[Congressional Record Volume 155, Number 197 (Monday, December 21, 2009)]
[Pages S13647-S13660]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


  The PRESIDING OFFICER. Under the previous order, the Senate will 
resume consideration of H.R. 3590, which the clerk will now 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 homebuyers credit in the case 
     of members of the Armed Forces and certain other Federal 
     employees, and for other purposes.


       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 
       Reid amendment No. 3279 (to amendment No. 3278), to change 
     the enactment date.

  The PRESIDING OFFICER. Under the previous order, the time until 12:30 
shall be equally divided and controlled between the two leaders or 
their designees.
  The assistant Democratic leader is recognized.
  Mr. DURBIN. Mr. President, this morning we are continuing to run time 
postcloture on the managers' amendment. Following any leader remarks, 
the time until 12:30 p.m. is equally divided between the two leaders or 
their designees. Senator Reid has asked me to serve as his designee on 
the Democratic side. At 12:30 p.m., we will begin alternating 1-hour 
blocks of time until 6:30 p.m., with the majority controlling

[[Page S13648]]

the first hour. If all 30 hours postcloture is required, then the 
rollcall vote on the managers' amendment will occur about 7:15 a.m. 
tomorrow, Tuesday morning, and the cloture vote on the substitute will 
occur immediately after that. So we expect at least two rollcall votes 
early Tuesday morning. Hopefully, votes will not be needed today to 
recess or adjourn this evening. That is the state of play and business 
on the floor.
  I see the majority leader has arrived on the floor, and I wish to 
give him a chance, if he is seeking that opportunity, to make any 
announcements he believes will be timely and appropriate.
  The majority leader indicates he is not going to make an 
announcement, so I wish to make some comments about where we are at 
this moment.
  I can't imagine there are many people in America who have been 
following this day's session because it began at 12:01 a.m., when the 
Senate was reconvened for a vote on the managers' amendment to health 
care reform, which took place just a few minutes after 1 a.m. this 
morning. We recessed and now are returning for the rest of the 
legislative day.
  When the history of the Senate is written, I think this vote will be 
included because it is a historic vote. We consider many issues in the 
Senate of great importance to individuals, groups, States, and to our 
Nation, but seldom do we address an issue of this magnitude or scope. 
This health care reform issue literally touches every person who is 
following this debate and many who are not even aware of it. What we 
are doing is addressing some of the fundamentals of our health care 
system in America that need to be changed.
  Whenever you are suggesting change in America, there is resistance. 
There are people who are currently comfortable with the health care 
system as we have it, and there are people who are benefiting from the 
system as we know it, particularly health insurance companies which 
enjoy great profits because of the current system of health care in 
America. But at the heart of the issue, we know this system is 
unsustainable and, as a result, we have engaged in almost a 1-year 
effort to thoroughly investigate our health care system and to find 
ways to change it for the better. This has called on so many of our 
colleagues to make extraordinary contributions to this search for 
  I wish to commend, first, our majority leader Harry Reid, who usually 
stands at our caucus meetings and says: Stop congratulating me; I am 
just doing my job. I am going to do it anyway. Senator Reid has worked 
tirelessly--and I have seen most of it firsthand--to build a coalition 
for health care reform within the Democratic caucus. We didn't have a 
single Republican vote that was in support of reform in the early 
morning hours. I hope that changes as time passes, but he had to build 
a coalition within our caucus of conservative and progressive Senators, 
and he did it, so we had all 60 Democratic Members voting for health 
care reform.
  We are united in the belief that there are fundamental things that 
need to be changed in our health care system. First, it needs to be 
more affordable. People cannot afford this dramatic escalation in the 
cost of health care. Ten years ago, a health care policy for a family 
of four offered through their employer cost about $6,000 a year in 
premiums. That is $500 a month which, instead of being paid to an 
employee as salary, was taken from them for health insurance--$500 a 
  Today, that number has grown to $12,000 a year for an average family 
of four for health insurance through their employment. One thousand 
dollars a month that might otherwise go to a family for basic 
necessities of life and savings and buying things that are important to 
their future instead goes to pay for health insurance. That escalation, 
that 100-percent increase in health insurance premiums in 10 years, is 
troubling but not nearly as troubling as the projection that if we 
continue to see an escalation in costs of health insurance premiums 
based on what we have seen in the past, in another 8 years it will 
double again. Imagine 8 years from now, in 2017, that you have to work 
and earn $2,000 a month just to pay for your health insurance. How many 
people will be able to do that? How many businesses will be able to 
afford it? The answer is obvious. More and more people will be dropped. 
Today, 50 million Americans have no health insurance. Many of them go 
to work every single day, but their employers can't afford to provide 
health insurance or they are unemployed or they have some other problem 
where they have been excluded by a health insurance company. So in 
addition to dealing with the fundamental issue of health care reform, 
we are focusing on affordability, how to bend the cost curve, as they 
say, or reduce the increase in costs of health insurance premiums. I 
wouldn't stand here and say to the people of America, with the passage 
of the bill we are now considering, everyone's health insurance is 
going down, but I think I can say, with some confidence, the rate of 
increase is going to decline, and that will give people a better chance 
of affordability. That is essential.
  Secondly, what about those 50 million uninsured people? I have met 
them, as the Senator from West Virginia has as well. These are not 
lazy, shiftless people who aren't trying. Many of them are trying hard, 
but they don't have a chance for health insurance coverage for a 
variety of reasons. We are going to change that. Of the 50 million 
currently uninsured, over 30 million will have insurance under this 
bill. Those in the lower income categories will qualify for what we 
call Medicaid, which is a Federal-State health insurance program for 
the poor and disabled. Most of those people--those who make less than 
$15,000 a year--will not pay any premiums because they can't. They 
don't have enough money. For those who are making slightly more, we 
provide in this bill tax credits that will help people pay for their 
premiums. So if your family is making up to $80,000 a year, the Tax 
Code will now help you pay for your monthly premium for health 
  So we are going to expand coverage. Thirty million people are going 
to have the security of health insurance coverage. We are bending the 
cost curve so the increase in health insurance premiums is not as 
steep, making sure more people are covered, and then, equally 
important, we are changing the rules when it comes to health insurance 

  For too long, these health insurance companies have ruled the roost. 
Since the early 1940s, they have been exempt from antitrust laws which 
allow them to literally collude and conspire with these set prices. 
Over half the insurance markets in America are dominated by only two 
companies, and it is legal under our law for those two companies to sit 
down and say: OK, how much are we going to charge? They don't compete 
with one another, they conspire with one another to set premium rates. 
If you think I am a conspiracy theorist, what I am stating to you is 
what the law clearly says in the McCarran-Ferguson Act--something I 
think should be repealed posthaste--because they can sit down and set 
premiums. They can also allocate markets. They can say to two 
companies: You take over St. Louis and those two companies will do 
Chicago and these two companies are going to do Wheeling, WV. They can 
set up the market structures so there is little or no competition. How 
can that be good? If we truly believe in a free market system, how can 
this be good for America?
  So what we are doing as well is saying: We are going to change some 
of these rules, some of the most egregious abuses by these health 
insurance companies--first and foremost, preexisting conditions. How 
many of us are in such perfect health that we can count on a health 
insurance company covering us without delving into our background, 
finding something in our family history or something in our own 
personal history and saying: Well, we are either not going to cover you 
or we are going to charge you dramatically more. Those days have to 
  Let me tell my colleagues what this bill does. It says immediately--
immediately--children under the age of 18 with preexisting conditions 
cannot be discriminated against by health insurance companies. You 
can't deny them coverage because a child is born and develops diabetes. 
You can't deny coverage because a child has had cancer and is fighting 
that cancer. You cannot

[[Page S13649]]

