[Congressional Record Volume 156, Number 46 (Tuesday, March 23, 2010)]
[Senate]
[Pages S1821-S1867]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010

  Mr. REID. Mr. President, I now move to proceed to H.R. 4872 and ask 
for the yeas and nays.
  The ACTING PRESIDENT pro tempore. Is there a sufficient second?
  The Republican leader is recognized.
  Mr. McCONNELL. Mr. President, if the Chair would indulge me a couple 
of parliamentary inquiries, which won't delay the process very long.
  As I understand it, the budget resolution instructed two Senate 
committees to report changes in law to reduce the deficit by $1 billion 
each over the next 5 years. The reconciliation instruction states that 
they were to report those changes by October 15, 2009, and that those 
measures are then sent to the Budget Committee to report the final 
measure. It is my understanding that nothing has been reported to date. 
Therefore, my inquiry is: Has the Budget Committee reported any 
reconciliation legislation to the Senate pursuant to the current budget 
resolution, S. Con. Res. 13?

  The ACTING PRESIDENT pro tempore. It has not.
  Mr. McCONNELL. Mr. President, the answer is: No, it has not?
  The ACTING PRESIDENT pro tempore. Correct.
  Mr. McCONNELL. Mr. President, one other parliamentary inquiry: My 
understanding is, each time the Senate has taken up a reconciliation 
bill on the floor, a Senate committee has reported a bill to the 
Senate, either through the Budget Committee or directly from the 
committee instructed. Therefore, my question to the Chair is: Is this 
the first time in history the Senate will consider a reconciliation 
even though no Senate committee has reported a bill to the Senate?
  The ACTING PRESIDENT pro tempore. It is the first time that the Chair 
is aware of it.
  Mr. McCONNELL. I thank the Chair.
  Mr. REID. I ask for the yeas and nays.
  The ACTING PRESIDENT pro tempore. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
and the Senator from New Mexico (Mr. Udall) are necessarily absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Utah (Mr. Bennett) and the Senator from Georgia (Mr. Isakson).
  The PRESIDING OFFICER (Mrs. Gillibrand). Are there any other Senators 
in the Chamber desiring to vote?
  The result was announced--yeas 56, nays 40, as follows:

                      [Rollcall Vote No. 63 Leg.]

                                YEAS--56

     Akaka
     Baucus
     Bayh
     Begich
     Bennet
     Bingaman
     Boxer
     Brown (OH)
     Burris
     Cantwell
     Cardin
     Carper
     Casey
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Franken
     Gillibrand
     Hagan
     Harkin
     Inouye

[[Page S1822]]


     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Specter
     Stabenow
     Tester
     Udall (CO)
     Warner
     Webb
     Whitehouse
     Wyden

                                NAYS--40

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

                             NOT VOTING--4

     Bennett
     Byrd
     Isakson
     Udall (NM)
  The motion was agreed to.
  Mrs. MURRAY. Madam President, I move to reconsider the vote.
  Mr. BAUCUS. Madam President, I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (H.R. 4872) to provide for reconciliation pursuant 
     to Title II of the concurrent resolution on the budget for 
     fiscal year 2010, S. Con. Res. 13.

  Mr. BAUCUS. Madam President, for the information of all Senators--and 
I might ask the Senator from New Hampshire if he agrees--it is probably 
best to alternate the time back and forth on each side with roughly 
one-half hour blocks of time, if that meets the approval of the 
minority.
  Mr. GREGG. I would suggest we do that for the first 2 hours, at least 
until we see how this is evolving. So the first half hour will go to 
the majority and the second half hour will go to the Republican side.
  Mr. BAUCUS. That would be my intention.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Madam President, this morning President Obama signed a 
law that will guarantee meaningful insurance reform, such as coverage 
for people with preexisting conditions. He signed comprehensive health 
care reform into law. Many of us have dreamed of that day for years. 
Now it is a fact. Now it is law. Now it is history. Indeed, it is 
historic. He signed a law that will ensure that average people without 
insurance will get health insurance choices just as Members of Congress 
do. This morning, President Obama signed a law that will control the 
growth of health care costs in years to come.
  Today, we have before us a bill to improve the new law. We do not 
have before us the whole health care reform bill. We do not have to 
reopen every argument we had over the last 2 years. We do not have to 
say everything we said about health care one more time. Rather, we have 
a bill before us that will do a few good things.
  We have before us a bill that will improve affordability by 
increasing tax credits to help pay for insurance premiums--increase 
those tax credits. We have before us a bill that will help with out-of-
pocket costs for lower and middle-income families; that is, to raise 
the assistance. We have before us a bill that will increase aid to 
States to help them shoulder the costs of covering Americans under 
Medicaid. We have before us a bill that will give additional help to 
States that took extra steps to cover the uninsured before reform took 
place. Together, these improvements will level the playing field among 
States under health care reform.
  We have before us a bill that will make sure no State is singled out 
for special treatment. We have before us a bill that will completely 
close the doughnut hole; that is, the coverage gap for Medicare 
prescription drug coverage. It is closed by the end of the budget 
window. We have before us a bill that will start with a $250 increase 
in Federal assistance toward coverage of the doughnut hole right away, 
this year, 2010. We have before us a bill that will fight fraud and 
fight waste and abuse in Medicare and Medicaid.
  That is the bill we have before us today. This is not the whole 
health care reform bill; this is a set of commonsense improvements to 
that new law signed by the President earlier today. I do not expect 
opponents of the bill to talk about these commonsense improvements. 
Frankly, it is pretty difficult to understand why Senators would want 
to oppose these commonsense improvements. Rather, if this debate is 
anything like the debate so far, opponents of this bill will try to 
change the subject. When people look at what health reform really does, 
they are more likely to support it, when they separate truth from 
fiction, separate the wheat from the chaff. So I expect that opponents 
of this bill will try to distract observers from what is really going 
on.
  Rather than talk about commonsense improvements to this bill, 
opponents will talk about the process. Over the 2 years we have been 
working on health care reform, there have been many on the other side 
who have sought to make the debate about process--not about what is in 
the bill, what improves people's lives, but about the process, the 
legislative process. They have sought to emphasize how messy the 
legislative process is--and sometimes it is a bit messy--and, of 
course, criticizing how Congress works is a heck of a lot easier than 
improving health care for the American people. Many opponents of health 
care reform are obsessed with process and procedure.
  I am much more focused on the people whom health care reform will 
help. I am focused on people such as Pat and her late husband Dan from 
Lincoln County in the northwestern corner of Montana.
  Pat and Dan used to have a ranch in southwestern Lincoln County. Dan 
was the fourth generation of his family to run the ranch. He grew up on 
the ranch, and he worked very hard every day of his life.
  In 2000, the doctors told Dan he had Hodgkin's lymphoma, but Pat and 
Dan did not have health insurance. Dan never took a handout, and Pat 
and Dan thought they could handle their bills on their own. That is the 
way they had always lived. That is the way a lot of people--I daresay 
most people--live. Then the medical bills started piling up. Swallowing 
his pride, Dan made what he called the hardest decision of his life: he 
filed for Medicaid. The State told him the only way they could be 
eligible for Medicaid was to put a lien on their ranch. As Dan's 
medical bills piled out of control, Pat and Dan were forced to sell 
their land. Pat said the cancer ravaged her husband's body. But selling 
their ranch to pay for medical costs broke his spirit. That is why we 
need to enact health care reform.

  Most bankruptcies in America these days are related to medical costs. 
Just think of that: Most bankruptcies in America today are related to 
medical costs. No one in America should have to sell everything they 
have, no one should have to go bankrupt just to pay medical bills.
  But I am not going to let the opponents' charges about the process go 
unanswered either. The idea that health care reform has been some sort 
of rush job is a total myth. It is a myth that deserves busting.
  The facts are, the Finance Committee and the HELP Committee--
committees with jurisdiction on health care reform--each went through a 
full and transparent process to consider health care reform 
legislation. By that I mean fully open, totally open to the public at 
all points. This has been the fullest and most transparent process for 
any major piece of legislation in memory.
  I might say, a journalist once approached me about a year ago and 
said: Senator, are you starting a new trend with such openness and such 
transparency, putting all the amendments on the Web, 8 days' notice; is 
that a whole new approach the Senate is going to pursue from now on?
  I said: I don't know, but I think it is the right thing to do today. 
From the start, I wanted us to develop a bipartisan consensus package. 
I wanted to work together. When someone gets ill or gets cancer, he or 
she is not a member of one party or the other. It is personal. We have 
to work together. That is what the American public wants. That is what 
I tried so hard to do. I wanted a bill that would have broad political 
support across the political spectrum.

[[Page S1823]]

  There has been a long tradition in the Republican Party in favor of 
comprehensive health care reform. That tradition stretches back to 
Theodore Roosevelt, to Richard Nixon, to Bob Dole, and to John Chafee. 
I believe what we set out to do and what we have done fits comfortably 
within the tradition of what those Republican leaders sought to do.
  We began almost 2 years ago. On May 6, 2008, we held our first 
hearings in a series on health care reform. In fact, the Finance 
Committee held 11 hearings in a series in 2008 alone. We held those 
hearings to help Senators come to a commonsense understanding of the 
health care crisis; to help explain why we are in such a crisis, what 
needs to be done, how the various parts of our health care system work, 
and what parts do not work. I held these hearings purely from an 
educational point of view, not an ideological point of view. I held 
them to educate all of us on the committee to get us ready for 2009. It 
was clear to me this Congress was going to work very hard and pass 
health care reform. We sought in the last Congress to lay the 
groundwork for passing the bill in this Congress.
  On June 16, 2008, nearly 2 years ago, Senator Grassley, my good 
friend and ranking member of the committee, and I convened a bipartisan 
health reform summit at the Library of Congress. We called it ``Prepare 
for Launch, Health Care Reform Summit of 2008.'' Chairman Ben Bernanke 
was there. Other notables were there. It was a full-day conference with 
members of the Finance Committee from both sides of the aisle to help 
us better understand how to solve our health care reform crisis. I was 
very impressed that all day long most Senators stayed. Late in the 
afternoon, I counted a majority of Senators on both sides still there 
asking questions of experts.
  Senator Grassley and I have brought some of the best minds in the 
country together to discuss health care reform. Senators from both 
sides of the aisle have engaged in open and constructive discussion.
  Then right after the 2008 election, on November 12, 2008, this 
Senator released an 89-page blueprint on health care reform. I have it 
right here. We named it ``Call to Action: Health Reform 2009.'' It was 
a comprehensive framework for health care reform. We posted that 
blueprint on the Internet for all to read.
  The ideas in that white paper reflected the broad consensus of 
thinking among health care efforts. We searched far and wide. What is 
the best thinking; what do other countries do. While looking at what 
other countries do, we clearly wanted to come up with a uniquely 
American solution. We are America. We are not Canada. We are not Great 
Britain. We are not Ireland. We are America. We spent about $2.5 
trillion on health care in America with public Medicaid, Medicare, and 
the Children's Health Insurance Program and private, commercial health 
insurance. I wanted to maintain that same balance with a uniquely 
American solution. They are reflected in this white paper.
  The ideas in that white paper remain the foundations of health care 
reform that became law this morning. That is a strong statement to 
make, but it is true--almost all the ideas all committees on both sides 
of the Congress have enacted and what are in the bill the President 
signed today.
  Of course, there are changes here and there. But the basic foundation 
in that white paper--this white paper right here that was put together 
in November 2008--remains the foundation of the health care bill that 
became law this morning.
  The ideas behind our health care reform legislation have been 
available for all Senators and the public to consider for more than 16 
months.
  The Washington Post called our white paper ``striking in both its 
timing and scope.'' The Washington Post said:

       Rarely, if ever, has a lawmaker with his clout moved so 
     early--eight days after the election of a new president--to 
     press for such an enormous undertaking.

  Then in April and May of last year, Senator Grassley and I released 
three bipartisan health care reform policy papers on the three major 
areas of reform. What are they? First, delivery system reform; second, 
insurance coverage; and third, options for financing. Once again, we 
made these papers public and posted them on the Finance Committee's Web 
site.
  Senator Grassley and I convened three open, televised bipartisan 
roundtable discussions with experts on those subjects. We held several 
day-long meetings of Finance Committee Senators to discuss the topics 
of those policy papers.
  On April 20, 2009, the New York Times reported:

       In setting forth detailed ``policy options'' and inviting 
     public comment, Mr. Baucus and Mr. Grassley set a precedent 
     for openness.
  On May 18, 2009, the newspaper Politico reported on our efforts to 
build consensus. Politico said that my ``frequent progress reports to 
reporters always include some discussion of keeping peace in the 
delicate alliance of Republicans, Democrats, industry, labor, 
physicians and consumer advocates.''
  That is so true. From the outset, I worked hard to keep all the 
groups talking to each other. That was a shortcoming back in the early 
nineties when health care reform fell apart, when the groups proposed 
the bills. By ``the groups,'' I mean consumer groups, hospitals, labor, 
medical device manufacturers, nursing homes--all the groups. I called 
up their CEOs and kept talking with them constantly: What do you think? 
A problem here? Let's make an adjustment. Stay at the table. Don't walk 
away from the table. Suspend judgment for 5 minutes. Let's find a way 
to put this together that is in everybody's best interest, America's 
best interest, if this passed.
  I had more than 142 meetings, both one on one and in groups, to 
discuss health care reform with Senators on both sides of the aisle. In 
all, those meetings added up to more than 150 hours of discussions.
  I tried to work out a bipartisan package with the Finance Committee. 
I started, as I always do, with the ranking Republican member of the 
Finance Committee, my good friend, Chuck Grassley. Since the Finance 
Committee and the HELP Committee share jurisdiction over health care, 
Senator Grassley and I agreed we wanted to include the ranking 
Republican member of the HELP Committee, Mike Enzi, and our colleague, 
Jeff Bingaman, who is also a member of both those two committees. As 
well, we reached out to the chairman of the Budget Committee, Kent 
Conrad, and the ranking Republican member of the Small Business 
Committee, Senator Olympia Snowe, both of whom are also members of the 
Finance Committee. Both Senators Conrad and Snowe have a long history 
of working across the aisle to reach a consensus. We also reached out 
to Senator Kennedy, then-chairman of the HELP Committee. We had 
meetings with him, all the relevant chairmen and ranking members 
together, meeting over in the other part of the Capitol with Senator 
Kennedy. How gracious he was and how he wanted to work together. He was 
not trying to do it for Ted Kennedy but for people who needed health 
care. It was very touching.
  It ended up we had a group of six Senators--three Democrats and three 
Republicans. We worked hard. We rolled up sleeves and plowed through 
the issues. We met 31 times for 63 hours over the course of 4 months.
  Many have said we met too long. Many said I should have broken up my 
discussions with my colleagues. But I wanted to go the extra mile. I 
wanted to try. I wanted to bend over backwards. I wanted to do 
everything I could to reach a bipartisan consensus. Why? Because that 
is the right thing to do.
  That group of six Senators came very close to an agreement. We did 
not end up reaching an agreement among all six of us, but I took the 
product of those bipartisan discussions, areas of tentative agreement, 
and made them the starting point for our committee markup; that is, the 
group of six helped forge through immense hours of discussing major 
improvements on our thinking.
  We converted that product into a committee mark. I made that mark 
public and posted it online on the Finance Committee's Web site on 
September 16, 2009. That was a full 6 days before the markup and 4 days 
longer than committee rules require.
  For the first time in history, on September 19, the Finance Committee

