 
who are going to serve in our small towns and rural communities. The 
Senator from Alaska has been one of our best leaders on making sure 
that we have this in the bill. I thank him for that very much.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. NELSON of Florida. Mr. President, I have been listening on C-SPAN 
2, in addition to having the privilege of being over here on the floor, 
to this debate that has been going on. The debate has been going on 
ever since the summer when we in the committee were fashioning this 
legislation. I must say that to hear one side of this debate, I would 
not recognize all of those hearings we had last summer and all the 
markup we did in the Finance Committee last September because what has 
been presented to the Senate, and what has been presented to the public 
through press conferences by the opposition to this bill in most cases 
simply is not correct.
  I want to give a couple of examples here this evening. In attacking 
this, saying what dastardly things this is going to do for the country 
and how this is going to increase costs and raise taxes--each one of 
these things can be refuted. But it is a typical tactic that, when you 
want to attack something and tear it down, you go after a specific item 
instead in order to obfuscate, which then misses the point of the whole 
piece of legislation.
  The point of the whole piece of legislation is to make health care 
available and affordable, in most cases through health insurance, in 
other cases through Medicare and Medicaid, and making it available, 
efficient, and affordable.
  I want to give one specific example. It is a technical term in the 
insurance industry called the ``medical loss ratio.'' It is the ratio 
in what an insurance company actually pays out in medical claims as 
opposed to what it pays for administrative expenses such as marketing, 
insurance agent commissions, underwriting, and an insurance company's 
profit. It is interesting that the term medical loss ratio tells you a 
lot about the insurance industry, because if you look at it only from 
their perspective, this percentage is their loss but in fact the 
percentage is the amount of the premium dollar that goes to actual 
medical care. What this amendment, this managers' amendment we are 
going to vote on in less than 2 hours right now says, is it causes a 
specific ratio so you are getting a high amount of return on the 
insurance premium dollar.
  Let me give an example. This is an example of the medical loss ratio 
of a number of small employers--small employers, that is group 
policies--as well as policies in the individual market. This is where 
you have an employer who pays for your health insurance but it is a 
small employer, usually under 50 employees.
  This is where you have policies that are given to individuals. The 
premiums usually are much higher if you are an individual buying 
insurance than if you are buying it in a group, by an employer-
sponsored group.
  These are specific examples in a particular year of the loss ratio. 
Interestingly, for Aetna, here, at 82 percent--that is not actually a 
loss to Aetna. It is interesting they call it a loss. That is actually 
82 cents of premium dollar,

[[Page S13627]]