deny coverage because of those preexisting conditions. That is 
fundamentally fair. It gets to the heart of what we should be doing as 
a nation.
  Senator Tom Harkin of Iowa stood at this podium early this morning 
and said: What this debate is about is whether health insurance is a 
right or a privilege. If it is a privilege only for the wealthy in 
America, then we have lost our way as a nation. We have to understand 
that protection of our well-being and health through health insurance 
is something every American is entitled to. We have to understand we 
are the only developed Nation on Earth where a person could literally 
die because they don't have health insurance.
  If you think that is overly dramatic, let me give an illustration.
  A man I met in Illinois had a health insurance policy that wasn't 
very good. It had a $5,000 copay. He had to take that copay so his 
premiums would be low enough so he could afford it. That man went to a 
doctor who said to him: I see some indications from tests that you need 
a colonoscopy. You may be developing colon cancer. So the man went and 
priced a colonoscopy procedure and found out it was $3,000 he would 
have to pay out-of-pocket and he said: I don't have it. So he didn't go 
through with the procedure. That is a risky thing, and it is something 
no one should have to face, but that is the current system.
  What we are trying to do is change that system so that basically 
preexisting conditions are excluded from the discrimination of health 
insurance companies, that basic procedures that are needed for 
prevention and wellness are included in every health insurance policy. 
We are also making certain that these health insurance companies can't 
cut you off when you need them the most, can't cancel your policy when 
you face an accident or a diagnosis where medical bills are going to 
pile up. That is one of the provisions of this bill as well.
  We also say, for families with young children who are off to 
college--and my wife and I have been through this--that you reach the 
point where you finally say: Wait a minute. My daughter is graduating 
from college. I wonder if she is still under my family health insurance 
plan. Today, in most cases, if your child has reached the age of 24, 
they are off your family plan. Well, we extend that now so those 24 and 
25 will have the protection of their family health insurance plan while 
they finish school, look for their first job and obtain their own 
health insurance. That is going to be peace of mind for a lot of 
families across America, just those 2 years when young people are the 
most vulnerable and need the protection of their family health 
insurance plan.
  Are these worth anything, these changes? I think they are worth a 
lot. I think that is why 60 Democrats stood proudly and voted for this.
  Senator McConnell, the Republican leader, turned to us in the midst 
of this dramatic debate early this morning and said: If one of you--and 
he pointed to all of us sitting here--doesn't vote against it, then all 
of you Democratic Senators will own this.
  We know that, and we have pride in that ownership because we know the 
alternative. Those who voted against change are voting for a system 
that is unsustainable and morally indefensible--a system which, 
frankly, today puts good, hard-working people, folks who follow the 
rules, Americans who believe they are doing the very best for their 
country, at a distinct disadvantage for one of the most basic things we 
expect in life: protection of good health care when we are facing 
illness and when we need a helping hand.
  This bill is also going to change the face of health care in America. 
I don't think I overstated it. Our bill has $10 billion to be invested 
in community health clinics. Senator Bernie Sanders of Vermont has been 
such a leader on this issue and deserves credit for it. He was dogged. 
Some Members looked to this bill for a variety of things, but Senator 
Sanders looked to this bill to provide a helping hand across America 
through community health clinics. As those clinics are built and 
expanded, more and more small towns in West Virginia and in Illinois 
are going to have satellite clinics where people, regardless of whether 
they are wealthy or not as wealthy, will have a chance to walk in the 
front door and see a medical professional. They will not be queuing 
outside the emergency rooms of hospitals, where their care is much more 
expensive. They will be going to these community health clinics and 
meeting primary care physicians who will give them the basic care they 
need before their medical problems become much more serious.
  That is what this bill is fundamentally about. There are many other 
parts to it, parts I am proud to be cosponsoring and proud to be 
supporting--giving a hand to small businesses, giving a hand to 
individuals to expand health insurance coverage.
  Some might ask: If you voted on it at 1 o'clock this morning, why are 
you still here? Because the minority is exercising its right under the 
Senate rules which requires us now to wait 30 hours before we can vote 
again on this one section of the bill. As I announced this morning, 
that means that in the early hours tomorrow morning, about 7:15 or 
7:20, Senators will be coming to the floor again for two votes to move 
this process forward. I understand it is the right of the minority to 
ask us to come in at 1 in the morning or early in the morning. They 
have that right. Historically, we have usually reached some 
accommodation and agreement, and I hope we can here. The 60 votes that 
were there last night will be there again tomorrow morning, and they 
will be there every time needed until this bill is finally passed.
  Those on the other side believe this bill is so bad that it is going 
to revitalize the Republican Party in the next election. I disagree 
with them. I think the American people, as they come to understand this 
bill, will view it in its historic context, one of the most dramatic 
steps forward to provide peace of mind and security to families and 
businesses across America for an issue we know needs to be addressed.
  There are some who came to the floor yesterday--there was one 
Senator. I invited him to come in and explain his remarks. He said 
people should say a prayer that someone would miss the vote at 1 a.m. I 
do not think we should be praying for misfortune for our Senators, that 
they would be delayed or for some other reason could not make the vote. 
Instead, we should be praying to overcome the misfortune of 30 million 
Americans who will not have health insurance if this bill fails. That 
is the kind of misfortune I want to avoid in the future.
  We also have one other item of business remaining, and that is the 
debt ceiling of America. It is something none of us want to face. It is 
almost like making your monthly payment for the mortgage, and that is 
what it is, the mortgage of America. We have to acknowledge the fact 
that as we fight a war and incur the costs, as we have the workings of 
government assessed, and we know there are costs, it adds to the 
expense of our government, and some of it is in debt, and that debt 
needs to be extended for a short period of time as we move forward into 
the next year that begins in just a few days. This debt ceiling issue 
is one we need to come to grips with before we leave at the end of this 
month. There is a short-term extension which I hope the Senate will 
  I wish to also say that Senator Conrad of North Dakota, chairman of 
the Senate Budget Committee, has been a real leader in talking about 
coming to grips with this long-term debt. I have said to him, in the 
midst of a recession, with high unemployment, most economists believe 
it would be a mistake for us to pull back in terms of the safety net 
for families out of work, to pull back in terms of the investment in 
infrastructure to put people to work, and Senator Conrad says he 
agrees. Although he believes we need to be honest about the debt of 
America, he has said to me repeatedly that he is not a Hooverite, 
referring to that period in history when the Great Depression hit and 
President Herbert Hoover believed government should address the debt of 
America instead of the depression of America. He lost that election to 
Franklin Roosevelt in 1932 as a result of that point of view.
  Many of us believe the debt is a serious issue to be grappled with, 
but at the current moment we have to focus on the millions of Americans 
out of work who need a helping hand, first with unemployment benefits, 
COBRA benefits, food stamps, the basic necessities of life. We have to 
provide opportunities for education and training,

[[Page S13650]]

and then we have to find a way to spark this economy and move it 
  Senator Reid has given to me and Senator Dorgan of North Dakota the 
responsibility of looking at the Senate jobs-creation package. We have 
been working on that, and we are close with our colleagues in the House 
in coming up with some ideas on how to expand employment. I hope we can 
have bipartisan support for that. It would certainly make it a lot 
easier, and it would be done more quickly so that we do not lose jobs 
in the next construction season coming up next year.
  That is the reality of the agenda we face when we return. I did tell 
you that now most Members of the Senate on both sides of the aisle are 
anxious to share their holiday season with their families. It is one of 
those special times of the year. We now have a record vote of 60 
Members on this side on health care reform. I hope we can get the 
agreement from the Republican side to bring this matter to closure 
soon, to vote on the debt ceiling, and to have at least a short 
adjournment for some time for us to return home to our States and home 
to our families.
  Mr. President, if there is no one seeking recognition at this time, I 
suggest the absence of a quorum and ask that the time under the quorum 
call be assessed against both sides.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Under the previous order, the time until 6:30 p.m. will be divided in 
1-hour alternating blocks of time, with the majority controlling the 
first block.
  Mr. BAUCUS. Mr. President, I wish to take a few moments this morning 
to talk about a provision in this package about which I am particularly 
proud. This would finally follow through on the Federal Government's 
responsibility to provide screening and medical care to residents at 
Superfund public health emergency sites.
  The term ``public health emergency'' is defined by the Comprehensive 
Environmental Response Compensation and Liability Act of 1980, 
otherwise known as CERCLA. People call that the Superfund law--CERCLA. 
That law reserves the declaration of public health emergency for the 
most hazardous Superfund sites. These are sites where the release or 
potential release of a hazardous substance rises to the level of an 
  When a public health emergency is declared, the law requires that the 
Secretary of Health and Human Services provide screening and medical 
care services to people who have been exposed. But to date, the 
government has not created a mechanism to allow the Secretary to 
deliver the screening and medical care required under current law. The 
bill before us finally provides that mechanism.
  First, it authorizes a grant program for the screening services. 
These screenings would determine if a medical condition is present that 
is attributable to environmental exposure. Then, it allows those 
individuals with a diagnosed medical condition due to the environmental 
exposure at the site to get medical care services.
  It also establishes a pilot program to provide additional medical 
care appropriate for the residents of the Superfund site at Libby, MT. 
This language responds to Libby's rural nature and the lack of access 
to traditional care. This provision is important because it will 
provide vital medical services to Americans who, through no fault of 
their own, have suffered horrible effects from their exposure to deadly 
poisons. It will provide the vital medical services we owe these 
Americans under our commitment in prior legislation; that is, the 
Superfund Act.
  This provision is especially important to me for a special reason. 
The Environmental Protection Agency currently has 1,270 sites 
designated where pollution contamination presents a danger to public 
health and welfare. Throughout the history of the program, the EPA has 
found only one site where conditions are so severe and the 
contamination so pervasive to have it warranted a declaration of a 
``public health emergency.'' That declaration occurred on June 17 of 
this year. EPA Administrator Jackson found that a public health 
emergency exists at the Superfund site in Libby, MT.
  Many Senators have heard me speak about Libby. Libby, MT, is a 
beautiful little town, a small town in northeastern Montana, surrounded 
by millions of acres of Federal forest lands. It appears to be an 
idyllic spot. It is home to families of all ages. It is a place where 
people spend their lives creating a sense of community not often found 
in the country today. It is also a town that has gone through lots of 
stress, lots of economic difficulties. The timber industry has 
virtually shut down Libby, one of the mainstays in Libby. Mining there 
is not quite what it used to be in years past. Here the people work 
together. They love Libby. It is tucked away, almost isolated in the 
northeastern part of Montana. Most people in Montana have never been to 
Libby, and some don't even know where Libby is, but they have this 
wonderful sense of community in their own town.
  However, Libby is also a Superfund site. It is the home of a big 
mine. It is a place where hundreds of people have grown sick and died--
died due to pervasive presence of asbestos spewed from the vermiculite 
mining and milling operations of W.R. Grace.
  Gold miners discovered vermiculite in Libby in 1881. In the 1920s, 
the Zonolite Company formed and began mining vermiculite. In 1963, W.R. 
Grace bought the Zonolite mining operations, operated it, and made a 
lot of money, frankly, and the mine closed in 1990.
  The EPA first visited Libby in 1999. In October 2002, EPA declared it 
a Superfund site. Cleanup was begun. It was very pervasive, very 
difficult, and it was a hard time getting the trust between the EPA and 
the people in the community. A lot of people didn't trust that EPA was 
doing the right job, not doing it the right way. In fact, I had to get 
so involved in so many ways in holding EPA's feet to the fire because 
they weren't doing something such as a base-level study. They didn't 
know how clean clean was. They did not do a very good job.
  A guy named Paul Peronard was the onsite coordinator, who was finally 
able to convince EPA back in Denver what they had to do. In my personal 
judgment, they didn't send Paul back because he was doing such a good 
job. Anyway, cleanup began in 2002, and we still have a long way to go.
  For decades, the W.R. Grace operation belched 5,000 pounds of 
asbestos into the air in and around Libby every day. Deadly asbestos 
coated the town and its inhabitants. People used raw vermiculite ore or 
expanded vermiculite to fill their gardens, their driveways, they put 
the stuff on the high school track, the little league ballfield, and 
put the stuff up in their attics. It was used everywhere, this stuff. 
People sort of sensed there was something not quite right with all this 
vermiculite and asbestos, but it was kind of hard to put your finger 
  One day, I visited Libby, and I will never forget, when I went to the 
mine, I was stunned to see these miners come off the mine and into 
their buses. They were caked with dust. I mean, it added new meaning to 
a dustbin. They were just caked with the stuff on their clothes. They 
got on the bus, went home.
  The one person I talked to and who got me interested in doing 
something about this--a guy named Les Scramsted--told me, when he got 
off the bus, he would go home--caked with dust--and embrace his wife, 
his kids would jump in his lap, and guess what: Les is now dead from 
asbestos-related vermiculite. His wife is ill, and one of his children 
has died as a consequence. Think of the pain he went through. He died 
because of mesothelioma asbestos. Also, even worse, he caused his wife 
to be ill and caused his son to die because of this disease.
  Mine workers brought the dust home with them, as I mentioned, on 
their clothing. They contaminated their own families without knowing 
the dust was poison. We knew something was wrong, but we didn't know it 
was that wrong.
  I think the company knew exactly what it was doing. In fact, I might 
say, the company has been subject to a criminal action against their 
officers, with allegations the officers knew they were contaminating 
the people and