[[Page S1824]]

posted online every amendment submitted to the clerk. We posted the 
full text of all 564 amendments. Members of the committee and the 
public had 3 days to review the amendments and prepare for the markup.
  Our Finance Committee markup stretched over 8 days. They were fully 
public. We worked well past 10 p.m. on most of the those days. The 
markup was the longest that the Finance Committee has conducted on any 
bill in 22 years.
  Prior to the markup, I accepted 122 amendments as part of a modified 
chairman's mark; 26 of those amendments incorporated into the mark came 
from Republican colleagues.
  During the markup, the committee considered 135 amendments. The 
committee accepted 41 amendments and rejected 55.
  On October 2, 2009, a full 11 days prior to a committee vote on the 
bill, I posted online the mark, as amended.
  On October 13, 2009, the Finance Committee ordered the bill reported 
by a bipartisan vote of 14 to 9.
  The majority leader then melded the Finance Committee and HELP 
Committee work products into a single bill. The majority leader moved 
to proceed to the bill on November 19 of last year. We had a full and 
open debate on the bill on the Senate floor, and on December 24 of last 
year, Christmas Eve, more than a month later, the Senate finally passed 
health care reform.
  I have taken some time to detail the long legislative history of this 
effort, and I did so because I believe that any fair observer of this 
legislative history will draw three conclusions: One, we tried mightily 
to work with our Republican colleagues to reach a broad consensus bill. 
We went the extra mile. We bent over backwards, and for a variety of 
reasons, our Republican colleagues simply did not want to be part, in 
the end, of this effort.
  Two, nobody rushed this bill. This has been a full and deliberative 
process--about 2 years. There is no way that health care reform was 
``rammed'' through the Congress. No way. Not true.
  Three, we have conducted a process more open than for any other major 
piece of legislation in the modern Senate. But opponents of the bill 
have tried to raise as many charges as they can. They have tried to 
throw as much mud at this effort as they can, hoping that something 
sticks.
  Their latest attack has been to criticize the use of the budget 
reconciliation process for the bill before us today. Some have charged 
that using reconciliation is somehow unusual. They argue that using 
budget reconciliation for health care is somehow unheard of. And they 
argue that we never use reconciliation for major bills. Nothing could 
be further from the truth.
  Is reconciliation unusual? The answer is clearly no. Budget 
reconciliation is a pretty common process in Congress. Since Congress 
began using the budget reconciliation process in 1980, some 30 years 
ago, Congress has passed some 23 reconciliation bills--23 in the last 
30 years. Thus, most years have seen reconciliation bills. It is an 
exceptional year that Congress does not pass a reconciliation bill.
  What about health care? Is health care something unusual for 
reconciliation? Once again, the answer is no.
  The nonpartisan Congressional Research Service took a survey of the 
22 reconciliation bills that made it through Congress to the 
President's desk. Of those 22 reconciliation bills, CRS, the 
Congressional Research Service, identified 12 of them with titles or 
other major legislative components pertaining to Medicare or Medicaid 
Programs. In other words, most reconciliation bills have addressed 
health care. Once again, it is the exceptional case where a 
reconciliation bill does not contain health care matters.
  What about major health care legislation? Is major health care 
legislation in reconciliation unusual? No. Once again the answer is no. 
CRS counted the number of pages in the law books on health care that 
the reconciliation process has put there. It was not a small number. 
CRS found that bills enacted using the reconciliation process 
contributed some 1,366 pages on health care to the Statutes at Large. 
CRS found that the average reconciliation bill with health care in it 
contributed some 124 pages to the Statutes at Large.
  Pages in Statutes at Large have more words than bills do, so these 
pages reflect far more pages than in bill text.
  Let's consider some of the major changes through health care that 
Congress has enacted in the last 30 years. There is COBRA, a health 
insurance program for people who lose their jobs. Congress enacted the 
COBRA health insurance program as part of a reconciliation bill. COBRA 
stands for the Consolidated Omnibus Budget Reconciliation Act--
reconciliation. A Republican-controlled Senate passed the COBRA health 
insurance program as part of reconciliation in 1986. Since then, three 
later reconciliation bills have amended the COBRA continuation coverage 
rules. Congress changed COBRA in reconciliation bills in years 1989, 
1990, and again in 1993.
  Another one of the largest health care expansions that Congress 
enacted in the last 30 years was the Children's Health Insurance 
Program, otherwise known as CHIP. Once again, we enacted it--you got it 
right--in reconciliation. Congress enacted CHIP as part of the Balanced 
Budget Act of 1997. Once again, it was a Republican-controlled Senate 
that passed the Children's Health Insurance Program as part of 
reconciliation in 1997.
  Then there is the Medicare Advantage Program. Medicare Advantage, or 
Medicare+Choice they called it then, was a major change in Medicare, 
introducing private insurance companies into the system. Once again, a 
Republican-controlled Senate passed that in reconciliation in 1997.
  It is hard to think of a major health insurance expansion that has 
not involved reconciliation. Sure, there were some. But it is an 
exceptional case where Congress enacts major changes to health care 
outside of reconciliation. When you think about it, that makes more 
sense. Congress created the budget reconciliation process to affect the 
budget, and any competent budget economist will tell you that health 
care cost growth is the biggest financial challenge facing our Nation. 
The President and other commentators on our fiscal plight make that 
statement repeatedly.
  If you want to address the budget in a significant way you need to 
address health care. Health care is exactly what the budget process was 
designed to address.
  Why did Congress create the budget process this way? Simple: Congress 
created the budget process so that Congress could make fiscal policy 
with a simple majority vote. The Congress that created reconciliation 
wanted to ensure that future Congresses could vote budget matters up or 
down, yes or no. Is it unusual for anything this large to have been 
passed in reconciliation? Once again, the answer is no. In terms of 
dollars and cents, the biggest reconciliation bill by far was the 2001 
Bush tax cuts. The 2001 reconciliation bill worsened the deficit by 
more than $550 billion over the first 5 years. That was a 
reconciliation bill.
  Not far behind was the 2003 Bush tax cut. That reconciliation bill 
worsened the deficit by more than $430 billion over the first 5 years.
  In terms of policy changes, it is hard to match the two Bush tax 
cuts. But another measure that came close was the 1996 welfare reform 
bill. Once again, that was a reconciliation bill. The 1996 welfare 
reform bill was the most sweeping revision of poverty programs since 
the Great Society. Once again, that reconciliation bill was passed by a 
Republican-controlled Senate.
  It is hard to say that we have not done big things in reconciliation. 
In sum, it is not as though we sneaked health care reform through the 
Senate. We passed it with an exhaustive open process and the Senate 
passed health care reform with a supermajority. We passed it with 60 
votes.
  Now all that remains to be done to complete health care reform is an 
up-or-down vote on this final bill. This last step in the health care 
reform deserves to get a simple majority vote. That is all that needs 
to be done to finish the job of reforming health care.
  Let me return to what this bill would do. This bill would help to 
make health care more affordable for people who do not have it and 
improve upon the Senate bill which the President signed this morning. 
We do it for people such as

[[Page S1825]]

Carmen and her daughter Merilee, from Paulson, MT. Carmen had 
insurance, but she still had problems with coverage and costs. Before 
March 2008, Carmen had insurance with a $5,000 deductible. She found 
herself avoiding care because of the high deductible. She and her 
daughter Merilee waited until they knew they needed help before they 
went to a doctor--certainly, with a deductible that high, $5,000. At 
one point Carmen's daughter contracted a urinary tract infection. 
Wanting to avoid the high deductible, Carmen and her daughter decided 
to wait a day and see how it goes, but her daughter did not get better. 
She needed to get care. Since it was Saturday and there was no urgent 
care open for 50 miles, the only option was to go to the emergency 
room. The hospital bill to Carmen was for $500, but her insurance 
company refused to pay it. Carmen appealed, asking them to pay the $70 
insurance would normally pay for urgent care and Carmen would pay the 
remaining balance, but her insurance company still denied her claim.
  When Carmen broke her fingers, her insurance company refused to pay 
for treatment. The insurance company paid only for x rays, even though 
Carmen was entitled to $650 of first-dollar coverage for accidents. 
Carmen paid for her own treatment, but she gave up on the therapy 
because it cost too much. Carmen's fingers will never fully heal.
  In March 2008, Carmen switched to another insurance company and 
lowered the deductible to $2,500. Remember, the last policy was a 
deductible of $5,000. Last month, Carmen received notice that her 
premiums would go up by about 32 percent. Carmen will have to keep her 
premiums down by decreasing her coverage. It is a strategy she has been 
using for years.
  We fight for health care for people such as Carmen and Merilee. We 
fight for health care for people such as William and Erinn, from Red 
Lodge. Erinn lost her father William when he was only 59 years old 
because their insurance company denied and delayed his bone marrow 
transplant until it was too late. William taught school for more than 
30 years. He thought he had good insurance through his retirement 
package. The doctors told William he had leukemia, but the doctors were 
able to treat it with oral chemotherapy for a long time.
  In 2002, the doctors determined that William would need more advanced 
chemotherapy. He underwent chemotherapy as long as he could and then 
the doctors determined he would need a bone marrow transplant. The 
insurance company paid for all the preparations, testing, and treatment 
leading up to the transplant, but the insurance company denied the 
procedure itself.
  Mr. President, I note I am running out of my half hour here. Let me 
say I will conclude here by noting that this is why we fight for 
people. This is why this health care bill is before us, for people such 
as Carmen and Merilee, Pat, and many people across this country who 
deserve much better. We are at the very end here, about to pass this 
legislation. The President signed the bill this morning. This is just 
to make it even a little bit better. It is a normal process, an open 
process. I urge all my colleagues to quickly pass this and help a lot 
of people and get on to other matters.

  I thank the Chair.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from New Hampshire.
  Mr. GREGG. I wish I could stand here and agree with the Senator from 
Montana. I wish as I looked at these bills that passed the House, and 
now we are getting the trailer bill, the buy-it bill, the bill that was 
used to purchase the votes in the House to pass the big bill, so I 
could say: America's children are going to be better off; that the 
people who have health care issues in this country are going to be 
better off. But that is impossible to say.
  Why is it impossible to say? Because this bill as it passed the House 
was an atrocity. It was an explosion of government the likes of which 
we have never seen in this country. It grows the Government by $2.6 
trillion and in the process it will interfere with almost every 
American who has private health insurance and how they get their 
insurance. It will take Americans who have health insurance today and 
it will push them out of that health insurance as the small employers 
across this country decide they can no longer afford it. It will say to 
Medicare recipients: We are going to cut your Medicare by $1 trillion 
when this is fully implemented--$1 trillion. We are going to take that 
money and we are going to use it to fund a brandnew entitlement over 
here for people who are not on Medicare, who are not seniors, and we 
are going to use it to expand other entitlements for people who are not 
on Medicare and who are not seniors.
  Then the Medicare recipients who have seen their program reduced by 
$1 trillion are going to be left with a program that remains on a path 
to insolvency, a path which will inevitably lead to lesser quality of 
care for people who get Medicare because providers will find themselves 
forced out of the system. People who are on Medicare Advantage will 
virtually find that insurance plan is eliminated.
  This bill has a lot of major problems, the big bill that passed the 
House. Now we get this trailer bill, this buy-it bill, which was used 
for purposes of getting votes in the House. This bill aggravates the 
fundamental problems of the bigger bill the President signed today. 
This bill adds more costs, creates more taxes, and will reduce 
Medicare's viability in a more significant way. Yet it is called good 
policy. It is very hard to understand that.
  When you look at these bills as a combination, especially when you 
put them in the context--thrown on this train was the nationalization 
of the student loan program, where 19 million students today are going 
to be forced into the process of getting their loans through the 
Federal Government instead of through their local banks, their 
community banks. When you look at this in that context, what this bill 
is about--and the President has been very forthright about this--it is 
a massive explosion in the size of the government, growing the 
government for one fundamental purpose: because this administration 
believes a bigger government creates prosperity.
  We do not believe that on our side of the aisle. We believe there are 
a lot of good things that could have been done to make health care 
better. I have offered a proposal to do that. Other Senators--Senator 
Barrasso has a proposal to do that. They would have all addressed the 
health insurance issues of making sure that everybody could get 
coverage if they have a preexisting condition. All these strawmen that 
are being thrown up as the reasons why this bill had to be passed would 
have been taken care of if a more reasonable bill had been passed. But 
what would not have happened would be this massive explosion in the 
size of the Federal Government which we will inevitably pass on to our 
children, a government they cannot afford.
  Under this bill, the cost to the Federal Government, which has 
traditionally been about 20 percent of our gross national product, will 
jump up to about 25, 26, or 27 percent of our gross national product. 
It will be unaffordable as a result of this.
  But they claim they pay for it. The way they claim they pay for it 
primarily is to cut Medicare by $1 trillion when fully implemented. 
This seems fundamentally unfair to the people on our side of the aisle. 
We all recognize that Medicare has serious problems. It has a $36 
trillion unfunded liability.
  We all recognize that Medicare recipients depend on that program. So 
if we are going to adjust Medicare payments, cut them as they do in 
this bill, eliminate programs such as Medicare Advantage for all 
intents and purposes, then those savings, as a matter of fairness, 
should stay with the Medicare system. I mean, that is what should 
happen. Those savings, which are huge in this bill--and I respect the 
fact that my colleagues on the other side of the aisle stepped up and 
made this massive attempt to cut Medicare. That was quite a decision on 
their part. But what they did was they took these savings, which should 
have gone to giving senior citizens a stronger and more vibrant 
program, they took them and they started a brandnew program and 
brandnew entitlements and expansions of other existing entitlements, 
none of which have anything to do with Medicare or senior citizens. So 
essentially they are funding this program, in large part, on the backs 
of the seniors of this country without doing anything substantive which 
will, in the long run, have made Medicare more solvent. In

[[Page S1826]]

fact, they basically doubled down on the problem because we know 
Medicare is headed into insolvency, and then they created these new 
entitlements.
  We know the record of the government around here on the issue of 
entitlements. We always underfund them. The promises are made, but they 
are never kept. So this will all end up rolling into a giant ball, like 
a huge, massive asteroid headed to Earth which is basically going to 
land on our children's head as debt. That is what we have headed toward 
us here.
  We already know we have a government we cannot afford. The debt of 
this country is going to double in the next 5 years under the 
President's budget, and it is going to triple in the next 10 years. The 
President's budget is going to get to a level of unsustainability 
within 5 to 7 years. We are already seeing the warning signs. The 
Chinese are telling us they might not want to buy our debt, and they 
are the ones who are financing us. Moody's says we may have to have our 
ratings looked at. Even Warren Buffett's debt today, this week, for the 
first time, sold at a better premium than U.S. debt. What does that 
mean? People have more confidence that Warren Buffet will pay them back 
than the United States. It is a pretty serious sign when the United 
States is supposed to be the best creditor in the world.
  What this bill does at its core on fiscal policy is to radically 
expand the size of government. And we all know it will not be paid for, 
so we all know it will significantly--probably radically--expand the 
debt our children are going to bear. Inevitably, we are not going to 
pass on to our children a healthier country fiscally; we are going to 
pass on to our children a sicker country fiscally. Are we going to get 
better health care for it? I seriously doubt it.
  I think we will hear from Dr. Barrasso about how he sees this 
affecting health care, and other Members of our side of the aisle who 
have some expertise in this area. Inevitably, when you start these 
major government programs, which essentially amount to quasi-
nationalizations of different areas of the American economy, you end up 
with less quality. It is inherent in having the government run things.
  So the first amendment we are going to offer here today is to try to 
straighten out this incredible inequity we would be paying for these 
new entitlements for uninsured Americans and for people on Medicaid 
with senior citizens' dollars by cutting the Medicare Program by over 
$1 trillion when fully implemented. So we have an amendment which 
essentially says this: You cannot reduce the Medicare spending if CBO 
cannot tell us that the other expenditures in this bill are paid for 
with something other than Medicare. It is a hard-and-fast commitment 
that Medicare savings will go to benefit Medicare, and that should be 
our purpose.


                           Amendment No. 3567

  I know some of my other colleagues wish to talk on this issue. First, 
I send an amendment to the desk.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from New Hampshire [Mr. Gregg], for himself and 
     Mr. Coburn, proposes an amendment numbered 3567.