an insured policyholder's premium dollar, that actually goes to medical 
coverage. That is good.
  United Health: 79; Humana, down at 77--77 cents of that $1 are going 
to health care.
  And the balance, 23 cents, is going to things such as administrative 
expenses, paying for insurance agents, commissions, paying for their 
profit. What does the bill do? The bill brings that up to 80 percent. 
And that is all policies, not just the new policies on the health 
insurance exchange. That is not just the policies insurance companies 
are going to write new for the small group. It is all those policies 
that are in existence.
  Look at the individual. The experience isn't quite as good. As a 
matter of fact, here is a company, Coventry, that was only paying 66 
cents on every premium dollar that was actually going to health care, 
and the rest of that, 34 cents, was going to profit and administrative 
expenses and executive salaries and bonuses and so forth. And lo and 
behold, what we are going to vote on tonight in less than 2 hours is 
going to have to be 80 cents on every dollar. If they don't make that 
80 cents on every dollar, they are going to get penalized. We are 
putting some real teeth in this on insurance companies for the first 
time.
  Look at the large group, the employer-sponsored insurance, the large 
group. These are five of the larger insurance companies. You can see 
they have a pretty good record thus far: WellPoint, 85, Humana, 82 
cents on every dollar. They have a better record because they have a 
lot more individual lives over which they can spread the insurance 
risk, and so they can pay out more in health insurance for health care 
and take out less for administrative expenses. But in this bill 
tonight, in an hour and 45 minutes, we are going to raise that to 85 
percent, 85 cents on every dollar.
  Before I came to the Senate--and I have had the good fortune of 
serving the public for now going on over 35 years--I had the privilege 
of being elected to one of the toughest jobs I have ever had in a 
lifetime of public service, and that was the elected insurance 
commissioner of Florida. It is also the elected treasurer. That 
position has morphed into what is called the chief financial officer. 
It is a member of the Florida cabinet. For 6 years, I got to see what 
insurance companies will do. I can tell you, instead of 85 percent and 
80 percent that we are going to require in this bill of every insurance 
premium dollar they pay out in medical care, I can tell you that some 
of the insurance companies I regulated back in the State of Florida 
were down in the sixties. A lot of that was going into big-time 
administrative offices, all kinds of jets, all kinds of padded expense 
accounts. You can see what we are trying to do here with this bill 
tonight.
  Let's ask, why do we have to have a ratio such as this and why is it 
important? It certainly is getting more medical care to the individual 
policyholder. But listen to this: A study that was done by the Senate 
Commerce Committee shows that the ratios are often below what is 
considered to be fair. Our Commerce Committee found that in the small 
business market, those with fewer than 50 employees, insurers spend 
only 79 cents out of every dollar on health care. That is in the 
Commerce Committee study. In the individual market, it is even worse. 
It is 74 cents. In the individual market, the insurer keeps more than a 
quarter of every individual premium dollar for overhead and profit.
  We need to ensure that the policyholder's premiums and the Federal 
subsidies that are going into the purchase of private health insurance 
on the exchange are used for actual medical care and not for wasteful 
administrative spending and marketing and profits. If we don't do this 
kind of thing, regulating insurance companies, then they are going to 
take advantage. They are going to take the advantage of making more 
money at the expense of patient care.
  I want to give an example. In spite of this recession, this economic 
recession we are in and the increasing unemployment over the past year, 
what has happened to the big insurance companies? They are posting big 
profits. They seem to be making more money by insuring fewer people. 
The only way you make more money with fewer customers is you get rid of 
your less profitable customers--in other words, the sick ones. That is 
called cherry-picking. You pick the good risks, which are the healthy 
ones, and you try to get rid of the sick ones.
  Let me give some examples. In the second quarter of this year, 2009, 
the largest health insurance company, UnitedHealth Group, announced a 
3-month profit of $859 million in one quarter, and it more than doubled 
the profits from the previous year. UnitedHealth earned these record 
profits in spite of the fact that it was insuring 600,000 fewer people 
than it did a year ago.
  Let me give another example. In the second quarter of this year, 
another large insurer, CIGNA, saw its profits jump 60 percent to $435 
million. CIGNA earned these healthy profits in spite of the fact that 
it is insuring 200,000 fewer people than a year ago.
  Another example: In the second quarter of 2009, Humana saw its 
profits rise 34 percent to $282 million. Humana earned those healthy 
profits in spite of the fact that it was insuring 100,000 fewer people 
than a year ago.
  At the same time they are dropping beneficiaries, insurance companies 
are paying their CEOs record salaries. In 2008, Aetna's CEO earned over 
$24 million. That is the equivalent of more than $66,000 per day. If 
you want to know where some of that administrative padding that is not 
coming back to the policyholder in health care is going, there is a 
good example. Aetna's CEO earned over $24 million in that 1 year, 2008.
  This medical loss ratio we are building into this bill on which we 
will vote shortly builds on other insurance provisions in this 
legislation which include guaranteed issue, which include prohibiting 
cancellations, banning preexisting conditions so that they can't 
terminate you or not insure you because they cook up some excuse, some 
flimsy excuse. I am not sure this has been brought out in this debate, 
but I think it is worthy of consideration by the Senate.
  In my closing minutes, I want to now step back and look at the 
overall package. Why is this a good deal for America, and why is it 
going to pass with an extraordinary threshold of 60 votes tonight? 
Because we are not going to allow in this legislation excessive rate 
increases in the health insurance exchange that is created new, that is 
going to insure 31 million new people. A lot of those people are people 
who don't have insurance now. A company will be banned from that health 
insurance exchange if it starts jacking up its rates excessively. You 
talk about an insurance commissioner's dream, a regulator's dream--
often your hands are tied and you are put into a straitjacket by the 
insurance laws of your State and you can't crack the whip on them. We 
are cracking the whip on them in this legislation.
  There has been a lot of talk about the program on Medicare other than 
Medicare fee-for-service called Medicare Advantage and how it is going 
to be whacked. I can tell you, for my State of Florida, there are 
950,000 senior citizens on Medicare Advantage, and it is not going to 
be whacked. There have been a lot of statements out here by people 
attributing it to Florida, that it was going to be cut. In this bill we 
are voting on tonight and whenever we go to final passage, it is not.
  By the way, there was a statement made here and something that was 
entered into the Record, a letter from a cardiologist from Jupiter, FL, 
who was complaining about how cardiologists' fees are being squeezed 
and they may not be able in the future to take care of Medicare 
recipients. I happen to know about this. I have been trying to help the 
cardiologists. But it was stated out here on the floor of the Senate 
that it is this bill that is doing that. That has nothing to do with 
this legislation. That has to do with the administrative functions of 
government in existing law, CMS, that, in my opinion, has used 
incomplete data to cut cardiologists, particularly that are needed in a 
State such as Florida where, in fact, so many senior citizens are 
needing the service in Medicare of cardiologists.
  Here is another major thing in this bill. We are setting up a 
nationwide insurance plan that will be sold on these health insurance 
exchanges, and it will be operated by the Office of Personnel

[[Page S13628]]

Management, the same office that governs the health insurance of 
Federal employees and Members of Congress.
  There is a part in this bill on tort reform. It sets up State grants 
to test alternatives to litigation.
  In my remaining minute, let's don't forget the 31 million more people 
who are going to come in insured and how this, over time, is going to 
bring down the cost of Medicare. It is not going to cut Medicare. It is 
going to save Medicare. It is going to do that with efficiencies such 
as electronic records and accountable care organizations and emphasis 
on primary care physicians.
  To conclude, what else does the bill do? It lowers the deficit over 
the next 10 years by $132 billion. In the second 10-year period, it is 
going to lower it by up to $1.3 trillion. That is serious deficit 
reduction.
  On that happy note, I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. Let me thank Senator Nelson for his strong commitment to 
Medicare. I know of no Senator who fights harder for Medicare and for 
making prescription drugs more affordable to seniors than the Senator 
from Florida. He has contributed his great expertise as a former 
insurance commissioner to the provisions we have in this bill on 
cracking down on insurance company abuses, and he just went through 
some of them there. I thank my good friend Senator Nelson from Florida 
for all of his great input into this bill.
  In a few minutes, the Senate will close its doors for a brief recess. 
When those doors reopen just after midnight, the Senate will reconvene 
for a historic purpose: to bring the promise of quality, affordable 
health care to millions of Americans. When those doors reopen, we who 
have the privilege of serving in this body will have the opportunity to 
vote for hope and opportunity and new help for working families who 
worry every day that their illness will cause them to go bankrupt.
  Mr. President, I yield the floor.

                          ____________________