[[Page S13651]]

didn't disclose it. That suit went on for a year. It is true the 
officers were acquitted not long ago, but in my personal judgment, it 
was because of a lousy prosecution. But it is an example where somebody 
thought--a lot of people thought--not only did the officers of this 
company contaminate people, but they knew they were contaminating 
people at Libby, MT.
  Asbestos was everywhere in Libby for decades. I must say, W.R. Grace 
Company sure did not help matters. I might say, parenthetically, this 
is the same company that is the subject of a book and a movie called 
``Civil Action,'' where W.R. Grace contaminated the water in Woburn, 
MA. In my judgment, they knew what they were doing. It is clear they 
knew what they were doing. As I recall, a big civil judgment was 
rendered against W.R. Grace because it was clear they knew what they 
were doing. They are now bankrupt. W.R. Grace shoved all their assets 
to another location so the plaintiffs in the suit against W.R. Grace 
could not attach their assets--and all the shenanigans this company 
undertook for their own benefit and at the expense of the people in 
  The type of asbestos in Libby is particularly deadly, and so many 
people in Libby are dead, dying, and sick because of this tremolite 
asbestos, an especially vicious, pernicious form of asbestos. This is 
not regular asbestos, such as chrysotile, this was tremolite asbestos 
mined at Libby, MT, where the fibers are deeper and they are stronger. 
They get in your lungs and they cause more damage and it takes longer 
to detect. It is that vicious.
  The effect on Libby has been severe. Today, we know that nearly 300 
residents of Libby have died--300. It is a small town. Thousands more 
have become sick with asbestos-related disease. That is 291 deaths in a 
county of 18,000. Lincoln County, MT, home to Libby, has the highest 
age-adjusted death rate due to asbestosis in the Nation.
  Libby is an isolated community with limited access to health care. 
The median household income in Libby in 2007 was $30,000. When I say 
``isolated community with limited access to medical care,'' what do I 
mean? There is just not that much there. And the company has reneged on 
its insurance policies. The company had mediocre insurance policies for 
folks, but as time goes on, the company just backs off--backs off. It 
is really what is happening in the health care reform here. They 
rescind--renege on their policies for one reason after another. The 
poor folks, when they know they have asbestos-related--either cancer or 
other lung-related disease, they do not have the resources to go to get 
the medical attention.
  I have been at this for years. It is so frustrating, it is so wrong 
what has happened to the people of Libby, MT.
  It is this combination of devastating characteristics that led the 
EPA Administrator in June to find that the public health emergency does 
exist at the Libby Superfund site. This finding was based on years of 
work, having originally been recommended by the EPA in 2001.
  I might say, I read the transcripts between EPA Administrators and 
OMB back in those years. The EPA Administrator under the Republican 
administration recommended that this action be taken, but it was 
squelched at the White House by OMB. The correspondence is clear. This 
is exactly what happened back then in a previous administration. That 
is why EPA has never used this authority, and the Agency indicates 
there are currently no sites on the National Priorities List that come 
close to the conditions at Libby.
  It is worth highlighting a few parts of the Administrator's findings. 
Let me indicate what they are. The Administrator has said:

       The Libby Asbestos Site is unique with respect to the 
     multiplicity of exposure routes [all ways this stuff gets to 
     them], the cumulative exposures experienced by community 
     members, and the adverse health effects from asbestos 
     exposure already present and documented in the residents.
       Investigations performed by the Agency for Toxic Substances 
     and Disease Registry (ATSDR) have found hundreds of cases of 
     asbestos-related disease in this relatively small community. 
     ATSDR documented a disease and death rate from asbestosis in 
     the Libby area significantly higher than the national average 
     for the period from 1979-1998. The occurrences of disease are 
     not limited to vermiculite facility workers or their 
     families, but are spread throughout the population.

  This is pervasive in the town--ballfields, tracks, lawns; it is 

       Medical care in Libby has historically been limited due to 
     Libby's isolated location and economic situation, thus 
     reducing the chance of early detection and treatment of 
     asbestos-related disease.

  This piece bears repeating:
  Let me refine that point. For a long time, we have been talking to 
lung specialists across the country about the Libby tremolite asbestos, 
and we got just so-so responses about how dangerous it was. Why? 
Because virtually none of those doctors had experience dealing with the 
pernicious kind of asbestos we have in Libby, MT. It took a long time 
to get their attention. We finally got some doctors to say this stuff 
in Libby is wicked stuff. That is why, frankly, EPA has started to 
understand how bad this really is.
  Essentially, the lack of access to health care services in Libby--I 
will say it again--has actually worsened the effects of this 
contamination. It just worked to their disadvantage.
  The language before us today helps to solve this. It allows us to 
fulfill the commitment we made to the people of Libby when we passed 
the Superfund Act 30 years ago. Heaven forbid, if in the future another 
Superfund site like Libby emerges, the bill before us today will allow 
the Secretary to use the authorities in this provision to fulfill our 
commitment to provide health care services for those residents as well.
  I can never talk about Libby without remembering my friend Les 
Skramsted. I mentioned his name a few moments ago. I first met Les in 
the year 2000 at the home of Gayla Benefield. Les was there, Gayla was 
there, and lots of other miners were there pleading for help, for some 
attention: We are dying. Someone pay attention to us. We are a small, 
isolated community up here in northwestern Montana. Please, someone, 
pay attention to us.
  This did get our attention. I was stunned by the stories they told. I 
was talking to Les over coffee and huckleberry pie--a very popular pie 
up in Libby. Les was watching me very closely when I said: You bet, I 
will help do something about this. He was very wary.
  After his neighbors and friends had finished telling me their 
stories, I will never forget that Les came up to me and said: Senator, 
a lot of people have come to Libby, and they told us they would help. 
Then they leave and nothing happens.
  He told me, I remember, I think at that instant--you know, in life 
sometimes you find four, five, six, seven instances, man to man, 
whatever it takes, you are going to make sure they get justice; 
whatever it takes, whatever it takes. Such a commitment. That was one. 
I said to myself: Boy, I am going to do whatever it takes to take care 
of this because these people of Libby deserve justice. They have not 
received it.
  He said: Senator, I heard you say that, but I will be watching you.
  I knew he would watch. I knew that would help. I didn't actually say 
it because I was going to do it anyway. I accepted Les's offer, and I 
have a big photograph of Les behind my desk.
  Les passed away a couple or 3 years ago. I spent a lot of time with 
him and his family at the hospital. I have a wonderful picture of Les 
Skramsted that reminds me what we have to do for the people of Libby 
but also for all the people in the Nation, people like Les Skramsted. 
It means that much to me.
  I have not forgotten Les. I will not forget Les. That is why this 
provision is in here. I think Les, right now, up there, may be smiling, 
saying: Yup, he did not forget Libby, he did not forget Les. That is 
what this provision is all about.
  This is a photograph behind me of Les Skramsted in Libby, MT. He is 
in a cemetery there, graves of lots of people in Libby who died. Les 
played a pretty mean guitar. He was a great guy--still is, always will 
  I yield to my colleague from Montana, Senator Tester.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. TESTER. Mr. President, come snow or sunshine--day or night--we 
are close to sealing the deal to change our country for the better, to 
finally hold insurance companies accountable, and

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to make health care affordable for all folks in this country.
  Right now we are all paying far too much for health insurance. Many 
of us can not get health insurance at all. And even worse, insurance 
companies don't always live up to their end of the bargain.
  Sure, a lot of folks are happy with the health care they have.
  Our doctors, nurses and hospitals and medical research are the best 
in the world.
  But when you add it all up, many are paying too much for it. Or 
nothing for it. Too many lives are lost. Too much money is wasted. And 
too many folks are falling through the cracks.
  They are calling out for help. I have heard their voices. Now I want 
you to hear their stories. They are ordinary people who stand to lose 
everything unless we reform our health care system.
  I support this health care reform bill because it saves lives. It 
saves money. It saves Medicare. And it is tough on insurance 
companies--taking them to task to ensure affordable, fair coverage.
  I have a perspective different than most of my friends in the Senate.
  I am--and always will be--a third generation Montana farmer. My wife 
Sharla and I do all the work on our farm. I am the guy sitting on the 
  A farmer knows a good year from a bad year. And I have had my share 
of bad years. In fact, for a few of those years--not long after our 
first kid was born--Sharla and I had to give up health insurance to 
make ends meet. We had no other choice but to hope and pray for health 
and safety.
  Thank God our prayers were answered.
  Now, I have the honor of serving Montana in the Senate.
  But mine is one of the thousands of real Montana families that has 
been forced to wing it, rather than depend on a health care system that 
works. And that holds insurance companies accountable.
  I know of a woman from Ravalli, MT, who cannot afford health 
insurance because of her pre-existing condition. She and her husband 
got letters from the insurance company telling them their premiums were 
going up, $500, to $600, to $700 per month. Through no fault of her 
own, her insurance just became too expensive. So she gave up.
  This legislation will prevent that sort of nonsense in the insurance 
industry from happening again. In this bill, a health insurer's 
participation in the exchanges will depend on its performance.
  Insurers that jack up their premiums before the exchanges begin will 
not be included. That is a powerful incentive to keep premiums 
  We all have friends and relatives who aren't fortunate enough to have 
a job where health insurance is part of the deal. So they do what 
millions of others are forced to do: they hope and pray they stay 
  We have a problem. It is time for a solution using common sense and 
fiscal responsibility. And that is why I am going to vote for this 
health care reform bill, so we can save lives, save money, save 
Medicare. And so we can hold insurance companies accountable, so they 
don't drop people when they are sick, or drive families into 
  Because of tax credits, this bill is good for small businesses. It 
gives eligible small businesses access to up to 6 years of tax credits. 
That will help small businesses buy health insurance for their 
  Because of tough new rules for the insurance industry, it is good for 
families and kids.
  And because of commonsense ideas like cross-State insurance markets, 
more competition, and more choices, it is good for millions of 
Americans who--until now--have had to rely on hope and prayers.
  If we do not pass this bill, our entire economy could fall apart 
beyond repair. Right now we are working hard to rebuild our economy, 
and it is working.
  We are creating jobs and investing in the basic infrastructure needed 
to get our economy back out of the ditch. Fixing our broken health care 
system is part of that job.
  Over the past few years, I have heard from thousands of Montanans 
telling me about the need to fix health care.
  One of them is Roxy Burley. Roxy owns a hair salon in Billings, MT.
  She just bought a home. She works hard. But she just can't afford 
health insurance. So, she says, she is walking a tightrope. Her home 
and her business are on one side. Her health is on the other side.
  If Roxy gets sick, she worries she will lose her home and her 
  In Montana, our economy relies on people like Roxy Burley. We can't 
afford to have our economy walking a tightrope.
  In this bill, Roxy will be protected from losing her home and 
business. Her annual out of pocket expenses are capped at no more than 
$5,950 per year.
  I want to share another story that hits home for me. It is the story 
of Mindy Renfro. She lives in Missoula, MT.
  Mindy got breast cancer not just once, not just twice, not just three 
times--four times: Breast cancers, four different cancers.
  The same cancer didn't come back. She got a different cancer each 
time. The first two times, Mindy's insurance paid for her treatment.
  The third time, the insurance company called her and said: We are 
sorry, but we are not going to pay. The underwriter, she says, 
determined her chances of survival were just too slim, so instead they 
offered to send a hospice nurse.
  Mindy was a single mom in her early 40s, and she was simply not ready 
to check out. So she asked about her options. She was told if she 
wanted to start chemo, she would have to come up with more than 
$100,000 in cash. Her only option was to sell her home. Mindy and her 
children sold their home, and moved into an apartment. They packed up 
and moved out of their home so they could sell it and she could start 
the treatment she needed to stay alive. After many years of trying to 
repay that debt, Mindy recently declared bankruptcy.
  I have heard many stories from folks in Montana who are in the same 
boat that Mindy is in. This isn't good business. This needs to stop. It 
is why I support this health care reform bill. I support it because 
under this bill, Mindy and people like her wouldn't have to declare 
bankruptcy. She would have had insurance, despite her preexisting 
condition of being a cancer survivor, and her annual out-of-pocket 
expenses would have been capped at no more than $5,950 per year, not 
the $100,000 in cash she needed to start cancer treatment. This bill is 
strong and decisive and tough on insurance companies so they cannot 
say, sorry, but no, when you get sick; so they cannot say, sorry, but 
no, if you have a preexisting condition.
  Another story is about former ranchers Dan and Pat Dejong. This 
picture is of Pat. Dan and Pat used to own a cattle ranch in 
northwestern Montana. The ranch had been in their family for four 
generations. Dan and Pat couldn't afford health insurance. Then Dan was 
diagnosed with cancer. To pay the bills they had to make the painful 
decision to sell off their ranch.
  I am going to tell you, when a piece of land has been in the family 
for four generations, you develop an attachment to that piece of land. 
But nonetheless when Dan got cancer, they had to pay the bills. They 
sold the family ranch. Under this bill, the Dejongs would have had 
access to subsidies so that they could have afforded health insurance 
in the first place. They never would have had to sell the ranch to pay 
the doctors' bills.
  I want to read what Pat wrote to me about that experience:

       The cancer ravaged Dan's body, but selling our ranch to pay 
     for medical costs broke his spirit.

  Dan Dejong lost his battle with cancer 2 years ago. All his bills 
were paid, but the ranch that had been in the family for four 
generations was gone, as well as Dan. After all that, Pat still cannot 
afford health insurance today.
  Under this health care reform bill, getting sick won't force folks 
such as Dan and Pat Dejong to sell the land that has been in their 
family for generations. That is because it limits the amount of money 
you would have to pay out-of-pocket to a rate you can afford based on 
how much you earn. That means no Americans would have to sell their 
homes or their family ranches to pay the medical bills.

[[Page S13653]]

  I know a lot of folks already have health insurance, and they are 
wondering, how is this going to affect me. Let me be clear: If you like 
your plan, you get to keep it. If you don't, you can look for a more 
affordable plan that works best for you and your family. Everyone will 
have access to affordable health insurance. Right now those with health 
insurance are subsidizing those without.
  The other day I struck up a conversation with a trucker back in 
Montana who told me: I don't need insurance. I don't want insurance. I 
don't get sick. I asked: What happens if you get into an accident? You 
are a trucker; that is always a possibility. He said: All I have to do 
is go to the emergency room where they take care of me, no questions 
  That is exactly the problem. When everybody is insured, costs will go 
down, because no one will be paying extra to cover the folks who rely 
on the emergency room for health care that they eventually never pay 
for. It is common sense. It saves lives, and it saves money.
  I have been on the phone with tens of thousands of Montanans over the 
past few weeks answering questions about health care. A lot of them 
want to know how we are going to pay for this bill. How much will it 
increase our debt?
  It won't increase our debt one thin dime. In fact, it will lower our 
deficit by hundreds of billions of dollars, $132 billion over the next 
10 years alone. It reduces the deficit even more in the decade after 
that. The fact that this bill saves money is pretty important to me. It 
doesn't add to the deficit. It cuts billions of dollars of government 
waste. It requires a bigger chunk of your premiums to go directly to 
better health care instead of administrative costs and profits, it 
saves money for families by lowering costs for everyone and by limiting 
the amount of money you have to pay out-of-pocket for health care and 
by emphasizing wellness and prevention--the low-hanging fruit of health 
care reform, and by holding insurance companies accountable so we don't 
pay more than our fair share for the health care we need.
  When you turn on the TV these days or open the newspaper, you see all 
sorts of spin about the health care reform and Medicare. It amazes me 
how distorted the facts have become. I have read the bill. The plain-
as-dirt fact is it makes Medicare stronger. All guaranteed Medicare 
benefits stay as they are. They are just that--guaranteed. Seniors are 
guaranteed to keep their benefits, such as hospital stays, access to 
doctors, home health care, nursing homes, and prescription drugs. How 
do we make Medicare stronger? We make it stronger by getting rid of 
wasteful spending, by making prescription drugs for seniors more 
affordable, and by spending your money smarter.
  Without this bill, Medicare will be on the rocks within a matter of 
years. If we don't fix it now, it will go broke, leaving entire 
generations in the lurch. Millions of Americans have worked hard all 
their lives for Medicare benefits. They have earned it. That is why we 
are making Medicare better, not worse. That is common sense.
  The same goes for VA health care. This bill does not affect VA health 
care or TRICARE. I serve on the Veterans' Affairs committee. Over the 
past 3 years we have made good progress in delivering the promises made 
to veterans. We still have a lot of work to do, but this health care 
reform legislation takes us forward even further for America's 
  Finally, this bill preserves some of the most important parts of 
quality health care: the relationship between you and your doctor and 
the freedom of choice you have as a patient. In Montana, as in many 
parts of the country, we don't tolerate the government snooping around 
our private lives or making personal decisions for us. Health care is 
no exception. This health care reform bill not only saves lives, it 
saves money and saves Medicare. It keeps the government out of the exam 
room and waiting room.
  I go home to Montana about every weekend to visit with the folks and 
hear what is on their minds. I meet with doctors and nurses, hospital 
administrators and regular folks from all over the State to hear their 
concerns. Everywhere I go, health care is the No. 1 issue. It is clear 
that the worst option is to do nothing at all. If that happens, 
insurance companies won't be held accountable. As costs go up, health 
care costs will continue to break families and people who need 
treatment to stay alive won't get it.
  I know a fellow farmer who worked some land back in Montana. When he 
got sick, he had to sell off entire chunks of his family farm to pay 
the bills, piece by piece. Piece by piece, I watched as he made painful 
sacrifices for his health care. Piece by piece, his livelihood was 
broken apart. No American deserves that.
  People are calling out for help, because a lot of folks are falling 
through the cracks. I say to them: We are listening. We hear you, and 
we are doing something about it. That is why this is a good bill. It is 
a bill I support. It will allow Americans to get the health insurance 
they have needed, and the insurance will be affordable. It is the 
result of a lot of hard work and working together to do what is right 
for the country--for America's rural families, seniors, veterans, small 
businesses, family farms, and ranchers. The people of this country 
deserve no less.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, I was proud last night to have voted for 
the health care bill. The reason is, as Senator Tester indicated, this 
bill accomplishes a whole lot. Before I go on to talk about what I want 
to focus on this afternoon, I do want to say there are a number of 
provisions in the Senate bill I don't support and I hope we can improve 
in the conference committee by adopting the House language. One is the 
issue of the public option, with which the Presiding Officer has been 
so strongly involved. At the end of the day, it seems to me the 
American people have been very clear. If they are not happy with their 
private insurance, they want the option of a Medicare type public 
option. I think we should give them that.
  Furthermore, as we look at the soaring cost of health care, we 
understand that one important mechanism to control escalating health 
care costs is a public option which provides real competition to 
private insurance companies that are only concerned about making as 
much money as possible. I know the Presiding Officer has worked very 
hard in that effort. I hope we can, in that regard, take the House 
language which includes a public option.
  The other area where I disagree with the Senate and agree with the 
House is on the issue of taxing health benefits for middle-income 
workers. The House provision raises substantial funding by putting a 
surtax on the very wealthiest people in the country, people who 
received huge tax breaks during the Bush years. That makes a lot more 
sense to me than taxing the health benefits of middle-income workers.
  Having said that, I want to focus on one new provision that was 
placed in the health care reform bill by Majority Leader Reid. I thank 
him very much for his strong support for this concept. I also thank 
Dick Durbin, Chuck Schumer, Patty Murray, the Presiding Officer, and 
the entire Democratic leadership for their support.
  That provision simply provides $10 billion over a 5-year period to 
the Federally Qualified Health Center Program and the National Health 
Service Corps. In my view, these two programs are some of the best and 
most effective public health care programs in the United States. They 
enjoy widespread bipartisan support. President Bush was a supporter. 
John McCain, when he ran for President, was a supporter of community 
health centers. Many Republicans have spoken positively of community 
health centers, as have virtually all Democrats. The reality, however, 
is that both community health centers and the National Health Service 
Corps have been starved for funding for many years. We are finally, in 
this bill, doing right by them.
  I should mention, importantly, that while we have placed $10 billion 
in the Senate bill, in the House bill there is $14 billion. My strong 
hope, expectation, and belief--and I have talked to the White House 
about this and the Senate leadership and House leadership--is that when 
this bill is finally passed, we will adopt the House language which 
calls for $14 billion.
  Let me tell you why this money is so terribly important. In a few 
days, the

[[Page S13654]]