  Mr. GREGG. Mr. President, I ask unanimous consent that the reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

 (Purpose: To prevent Medicare from being raided for new entitlements 
             and to use Medicare savings to save Medicare)

       At the end of subtitle B of title I, add the following:

     SEC. ___. PREVENTING THE IMPLEMENTATION OF NEW ENTITLEMENTS 
                   THAT WOULD RAID MEDICARE.

       (a) Ban on New Spending Taking Effect.--
       (1) In general.--Notwithstanding any other provision of 
     law, the Secretary of the Treasury and the Secretary of 
     Health and Human Services are prohibited from implementing 
     any spending increase or revenue reduction provision in 
     either the Patient Protection and Affordable Care Act or this 
     Act (referred to in this section as the ``Health Care Acts'') 
     unless both the Director of the Office of Management and 
     Budget (referred to in this section as ``OMB'') and the Chief 
     Actuary of the Centers for Medicare and Medicaid Services 
     Office of the Actuary (referred to in this section as ``CMS 
     OACT'') certify that they project that all of the projected 
     Federal spending increases and revenue reductions resulting 
     from the Health Care Acts will be offset by projected gross 
     savings from the Health Care Acts.
       (2) Calculations.--For purposes of this section, projected 
     gross savings shall--
       (A) include gross reductions in Federal spending and gross 
     increases in revenues made by the Health Care Acts; and
       (B) exclude any projected gross savings or other offsets 
     directly resulting from changes to Medicare made by the 
     Health Care Acts.
       (b) Limit on Future Spending.--For the purpose of carrying 
     out this section and upon the enactment of this Act, CMS OACT 
     and the OMB shall--
       (1) certify whether all of the projected Federal spending 
     increases and revenue reductions resulting from the Health 
     Care Acts, starting with fiscal year 2014 and for the 
     following 9 fiscal years, are fully offset by projected gross 
     savings resulting from the Health Care Acts (as calculated 
     under subsection (a)(2)); and
       (2) provide detailed estimates of such spending increases, 
     revenue reductions, and gross savings, year by year, program 
     by program and provision by provision.

  Mr. GREGG. I have defined what the amendment's purpose is: to make 
sure that Medicare reductions in this bill, things that directly impact 
seniors, such as reducing their provider payments, so probably fewer 
doctors will see them, or eliminating things or dramatically reducing 
Medicare Advantage--if we are going to do that as a Congress, those 
savings have to go to benefit Medicare, not to create new programs no 
matter how worthy they may be.
  I see many of my colleagues rising wishing to talk about this. I ask 
unanimous consent to be able to proceed as if in a colloquy.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Tennessee.
  Mr. ALEXANDER. If I might ask a question of the Senator from New 
Hampshire, the President's budget said it would cost $371 billion over 
10 years to properly pay for doctors who see Medicare patients. I 
believe the Congressional Budget Office says the number was over $250 
billion. Can you imagine a comprehensive health care bill that improves 
Medicare without paying doctors to serve Medicare patients? Can you 
then explain to me how you can possibly say the bill does not add to 
the Federal deficit if it does not include paying doctors to serve 
Medicare patients?
  Mr. GREGG. Well, the Senator from Tennessee has asked an excellent 
question, which is, How can you pass a health care reform bill and 
leave off the reform that is necessary to pay the doctors to see their 
patients and claim you are actually covering the cost of health care? 
And CBO has scored that at about $250 billion, maybe as high as $350 
billion. It is simply ignored. It is as if paying doctors is not part 
of health care reform, and therefore it has been ignored by the 
majority. But if you wanted to properly score the cost of this bill, 
you have to add back in that $250 to $350 billion. Obviously, that puts 
them in a very tight debt situation, deficit situation, even under the 
gamesmanship which was used to get to the score in the first place, 
which, as we all remember, was you score it 10 years of income, 10 
years of taxes, 10 years of spending cuts, against 6 years of actual 
programs. That is how they got the score they claim. The real score on 
this bill is $2.6 trillion of new spending, and it is a massive 
expansion of the deficit, much of which will be caused by the failure 
to fix the doctor issue.
  Mrs. HUTCHISON. Mr. President, I would ask the Senator from New 
Hampshire how it is that we can cut back on Medicare for our seniors, 
and I would like for him to talk about the impact especially on rural 
hospitals because rural hospitals serve a larger number, percentage-
wise, of Medicare patients. In my home State of Texas, 29 percent of 
all of our hospitals are located in rural areas.
  I received a letter from the Texas Organization of Rural and 
Community Hospitals, which represents 150 rural hospitals in the State, 
saying: We 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.
  I would ask the Senator from New Hampshire if, in his State and from 
what he is hearing from other States, they are likewise concerned about 
the impact on our rural residents who are

[[Page S1827]]

Medicare patients and the cuts to hospitals that are going to be really 
disproportionate when you look at the big picture, and for what 
purpose? Fewer people served, and that is supposed to be health care 
reform?
  Mr. GREGG. Well, the Senator is absolutely right. This is going to 
have a huge impact, especially on rural hospitals that have heavy 
Medicare populations because those populations will find their 
providers are no longer able to make enough money to exist.
  We actually have one of the leading Members of the Senate here, who 
is a doctor, who provided health care in a rural setting and is just 
recently out of the field, so to say, who might be able to comment, to 
add even more expertise on that.
  Mr. BARRASSO. I would absolutely like to do that because Wyoming 
clearly is a rural State, long distances between patients and the 
hospitals.
  This Sunday, just 2 days ago, I was visiting the Elk Horn Valley 
Rehab Hospital in Casper, WY, down the road from the Wyoming Medical 
Center, to see a friend of mine, Ted Lee. Ted is now in his eighties. 
Ted is a veteran of World War II. Ted actually drove a Jeep for 
Eisenhower, who was a general at the time, and Ted has been back to 
Washington as part of the Honor Flights, as we honor our World War II 
veterans.
  Ted had fallen at home on the Wyoming ice and snow and had broken his 
hip. His wife Jackie called my wife Bobbi and me at home over the 
weekend to say: Ted is in the hospital. Would you stop by?
  Ted is a terrific guy. I repaired his shoulder. I operated on his 
leg, when, at the age of 70, he jumped from an airplane to show he 
could still jump out of a plane with a parachute. And I replaced both 
of Jackie's knees. I know these people like family.
  I went to the hospital to see Ted, and he said: What are those people 
in Washington thinking? What are they thinking?
  Ted is very sharp. He said: I paid in. I fought for my country. I put 
my money into Medicare. Why are they taking my Medicare money, not to 
save Medicare but to start a whole new government program--a whole new 
government program for people who did not pay into the system, did not 
fight for their country, on and on. What is wrong with the people in 
Washington? What are they thinking? Don't they realize that it is our 
money, we paid in, we are expecting care, and now all of a sudden they 
are going to take Medicare money and start a new government program.
  Ted said--and he knows; this is a guy who follows us--they are going 
to take it from the hospitals, and he had just been in the hospital; 
they are going to take it from Medicare Advantage, $120 billion, 
because there are a lot of people in Wyoming who see the advantages of 
signing up for Medicare Advantage; they are taking it from the home 
health care agency, and Ted is likely to need home health care help 
when he gets home. It is a lifeline to allow him to stay out of the 
hospital and at home. He also knows it is going to cut a lot of money 
from nursing homes. We are trying to keep Ted out of a nursing home. 
But he understands clearly that these Medicare cuts are going to affect 
doctors, hospitals, nursing homes, home health agencies, even hospice 
providers, and all of that money is going to be taken away not to save 
Medicare, which he knows is going to be broke in 2017, but to start a 
whole new government program.
  When we get to the specifics of rural hospitals and rural health--and 
I see my colleague from Nebraska, who is a former Governor of Nebraska.
  There was a front-page story in the New York Times a few months back: 
``For Elderly in Rural Areas, Times Are Distinctly Harder.'' Times are 
distinctly harder. And they quote a woman from Oshkosh, NE, who says: 
``One foot in the grave, the other sliding.'' One foot in the grave, 
the other sliding.
  So I ask my colleague and friend from Nebraska, who has served as 
Governor--lots of rural areas in Nebraska--in Nebraska does the Senator 
see these same concerns where folks here in Washington are taking money 
away from our seniors on Medicare, money they depend on for their 
health care, to start a whole new government program? And it is 
fundamentally not right, and that is why we are bringing this 
amendment.
  Mr. JOHANNS. I so appreciate the opportunity to speak to this issue 
because this is enormously important for our rural States.
  We took a look at this bill. We tried to give it a good, fair look in 
terms of its impact on Nebraska. If I might, let me cite some 
statistics, and you can repeat these statistics whether you are in 
Texas or Tennessee or Wyoming or wherever. Two-thirds of our home 
health agencies, if this bill--well, this bill became law today--two-
thirds will be operating in the red by 2016, home health agencies. So 
what does that mean? Here is what it means: Back home in Nebraska, if 
you are in a major city such as Omaha, Lincoln, Kearney, whatever, it 
appears to me that you are probably going to get through this pretty 
reasonably. However, if you are in a rural area, you are going to lose 
service. They are going to pull in on the services to these rural 
areas. Why? Because they can't afford to send a home health person out 
50 or 75 or 100 miles.
  We asked ourselves, What would be the impact of this bill on nursing 
homes? Again, we have rural nursing homes all over our State. This is 
exactly what has happened in other States. People want to spend their 
elderly years in their community or near their community. These nursing 
homes are fighting to stay open today; they will take a $93 million 
hit. We are going to have nursing homes close in Nebraska.
  Hospitals and hospice will also experience major reductions.
  To those Nebraskans who are on Medicare Advantage, 35,000 Nebraskans 
are going to see a cut in the amount of money they receive only 
exacerbated by what we are talking about today.
  If I might, let me anticipate an argument. I know, because you have 
been watching this, somebody from the other side is going to say: Come 
on, Mike. This is the way it works. We extend the life of Medicare.
  The Actuary in CBO has looked at that, in a rather amazing analysis, 
and said: Yes; right. What you are doing is double counting the same 
dollar. This comes from CBO, but I can take the same from CMS. CBO 
said: The key point is, the savings to the HI trust fund, under the 
Patient Protection and Affordable Care Act, would be received by the 
government only once, so they cannot be set aside to pay for future 
Medicare spending and at the same time pay for current spending.
  That is exactly what they have tried to do here.
  Mr. GREGG. If the Senator will yield on that point, CBO also says: In 
effect, the majority of the HI trust fund savings, under the big bill 
which was signed today and the reconciliation proposal which we are 
dealing with today, would be used to pay for other spending and, 
therefore, would not enhance the ability of the government to pay for 
the future of Medicare benefits.
  The amendment we have at the desk does the opposite. It will allow us 
to use any savings to pay for Medicare benefits and enhance the 
strength of the trust fund.
  Mr. JOHANNS. That is exactly why I stand here today--to bring honesty 
to the accounting. If you bring honesty to the accounting, you can see 
what we are doing to the American people.
  A former CBO Director recently said: Fantasy in, fantasy out. They 
will only score what is laid in front of them. They had this gimmick 
laid in front of them which is what they had to score. I applaud what 
this amendment does because what it is saying is: Let's cut through all 
this. Let's score this honestly. If we have savings in Medicare, let's 
keep that money in Medicare. Believe me, that is the right way to go 
about this. This idea of double counting the same dollar makes no sense 
whatsoever.
  Mr. GREGG. The Senator is right. It is important to note that one 
program under Medicare will be absolutely devastated. I understand 
Texas has a lot of people in that program. Maybe the Senator from Texas 
could speak to that.
  Mrs. HUTCHISON. The Senator from New Hampshire is correct. That is 
why I strongly support the amendment at the desk. The bill will wipe 
out Medicare Advantage, make no mistake about it. Texas has 500,000 
people who pay into Medicare Advantage because

[[Page S1828]]

it gives them extra things that they don't get under Medicare, such as 
eye care and eye glasses and things that are so important. In fact, 
what is so interesting about the bill before us, the reconciliation 
bill, is it actually increases the cuts in Medicare Advantage over and 
above what was in the Senate bill.
  Mr. GREGG. It takes that money out of Medicare and uses it to fund a 
new entitlement for people who are not on Medicare and have never paid 
into Medicare.
  Mrs. HUTCHISON. Exactly; taking away way from seniors who tried to do 
something a little bit better for themselves, mostly in rural areas. It 
cuts them even more than the Senate bill the President signed today: 
$200 billion in cuts to Medicare Advantage. It will obliterate the 
Medicare Advantage Program for so many of our seniors, in the millions 
across the country. In fact, here is a statistic: Between 2003 and 
2007, more than 600,000 beneficiaries in rural areas joined the 
Medicare Advantage Program, a 420-percent increase in Medicare 
Advantage, because seniors saw it was a better deal for them and they 
decided to take it.
  Mr. ALEXANDER. I wonder if I might ask the Senator from New 
Hampshire, I hear it often said by supporters of the bill, which became 
law today, that we on the Republican side are overstating it when we 
say there are Medicare cuts. Don't I remember that the Director of the 
CBO testified that fully half of those on Medicare Advantage would see 
their benefits cut by a bill such as the one that became law today? 
Don't one out of four recipients of Medicare subscribe to Medicare 
Advantage? Can we not expect for at least one out of those four 
Medicare Advantage beneficiaries to have their benefits affected by 
this law?
  Mr. GREGG. The Senator is absolutely right. The original number under 
the original bill was 11 million seniors would lose their Medicare 
Advantage. That number has to go up now because, if this bill passes, 
it increases the cut to Medicare Advantage. Again, it takes that money 
and funds bringing people onto the system who don't have insurance 
coverage today but who are definitely not seniors and who have never 
paid into the Medicare trust fund.
  I see the Senator from Idaho rising. Does he wish to speak?
  Mr. RISCH. Mr. President, I came to the floor to join in this. I 
can't understand this. It amazes me that the other side thinks the 
American people are so stupid that they are going to believe you can 
take $500 billion out of Medicare and that it is going to be good for 
the American people and that it is going to be good for the system. In 
addition, what has been discussed about this phony smoke-and-mirrors 
accounting, the American people understand this. Most importantly, we 
have heard from the American people over and over: Don't touch our 
Medicare. When they say ``our Medicare,'' they mean our Medicare. This 
isn't a gift from the Federal Government. There was a bipartisan 
coalition of Republicans and Democrats who brought the Medicare system 
online in America. They made a contract with the American people. If 
you work, you are going to contribute into the Medicare trust fund, and 
your employer is going to contribute into the Medicare trust fund. It 
is going to be there for you to be used when it is necessary for 
Medicare purposes.
  My office is flooded with phone calls saying: You politicians, leave 
your hands off our Medicare.
  I have watched this process over the years and have seen people try 
to raid Medicare for substantially less than what we are talking about 
here. We are talking about $\1/2\ trillion that is being stolen from 
Medicare. Where is the media on this? They tout this bill, that it will 
do this and it will do that. Nobody ever talks about the downside of a 
$\1/2\ trillion theft from Medicare. The American people are smart. 
They understand what is being done.
  Anyone who supports this is going to pay the price for this in 
November. I guarantee you, your seniors at home, even young people and 
people who are middle-aged who are looking forward to Medicare are 
going to ask: Did you vote to steal money from my Medicare?
  You better be ready to answer that question. Don't give them an 
answer with the smoke and mirrors, that by double accounting somehow 
taking $\1/2\ trillion out is going to make Medicare better. The 
American people are smarter than this. You are going to find that out 
this fall.
  Mr. GREGG. Remember, the only way that can be avoided, the only way 
this bill and the bill that was just passed today, signed today by the 
President, can be kept from taking Medicare funds to fund new 
initiatives that have nothing to do with Medicare, such as insurance 
fraud and the expansion of Medicaid, is to pass this amendment. This 
is it. If you don't vote for this amendment, then you are voting to 
raid Medicare for the purpose of using that money for some other 
purpose which has nothing to do with Medicare. Basically, you are 
funding this bill on the backs of seniors.