Senate will be voting on final passage of a historic health reform bill 
that will insure an additional 31 million Americans who have no health 
insurance. That is a huge accomplishment. About half of the new people 
who will get health insurance will be enrolled in an expanded Medicaid 
Program. While this reduction in the number of uninsured is an 
essential step in achieving reform, we have to ask a very simple 
question: If 15 million more people go into Medicaid, where are they 
going to access the health care they need?
  It is no secret that today Medicare is a strained program. When some 
of my Republican friends make that point, I have to say they are right; 
it is a strained program. That is why expanding community health 
centers in the National Health Service Corps is so important.
  We talk about the number of people uninsured--a very important 
number--46 million. But we do not talk about the number of people who 
every day do not have access to a physician or a dentist on a regular 
basis, and that number is close to 60 million. These are people who, 
when they get sick, cannot find a doctor. Where do they go?
  Well, several things happen. They may end up going to the emergency 
room, which is the most expensive form of primary health care we have--
that is where they go--or even worse, they do not go to any doctor at 
all. What happens is, they get sicker and sicker. Then they go 
stumbling into a doctor's office, and the doctor says: Why didn't you 
come in here 6 months ago?
  And the person says: I don't have any health insurance. I couldn't 
afford it.
  Then they go to the hospital, and we spend tens and tens of thousands 
of dollars treating somebody who is now suffering in a way they should 
not be suffering, at greater expense to the system than should have 
been the case. Now, what sense does that make?
  Let me tell you the worst-case scenario. The worst-case scenario is, 
they walk into the doctor's office, and the doctor says: It is too 
late. I can't help you anymore. You should have been in here 6 months 
ago. I have talked to physicians who have told me about that. I suspect 
the Presiding Officer has as well. That is why this year we are going 
to see 45,000 of our fellow Americans die because they do not have 
health insurance, and they do not get to the doctor when they should.
  Now, one of the advantages of the community health care program is 
that it is an enormously cost-effective program. One study recently 
reported that $20 billion is wasted every year in this country in 
unnecessary and inappropriate use of hospital emergency rooms for 
nonemergency care. When you walk into an emergency room--I do not know 
about West Virginia--but in Vermont it is about $600. If you get that 
similar care for a nonemergency-type ailment, the cost is $100. So 
think about all of the money we save--we save--when we have community 
health centers expanding all over the country.
  One of the issues we have not focused on enough, in my view, in this 
whole health care debate is the very serious crisis in primary health 
care in general. The American College of Physicians, in a recent 
report, warned that the Nation's primary care workforce--which it 
called ``the backbone of our health care system''--is, in its own 
words, ``on the verge of collapse.'' That is the American College of 
  Over the past 8 years, for example, the number of family practice 
residents fell 22 percent, while the overall number of medical 
residents rose 10 percent. Currently--this is an extraordinarily 
frightening statistic--only 2 percent of medical students interested in 
internal medicine intend to pursue primary care as their specialty--2 
  This growing crisis was recently underscored in a report by the 
Association of Academic Health Centers, which warned that the country 
is rapidly running ``out of time to address what is out of order in our 
health workforce.''
  The good news is that 20 million of those people who live in 
medically underserved areas are fortunate to live where there are 
federally qualified community health centers.
  Let me explain a bit. What is a federally qualified health center--
which exists in all of our 50 States? It is a center which says: If you 
have no health insurance, you can walk in and do you know what. You 
will pay not only for primary health care but for dental care--which is 
a huge problem all over this country--for mental health counseling, and 
you will get the lowest cost prescription drugs available in America. 
And if you do not have any health insurance, you get it on a sliding-
scale basis. If you have Medicaid, you are welcome into the center. If 
you have Medicare, you are welcome. If you have private health 
insurance, you are welcome into these centers. Currently, these centers 
serve 20 million Americans in all of our 50 States.
  Conceived in 1965 as a bold, new experiment in the delivery of 
preventive and primary health care services to our Nation's most 
vulnerable people and communities, community health centers are an 
enduring model of primary care for the country and are designed to 
empower communities to create locally tailored solutions that improve 
access to care and the health of those they serve.
  West Virginia centers will be different than Vermont centers, which 
will be different than California centers because they are designed and 
locally controlled to serve the needs of the local population.
  By mission and mandate, community health centers must see all those 
who seek their care regardless of health status, income level, or 
insurance status. If you are rich, if you are poor, you will gain 
access to these community centers. Nobody is tossed away. Today, these 
health centers are America's health care home to one out of every four 
low-income uninsured individuals, one out of every six rural Americans, 
as well as one out of every seven Medicaid beneficiaries, and one in 
four low-income people of color. We need to guarantee that as we expand 
coverage, we expand community health centers as well. They are the one 
primary care provider who will see those on Medicaid without 
  Furthermore, community health centers already employ so many of the 
features of what we seek in the medical home model. They provide 
integrated health care, which is what we are talking about.
  A study recently by George Washington University--we are talking 
about spending money. What is so exciting about this whole concept is 
you are going to create more health care opportunities for people, and 
you save money--save money--by keeping them out of the emergency room 
and out of the hospital. A study by George Washington University found 
that patients using health centers have annual overall medical care 
costs that are more than $1,000 lower than those who do not use a 
health center--$1,000. That translated to more than $24 billion in 
savings for the health care system last year alone.
  We are keeping people out of the emergency room, we are keeping 
people out of hospitals, and we are keeping them from getting sicker 
than they otherwise would be. That is why I am so pleased Majority 
Leader Reid has looked at this track record and concurred that we will 
guarantee--guarantee--funding of health centers over the next 5 years 
in order to provide health care to more people and to save money at the 
same time.
  Let me tell you in concrete terms what $14 billion--the amount of 
money that is in the House bill--will mean to the American people. What 
it will do is it will increase the number of people who have access to 
community health centers, from the current 20 million to 45 million 
over a 5-year period--20 million to 45 million. We are more than 
doubling the number of people who will be able to walk into a clinic 
for health care, dental care, low-cost prescription drugs, primary 
health care--in 5 years going from 20 million to 45 million people.
  This funding would create new or expanded health centers in an 
additional 10,000 communities--10,000 communities--from one end of our 
country to the other. In some cases, entirely new federally qualified 
health centers would be established. In other cases, new satellite 
centers would be created. In Vermont, for example, we have eight 
community health centers. We have 40 total sites. That is true all over 
this country.
  But can you imagine, Mr. President, that in the United States of 
America, within a 5-year period, 10,000 new community health centers in 
this country

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would be established? People would not have to go 50 or 100 miles to 
find access to health care. It would be there in their own community. 
It would be in urban areas, in rural areas. This is extraordinary.
  Now, these community health centers and the growth of these community 
health centers do not mean much unless we have the medical personnel to 
adequately staff them.
  As I mentioned a moment ago, everybody concludes we have a real 
crisis in terms of access to primary health care in this country and 
the number of physicians and dentists and nurses who serve in the 
primary care area. What this language does, that we have just added, is 
it would--if we adopt the House numbers--triple funding in a 5-year 
period for the National Health Service Corps, which provides loan 
repayments and scholarships to medical students.
  For the University of Vermont Medical School, if my memory is 
correct--this is fairly typical for America--the average medical school 
student graduates with $150,000 of debt. Well, if you graduate with 
$150,000 of debt, what are you going to do? You are not going to do 
primary health care. You are going to go into some fancy specialty and 
start making a whole lot of money to pay off that debt. But what the 
National Health Service Corps will be able to do is provide debt 
forgiveness and scholarships for an additional 20,000--an additional 
20,000--primary care doctors, dentists, and nurses. That is a lot of 
new medical personnel that is going to get out into underserved areas 
all over America. That is a very exciting thought.
  In short, when we more than double, in 5 years, the number of people 
who have access to community health centers, and within that same 
period of time we add an additional 20,000 primary health care doctors, 
dentists, and nurses, we are talking about nothing less than a 
revolution in primary health care in America--something which we have 
needed for a long time.
  So let me conclude by saying: I want to again thank the majority 
leader, Senator Reid. I want to thank Senator Durbin, Senator Schumer, 
Senator Murray, and thank the Presiding Officer and the Democratic 
leadership for their support of this concept. As you know, this idea 
was developed back in the 1960s with Senator Ted Kennedy, who developed 
this concept in the first place. It has expanded, and now we are going 
to take it a giant step forward and, in the process, I think we are 
going to make a difference--a real difference--in improving the lives 
and the well-being and the access to health care of tens of millions of 
  Mr. President, thank you very much. With that, I yield the floor and 
suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. GRASSLEY. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GRASSLEY. Mr. President, I would call to the attention of the 
leadership of the majority party that I have a unanimous consent 
request I wish to make. I am going to be visiting with my colleagues 
about the issue of taxes on medical devices, so my unanimous consent is 
in regard to that. I hope people would observe that if there is an 
effort to block this motion I am going to make, I think it is an 
endorsement of the tax on medical devices such as the Berlin heart and 
hundreds of others that children across this country rely on.
  With that in mind, I ask unanimous consent to set aside the pending 
amendment in order to offer my motion to commit.
  The PRESIDING OFFICER. Is there objection?
  Mr. DURBIN. With regret, I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. GRASSLEY. Mr. President, it is disappointing for those of us on 
this side of the aisle to not be permitted to offer an amendment or 
motion that is as important as this, so I will go ahead with my 
  This is another major problem in the Reid bill. Of the many taxes in 
this bill, I am especially worried about the excise tax on medical 
devices. Medical device technology is responsible for saving many lives 
and extending the overall life expectancy of people in the United 
  In the United States, over 6,000 companies are in the business of 
developing lifesaving medical products. The majority of these companies 
are very small businesses. Small business we tend to measure around 
here as being those with less than 500 employees. So what will happen 
when the Reid amendment imposes a tax hike of $20 billion on these 
innovative medical devices? I think that is something we ought to 
consider if we are considering the quality of life in America and 
quality health care to preserve that life and extend life expectancy.
  During the markup of the Finance Committee bill, I asked the question 
to the nonpartisan Congressional Budget Office and the nonpartisan 
Joint Committee on Taxation--and let me emphasize the word 
``nonpartisan'' because these folks are professionals. So both of these 
organizations, the Congressional Budget Office and the Joint Committee 
on Taxation, said these excise taxes will be passed on to consumers in 
the form of higher prices and higher insurance premiums.
  Also, I wish to emphasize on this chart a statement of the Chief 
Actuary of the HHS. The Congressional Budget Office, the Joint 
Committee on Taxation, and the Chief Actuary all say the tax gets 
passed on to consumers. Who are the consumers of these devices? Who is 
going to bear the cost of the new medical device excise tax? Well, it 
is quite a burden, so I am going to share some real-life stories here.
  I will start by telling the story of the Tillman family, a family who 
would bear the burden of this new medical device tax. At only 5 months 
old, Tiana Tillman had her life saved by a medical device. This story 
has received a lot of attention because Tiana's father is a 
professional football player for the Chicago Bears. However, lifesaving 
stories such as this happen all across the country regularly.
  When Charles Tillman reported to training camp in 2008, it wasn't 
long before his coach told him that his 5-month-old daughter Tiana had 
been rushed to the hospital. When Charles got to the hospital, Tiana's 
heart rate was over 200 beats per minute. That doctor told Charles and 
his wife Jackie that Tiana may not make it through the night. Tiana 
survived that night, and after a series of tests, she was diagnosed 
with cardio myopathy, an enlarged heart that is unable to function 
properly. Her condition was critical, and without a heart transplant 
she would not survive. But finding pediatric donors is very difficult 
and many children do not survive the long wait time, so Tiana was 
immediately put on an ECMO, a device that would help the function of 
the heart while Tiana waited for a transplant.
  However, ECMO is an old device that has many shortcomings. Infants 
can only survive on ECMO for about 3 weeks, much shorter than the 
average wait for a donor heart. ECMO also requires that the patient 
take a paralytic medication which prevents a patient from moving and at 
the same time that obviously weakens the body.
  The Tillmans waited for one of two outcomes: Either Tiana would 
receive a transplant or she would die waiting on ECMO.
  But then the doctors told them about a new pediatric medical device 
called the Berlin heart. The Berlin heart is an external device that 
performs the function of the heart and lungs. It is designed for a 
long-term support to keep infants and young children alive for up to 
421 days while they wait for the donor heart--obviously a lot longer 
than the 3 weeks on ECMO. So the Tillmans decided to move forward with 
the Berlin heart.
  After 13 days of being on ECMO without any movement, Tiana underwent 
surgery to connect the Berlin heart. So we have pictures here that show 
what this is like. These two photos are of Tiana with the Berlin heart. 
You can see that this device is run by a laptop at the foot of the 
hospital bed. It pumps the blood through her body, a job that her heart 
could not perform on its own.
  Unlike ECMO, the Berlin heart and its long-term support capabilities 
allowed the Tillmans some peace of mind while they waited for that 
donor. The doctor said that the Berlin heart