  How much time do we have remaining?
  The PRESIDING OFFICER. The Senator has 1 minute remaining.
  Mr. GREGG. I know the Senator from Tennessee wanted to conclude.
  Mr. ALEXANDER. Mr. President, I conclude by congratulating the 
Senator from New Hampshire for a very straightforward amendment. As I 
understand it, it says: If you are going to take any money out of 
Medicare, it has to be spent on Medicare.
  Mr. GREGG. That is correct.
  Mr. ALEXANDER. It can't be spent on some new government program.
  Mr. GREGG. You can't create a new program until you can prove it is 
paid for with something other than Medicare money.
  Mr. ALEXANDER. You have reemphasized that $\1/2\ trillion is coming 
out of Medicare and that it will affect the benefits of one-fourth of 
those who have Medicare Advantage. What you are trying to do is simply 
say: If there are savings in Medicare, spend it on Medicare because 
Medicare is going broke. This will help keep it solvent.
  Mr. GREGG. That is the only fair thing to do for the seniors of 
America who are facing a system which has a very significant unfunded 
liability and which they paid into for all their lives and have a right 
to assume will be solvent and not have it used as a piggy bank for 
other programs which the other side of the aisle thinks are important 
but which have nothing to do with Medicare.
  As I understand, the Democratic side now has a half hour and then we 
have a half hour.
  The PRESIDING OFFICER. The Senator is correct.
  The Senator from Montana.
  Mr. BAUCUS. Senator Harkin wishes to speak, but allow me to make a 
few points clear. The amendment offered by the Senator from New 
Hampshire is a killer amendment. It kills the bill. It is that simple. 
It basically is an amendment that kills the health care bill that just 
became law that the President signed this morning. This is a debate we 
had when we were on the bill. The Senate has already considered the 
arguments made by the Senator from New Hampshire and others. The Senate 
decided against those arguments. The Senate has decided to pass health 
care reform, as has the House of Representatives, and the President 
signed it. So this, in a certain sense, is a stale argument. This is an 
argument after the bill has already been passed. It makes more sense to 
make these arguments beforehand, not after.
  Second, what is the effect? Let me read from the amendment. It says: 
The Secretary of the Treasury and the Secretary of Health and Human 
Services are prohibited from implementing any spending increase/revenue 
reduction provisions in the bill just signed by the President unless 
certain conditions occur. That means no spending to fill the doughnut 
hole. That means seniors will still have to spend more on drugs. That 
means no spending to help States cover Medicaid expenses for the 
expanded population. That means States will be left high and dry. That 
means no primary care payments to primary care physicians, whether it 
is Medicaid or Medicare. That means no tax credits for Americans who 
are struggling to buy health insurance. That means no payments to help 
struggling Americans make the out-of-pocket costs. It makes no sense. 
This is an example of why this is a killer amendment.
  I strongly urge my colleagues to recognize we have had this debate 
already. This is not new. They have not said anything new. This debate 
occurred while we were considering health care reform. The Senate has 
considered

[[Page S1829]]

those arguments, has listened to those arguments. We debated this 
amendment already back and forth. The Senate decided by a vote not to 
accept those arguments. So we are talking about something that is 
history. It has already passed. In a certain sense it is irrelevant.
  On the other hand, this amendment is relevant on reconciliation. This 
amendment is an attempt to kill the bill. I strongly urge my colleagues 
to reject this amendment.
  Don't forget, our bill includes financial incentives for doctors and 
hospitals to collaborate and coordinate care for seniors. I thought 
that is something we wanted. This amendment says: No, you can't do 
that. We can't come up with financial incentives for doctors and 
hospitals to collaborate. This does not happen often enough in Medicare 
today. We need to have more collaboration. We need doctors and 
hospitals to work better together. We need some demonstration systems. 
We need pilot projects to help us find ways to better pay doctors and 
hospitals based on quality of care and less on quantity of care. There 
is nobody who disagrees with that statement, at least nobody who has 
given a lot of thought to health care reform. This amendment would stop 
that. It would prevent us from trying to find a way to reduce health 
care costs which are eating us alive, eating up family budgets, eating 
up company budgets and also public budgets, in terms of Medicaid and 
Medicare, unless we get health care costs under control. The way to do 
that is to change the delivery system. I think that is the game changer 
in the bill; frankly, one of the most important parts of the bill. 
But--no, no, no--this amendment says you cannot do that. You cannot 
begin to take the steps necessary in the long term to start reducing 
health care costs.

  Our bill also--the underlying bill, which this amendment would kill--
reduces Medicare spending by reducing hospital readmissions. I thought 
we wanted to do that. I thought we wanted to reduce the hospital 
readmissions. This amendment would, in effect, say: No, you cannot do 
that.
  Better coordination of care again means patients do not have to come 
back to the hospital because of complications, because of allergies and 
problems post surgery. What else does the underlying bill do? It keeps 
more money in the Medicare accounts by making smart reforms to the 
program. Fewer funds will be spent simply by paying doctors for quality 
of care and not quantity of care--by cutting out wasteful overpayments 
to providers and private insurance companies that do not add value to 
patients, and by creating an innovation center within the Medicare 
Program so that groundbreaking ways to deliver health care better are 
discovered more often and put in place without delay.
  That is a very important point. We need to have, by creating an 
innovation center within the Medicare Program, groundbreaking ways to 
deliver better health care. We have to spend some money on these new 
demonstration and pilot projects so we can have a much better health 
care system.
  Mr. President, I now yield the remainder of the time in this half 
hour to the chairman of the HELP Committee. I yield time under control 
on the bill.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. Mr. President, thank you very much. I thank Chairman 
Baucus for yielding me this time.
  I listened with great interest to the distinguished senior Senator 
from Montana as he recounted the extraordinary lengths to which 
Democrats went on his committee in soliciting bipartisan Republican 
support in the drafting of the health reform bill in the Finance 
Committee.
  On both the Finance Committee, which Senator Baucus chairs, and on 
the Committee on Health, Education, Labor, and Pensions, which I chair, 
the majority party insisted on a process that was consistently open, 
transparent, and inclusive.
  At every step, the Democratic majority acted in good faith. 
Republican Senators were fully involved during public committee 
hearings and markups, as well as in private discussions and 
negotiations. The ideas and amendments of Republican Senators helped to 
shape the substance of the bill in a multitude of ways.
  In the HELP Committee, in 2008 and 2009, we held 47 bipartisan 
meetings on health reform, including 14 bipartisan roundtables, 13 
bipartisan committee hearings, and 20 bipartisan walk-throughs on the 
bill.
  Then the HELP Committee spent nearly 3 weeks during June and July 
marking up the bill--June and July of last year. To be exact, our 
markup spanned 13 days and a total of 54 hours. We went out of our way 
to accommodate our Republican colleagues who offered over 200 
amendments. We accepted 161 Republican amendments on our bill. By any 
standard, this was an extraordinarily open and inclusive process.
  I must point out that Democrats in good faith and in the best spirit 
of bipartisanship insisted on this inclusive process, despite numerous 
public statements by some Republican Senators to the effect that their 
game plan was to delay and obstruct and filibuster and kill the bill. 
Indeed, the junior Senator from South Carolina famously said:

       If we're able to stop Obama on this, it will be his 
     Waterloo. It will break him.

  Even in the face of that, we said, nonetheless, that is just one 
person. We are going to have an open and inclusive process.
  Many critics have said that Democrats pursued inclusion and 
bipartisanship to a fault. They have criticized us for consuming many 
months negotiating with Republicans, accepting their amendments, 
accommodating their ideas and objections, even in the teeth of their 
public declarations that they intended to kill the bill.
  For the record, I am proud of the fact that we went the extra mile to 
include Republican Senators and to incorporate their ideas and input. 
It was the right thing to do, even if the hand of cooperation and 
bipartisanship we extended was rejected.
  With passage of the Patient Protection and Affordable Care Act, the 
111th Congress has made history, just as previous Congresses did in 
1935 by passing Social Security and in 1965 by passing the law creating 
Medicare. Each of those bills marked a giant step forward for the 
American people, and each was stridently opposed by defenders of the 
status quo. But in the end, a critical mass of Senators and 
Representatives rose to the historic occasion. They voted their hopes 
and not their fears. And--as we now know in retrospect--they passed 
laws that transformed America in profoundly positive ways.
  The health reform law President Obama signed earlier today will also 
transform America in profound and positive ways. Indeed, it already 
has. Despite all the talk recently about how our Nation has become 
divided and ungovernable, we have proved not only that we are 
governable, but also that we still have the capacity to take charge of 
our destiny and to act with boldness and vision.
  One prominent commentator said passage of the health reform bill is 
``a victory for America's soul.'' I could not agree more. Yet this new 
law is fully paid for. Indeed, it helps to reduce the deficit by $143 
billion in the first decade, and by a whopping $1.2 trillion in the 
second decade. That is deficit reduction.
  Yes, this new law includes important and long overdue measures to 
crack down on abuses by health insurance companies--abuses that leave 
all Americans, including those with insurance, just one illness away 
from financial catastrophe. No longer will health insurance companies 
be able to cancel your insurance when you get a serious illness. No 
longer will they be able to impose lifetime caps or annual caps on 
their payoffs. No longer will they be able to systematically 
discriminate against women by charging higher premiums just because--
just because--you are a woman. No longer--once this bill becomes fully 
operational--will they be able to deny coverage based on preexisting 
conditions.
  In addition, the new law includes a whole array of provisions 
promoting wellness, prevention, and public health--something I have 
personally championed for many years. This will finally begin to change 
the paradigm from our current sick care system to a true health care 
system--one that keeps people healthy and out of the hospital in the 
first place. This bill will begin to recreate America as a wellness 
society, focused on healthful lifestyles, good nutrition, physical 
activity, and

[[Page S1830]]

preventing the chronic diseases that take such a toll on our bodies and 
on our budgets.
  There has been a lot of talk about bending the cost curve in health 
care, and there have been a lot of different ways people have suggested 
on how we bend the cost curve. Quite frankly, I think the one biggest 
way we are going to be able to bend the cost curve is by focusing more 
on prevention. We know how to do it. We know it works. We know it saves 
money. We have good data on this. If you do not believe me, ask Pitney 
Bowes and what they did to their bottom line. Ask Safeway corporation 
what happened to their bottom line in terms of health care costs when 
they put in place widespread prevention and wellness policies. So we 
have private companies out there that are doing wonderful things we 
could be doing nationwide, and we can have the same kind of savings 
nationally for America as these private companies have for their bottom 
line.
  There is one more critical reform in this new law. It includes the 
Community First Choice Option, which represents a major advance in 
allowing people with disabilities and older Americans with chronic 
conditions to remain in their homes and with their family and 
community. It will increase access to medical examination and 
diagnostic equipment designed to accommodate people with disabilities.
  Here I want to speak to all of my friends in the disability community 
in America. After the passage of the Americans with Disabilities Act in 
1990, the next big hurdle was to break down the discrimination that 
exists in Federal law that pertains to people who are eligible for 
institutional care but who would rather live in their own homes and in 
their communities. Right now, under Federal law, if you qualify for 
institutional care, Medicaid must pay for that--must pay for that. If, 
however, you do not want to live in an institution, and you want to 
live on your own, near your friends or your family in the community, 
Medicaid does not have to pay for that. Yet we know that for every one 
person in a nursing home, we can support three people with disabilities 
living in the community.
  So we have tried ever since 1990 to change this. We had the first 
bill in the mid-1990s. It was called MiCASSA, the Medicaid Community-
Based Attendant Services and Supports Act. We tried for a long time to 
get that. We could never get it done. Then in the last few years, we 
changed the name of it to the Community Choice Act, and we still could 
not get that done.
  Last year, at about this time, I paid my first visit to President 
Obama in the White House. I wanted to have a personal meeting with him 
to talk about this one issue; that if we are going to do health care 
reform, we cannot leave people with disabilities behind, and the one 
thing that matters most is to ensure that people with disabilities have 
their own choice about where they want to live. If they want to live in 
an institution, fine. But if they would rather live by themselves in 
the community, with their family and their friends, they ought to have 
that choice. President Obama agreed with that, and so began the long 
process.
  There is one part of the bill that not too many people know about. I 
say to my friends in the disability community, we have finally overcome 
the obstacle. In this bill is the Community First Choice Option, which 
will allow the Federal Government--beginning in October of 2011--to 
begin to pay to States an increased part of their Medicaid payment so 
people with disabilities can choose where they want to live--not where 
the government tells them they have to live.
  To me, this is a profound change in how we are going to treat people 
with disabilities in our society. This is one of the landmark 
disability rights parts of this bill, and not too many people know 
about it. But I think after the signing of the bill today, people in 
the disability community all over America will know it is in there.
  So these are important landmark reforms that benefit all Americans. 
But, as a commentator put it, the new health care reform law is also a 
victory for America's soul. At long last, we are realizing Senator 
Kennedy's dream of extending access to quality affordable health 
insurance to every American. We are ending the last shameful bastion of 
legal discrimination and exclusion in our country.
  I have stated this before when people said: What are you talking 
about, discrimination, well, over the decades, we have outlawed 
discrimination in our country on the basis of race, color, national 
origin, based on gender. We have outlawed discrimination also based on 
disability with the Americans with Disabilities Act in 1990. But until 
now--think about it--it has been perfectly legal to discriminate 
against our fellow Americans because of illness, because of sickness--
to exclude tens of millions of our citizens from decent health care 
simply because they cannot afford it. Think about that.
  I hear some people talking about setting up pools: They are going to 
have a pool here and a pool here--a pool for the elderly, a pool for 
high risk--a pool here and a pool there; different people get in these 
different pools. My friends, that is nothing more or less than blatant 
discrimination. Are we not all one American family? That is what we 
said when we passed the Americans with Disabilities Act. This is our 
family. It should not be shunted aside, separated out. We said the same 
thing on the basis of race years ago with the Civil Rights Act, on the 
basis of gender, national origin.
  With the signing of the bill today, we have said no longer are we 
going to discriminate against people because they are sick. Think about 
that. No longer are we going to discriminate against people simply 
because they are sick. This is a profound change in the way we are 
going to deal with each other as a society.
  So when President Obama signed that bill this morning, he set in 
motion a series of changes that will tear down these last barriers of 
discrimination and exclusion. That truly is a great moral victory. And 
it is a victory for America's soul. It is a victory that every American 
can be proud of.
  On that score, I certainly include our Republican friends. In the 
end, not a single Republican in either the House or the Senate voted 
for health care reform. I say that is unfortunate. But, make no 
mistake, Republican ideas are much a part of this new law. In our 
committee, the HELP Committee, which I chair, Republicans were full-
fledged participants, as I said. They offered 210 amendments. We 
accepted 161--many of them making substantive contributions to the 
bill.