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helped Tiana regain her strength because she was off the paralytic 
medication and was finally able to move. Not long after Tiana was 
connected to the Berlin heart, a donor was found and Tiana underwent an 
8-hour transplant surgery. The risky surgery was a success. Usually it 
takes some time for the new heart to start working, but doctors said 
that due to Tiana's strength, her new heart started working 
  I wish to talk about the tax on devices such as this.
  This picture shows Tiana today holding a football. That is Tiana 
today, and we shouldn't be surprised about her love for football, 
considering her father is a professional football player. She enjoys 
playing on her swing set and watching her dad play football.
  There are many people responsible for the successful effort to save 
Tiana's life, but without the Berlin heart to keep her alive and help 
her to gain strength, they may not have had that opportunity.
  What does this legislation have to do with this story about Tiana? 
Well, the Reid bill would increase costs for families such as the 
Tillmans. In fact, the Reid bill would tax every pediatric medical 
  Pediatric devices aren't the only devices affected by the tax on 
medical devices in the Reid bill. The Reid bill also taxes one of the 
most important modern technologies: automatic external defibrillators. 
The defibrillator is used to save people from sudden cardiac arrest, 
and that is the leading cause of death in this country. Each year, 
nearly 325,000 people die from sudden cardiac arrest. That is nearly 
1,000 deaths a day. Sudden cardiac arrest occurs when the heart's 
electrical system malfunctions and the heart stops beating abruptly and 
without warning. When this happens, the heart is no longer able to pump 
blood to the rest of the body, and for about 95 percent of the victims, 
death occurs. Once cardiac arrest occurs, the clock starts ticking and 
the victim's proximity to a defibrillator could mean the difference 
between living and dying. As many as 30 to 50 percent of the victims 
could survive if such a device is used within 5 minutes of sudden 
cardiac arrest.
  Here we have the story then of Mari Ann Wearda. Mari Ann is a 
constituent of the county I have lived my entire 76 years in, Butler 
County, IA. She is also a survivor of a sudden cardiac arrest, thanks 
to the prompt response of the Hampton Police Department and the 
availability of a defibrillator.
  On July 26, 2002, Mari Ann pulled up to a stoplight in Hampton, IA. 
Without any warning, Mari Ann experienced sudden cardiac arrest. As she 
slumped over the steering wheel, her car drifted across the road, 
climbed the curb, knocked over a sign, and came to rest against a tree. 
She was only minutes away from brain damage and death. At 11:38 a.m. 
the police station dispatched Officer Chad Elness, who arrived at the 
scene 2 minutes later, at 11:40. When Officer Elness arrived, Mari Ann 
was as blue as his uniform, according to his own report.
  Officer Elness attached the defibrillator to Mari Ann and pushed the 
button, sending 200 joules of electricity through her heart. That was 
one of the two shocks that Mari Ann required. Between the shocks, the 
defibrillator prompted officer Elness to perform CPR. Twice he almost 
lost Mari Ann. But by 11:50 a.m., Mari Ann had a pulse and her color 
was improving. At 11:52, just 11 minutes after the defibrillator was 
turned on, it had saved her life and was turned off.
  Mari Ann then was taken by helicopter to Mercy Hospital, Mason City, 
IA, where she received care. One week later--just one week later--she 
was back home with no permanent damage.
  Defibrillators are only effective if they are used within minutes of 
cardiac arrest, which means that in order to save more lives, there 
needs to be more of these devices. But do you know what this bill would 
do about all that? It would increase the cost, meaning there would then 
be fewer defibrillators.
  We understand the laws of economics. If we increase a price, we get 
less of it. If we lower a price, we get more of it. So we are going to 
increase the price of these devices. That would make it more difficult 
for police departments, schools, libraries, churches, and other public 
places to purchase defibrillators, or for an individual to have one. If 
you have to be within 5 minutes of their use, you can understand why 
they have to be in every police department, school, library, church, 
and a lot of other places. Right now, only one-third of police 
departments are equipped with defibrillators. However, Mari Ann was 
lucky that the Hampton Police Department had already purchased the 
  Increasing the cost of defibrillators will make it more difficult for 
communities to make this lifesaving investment. We already have 62--
62--defibrillator stations throughout the Capitol and the three Senate 
office buildings. So you and I are protected, but we are going to put a 
tax on them for the people in the rest of the country. It seems as 
though around here we have one set of morals and ethics for Capitol 
Hill and another set of morals and ethics for the rest of the country. 
Congress clearly understands why having so many of these devices, the 
importance of them and having them on hand to protect us and to protect 
our staffs and the million visitors who come to the Capitol.

  I made a motion that was objected to, so I cannot go through with 
that motion. My motion would have stopped this new Federal tax from 
increasing the cost of defibrillators and hurting the chances of 
placing the devices where they need to be--hopefully, within 5 minutes 
of people who need them. It is a disappointment my colleagues on the 
other side of the aisle would not allow that motion to go through.
  It is a sad state of affairs when the majority is not only blocking 
the offering of the motions and amendments that will improve the bill 
but also trying to ram through a bill before the American people even 
know what is in it.
  Yesterday, we heard things about Republicans having not offered 
amendments. There are 214 Republican amendments at the desk. One would 
think we would have a chance to offer more than a dozen or so--I doubt 
it is even a dozen at this point--on a bill that is going to 
restructure one-sixth of the economy.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.
  Mrs. HUTCHISON. Mr. President, may I ask, is it 10 minutes--what is 
the procedural position as of now?
  The PRESIDING OFFICER. The minority party controls the time until 
2:30 and there are no individual limits.
  Mrs. HUTCHISON. I thank the Chair.
  Mr. President, for weeks we have been debating legislation that will 
dramatically and permanently reform our health care industry. It will 
impact the life of every American, and it will add to our growing 
national debt.
  On Saturday, the majority leader filed an amendment increasing the 
size of this bill. Early this morning at 1 a.m., we had a vote to 
proceed to the revised bill that makes a mockery of transparency and 
public policy. Yet even though the majority took the opportunity to 
amend the bill, it is clear the concerns of the American people were 
not heard by my friends on the other side of the aisle.
  I was astounded to see this revised bill still contains $\1/2\ 
trillion in new taxes, $\1/2\ trillion in Medicare cuts and mandates 
and penalties on individuals and businesses throughout our country at a 
time when businesses are struggling, unemployment is up, and families 
are trying to make ends meet.
  I wish to talk about the taxes. The revised bill has an additional 
$25 billion in taxes than the bill as introduced. We have been hearing 
for weeks about families who are struggling to pay their mortgage, 
struggling to find a job, struggling to pay their utility bills. Yet 
what do we find in this new bill? More taxes and more mandates.
  The American people overwhelmingly oppose this bill, and just when we 
thought the final product could not get any worse, it does.
  Under the revised bill, the taxes collected from individuals who 
cannot afford health insurance has been raised from $8 billion to $15 
billion--almost double. Why? Because the penalty for not purchasing 
insurance has become more severe. If you cannot afford insurance, the 
tax is either $750 or 2 percent of your taxable income, whichever is 
  There are still taxes that begin next month, less than 2 weeks from 

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Less than 2 weeks from now in this bill, $22 billion in taxes on 
prescription drug companies will start, and the public can expect to 
see higher prices for medicines.
  In 2011, we see $60 billion in taxes on insurance companies except 
for companies in two particular States. That does not seem fair. 
Fortunately, the Constitution's equal protection clause may have 
something to say about this gross situation. This will not stand the 
test of the Constitution, I hope, because the deals that have been made 
to get votes from specific Senators cannot be considered equal 
protection under the law.
  If it does stand and the taxes start in 2011, people who have 
insurance are going to pay higher premiums--even higher than what has 
been projected already.
  In 2011, we also see the taxes on medical device manufacturers. So 
the public can expect to see higher prices for devices--thermometers, 
blood sugar machines, canes, walkers--the things people need to stay 
healthy. That is another $19 billion in taxes.
  Then there is another round of taxes in 2013: $149 billion in taxes 
on high-benefit plans; a 40-percent excise tax on the amount by which 
premiums exceed $8,500 for individuals and $23,000 for families; $87 
billion collected from a Medicare payroll tax. This tax is actually $33 
billion higher than in the prior bill. Individuals earning more than 
$200,000 and couples earning more than $250,000 are now assessed at a 
tax rate of 2.35 percent for a new Medicare payroll tax rather than 
1.45 percent. So if you are a couple earning $125,000 each, you have 
another tax increase, in addition to possibly a tax on not having 
insurance or a high-benefit plan.
  Also, $15 billion will be collected by raising the threshold for the 
medical deduction. To receive the medical deduction, you must now spend 
10 percent of your income on medical expenses rather than 7.5 percent. 
This tax will impact those who have high medical costs or are suffering 
from a catastrophic or chronic illness.
  This bill taxes those who have insurance and those who do not. All 
these taxes are collected. All the taxes I have mentioned will be 
collected before there would be the option that is the purpose of this 
bill. Whatever the insurance option becomes, it takes effect in 2014. 
All the taxes I have mentioned start before 2014.
  Senator Thune and I had a motion that would have sent this bill back 
to the committee and required that everything in this bill start at the 
same time. So if the program starts in 2014, the taxes would start in 
2014. Under our motion, not one dime in taxes would be paid before 
Americans are offered the insurance option in the bill. The motion was 
defeated. Now the Democrats have revised their bill and the taxes 
collected are even higher than the previous bill.
  But do not forget the penalties to businesses that cannot afford to 
offer health insurance to their employees. A tax of $750 per employee 
is assessed. This at a time when unemployment has reached double 
digits. We should be encouraging employers to hire new workers. Yet 
this bill imposes $28 billion in new taxes on employers.
  What will these taxes do to small businesses which create 70 percent 
of the new jobs in our country? In a letter sent to the majority 
leader, the Small Business Coalition for Affordable Health Care stated:

       With its new taxes, mandates, growth in government programs 
     and overall price tag, the Patient Protection and Affordable 
     Care Act--

  The bill we are discussing--

     costs too much and delivers too little. . . . Any potential 
     savings from those reforms are more than outweighed by the 
     new taxes, new mandates and expensive new government programs 
     included in this bill.

  That letter is signed, in addition to the Small Business Coalition, 
by associations such as the Farm Bureau, Associated Builders and 
Contractors, Associated General Contractors of America, the National 
Association of Homebuilders, the National Association of Manufacturers, 
the National Automobile Dealers Association, the National Retail 
Federation, and more.
  The National Federation of Independent Business, which is the voice 
of small business, sent a letter expressing their strong concerns over 
this bill. It says:

       The current bill does not do enough to reduce costs for 
     small business owners and their employees. Despite the 
     inclusion of insurance market reforms in the small-group and 
     individual marketplaces, the savings that may materialize are 
     too small for too few and the increase in premium costs are 
     too great for too many.

  That is the tax situation. How about the $\1/2\ trillion in Medicare 
cuts? They are still there. They were in the first bill, and they are 
there now.
  There are $120 billion in cuts to Medicare Advantage, which we know 
reduces choices for seniors. In my State of Texas, over 500,000 
currently enrolled enjoy the benefits of Medicare Advantage. That is in 
my State alone. Millions across the country like Medicare Advantage, 
but many seniors, without a doubt, are going to lose this option.
  Oddly enough, once again, one of the points in the new bill is, there 
was an opt-out for certain States on Medicare Advantage cuts. So some 
States are going to have the Medicare Advantage cuts while other States 
will not.
  The individual fixes for certain States, presumably to get the votes 
of certain Senators, do not pass the test of transparency. If you put 
it in the nicest way, it does not pass the test for fairness, for due 
process and equal treatment under the law, and it certainly does not 
pass the test for what is the right way for us to pass comprehensive 
reform legislation.
  The other health care cuts in Medicare would be $186 billion in cuts 
to nursing homes, home health care, and hospice providers.
  Then there are the cuts to hospitals, approximately $135 billion in 
cuts to hospitals. The Texas Hospital Association has estimated that 
hospitals in my State will suffer almost $10 billion in reduced 
  I have a letter from the Texas Hospital Association that outlines 
their concerns with these cuts and this bill and they are very 
concerned. Here is one of the quotes from their letter. The Texas 
Hospital Association says:

       With a significant reduction in payments, hospitals may be 
     forced to reduce medical services. [H]ospitals . . . may be 
     forced to close or merge with another hospital, or severely 
     reduce the services they provide to their community. 
     Essential services, such as maternity care, emergency 
     services, medical-surgical services or wellness programs may 
     be reduced or entirely eliminated.

  I have talked with so many hospital administrators and people on 
hospital boards, and they are very concerned about the cuts in this 
bill because most of them are on very thin margins. They are 
struggling, especially in our rural areas. They are very worried there 
are going to be shutdowns of hospitals throughout our State and 
certainly our country.
  Our aging population is growing, so cutting payments to providers who 
treat those patients, whether it is in hospitals or health care 
providers, does not seem to be a way to reform Medicare.
  Cuts in Medicare, and especially the payments for treating low-income 
seniors, will disproportionately impact rural hospitals which are the 
safety net for health care outside the metropolitan areas. The Texas 
Organization of Rural and Community Hospitals, which represents 150 
rural hospitals in Texas, said in a letter:

       We also fear the Medicare cuts as proposed could 
     disproportionately hurt rural hospitals which are the health 
     care safety net for more than 2 million rural Texans. Because 
     of lower financial margins and higher percentage of Medicare 
     patients, rural hospitals will be impacted more than urban 
     hospitals by any reductions in reimbursement. These proposed 
     Medicare cuts could have a devastating effect . . . which 
     could lead to curtailing of certain services. And the closure 
     of some of these Texas hospitals is a very real possibility. 
     . . .

  How could anyone support a reform bill that will result in seniors 
having to drive 30, 60, 90 miles and more to get the care they need--
care that was accessible in their own community before this bill took 
  Mr. President, what we have is a bill heavy with tax hikes, Medicare 
cuts, and government intrusion. This bill is being forced through 
Congress the week of Christmas because everyone knows this is not the 
reform that Americans want. The polls are showing that. We all know 
polls can have margins of error, and maybe they are not completely 
accurate, but the trend in the polls is clear: It has gone from people 
thinking that health care reform is a good thing and supporting it, in 
the majority, to going down now to the point where the trend is clear 

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American people now do not support this bill, they would rather have 
nothing, according to the latest polls, and have Congress start all 
over and do what they hoped it would do, and that is bring down the 
cost of health care not have this be a big government increase in debt, 
cuts to Medicare, and increases on taxes to small business and 
families, especially at this time in our country's economic period.
  My Republican colleagues and I have tried to offer fiscally 
responsible alternatives to reform, allowing small businesses to pool 
together, increase the size of their risk pools, which will bring 
premiums down. If you have an exchange it would be fine unless you have 
so many mandates, such as we see in this bill, that are going to cause 
the prices to stay up and even go higher because of all the taxes on 
the underlying companies that are providing the health care.
  Creating an online marketplace free from mandates and government 
interference where the public can easily compare and select insurance 
plans would be a Republican proposal, something that I think would be a 
point at which we could start having health care reform that would be 
truly effective for America, if you didn't have the mandates that would 
drive up the cost.
  Offering tax credits to individuals and families who purchase 
insurance on their own, that is a bill that we have put forward. Five 
thousand dollars per family would cut the cost and make it affordable 
without any government intervention that would be necessary.
  Of course, medical malpractice reform could take $54 billion out of 
the cost of health care by stopping the frivolous lawsuits, or at least 
limiting them. Yet Republicans were really not at the table. The bill 
was written in a room, with no transparency, no C-SPAN cameras, and no 
Republicans. We did not have input into this bill. That is why it is a 
partisan bill. That is why the vote last night--or this morning at 1 
a.m.--was completely, 100 percent partisan. Why would a Republican vote 
for a bill that goes against every principle we have--higher taxes, 
higher mandates, and cuts in Medicare--and in which we had not one 
amendment pass? We offered amendments, but there were hundreds of 
amendments left on the table that we were closed out of offering 
because of the rush to pass this bill before Christmas.
  Mr. President, Americans asked for reform; they deserve it. This bill 
is not the reform Americans hoped to get from a Congress that should 
have acted responsibly but did not.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mr. CORNYN. Mr. President, as my colleagues on this side of the 
aisle, I voted against the Reid health care bill last night because it 
cuts $470 billion from Medicare to create a brand-new entitlement 
program that will cost approximately $2.5 trillion over the next 10 
years--a price we cannot afford. It increases premiums for American 
families who currently have health insurance and who are struggling to 
make ends meet during tough economic times. It increases taxes on small 
businesses and individuals, which is a terrible idea, particularly at a 
time when our economy is struggling and our job creators are struggling 
to be able to keep people on their payroll and possibly expand their 
payroll and hire people back and bring down the unemployment rate.
  I want to talk about the way this bill came to pass--at least the 
cloture vote this morning at 1 a.m.--and I want to talk about the 
process. I recall when Senator Obama was running for President, he 
talked about wanting to change politics as usual in Washington, DC. But 
I have to tell you, the majority and this administration have, in many 
ways, confirmed people's worst suspicions about Washington politics as 
usual. They have taken it to a new level--and not a higher level; it is 
a lower level.
  As a matter of fact, the bartering for votes for cloture, the special 
sweetheart deals with drug industries, with Senators, in order to get 
the 60 votes last night, does nothing more than confirm the worst fears 
and cynicism the American people have about the way Washington works.
  We know this bill is a direct result of many special deals with 
special interest groups and their lobbyists. We heard the President say 
when he campaigned that he wanted to have a transparent process; that 
this would take place in front of C-SPAN and at a roundtable so people 
could see who was making arguments on behalf of the drug companies and 
the insurance companies. But that rhetoric conflicts with the reality, 
where the drug companies and the insurance companies and others were 
negotiating behind closed doors for sweetheart deals that ultimately 
ended up getting 60 votes.
  So it turned out it was the Obama administration that cynically said 
one thing during the campaign and then, when it came to actually 
passing legislation, did completely the opposite. This is tragic, in my 
view, Mr. President. The American people want to believe in their 
government. They want to believe their elected leaders are trying to do 
their best on behalf of the American people. But this process confirms 
their worst suspicions. No wonder public opinion of Congress is in the 
  Rather than listening to the American people, the creators of this 
bill started cutting deals with special interests first and cut those 
deals early. The White House struck a deal with the pharmaceutical 
industry, as you know, which produced in part, as the New York Times 
reported, about $150 million in television advertising supporting this 
bill. This deal got 24 Democrats when we were debating the issue of 
drug reimportation to switch their votes from their previous position 
against drug reimportation earlier this month.
  Notwithstanding all the rhetoric about insurance companies, basically 
this is a sweetheart deal with insurance companies because insurance 
companies will get $476 billion of your tax dollars and my tax dollars 
to pay for the subsidies and the insurance provided in this bill.
  The hospital industry cut a special deal that provided them an 
exemption from the payment advisory board. Then there were groups such 
as AARP that purport to serve seniors as a public interest but, as we 
know, primarily pocket money as a result of the sale of insurance 
policies--insurance policies that are going to be necessary because of 
cuts in Medicare Advantage for 11 million seniors, just to name one 
  This bill was the result of backroom deals with specific Senators, 
persuading them to vote for cloture, which has caused some people on 
the blogs and the Internet to call it ``Cash for Cloture.'' In order to 
get 60 votes for cloture, we know one of the first examples of that was 
the so-called ``Louisiana purchase.'' Charles Krauthammer said it well:

       Well, after watching Louisiana get $100 million in what 
     some have called ``The Louisiana Purchase,'' she ought to ask 
     for $500 million at least. And that's because Obama said he 
     would end business as usual in Washington. So it's a new kind 
     of business as usual.

  In other words, I guess the price has gone up. But as one business 
leader in Louisiana points out, notwithstanding the special sweetheart 
deal for the State of Louisiana directing $300 million to the State, 
the Medicare expansion alone will result in the taxpayers and the 
people of Louisiana being a net loser.
  We also know in order to get 60 votes, the majority leader had to cut 
a deal with a Senator from Nebraska--the senior Senator from Nebraska--
in order to get the vote for cloture. It has been widely reported that 
the meeting with the senior Senator from Nebraska took place for 13 
hours behind closed doors, after which they negotiated some language 
which, purportedly, no longer allowed the use of tax dollars to pay for 
abortions. But according to the Conference of Catholic Bishops and 
other pro-life groups, the language is completely ineffectual and it 
restores or actually produces taxpayer-paid-for abortions for the first 
time in three decades.