  As others have pointed out, our national health reforms are similar 
in many respects to the very successful reforms undertaken by 
Republican Governor Mitt Romney in the Commonwealth of Massachusetts.
  I fully predict that, as with Social Security and Medicare, the 
changes in the new health reform law, as they become better known and 
take effect, will win overwhelming bipartisan support among the 
American people.
  In the near term, however, it is disappointing that some Republican 
legislators--I think maybe taking their cue from the more extreme 
voices on talk radio or Fox TV--are pledging to repeal this new law. In 
fact, the distinguished minority leader, the Republican leader, a 
couple of weeks ago in a press conference said if we pass this bill, 
their motto was going to be ``Elect Republicans and We'll Repeal It.'' 
This strikes me as bad public policy and, quite frankly, bad politics.
  Do Republicans really want to repeal the ban on denying insurance 
coverage due to preexisting conditions? Do they really want to repeal 
the ban on insurance companies cancelling your policy if you get sick? 
Do they really want to repeal the ban on annual and lifetime benefit 
payments? Do they really want to repeal the dramatic shrinking of the 
doughnut hole? Do Republicans really want to take away from the 
American people the fact that now in law your child can remain on your 
policy until the age of 26? Do they want to take that away from you? Do 
they want to take away from you the right you have now--the right under 
law--that no matter how sick your child gets--maybe born with a 
disability, maybe born with an illness--the insurance company cannot 
discriminate against your child based on a preexisting condition? That 
is the law of the land. Do Republicans really want to take that away 
from you?
  I would strongly advise against these scorching tactics. This health 
reform

[[Page S1831]]

bill has been passed and signed into law. It is now time for the bitter 
partisan rancor to stop. It is time to move forward united as an 
American people, just as we did on Social Security and Medicare. It is 
time to put politics aside and put our country first.
  Today we have before us this reconciliation bill that includes a 
number of modifications to strengthen the reform bill President Obama 
signed earlier today. The bill he signed earlier today was the exact 
same bill we passed on Christmas Eve of last year. But there is 
something else. This reform bill also includes reforms in the student 
lending program that in their own way are also profound and historic.
  Let me mention a few of these provisions that will build on the new 
health reform law. This reconciliation bill will make health 
insurance--as Senator Baucus said earlier, all families between 133 
percent and 400 percent of poverty will see lower health care costs. 
The bill will shrink and notably do away with the doughnut hole in the 
Medicare prescription drug program. We have new provisions cutting back 
on waste and fraud in Medicare and Medicaid. In fact, these are some 
ideas proposed by Republicans at the White House summit, and we put it 
in the bill. It increases funding for community health centers by $2.5 
billion, new consumer protections for employer-provided health plans 
that are grandfathered in by the health reform law.
  In addition, the bill includes a provision that is critically 
important to ensuring that our health care providers and hospitals are 
fairly reimbursed. Many folks know Medicare varies reimbursement based 
on geography. That means many rural States such as Iowa, Oregon, 
Arkansas, Minnesota, and many others are reimbursed at much lower rates 
than urban areas regardless of the quality of the services they 
provide. This bill helps to right that, to address the geographic 
disparities, both for doctors and hospitals. In addition, we have 
received a written guarantee from Health and Human Services Secretary 
Kathleen Sebelius for further action to reform Medicare reimbursement 
rates.
  This will finally move us to a fairer, more effective reimbursement 
model that emphasizes quality over quantity. I said this reconciliation 
bill includes both health care and education provisions. The education 
title of the bill includes landmark provisions to make college more 
affordable and accessible. It does so by eliminating tens of billions 
of dollars in wasteful subsidies to banks, redirecting most of that 
money to low-income college students in the form of increased Pell 
grants. The status quo in student lending is just incredibly wasteful. 
It is like a bizarre Rube Goldberg process that makes no sense.
  Think about the present system. The Federal Government pays fees to 
private banks to make entirely risk-free loans using taxpayer money. 
The loans, which are already guaranteed by the Federal Government, are 
then sold back to the Federal Government. The banks pocket tens of 
billions of dollars--taxpayers' dollars--in fees and totally risk-free 
profits. This is a brazen case of corporate welfare--a huge government 
giveaway to bankers and to Sallie Mae. It is time to end it. This bill 
does. Simply put, this bill cuts out the middleman, saves $61 billion 
over the next 10 years, and gives it to students. The remainder we have 
invested, as I said, in more generous Pell grants.
  We reduce the deficit by $10 billion. We have deficit reduction in 
here. We increase the Pell grants from now, from 2010 to 2017, from 
$5,550 to $5,975, and then we put in a cost-of-living increase on Pell 
grants based on the Consumer Price Index. This $36 billion includes an 
investment of $13.5 billion right now for the Pell grants--right now--
to fill a hole in the Pell grant. That would increase student aid this 
year for students going to college, low-income students who need that 
help. It also invests $2.5 billion in Historically Black Colleges and 
Universities. It also provides money to student services so they can 
support students and give them the support they need to stay in school 
and to graduate--money to help nonprofits do that.
  So, again, this reconciliation bill builds on and strengthens the 
health reforms signed into law by President Obama today. As I have said 
many times in the past, I look upon the health care bill we passed in 
December as a starter home, something on which we can build now and in 
the future. We make modifications now, and we will make them in the 
future. We can always make modifications. It is a bill, a law. We can 
make changes as we go along. So we are making some of those fixes today 
to bridge some of the differences between the House and the Senate, to 
make some needed changes.
  The Congressional Budget Office, again, says deficit reduction will 
be $143 billion in the first decade, an additional $1.2 trillion in the 
second decade--big deficit reductions.
  I am sorry the Republicans seem to take pride in their reputation as 
the party of no. We all remember William F. Buckley's conservative 
motto; William F. Buckley, the father of the conservative movement. He 
said: The role of conservatives is ``to stand athwart history yelling 
stop.'' Well, that is exactly what our Republican colleagues did by 
filibustering and trying to kill health care reform. That is exactly 
what they are trying to do now--to obstruct and kill this 
reconciliation bill. But it will not succeed. We are going to get the 
reconciliation bill done. We are going to get it passed, and we are 
going to move beyond. We are going to move beyond the rancor and the 
bitterness and bring our American family together. We will bring them 
together so everyone is guaranteed the right to health care and that we 
stop the abusive practices of the health insurance industry we have 
seen in the past.
  So, by any measure, this bill is good for the American people. It is 
good for students. It is good for our colleges, our community colleges, 
our private colleges in getting rid of the guaranteed loan program and 
going to a direct loan program. It is also good for the health of the 
American people.
  As I said at the beginning, this bill is good for the soul of 
America. It is good to remind us that we are, once again, an American 
family; that no one should be discriminated against simply because they 
are sick or have an illness or because fate has dealt them a blow by 
becoming disabled. That is what this bill is about more than anything 
else. It is time to get on with it, get it passed, and move on.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Hagan). The Senator from Montana.
  Mr. BAUCUS. Madam President, how much time is remaining on this half-
hour block?
  The PRESIDING OFFICER. No time remains for the Democrats.
  Mr. BAUCUS. I thank the Senator.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mr. GREGG. Madam President, we are about to hear from Senator McCain 
who has an amendment dealing with a number of these special deals that 
are in this bill. First off, this bill is an outrage on the body 
politic to begin with, the way it was handled. It was drafted in a 
secret room, behind a secret room, behind a hidden door somewhere over 
on the majority side. It was brought out on Saturday night, put on our 
desks. We were told we had to vote on it on Christmas Eve. Then it was 
sent to the House. The House didn't get to amend it. They sent it to 
the President. But in order to get it passed in the House, they had to 
do this trailer bill which we are dealing with tonight, and which I 
call the buy-it bill, where they went around and bought votes. A lot of 
votes were bought around here using the buy-it bill method.
  Senator McCain has sort of been the conscience of the Senate on this 
type of issue, where there are targeted benefits for special States 
which aren't appropriate and have nothing to do substantively with the 
bill. Therefore, we should address those openly. We haven't had a 
chance to do that because our side has never been allowed to amend 
anything around here on this bill of any substance.
  So it is Senator McCain's intention, when he gets here, to offer an 
amendment dealing with one of these, or maybe a series of these 
situations where there were special deals cut which have been given 
certain names, such as the ``Cornhusker kickback'' and the ``Louisiana 
purchase'' and the Florida ``Gator aid.'' So I believe that is what 
Senator McCain is here for, and we are looking forward to it because it 
is appropriate that we bring out into the light these deals which no 
American had a chance to participate in

[[Page S1832]]

other than that small cadre in that small room--as I said, the hidden 
room behind the hidden room behind the hidden door.
  Certainly, they didn't go through any committee, these deals. They 
didn't come across the floor of the Senate, these deals, and they 
didn't go through the floor of the House, and they should be voted on 
as to whether they are appropriate.
  Mr. ALEXANDER addressed the Chair.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. GREGG. Madam President, I ask unanimous consent to proceed as in 
a colloquy.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ALEXANDER. Madam President, could Senator McCain be allowed to 
lead the colloquy? I ask unanimous consent that Senator McCain be 
allowed to lead the colloquy.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. ALEXANDER. Madam President, I am glad to see the Senator from 
Arizona who has been a consistent proponent of openness in government. 
I heard the Senator from New Hampshire say that a lot of these 
sweetheart deals hadn't been voted on. I wonder if we may have a chance 
to vote on them soon, I ask the Senator from Arizona.
  Mr. McCAIN. Madam President, I thank my friend from Tennessee. May I 
say I am going to offer an amendment that would remove some of the 
remaining sweetheart deals. To be honest with my colleagues, I don't 
think we are going to find out all of what was in this 2,733-page 
legislation for a long time.
  As you know, it is that size, and it takes an expert, even though I 
read the bill, to go from one point to another. For example, it took us 
a long time to figure out that the State of Connecticut has a $100 
million deal to build a hospital in Connecticut.
  Now, you wouldn't know that at first glance, but after going through 
it, you figure out it is there. There are a lot of provisions in this 
2,733-page piece of legislation that we will find, but we are going to 
try to get rid of some of them in this amendment, which is, by the way, 
a commitment I thought had been made but obviously was not.
  The most egregious have been removed. The ``Cornhusker kickback'' has 
been removed, and I believe the ``Gator aid'' provision has been 
removed as well. But we certainly have a number of others that remain 
in the bill, and we will be finding them in the future.
  I ask my colleague from New Hampshire, is it in order for me to 
propose the amendment? What is the parliamentary situation?
  Mr. GREGG. As I understand it, the majority would like to see the 
amendment, which is certainly reasonable. We will give them a copy of 
the amendment, and then hopefully at the end of our debate time we will 
be able to set my amendment aside. We will get a copy.
  Mr. McCAIN. I say to my friend from New Hampshire, while we are on 
the subject, it is not only the sweetheart deals that are carved out 
for individual Members, the latest being additional Medicaid funding 
for Tennessee hospitals, which was just added, I understand, within the 
last 48 hours or so, but there is also the part that is really hard for 
us to amend, as I am sure the Senator from New Hampshire knows--for 
example, the PhRMA deal, the deal that was cut for the pharmaceutical 
manufacturers.
  The Senator from New Hampshire may remember that back in August, 
there was a story in the New York Times:

       Drug industry lobbyists reacted with alarm this week to a 
     House health care overhaul measure that would allow the 
     government to negotiate drug prices and demand additional 
     rebates from drug manufacturers.
       In response, the industry successfully demanded that the 
     White House explicitly acknowledge for the first time that it 
     had committed to protect drug makers from bearing further 
     costs in the overhaul. The Obama administration had never 
     spelled out the details of the agreement.
       ``We were assured: `We need somebody to come in first. If 
     you come in first, you will have a rock-solid deal.' '' Billy 
     Tauzin--

  By the way, I understand he has a salary of over $2 million a year--

     the former Republican House member from Louisiana who now 
     leads the pharmaceutical trade group, said Wednesday: ``Who 
     is ever going to go into a deal with the White House again if 
     they don't keep their word? You are just going to duke it out 
     instead.''
       A deputy White House chief of staff, Jim Messina, confirmed 
     Mr. Tauzin's account of the deal in an e-mail message on 
     Wednesday night.
       ``The president encouraged this approach,'' Mr. Messina 
     wrote. ``He wanted to bring all the parties to the table to 
     discuss health insurance reform.''

  I say to my friend from New Hampshire, while we are awaiting approval 
of this amendment from the other side, how many deals were cut with 
PhRMA? What were the deals cut for the AMA? What were the deals cut 
with the hospital association? What were the deals cut with all these 
other organizations that have caused Americans to be so unhappy with 
this process we have gone through?
  There really is not any way, I say to my colleague from New 
Hampshire, that I can amend the PhRMA deal. We tried to have drug 
reimportation from Canada. We tried to have pharmaceutical companies 
compete for Medicare recipients. As Mr. Tauzin said:

       ``We were assured: `We need somebody to come in first. If 
     you come in first, you will have a rock-solid deal' ''. . . .

  I don't know whether it was the President found himself on the road 
to Damascus or what caused the conversion from then-Senator Obama who 
strongly supported drug reimportation from Canada for prescription 
drugs to the administration now opposing it.


                           Amendment No. 3570

  Anyway, I understand my amendment has been agreed to.
  I call up the McCain-Burr-Coburn amendment.
  Mr. GREGG. I believe the Senator has to set my amendment aside.
  Mr. BAUCUS. The Gregg amendment is already pending. I understand 
Senator McCain would like to ask unanimous consent that the pending 
amendment be set aside so that his amendment could then be in order. If 
so, I have no objection.
  The PRESIDING OFFICER. Is there an objection to setting aside the 
pending amendment? Without objection, it is so ordered.
  The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Arizona [Mr. McCain] proposes an amendment 
     numbered 3570.

  Mr. McCAIN. Madam President, I ask unanimous consent that the reading 
of the amendment dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

  (Purpose: To eliminate the sweetheart deals for Tennessee, Hawaii, 
         Louisiana, Montana, Connecticut, and frontier States)

       At the end of subtitle F of title I, add the following:

     SEC. 1502. ELIMINATION OF SWEETHEART DEALS.

       (a) Repeals.--Effective as if included in the enactment of 
     the Patient Protection and Affordable Care Act, the following 
     provisions are repealed:
       (1) Sweetheart deal to provide tennessee with medicaid dsh 
     funds.--Clause (v) of section 1923(f)(6)(A) of the Social 
     Security Act (42 U.S.C. 1396r-4(f)(6)(A)), as added by 
     section 1203(b) of this Act.
       (2) Sweetheart deal to provide hawaii with medicaid dsh 
     funds.--Clause (iii) of section 1923(f)(6)(B) of the Social 
     Security Act (42 U.S.C. 1396r-4(f)(6)(B)), as added by 
     section 10201(e)(1)(A) of the Patient Protection and 
     Affordable Care Act.
       (3) Sweetheart deal to provide louisiana with a special 
     increased medicaid fmap.--Subsection (aa) of section 1905 of 
     the Social Security Act, as added by section 2006 of the 
     Patient Protection and Affordable Care Act.
       (4) Sweetheart deal that increases medicare reimbursement 
     just for frontier states.--Section 10324 of the Patient 
     Protection and Affordable Care Act (and the amendments made 
     by such section).
       (5) Sweetheart deal granting medicare coverage for 
     individuals exposed to environmental hazards in libby, 
     montana.--Section 10323 of the Patient Protection and 
     Affordable Care Act (and the amendments made by such 
     section).
       (6) Sweetheart deal for a hospital in connecticut.--Section 
     10502 of the Patient Protection and Affordable Care Act.
       (b) Elimination of Sweetheart Deal That Reclassifies 
     Hospitals in Michigan and Connecticut to Increase Their 
     Medicare Reimbursement.--Section 3137(a) of the Patient 
     Protection and Affordable Care Act, as amended by section 
     10317 of such Act, is amended--
       (1) in paragraph (2)--
       (A) by striking ``fiscal year 2010'' and all that follows 
     through ``for purposes of implementation of the amendment'' 
     and inserting ``fiscal year 2010.--For purposes of 
     implementation of the amendment''; and
       (B) by striking subparagraph (B); and

[[Page S1833]]

       (2) by striking paragraph (3).