  What else did the senior Senator from Nebraska get? Well, the State 
of Nebraska purportedly got a free ride from Washington's new unfunded 
Medicare mandates on the States. But, of course, we know every other 
State ends up paying for that sweetheart deal the senior Senator got 
for Nebraska. What do Nebraskans think about it? Well,

[[Page S13659]]

ask the Governor--Governor Dave Heineman--who said yesterday he had 
nothing to do with that bill, and called the overall bill bad news for 
Nebraska and bad news for Americans. Governor Heineman said Nebraskans 
did not ask for a special deal, only a fair deal.
  We also know that in order to get 60 votes, the majority leader had 
to cut a special deal for Vermont. One Senator from Vermont threatened 
to vote against the bill, but then, lo and behold, the managers' 
package included $600 million benefiting only that one State. The 
Senator who threatened to vote no decided to vote yes after that 
special deal was concluded.
  The New York Times lists several other sweetheart deals that produced 
this monstrous piece of legislation. The intended beneficiaries, 
though, in many instances, were identified in a vague and sort of 
cryptic way, such as: Individuals exposed to environmental health 
hazards recognized as a public health emergency in a declaration issued 
by the Federal Government on June 17. Well, there is only one State 
that would qualify for that, notwithstanding this sort of vague 
description designed to hide the ball and obscure what was actually 
happening through another sweetheart deal as part of this bill.
  Another item in the package would increase Medicare payments to 
doctors and hospitals in any States where at least 50 percent of the 
counties are ``frontier counties,'' defined as those having a 
population density of less than six people per square mile.
  Then we know there was another $100 million sweetheart deal for an 
unnamed health care facility affiliated with an academic health center 
at a public research university in a State where there is only one 
public medical and dental school. The Associated Press reports that the 
State that qualifies for that special deal is the State of Connecticut, 
where the senior Senator currently is in a tough reelection fight.
  When asked about these special deals in the managers' amendment, the 
response of Mr. Axelrod--the architect of the campaign strategy for 
this administration to bring change to Washington--was pretty telling. 
He said: That is the way it has been; that is the way it will always 
  Well, maybe in Chicago, but not in my State, and not in the heartland 
and the vast expansion of this great country where the American people 
want us to come and represent our constituents and vote for what is 
right in terms of policy, not what kind of sweetheart deals we can eke 
out at the expense of the rest of the American people.
  The very thing that is happening with this health care bill 
demonstrates why Washington takeovers are such a terrible idea because 
instead of health care decisions being made between patients and 
doctors, health care decisions are overcome through a political process 
where elected officials choose winners and losers.
  Politics has become a dirty word outside the beltway, and certainly 
we can understand why. This process has only reconfirmed in the minds 
of many people that what we are doing here is not the people's business 
but protecting special interests and special sweetheart deals. Rather 
than making decisions about what is best for the American people, this 
deal has been driven by deals with special interest groups and 
lobbyists. Rather than listen to constituents, individual Senators have 
decided that their votes should be traded for tax dollars and other 
sweetheart benefits that go to their States. No doubt about it, this 
bill takes the power from individual Americans to make their own health 
care decisions and transfers that to Washington, DC, and this new low 
level of politics as usual.
  According to one recent poll that was reported today, Rasmussen, for 
one State I will not mention by name, found only 30 percent of the 
respondents to this poll favor this health care bill and 64 percent are 
opposed. The Senators from those States voted for the bill where only 
30 percent of their constituents reportedly support the bill. That is 
not the only example.
  You can only ask yourself why in the world would Senators vote for a 
bill when two-thirds of their constituents are opposed to it. Who must 
they be listening to? Are they listening to the people whom they 
represent and who sent them here to Washington to represent them or are 
they listening to the special interests or have they decided somehow 
that they have become miraculously smarter than their constituents and 
they know what is better for their constituents than what their 
constituents know themselves?
  This debate is not over. There is still a chance to vote against this 
bill. As Senator McConnell said last night, any single Senator on the 
other side of the aisle can stop this bill or every one who votes for 
it will own it.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Warner). The Senator from Nebraska.
  Mr. JOHANNS. Mr. President, let me start my comments today by 
complimenting the Senator from Texas. I thought he did an excellent job 
of shining the light on something that is now gathering a lot of 
attention because the managers' amendment is out and we can read the 
words and we can start to understand the special deals that were cut to 
get the votes to make this happen. I applaud the Senator for standing 
here so courageously.
  My State, the great State of Nebraska, has been pulled into the 
debate. I want to start out today by saying here on this Senate floor 
that I am enormously proud of my State, probably like all Senators in 
reference to their State. I am enormously proud of the people of 
Nebraska. I have gotten to know them well. I was their Governor. On a 
more localized basis, I was also the mayor of Lincoln. I date my time 
in public service back to the time when I was Lancaster County 
commissioner and a city council member in Lincoln. These are good, 
decent, honorable people who are always looking to try to figure out 
the right way of doing things.
  I stand here today to acknowledge that and to tell all Nebraskans how 
proud I am to be here today. But I rise today to share with my 
colleagues the reactions of Nebraskans to the special deal that got cut 
for Nebraska that came to light over the weekend as the managers' 
amendment was released and analyzed.
  Less than 24 hours after the announcement of the special carve-out 
for Nebraska, with virtually no warning, no preparation to speak of, 
2,000 people gathered in Omaha, NE, Nebraskans who, in one voice, cried 
foul. Nebraskans are frustrated and angry that our beloved State has 
been thrust into the same pot with all of the other special deals that 
get cut here. In fact, they are outraged that a backroom deal for our 
State might have been what puts this bill across the finish line.
  You see, I fundamentally believe that if this health care bill is so 
good, it should stand on its own merits. There should be no special 
deals, no carve-outs for anyone in this health care bill--not for 
States, not for insurance companies, and not for individual Senators.
  I stand here today and I find it is enormously ironic that advocates 
for this bill, who worked overtime to vilify insurance companies, in 
the last hours of putting this bill together struck a special deal with 
two insurance companies in Omaha, NE, that they would be carved out of 
their responsibility in this bill to pay taxes. I find it painful to 
even acknowledge that happened.
  I said at the beginning of this debate that changes of this 
magnitude, affecting one-sixth of our economy, must be fair and they 
must be believed to be fair by the people. The special deal for Nevada 
was wrong. I said that. In fact, one of the six reform principles I 
publicly outlined and took out to townhall meetings I stand by today. 
It simply said: No special deals.
  The special deal for Nevada was wrong, as is the carve-out for 
Louisiana. And the same applies for the backroom deal that was struck 
for my State, the great State of Nebraska.
  All of the special deals should be removed from this legislation. If 
this bill cannot pass without the carve-outs and the special deals, 
what further evidence could we possibly need to draw the conclusion 
that this is enormously bad policy? If you literally had to sit down in 
the last hours of negotiations and strike a special deal, do we need 
any other argument about how bad the policy of this bill is for my 
State and the citizens of Nebraska?
  Our Governor said it well: Nebraskans don't want a special deal. You 
see, I went around the State for

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months doing townhalls and listening to Nebraskans. They do not want a 
special deal. No Nebraskan came up to me and said: Mike, give me a 
special deal. You see, their request is simple: They want to be able to 
see the doctor of their choice and to keep the current plan they have. 
They want our job creators, our small businesses, to get our economy 
moving and create jobs in our communities from large to small, free of 
the $\1/2\ trillion in taxes and fees this bill will keep on our 
  The managers' amendment does nothing to change the core problems with 
this bill. The nearly $500 billion in Medicare cuts will be devastating 
to Nebraska. No special deal with an insurance company is going to make 
Nebraskans feel better about that. No special deal to make the State 
budget look better is going to make Nebraskans feel any better about 
the Medicare cuts and the impacts on our hospitals, our nursing homes, 
our home health care industry, and our hospice industry. Nationally, 
Governors--Republicans and Democrats--have stepped forward to say they 
cannot afford the unfunded mandates that come from Washington and drive 
their budgets into the red.
  The special deal struck on abortion is enormously tragic and 
insufficient. It breaks my heart. This is a far cry from the 30 years 
of policy by this U.S. Government. You see, when this is done and over, 
what we will be reporting to our citizens is that taxpayer funds will 
fund abortions if this bill passes. You see, no watered-down accounting 
gimmick will convince the pro-life community in my State otherwise. In 
fact, they have publicly said they feel betrayed.
  I will wrap up with this. This bad deal is not sealed. There is time 
for truly pro-life Senators to stand tall and say no. There is still 
time for principled Senators to reject the carve-outs and to cast aside 
the bad backroom deals. There is still time for Senators to listen to 
the people and reject reckless Federal policy.
  Fair treatment is not too much to ask of Washington. I know in my 
State, that is what they are asking for. I will firmly stand behind any 
Senator who has the courage to stop this train wreck. I will be the 
first to lead the applause. I am confident that the standing ovation 
for that courageous Senator will extend all the way back to Nebraska 
and it will be deafening.
  I yield the floor.
  Mr. GRASSLEY. Mr. President, how much time remains?
  The PRESIDING OFFICER. There is 2\1/2\ minutes.
  Mr. GRASSLEY. I would think one of the things we would have seen from 
the majority at this point is a list of what the last two Senators were 
talking about, all the earmarks that are in this bill, because I asked 
for a parliamentary inquiry yesterday--I am not going to ask that 
again--but, as we said yesterday, rule XLIV was adopted as part of a 
major ethics and reform legislation, adopted in 2007. It was part of 
the Honest Leadership and Open Government Act. The Democratic 
leadership made it the first bill to be introduced when they took the 
majority in 2007, taking control of Congress for the first time for a 
long period of time. This bill passed by unanimous consent.
  When rule XLIV was passed, the theory behind it was that we ought to 
have total transparency on earmarks. It applies to floor amendments 
such as the pending Reid bill. It requires the sponsor of the amendment 
to provide a list of earmarks in that amendment.
  Earmarks are provisions that provide limited tax benefits. Those 
words, ``limited tax benefits,'' are words out of the rule. Another 
substitute language for limited tax benefits is ``congressionally-
directed spending items'' or ``earmarks,'' as they are generally 
referred to by the public at large.
  Given what a priority the new rule passed in 2007 was given and the 
importance of it, one would expect that the majority leader would be 
making every effort to comply with it. One would think he would be 
wanting to set a good example in complying with the rule and disclosing 
these earmarks. In order to assure transparency of these very narrow 
provisions, such as what Senator Johanns just referred to, to get the 
votes of specific Members of the majority party who probably would not 
have voted for this bill, you would think that ought to be made public. 
That is what rule XLIV is about. Of course, that burden under that rule 
is on the sponsor to provide the list.
  Once again, I am going to ask the Democratic leadership to comply 
with the Honest Leadership and Open Government Act.
  The PRESIDING OFFICER. The time for the minority has expired.
  The Senator from Montana.