  Mr. McCAIN. Madam President, I thank my colleague, the Senator from 
Montana, for his courtesy.
  This amendment removes some of the remaining egregious sweetheart 
deals contained in the health reform legislation. It removes the 
following items from the health reform legislation: additional Medicaid 
funding for Hawaii hospitals; additional Medicaid funding for Tennessee 
hospitals; the ``Louisiana purchase'' provided special Medicaid funding 
for Louisiana; special Medicare funding primarily for reclassified 
hospitals in Michigan and Connecticut; the UConn proposal that provides 
$100 million for a Connecticut hospital; the frontier funding provision 
providing new Medicare money for Montana, South Dakota, North Dakota, 
and Wyoming; the provision allowing for certain residents in Libby, MT, 
to participate in a new Medicare Program.
  Let me say that I believe many of these proposals, including the 
Libby, MT, proposal, may be worthwhile, but what are they doing in a 
health care reform bill? What is the purpose except to put in a special 
deal for a favored group? They may need this help. They may possibly 
very badly and urgently need it. It seems to me, if that were the case, 
we could make that argument and provide the people in Libby, MT, the 
ability to participate in a Medicare Program as it stands. It is 
something that is not in keeping with health care reform.
  The funding for Hawaii hospitals is there.
  I want to say a word about the ``Louisiana purchase.'' The Senator 
from Louisiana comes down and forcefully and very convincingly argues 
that this is very needed for the State of Louisiana, and Louisiana was 
hit by Hurricane Katrina. I point out that the State of Mississippi was 
also hit and devastated by Hurricane Katrina, but we do not have 
anything in here for the State of Mississippi. I know the Governor of 
Mississippi would argue that the devastation on the Mississippi coast 
was equally as terrible as that for Louisiana. Instead, we have $300 
million providing special Medicaid funding for Louisiana.
  There are also States, including my own, that have suffered 
devastating acts of God, acts of nature also from time to time.
  Here we are at the eleventh hour with a situation where there are 
still these backroom deals done that possibly we could address with an 
amendment. The other deals we cannot because they were side agreements, 
such as the pharmaceutical companies I just read from, such as the deal 
with the American Medical Association, the ones with the hospitals, the 
others that were cut in order to get Members to come on board and 
support this legislation. This provides for an opportunity to remove 
these provisions from the bill.
  Comments made by Senator Reid's office:

       You will find a number of States are treated different from 
     other States. That's what legislation is all about. It's 
     compromise. We worked on a number of things to get different 
     people's votes. There are many things you will look at in 
     this legislation and say: I wonder why that happened? A lot 
     of times you think something was done and, oh, that's how you 
     got their vote. Most of the time, that's really not true. 
     Some of the time it is.

  If I could quote to my colleagues again the recent article from March 
21 called ``Inside the Pelosi Sausage Factory,'' I quote from the Wall 
Street Journal article:

       Never before has the average American been treated to such 
     a live-action view of the sordid politics necessary to push a 
     deeply flawed bill to completion. It was dirty deals, open 
     threats, broken promises and disregard for democracy that 
     pulled ObamaCare to this point, and yesterday the same 
     machinations pushed it across the finish line . . .
       As for those who needed more persuasion: California Rep. 
     Jim Costa bragged publicly that during his meeting in the 
     Oval Office, he'd demanded the administration increase water 
     to his Central Valley district. On Tuesday, Interior pushed 
     up its announcement, giving the Central Valley farmers 25 
     percent of water supplies, rather than the expected 5 percent 
     allocation. Mr. Costa, who denies there was a quid pro quo, 
     on Saturday said he'd flip to a yes.
       Florida Rep. Susan Kosmas (whose district is home to the 
     Kennedy Space Center) admitted that in her own Thursday 
     meeting with the president, she'd brought up the need for 
     more NASA funding. On Friday she flipped to a yes. So watch 
     the NASA budget.
       Democrats inserted a new provision providing $100 million 
     in extra Medicaid money for Tennessee. Retiring Tennessee 
     Rep. Bart Gordon flipped to a yes vote on Thursday.
       Outside heavies were enlisted to warn potential no votes 
     that unions and other Democrats would run them out of 
     Congress.

  The list goes on and on.
  Again, eight times the President of the United States said in the 
campaign that all negotiations on health care reform would be conducted 
with C-SPAN cameras in the room. He said: We will find out who is on 
the side of pharmaceutical companies, who is on the side of the voters. 
Unfortunately, these deals were made out of the view of the C-SPAN 
cameras--in fact, behind closed doors.
  This is a pretty simple amendment. I repeat, it removes the 
additional Medicaid funding for Hawaii hospitals; additional Medicaid 
funding for Tennessee hospitals; the ``Louisiana purchase;'' special 
Medicare funding primarily for reclassified hospitals in Michigan and 
Connecticut; $100 million for a Connecticut hospital; the frontier 
funding provision providing new Medicare money for Montana, South 
Dakota, North Dakota, and Wyoming; and the special provision for Libby, 
MT.
  I know, again, that people will stand and defend each one of these 
provisions. They are provisions that were not allowed or provided to 
every other State in America. That is what makes them a special deal. 
That is what makes Americans think that the way we do business around 
here is not in their interest. It makes Americans believe we are 
cutting these deals in order to secure votes. Whenever these deals are 
cut, then the residents of other States are the ones who foot the bill.
  I hope my colleagues will consider this amendment and remove all of 
these remaining provisions. I cannot assure my colleagues or my 
constituents that we have found them all, but at least it is a step in 
the right direction.
  Mr. GREGG. Will the Senator yield for a question?
  Mr. McCAIN. I will be glad to.
  Mr. GREGG. It seems to me that what the Senator is trying to do is 
get back to what the other side claimed they were doing, which is 
health care reform. What the Senator is trying to do is take out of 
this health care bill a lot of special walking-around money events that 
did not have anything to do with health care reform; they just had to 
do with getting a vote--getting a vote here, getting a vote there. If 
they were going to do real health care reform, then it should rise and 
fall of its own weight. It should not require that these special deals 
be put in there to get a vote, should it?
  Mr. McCAIN. I believe all of my colleagues are of the highest 
integrity, honorable people. I respect and admire their service to 
their States and the Nation. But there is no doubt, I say to my friend 
from New Hampshire, there is no doubt that these kinds of provisions in 
a 2,700-page piece of legislation create the appearance that some 
States are favored over others because of either the influence of their 
elected representative or in order to secure those votes. That is the 
appearance the American people have when we find these earmarks in 
legislation which are somehow inserted without votes, without debate, 
without discussion, and there they are.
  Mr. GREGG. I guess my point is, independent of these amendments, 
Members should be able to vote on this bill up or down without these 
amendments in it. These amendments are extraneous to health care 
reform. The core of health care reform has nothing to do with any of 
these amendments. As the Senator from Arizona says, they may be 
worthwhile in some instances, but they are not tied to the purpose of 
this bill, which was allegedly health care reform; isn't that correct?
  Mr. McCAIN. I totally agree. Again, I pointed out a short time ago--
as in the day before yesterday--what was the rationale for adding $100 
million in extra Medicaid money for Tennessee? Why, after a year of 
debate and discussion on this, all of a sudden $100 million extra for 
Medicaid is deemed necessary for the State of Tennessee? This is what 
arouses the suspicion of the American people, I say to my colleague.

  There will be a stout defense of every one of these. But the point is 
that if they are done in the regular authorization and appropriations 
bills, and certainly not in the name of health care

[[Page S1834]]

reform, they are extra money. Where is the reform in $100 million for a 
hospital in Connecticut? What does that have to do with reform? 
Nothing.
  I reserve the remainder of my time.
  The PRESIDING OFFICER. Who yields time to the Senator from Wyoming?
  Mr. McCAIN. I yield to the Senator from Wyoming such time as he may 
consume.
  The PRESIDING OFFICER. The Senator from Wyoming has the floor.
  Mr. BARRASSO. Madam President, it is a privilege to be here on the 
floor with my colleague from Arizona because he talks so well on this 
topic and he knows it so very well. He knows how to read this 
legislation and look through the nooks and the crannies.
  I will tell all of you and my colleagues that I spent some time 
Sunday visiting my friend, a veteran from World War II, in the 
hospital. He broke his hip and he is recovering and he is bothered by a 
lot of things. He said what are the people in Washington thinking? He 
is recovering from his surgery and he said why are they taking my 
Medicare money to start a new government program and how in the heck 
did they get all of those votes that they needed to get this bill 
passed? He said has it been vote buying, sweetheart deals, a culture of 
corruption in Washington?
  Those are the questions being asked by people all around this country 
which is why this bill, when it was brought to the floor in the House, 
what we have seen is that half of the people of America are vehemently 
opposed, strongly opposed to the bill and fewer than one in four 
supports it.
  The thing that touched the nerve of the American people before 
Christmas was the ``Cornhusker kickback.'' That actually has not been 
taken out of the bill. What they have done is said let's spend more 
money and give that same special sweetheart deal to other States around 
the rest of the country. So that actually is still in there. Yet the 
President said we are not going to have any special deals. It happened 
when Senator McCain and I were at the White House for this summit and 
Senator McCain asked the specific question of the President, he said, 
What about all these deals.
  He said they should come out.
  Yet we see today that not only have many of those deals not come out, 
there is a whole list of additional sweetheart deals put in to get this 
bill through the House of Representatives. The people of Wyoming are 
asking why.
  Mr. GREGG. Will the Senator from Wyoming on that point yield because 
I think he has made a very important point. I was not at the summit but 
I would like the Senator from Arizona to relate to us what the exchange 
was with the President on the issue of those sweetheart deals because I 
think if the President's position is they should be out and they don't 
have anything to do with the fundamental reform exercise, shouldn't 
they be out?
  Mr. McCAIN. I would say to my friend, I had the exchange with the 
President specifically over the so-called ``Gator Aid'' amendment 
because 330,000 citizens of my State were enrolled in Medicare 
Advantage who are going to be placed at a great disadvantage because we 
had carved out a special provision for 800,000 citizens of Florida who 
were under the Medicare Advantage Program.
  By the way, I remind my colleagues that I proposed an amendment to 
remove that on this floor from that bill. Does anybody really believe 
that if it had not been for the publicity surrounding these special 
deals that they would have voluntarily taken out the 800,000-person 
carve-out for the State of Florida? I do not think so because I 
proposed an amendment to take it out and it was defeated. It was kept 
in on a party-line vote.
  Fortunately I brought it up at the White House with the President and 
the President agreed it was not a good idea. So, after voting to keep 
it in, after defeating an amendment that--I tried to remove it--
fortunately there was enough publicity, there was enough focus on it 
that it forced them to take it out.
  Unfortunately, there is not enough focus on the hospital in 
Connecticut and these other provisions which are special deals.
  Mr. BARRASSO. So here we are. We are looking at a bill, in my 
opinion, having practiced medicine for 25 years, taking care of 
families all across the State of Wyoming, that is fundamentally going 
to be bad for patients, bad for providers, our nurses and our doctors, 
and bad for payers, the people who are going to pay the bill, the 
American taxpayers. That is why Warren Buffett, when he looked at this 
whole piece of legislation, said it is time to eliminate about 2,500 
pages of the nonsense and focus on cutting costs.
  In my opinion, having looked at this and visiting with other 
physicians and hospital administrators, it looks to me that with the 
bill the President signed into law today, which cuts Medicare by $500 
billion, not to save Medicare but to start a whole new government 
program, which raises taxes by another $500 billion on American 
families, I believe this bill, still loaded with sweetheart deals, is 
going to cause people to see that their own insurance premiums are 
going to go up, their taxes are going to go up, and they are going to 
find out that the quality of their medical care is going to go down.
  We saw it in Massachusetts where, with the result of this program, a 
program very similar, it is now the most expensive State in the country 
for health insurance. It is breaking the budget of the State and people 
have to wait 42 days to get a physician. Yet the President says we are 
going to cover more people and he is going to do it by cramming 16 
million more Americans onto Medicaid, a program in which many doctors 
will not even see those patients because the reimbursement is so low.
  I see my colleague from New Hampshire and I said that is what I am 
hearing in Wyoming. Is that what we are hearing in New Hampshire? And 
then maybe our friend from Arizona has different thoughts.
  Mr. GREGG. It absolutely is, and the doctor has described it 
personally, from his own personal experience and that is a lot of 
doctors are not going to see patients, especially on Medicaid or 
Medicare, because the reimbursement rates are so low.
  There is a philosophical issue here of whether a bill should be 
filled with these sweetheart deals, but there is a practical issue too. 
I can't imagine why anybody on the other side of the aisle would be 
against eliminating these sweetheart deals other than the people who 
come from these States that benefit from them. This is not going to be 
extraordinarily disruptive to this bill. If this amendment were to 
pass, which took out these various deals which should not be in the 
bill to begin with, the bill goes back to the House. The House doesn't 
like these deals. Heck, they are for Senators. I suspect the House 
would be happy to have these deals come out so they will repass the 
bill without these deals.
  Why not vote this amendment? Why not positively vote this amendment? 
There is no logical reason not to do it other than, I guess, nobody 
wants to let any amendments pass that deal with this bill in any way, 
even if they are extraordinarily reasonable amendments such as this, on 
which there should be unanimity, except for the folks who benefit from 
the specific deals.
  Mr. McCAIN. Madam President, I wish to summarize by saying I hope we 
will take out these deals. I hope every time we find another one in 
this 2,733-page legislation, we will take it out too. But I hope also 
that my friends on the other side of the aisle and the President of the 
United States will learn a lesson. Next time you want to sit down and 
enact a major piece of legislation, bring us in in the beginning. Bring 
us in so we can have true bipartisan negotiations, and any allegation 
to the contrary is patently false. I know because I have been involved 
in bipartisan negotiations and this is what happens when you have to go 
around shopping for votes to finally put you over the top. The American 
people, with the election of a new Senator from Massachusetts, have 
rejected this process. They have rejected this process.
  Let's listen to the people of this country who say they want these 
things out. That is not how they want the Congress of the United States 
to do business. Let's take them out. Let's stop this legislation and 
let's start from the beginning and let's fix health

[[Page S1835]]

care in America. And, certainly, let's all pledge to stop doing these 
kinds of backroom behaviors that the American people have grown sick 
and tired of.

  Mr. GREGG. Madam President, I congratulate the Senator from Arizona, 
again, for being the voice of conscience for this body relative to 
making sure we are playing straight with the American people and their 
tax dollars by not allowing these types of special deals to be put into 
bills. He has a long and very strong record in this area. This 
amendment--I cannot imagine why it would be opposed.
  I understand that the 2 hours which we had time agreements under has 
basically been completed. I suggest for the next 2 hours we continue 
with this same course of action, if it is agreeable to the Democratic 
manager. We have a half hour on the Democratic side, a half hour on our 
side; a half hour on the Democratic side, a half hour on our side. Is 
that acceptable?
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. At this point let's keep it to 1 hour; a half hour to 
each side and we can go back and revisit it.
  Mr. GREGG. So the next hour will be divided 30 minutes with the 
majority and 30 minutes with the minority.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. BAUCUS. I am sorry, was there consent?
  The PRESIDING OFFICER. There will be 1 hour equally divided, with the 
majority having the first half hour.
  The Senator from Arizona has 1 minute remaining.
  Mr. McCAIN. I will summarize again. These deals were cut for special 
situations. We have had disasters all over America. We had a disaster 
in the State of Mississippi. There was nothing in this for the State of 
Mississippi, which was struck by Katrina as well. The fact is it was 
also done in a managers' package. There was no debate, there was no 
discussion. I certainly, and the rest of this side, was not told about 
it and I was not the only one.
  It was a deal that was cut. These deals have all got to be removed. I 
certainly will support doing anything necessary to help any State in 
America that is struck by a disaster, not just Louisiana, but Arizona 
and California and every other State that has been. But I will not do 
it by inserting a special provision in what is supposed to be a health 
care reform bill.
  I urge my colleagues to remove all of these sweetheart deals.
  I yield the remainder of my time.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, I yield the chairman of the Budget 
Committee, Senator Conrad, 20 minutes from our time in opposition to 
the McCain amendment.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. CONRAD. Madam President, I thank Chairman Baucus for his 
extraordinary leadership in legislation that became the law of the land 
today with the signature by the President. That is the bill that came 
out of the Senate. It came out of the Finance Committee, it came out of 
the HELP Committee. This bill went to the House, was passed and was 
signed into law by the President today.
  This was the headline from the New York Times yesterday: ``Congress 
Sends White House Landmark Health Overhaul.'' Landmark health overhaul 
indeed it is.
  The Senate is now turning to a separate reconciliation bill passed by 
the House. That bill includes modifications to the comprehensive reform 
measure President Obama signed today.
  These are changes that have been negotiated with the House. This 
health care fixer bill represents a limited and appropriate use of the 
reconciliation process. And the reconciliation bill also includes 
certain education provisions to make college more affordable, and to 
support higher education.
  I want to begin by highlighting the impact of the comprehensive bill 
passed by the Senate on Christmas Eve, passed by the House over the 
weekend, signed into law by the President today. That bill meets key 
reform benchmarks. It is fully paid for and in fact reduces both the 
short- and long-term deficits. It expands coverage to 94 percent of 
Americans. It promotes choice and competition. It contains critical 
insurance market reforms and bans the denial of coverage based on 
preexisting conditions. It contains delivery system reforms that will 
bring us better quality at lower cost.
  Here is what this health care reform bill will mean for my State of 
North Dakota. It ends insurance abuses. Insurers will no longer be able 
to deny coverage for you or your children because of preexisting 
conditions or raise premiums when you get sick.
  It provides tax breaks for small businesses. Small businesses will 
get tax credits to help buy coverage for their workers.
  I had a Republican businessman tell a friend of mine over the weekend 
that he has had to stop coverage of his employees, although he would 
like to extend it to them, but believes that this bill now will allow 
him to once again provide insurance coverage to his employees.
  It insures young people. Young North Dakotans will be able to stay on 
their parents' health insurance until they are 26 years old. It expands 
coverage. North Dakotans will get more choice and tax credits to make 
health coverage more affordable. It helps workers. Workers will be able 
to change jobs without fear of losing health care coverage. It improves 
Medicare. Seniors will get preventive services without copayments, and 
the gap in prescription drug coverage will be eliminated. It lowers 
costs. Premiums for the same level of coverage will be lower after 
health care reform than they would have been without it.
  Despite claims from some of my Republican colleagues that this health 
care reform adds to the deficit, it does not. The Congressional Budget 
Office, which is the official scorer, has said that the comprehensive 
bill signed by the President today reduces the deficit by $118 billion 
over the first 10 years. As I will show later, when you add in the 
impact of the reconciliation bill before us now, the total deficit 
reduction in the first 10-year period is $143 billion. It is not my 
estimate, not the Democratic Party's estimate, not the Democratic 
leadership's estimate; that is the estimate by the nonpartisan 
Congressional Budget Office that officially scores legislation before 
this Congress.
  This reform continues to reduce the deficit in the second 10 years. 
Here is what CBO said in its analysis of the reform signed into law by 
the President today:

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

  To translate that into dollar terms, that would be a reduction in the 
deficit in the second 10 years of $650 billion to $1.3 trillion. And 
now we have the happy ability to inform our colleagues that with the 
reconciliation bill added in, the total deficit reduction will be one-
half of 1 percent of GDP in the second 10 years or $1.3 trillion.
  This health care reform package also expands coverage. Again, I am 
referring now to the bill signed into law by the President today 
because that bill alone expands coverage to 94 percent of the American 
people by building off the existing employer-based system. It creates 
State-based health exchanges for individuals and small businesses. It 
provides tax credits to help individuals and small businesses buy 
insurance. It expands Medicaid eligibility while providing additional 
assistance to the States to pay for it.
  This health care reform also includes dramatic reforms in the health 
insurance market--measures that will positively impact millions of 
Americans. It prohibits insurers from denying coverage for preexisting 
conditions. It prohibits insurers from rescinding coverage when people 
get sick. It bans insurers from imposing lifetime caps and unreasonable 
annual limits on health care benefits. It prevents insurers from 
charging more based on health status.
  This reform package signed by the President today takes a number of 
important steps to improve the quality of care. It covers preventive 
services. It provides incentives for healthy lifestyles. It promotes 
the adoption of best practices and the use of comparative effectiveness 
research to find out, on a scientific basis, what actually works. Who 
is against using something that actually works?
  It includes delivery system reforms that encourage quality over 
quantity

[[Page S1836]]

of care--something health care economists have told us is the single 
most important part of this package. These delivery system reforms do 
not get a lot of attention, but they have the potential to dramatically 
improve our long-term health outcomes. These reforms include 
accountable care organizations, primary care payment bonuses, 
readmissions, hospital value-based purchasing, comparative 
effectiveness research, a CMS innovation center, an independent payment 
advisory board and payment bundling--all of them recommended by 
Democratic and Republican health care economists who told us these are 
the things that can fundamentally change our system to lower costs over 
time and improve quality.
  You would not know it from listening to some of the coverage, but 
this health care reform has widespread support among health care 
experts and health care organizations in my State of North Dakota. This 
legislation has been endorsed by the North Dakota Hospital Association; 
the North Dakota Medical Association, representing our State's doctors; 
the North Dakota Nurses Association, representing our State's nurses; 
the North Dakota AARP, representing our State's seniors; the Community 
Health Care Association, and on and on.
  There has been a lot of misinformation spread about this health care 
reform package, so I want to take a moment to say what is not in this 
plan. It does not include government-run health care. There is no 
government takeover. This is private insurance, not government 
insurance. It includes no cut in guaranteed benefits for seniors. The 
Medicare savings overwhelmingly are savings from providers negotiated 
with providers. Why would they agree to hundreds of billions of dollars 
in lower payments than they were expecting--in other words, less of an 
increase than they were anticipating? Because they know, with 30 
million more people insured, that their costs will be reduced and they 
can afford less of an increase. It includes no death panels. It 
includes no coverage for illegal immigrants. It includes no expansion 
of Federal funding for abortion services.
  I would like to briefly address the reconciliation bill that is 
before us now. Remember, we have already passed comprehensive reform. 
That was done on Christmas Eve. That was passed by the House this 
weekend. That was signed into law by the President today. What is 
before us now is a reconciliation package. It includes limited 
modifications or fixes to the comprehensive health care bill which 
passed earlier. It is fully paid for and includes additional deficit 
reductions over and above the comprehensive bill that became law today. 
This reconciliation bill follows the requirements of reconciliation by 
including budget-related provisions only, no proposed changes on 
strictly policy matters.
  Here are key health care fixes in this bill: It improves the 
affordability of health care. It eliminates the gap in Medicare drug 
coverage, also known as the doughnut hole. It adjusts the amount of 
Federal aid going to States for Medicare, and also States are treated 
the same. Despite the rhetoric on the other side, let's be clear on 
Medicaid. All States are treated the same. It further reduces 
overpayments to Medicare Advantage, and it takes additional steps to 
reduce waste, fraud, and abuse.
  Here are key education provisions in the reconciliation bill as well: 
It expands Pell grants to make college more affordable. It eliminates 
bank-based student lending, which saves, according to CBO, $61 billion 
of taxpayer money that can then be redirected to actually support 
students. I thought that is what student aid was about, to support 
students. It supports historically Black colleges and extends funding 
for higher education.
  Some of my colleagues of the party opposite have described 
reconciliation as an obscure and rarely used procedure. The fact is, it 
has been used 22 times, 16 times when they were in control of the 
Senate. And we are using reconciliation to appropriately reduce the 
deficit, unlike our friends on the other side, who used the process to 
pass unpaid-for tax cuts that resulted in much higher deficits.
  Here is how Senator Gregg justified the use of reconciliation by the 
then Republican majority in 2005 in its effort to open the Arctic 
National Wildlife Refuge to drilling. He stated:

       Reconciliation is a rule of the Senate set up under the 
     Budget Act . . . The fact is, all this rule of the Senate 
     does is allow a majority of the Senate to take a position and 
     pass a piece of legislation [and it does it with a simple 
     majority vote.] Is there something wrong with majority rules? 
     I do not think so. The reason the Budget Act was written in 
     this way was to allow certain unique issues to be passed with 
     a majority vote. That is what is being asked for here.

  That is the quote of Senator Gregg, who was then chairman of the 
Budget Committee. He said: It allows a simple majority vote. He asked: 
What is wrong with that? It is interesting now to hear the other side 
say that somehow that is wrong.
  As I noted, this reconciliation bill will add further deficit 
reduction to the health care reform estimate. Here is CBO's estimate of 
the combined effect of the bill signed into law by the President today 
and the bill that is before us now. It shows that the deficits will be 
reduced by a total of $143 billion over the first 10 years--$143 
billion. That is according to the Congressional Budget Office. The two 
measures taken together will continue to reduce deficits in the second 
10 years and beyond.
  Here is what CBO said in its cost estimate:

       . . . [T]he combined effect of enacting [the Senate bill] 
     and the reconciliation proposal would . . . be to reduce 
     federal budget deficits over the ensuing decade [beyond 2019] 
     relative to those projected under current law--with a total 
     effect during that decade in a broad range around one-half 
     percent of GDP.

  That translates into dollars of $1.38 trillion. One-half percent of 
GDP in the second decade is $1.3 trillion of deficit reduction--not 
million, not billion; trillion--$1.3 trillion dollars of deficit 
reduction, according to the Congressional Budget Office.
  Anybody who does not want additional deficit reduction ought to vote 
no. Those who want to reduce the burgeoning deficit and debt ought to 
vote aye.
  This health care reform bill does not represent the end of the story. 
It is a beginning. But it is an important beginning, one that reduces 
the deficit and reduces the debt--not according to Democrats, not 
according to Republicans, but according to the nonpartisan 
Congressional Budget Office, which has the responsibility of giving us 
objective analysis. That is their job. They do it well.
  This bill, combined with the bill signed earlier today by the 
President, reduces the deficit by $1.3 trillion. In addition, it has 
these critically important insurance and delivery system reforms that 
every health care economist who came before us said would, over time, 
make a meaningful difference in reducing health care costs for American 
consumers.
  How much time do I have remaining?
  The PRESIDING OFFICER. The Senator has 3 minutes remaining.
  Mr. CONRAD. I would like to end by talking about a matter that has 
been brought up by some on the other side, the so-called frontier 
amendment. The frontier amendment was offered openly here on the floor 
of the Senate by my colleague, Senator Dorgan. Everybody had a chance 
to review that amendment. It does not affect one State; it affects five 
States. Some of the States are represented by just Republican Senators. 
In fact, two of the States are represented just by Republican Senators. 
One of the States is represented by one Democrat and one Republican, 
the other two by two Democrats. This is certainly not a partisan 
amendment.
  Why was it offered by my colleague, Senator Dorgan? It was offered 
because these five States are at the bottom in Medicare reimbursement 
and have been for many years. They are the most rural States in the 
Nation. The way the formula works, those States have been penalized.
  Let me just say that in my State, to treat the exact same illness, 
the hospitals in my State get one-third to one-half as much as the more 
populous States in the country to treat the exact same illness.
  When we go to get technology, we don't get a rural discount. In fact, 
we pay more because we are buying in smaller order quantities. When we 
go to attract a doctor or nurse, they don't say to us: Because you get 
one-third or one-half as much in Medicare reimbursement, we will only 
charge you one-third to one-half as much to come

[[Page S1837]]

to your State or to stay in your State. That isn't what happens.
  I have had the major hospital administrators in my State say: Unless 
health care reform fixes this, we are going to begin to have to lay off 
people and to begin to reduce services, and reduce them dramatically, 
because we can no longer survive getting reimbursement for the majority 
of our patients because, remember, the majority of the patients in 
these rural hospitals are Medicare-eligible patients. They are getting 
one-third to one-half as much as the more populous States, the 
hospitals in the more populous States, to treat the exact same 
illnesses.
  That is not fair. That is fundamentally an issue for health care 
reform. That is why this amendment is included, and that is why it 
deserves to be retained.
  I thank the chairman of the Finance Committee for his extraordinary 
effort. I am in my 24th year here. I have never seen a Member put in 
the kind of concentrated and focused effort as the chairman of the 
Finance Committee did on this bill--hundreds of hours of his personal 
time over a year and a half to get a good package, a responsible 
package.
  I also thank Chris Dodd, chairman of the HELP Committee, for his 
exceptional efforts; and certainly our leader, Harry Reid, for bringing 
the two together in a way that enjoyed the unanimous support of the 
Members on our side of the aisle. That is a remarkable accomplishment.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Udall of Colorado). The Senator from 
Montana.
  Mr. BAUCUS. Mr. President, speaking on the bill, I thank my friend 
from North Dakota for his kind statement. Knowing all the hours and 
days and weeks, months that we spent on this bill, I thank him because 
my good friend has been there for most of those hours and weeks and 
months spent on this bill. I thank him very much for that observation, 
as well as Senators Harkin and Dodd and the ranking members, too, in 
many respects.
  I yield 5 minutes to the Senator from Louisiana from the time under 
our control on the bill.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Ms. LANDRIEU. I thank the chairman and add my compliments to him for 
his extraordinary leadership over the last several months in managing 
this very important piece of legislation through the process, a major 
piece of legislation that garnered 60 votes on the floor of the Senate.
  The Chair knows because he has worked on many pieces of legislation, 
even in his short time in the Senate, but his longer time in the House, 
how difficult that is, particularly on an issue such as this that has 
eluded our country time and time again. Even though great attempts were 
made by extraordinary Presidents and wonderful Congresses in the past, 
this victory has eluded them. But we are close to capturing it now.
  I thank the chairman of the Finance Committee. He probably spent more 
time, except maybe for Harry Reid himself, on ushering us to this 
point. I was in many of those meetings, and his patience was 
inspirational, as was his steady hand when things got tough. I thank 
him, and I also thank the chairman of the Budget Committee. No one has 
a better command of this budget in this entire body than Kent Conrad. 
He has spoken in some detail and depth about the significant cost 
reductions and deficit reductions that will occur because of our work.
  I came down to speak specifically about the amendment just offered by 
the Senator from Arizona. I actually went to the desk to get a copy of 
it because I wanted to read it for myself. This amendment is a stunt. 
It doesn't deserve the time I am going to give to explain the portion 
of it that refers to Louisiana. The reason I say it is a stunt is 
because it is actually written for television or the Internet. It is 
not written for any serious debate. In my view, it is beneath the 
Senator from Arizona who at one time was a candidate for President. The 
reason I say it is a stunt is because the word ``sweetheart'' is 
actually written in this amendment.
  Normally, the only time I see that word is when my husband sends me a 
dozen roses on Valentine's Day, which he does most years. But to 
actually draft an amendment like this that actually uses the words 
``sweetheart deal'' is an insult to the people of our country, and I 
would expect more from him.
  I have tried to explain this to him privately on any number of 
occasions. I have provided him and his staff with every document they 
have ever requested. I am here to say one more time, the people of 
Louisiana do not deserve the derision from him or from any member of 
the Republican team, my Republican allies, because of asking for a 
correction in a formula that would have been devastating to the State 
of Louisiana or to any State that experienced the kind of catastrophic 
disaster we did.
  This amendment that I got on might have been unknown to Senator 
McCain, but it was not a secret. How would I know that? Because 
actually I called a press conference with the Governor of Louisiana, 
Republican Governor, and announced it. That is why I know it wasn't a 
secret. We didn't have one press conference together; we had three.
  As I have explained to the Senator from Arizona, just because he 
didn't know about it doesn't mean it was a secret. There are lots of 
things that happen in Washington--it is a big place; it is a big 
country--that he doesn't know about. This is one of them.
  There were three press conferences called, and our entire delegation 
wrote a letter, a public letter, which I have given to every reporter 
who has asked for it, asking for consideration for this.
  No. 3, how would I know it is not a secret? Because my legislature, 
which is represented by 50 percent Republican and 50 percent Democrat, 
unanimously passed it in a public forum. So the people of Louisiana, 
whom I represent, believe me, are sick and tired of hearing their name 
dragged through the mud. You want to drag a name through the mud, drag 
mine. But leave the people I represent out of it.
  When the health care debate came forward and we recognized, at the 
Governor's request--I ask for a minute more.
  Mr. BAUCUS. Off the bill.
  Ms. LANDRIEU. When the health care debate started, our Governor 
recognized that without this change, the State of Louisiana would lose 
somewhere about $450 million because, under the formula that was 
calculated, which is done publicly, the Federal Government declared 
that the Louisiana per capita income had increased 40 percent. It has 
never happened in the history of the United States. No State in no year 
in no decade--even with the gold rush, even with discovering oil, even 
with the greatest inventions of the world--no State's income has ever 
gone up 40 percent. And ours did not. The people I represent are not 
richer because of Katrina; we are poorer.
  I will not back up a minute to ask for help for them. All I have 
asked in this bill, and we have gotten, despite the effort on the other 
side to undo it, and we will not undo it--all we are asking for is to 
let us pay the same Medicaid match that we have paid for the last 10 
years, as long as I know. Louisiana pays 30 cents; the Federal 
Government pays 70. Our people are covered.
  I ask for 30 more seconds, and I promise I will end here. We are not 
asking for special treatment. We are asking just to pay the same amount 
of Medicaid as we have paid for the last 10 years. It was not done 
secretly. It was not done behind closed doors. It was not done to buy 
my vote. My vote was given to this bill because this bill deserves it, 
because it is a very good piece of legislation.
  I told the leader I would vote for it whether this was in it or not. 
I am tired, but I am not going to sit down and not defend the people of 
my State.
  The other Members can speak about what they wanted. This is not a 
sweetheart deal. It is a stunt from a Senator I would expect more from.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I have very little time left, perhaps 
maybe a minute or two. I will use it. But I want to speak more on this 
subject at a later time. I might also inform my colleagues that the 
next half hour, which is allocated to the Republican side, will expire 
at around roughly 6:40. At that time, we will try to work out an 
agreement where we trade, both sides, half hour per side.

[[Page S1838]]

  I alert colleagues, if they wish to speak on this reconciliation 
bill, in about 30 minutes we will try to set up an arrangement for 
colleagues to speak.
  How much time do I have remaining?
  The PRESIDING OFFICER. The Senator has 55 seconds.
  Mr. BAUCUS. I think it more prudent not to use those 55 seconds but 
to keep it. I will let the Senator from New Hampshire allocate time.
  The PRESIDING OFFICER. The Senator from Idaho.
  Mr. CRAPO. Mr. President, I would like to respond to a couple 
comments just made and then at the first available option, I will file 
a motion to recommit the bill. Before I get into a discussion of this 
motion, I would like to respond to the argument that is consistently 
made that the health care legislation that was signed by the President 
today and is supplemented by this reconciliation bill is going to 
actually result in deficit reduction.
  What we need to understand is that among the many other pieces of 
this bill, ultimately it will result in growing the Federal Government 
by about $2.6 trillion over the next 10 years. This chart shows 
graphically or pictorially what will happen.
  You will notice I have had to mark out the numbers there and change 
the 2.5 to 2.6. That is because under the original bill it was 2.5. Now 
with the bill before us today it is going up, not down, to $2.6 
trillion of new spending.
  There are only a few ways you can claim that is going to result in a 
reduction of our deficit. Nobody denies it is going to result in a 
massive increase in the size of the Federal Government, regardless of 
the other portions of this bill.
  How does a $2.6 trillion increase in spending result in deficit 
reduction? First, because there are massive new taxes in this bill that 
go along with this increase in spending that are offset against it. 
Secondly, because there are massive cuts in Medicare, over $500 
billion, $610 billion of new taxes, $529 billion of new Medicare cuts, 
which results in about a $1 trillion offset, about $1.1 trillion of 
offset. How do you get to the rest of the offset to claim that this 
bill is deficit neutral or reduces the deficit?
  That is what I call the gimmicks. For example, $29 billion of Social 
Security revenue is raided from the Social Security trust fund and 
allocated to this bill. The CLASS Act, which has been called a Ponzi 
scheme by Members of the other side of the aisle, is adding another $70 
billion of revenue. The Medicare cuts are actually counted twice 
because they are not used to sustain the Medicare system. They are used 
to finance a brandnew entitlement system in this bill.
  When you sort through it all, if you stop the gimmicks, and if you do 
the math with the gimmicks taken out, we don't have deficit reduction. 
We actually have a deficit increase, about $619 billion of increased 
deficit under this bill.
  I think we need to get the facts all out in front of us and discuss 
them. But I want to talk specifically for just a moment now about the 
motion I am going to make. The motion I am going to make is the same 
motion I made when we debated the main health care bill last December. 
It is a motion that simply helps us make sure this bill complies with 
the President's promise.
  What did the President promise? The President has said multiple 
times--and here is one of his quotes:

       I can make a firm pledge . . . no family making less than 
     $250,000 will see their taxes increase--not your income 
     taxes, not your payroll taxes, not your capital gains taxes, 
     not any of your taxes . . . you will not see any of your 
     taxes increase one single dime.

  That was the President's pledge.
  When I brought this motion--when we debated the original health care 
bill that was signed into law by the President today--it was attacked 
and actually defeated on the floor on the grounds that to do so, to 
adopt my motion, would result in killing the bill. It would destroy the 
bill. All my motion did was say, let's temporarily send this bill back 
to the committee, have them strip out all of the taxes that hit the 
middle class--families making less than $250,000--and bring the bill 
right back to the floor. I was told that would kill the bill, that 
would gut the bill.
  Well, first of all, if that was going to gut the bill, then that is a 
concession that the bill is full of taxes on families who make less 
than 250,000. As a matter of fact, that is true. Again, the bill before 
this reconciliation bill was analyzed by the Joint Committee on 
Taxation, and their conclusion--not mine--was that by 2019 at least 73 
million American households earning below $200,000 will be paying more 
taxes because of the taxes imposed by this bill--that $610 billion of 
taxes that is used to help claim that this bill does not increase the 
deficit.
  Well, what happened last time when we debated it? It was attacked 
because it would gut the bill if we took these taxes out of it, and my 
motion was defeated.
  There was another argument made against the motion at that time; that 
is, the bill we were debating was not actually a tax increase, it was a 
tax cut. The way that argument went was: We have more tax cuts in the 
bill than we have tax increases. The only way that argument could be 
made is by saying the subsidies that are provided to low-income 
individuals in our country are tax cuts, even though they do not pay 
any taxes. Yet, all of the subsidies in the new entitlement program 
were counted as tax cuts, and they were offset against the true tax 
increases that are going to be paid by the middle class in America; and 
the argument was made it was a tax cut.
  Well, first of all, it is not a valid argument. There are $610 
billion of new taxes in this bill. Secondly, I do not think that is 
what President Obama was talking about. He did not say: I will not 
raise your taxes more for some people than I will cut them for someone 
else. He was saying he would not raise taxes, and that this bill would 
not be allowed to be used as a vehicle to do so.
  Let's get back to the main argument that was made against my motion 
before; that is, it would gut the bill. Well, that cannot be true 
anymore. The bill was signed into law by the President today, so it is 
law today. And now I think it is time for this Congress to simply fix 
the problem. All we have to do with my motion--when I am allowed to 
have an opportunity to propose it--is to commit this bill to the 
committee and have the committee take out all the taxes that apply to 
individuals who make less than 200,000 and families who make less than 
$250,000.
  It is very straightforward. You can argue that there are not such 
taxes in the bill, and if there are not, then my motion will not do a 
thing to the bill. But the reality is, the vast majority of the taxes 
in this bill are going to be paid by the middle class. By the Joint Tax 
Committee's analysis, 73 million households in America are going to be 
paying these taxes, and all this motion does is say let's get back to 
the President's pledge and do what the President said. Let's take out 
of the bill the taxes that are going to be slamming the middle class in 
America as this bill becomes law.
  With that, Mr. President, I would be glad to yield to any of my 
colleagues here on the floor who would like to make comments on this 
issue. Senator Risch, my colleague from Idaho.
  The PRESIDING OFFICER. The Senator from Idaho.
  Mr. RISCH. Thank you, Mr. President.
  I rise in support of my distinguished colleague from Idaho. He has 
brought to the floor the language that the President of the United 
States gave to the American people in order to convince them to vote 
for him for President of the United States. It was a serious promise. 
It was a serious commitment. He said: I will not increase the taxes on 
individuals making less than $200,000 a year or families making less 
than $250,000 a year. My good friend from Idaho points out there are 
numerous provisions in this bill that break that promise.
  I am disappointed the President has done this. I am disappointed he 
will not take responsibility for it. I am disappointed he did not point 
it out when he signed the bill. He talked only about the good things it 
did. The President should--he really should--keep the commitment he 
made to the American people. If we are going to have a country where 
people have faith in their government, particularly in its Chief 
Executive, they have to believe what he said.
  My good friend from Idaho has indicated he is going to bring a motion 
to

[[Page S1839]]

commit the bill to get all of these out of there. I want to talk about 
one that is very focused. I am only going to talk about one of these 
taxes the President of the United States is raising on people who make 
less than $200,000 a year. The reason I bring this one to the floor is 
this is a direct assault on some of the most vulnerable people in this 
country.
  This particular increase in taxes is on 14.7 million people who earn 
less than $200,000 a year and who have had substantial medical bills 
during the year. How this bill does it, it simply changes the 
percentage which you can deduct on your income tax return if you incur 
medical expenses. It is not a slight amount. It is $15 billion that 
this tax takes from some of the most vulnerable people in America.
  The President of the United States promised he would not raise taxes 
on people who made less than $200,000 a year. He made that promise, and 
this provision in the bill--in the bill that has been signed into law 
by the President--breaks that promise, and it breaks the promise not 
just on people who make $200,000 or less a year, but it breaks the 
promise as to the most vulnerable people in America.
  The provision in this bill the President signed into law this morning 
affects 14.7 million people. Today, 14.8 million people take this 
deduction. They are people who have been injured, people who have been 
sick, people who suffer from diseases, and they take this deduction 
because the Congress of the United States has deemed it appropriate 
that when you expend this kind of money, and you are in this vulnerable 
a position, you should be entitled to deduct it from your taxes. This 
bill changes that.
  When the President of the United States put the pen to that bill this 
morning, it was in direct violation of his pledge not to increase taxes 
on people who make less than $200,000 a year.
  So what do we have here? We have a bill that is reaching into the 
pockets of 14.7 million Americans and taking directly out of their 
pocket $15 billion, in direct contravention of the promise the 
President of the United States made to the American people when he 
stood up and asked them to elect him. Not only does it do that, it 
hurts the most vulnerable people in America.
  My fellow Senators, I urge that you vote for this motion when it 
comes up for a vote. And it will come up for a vote. It will help 
constituents in every single State in America. It will put that $15 
billion back in the pockets of some of the most vulnerable people in 
America. It will restore the promise the President of the United States 
made to these 14.7 million people--many of whom voted for the 
President, and voted for the President believing he would take care of 
them and see that their taxes did not increase. We can help the 
President keep his promise that he broke this morning when he signed 
that bill.
  I yield to my good friend, Senator Brownback.
  Mr. BROWNBACK. I thank the Senator.
  I rise to support my colleague from Idaho on this motion. I think 
this makes sense. The Senator from Idaho is helping the President 
fulfill a campaign promise. It made sense to everybody across the 
country. I have looked at it, and I do not think we should raise taxes, 
period. I think it is taking money out of the economy. But he said: I 
want to raise some taxes on people making over $200,000. Everybody 
heard it and thought: OK, that is not me, so I will vote for that. I 
like that idea.
  I want to take a particularly narrow piece of this that is in the 
bill that we have wrestled with in this body for some period of time, 
and that is the issue of the alternative minimum tax. That was passed 
years ago. It was supposed to be a tax on wealthy people who were 
avoiding paying income tax. So we put it in place and said: Well, 
people who are wealthy should not be able to plan their way out of 
paying income tax, so we are going to put this alternative minimum tax 
in, and it is going to be on a set amount of money.
  It was not indexed for inflation over time. So now, 10 years later, 
all of a sudden, there are a number of people--because of inflation 
happening over a period of time--who get brought in under the 
alternative minimum tax, to where we then fight about it in this body 
as to how we are going to do the AMT fix. That is an annual debate we 
have here.
  Well, this tax on Medicare plans, or on the health care reform plans, 
where, OK, it is not supposed to tax people who make below $200,000--
which I agree with, even though there are pieces in here that do--with 
inflation, over a period of time, you are going to see a large number 
of people, in 2009 dollars, making $200,000 or below who get taxed 
because of inflation and its value. We are looking at a situation in 
the country now, with the monetary policy--lots of money out in the 
money supply, with the Federal Government's excessive spending, huge 
amounts: $1.5 trillion in deficit spending--that the likelihood of 
inflation coming along is pretty high. Maybe it does not come this 
year, but it does next year.
  We normally run somewhere around a 3-percent inflation rate anyway. 
You get that stoking up. Here is a chart the Joint Economic Committee 
staff has done about what happens over a period of time when you do not 
index for inflation, and this bill is not indexed for inflation.
  So all of a sudden you end up having the middle class, and even 
people currently determined as poor, actually paying the wealthy tax, 
and it is because of the lack of indexing for inflation over time. So 
you end up over a period of time having people currently classified as 
poor paying a wealthy tax--unless you adopt something such as the Crapo 
motion that says if you are making below this figure, you do not get 
taxed, you are not going to get taxed.
  This actually ends up being pretty substantial and hitting a large 
number of people over time, to the point where you are going to have a 
large group--again, this is from the Joint Economic Committee: For 
every low to middle-income family with a tax cut, three low to middle-
income families have a tax increase.
  The President said: That is not what I am going to do. I am not going 
to raise taxes on people who are low or middle income. Unless you adopt 
the Crapo motion, you are going to have this taking place. So I think 
this makes sense overall to fix the bill. It certainly does not kill 
the bill. The bill is signed into law, as Senator Crapo pointed out. 
You cannot kill the bill now. I think it should be repealed, but I 
certainly think we should not be having people taxed who are making 
below $200,000. We should not be having them taxed now. We should not 
be having them taxed into the future, even though that is actually now 
built into the bill and part of its pay-for provision.
  But let's be sincere with the American public. Let's fulfill this 
piece. Unless you adopt the Crapo motion, we are not going to be able 
to guarantee that to the American public.
  I think this is a very commonsense amendment. I think this is one 
that helps deal with the problems in the underlying bill. I think it is 
one that is honest with the American public, and it is certainly one I 
hope we can pass.
  I would ask my good friend from Idaho to address this issue from, as 
you put this forward, has the administration said: Yes, we agree with 
you because this is what we said on the campaign trail and this only 
fulfills the promise. Maybe they have offered you an Executive order, 
that you could get this by Executive order.
  Mr. CRAPO. Well, I would say to my colleague from Kansas that I have 
not had any direct response from the White House, although when I made 
these speeches and when I made the motion when we debated the original 
bill, there were some responses on the Web that indicated that, in 
fact, I was not correct in my facts. The argument was made at that time 
that, in fact, the bill we were debating did not have--was not a tax 
increase bill, it was a tax cut bill. You probably heard my response to 
that argument earlier.
  The way the defenders of this bill claim it is a tax cut is, they 
take all the subsidies that are being provided for this new entitlement 
that is created in the bill, administer those through the IRS, and then 
claim that those are tax cuts and that they outweigh the tax increases 
that are included in the bill and that, therefore, the bill is a net 
tax cut. As I said earlier, first of all, the President was not talking 
in net terms. He didn't say: We

[[Page S1840]]

will raise taxes for this group more than we will cut taxes for this 
group.
  Leaving that aside, the fact is, I don't think most Americans fall 
for that. Most Americans don't think that the subsidy which is scored 
as spending is a tax cut.
  Mr. BAUCUS addressed the Chair.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Might I ask my friend if he wishes to have the pending 
amendment set aside so his motion can be made in order?


                            Motion to Commit

  Mr. CRAPO. Mr. President, if that would be allowed, I ask unanimous 
consent to set aside the pending amendment to offer a motion to commit 
with instructions that I have here and which I submit to the desk.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. Mr. President, I have no objection. I ask unanimous 
consent that if the time is consumed, the motion be set aside at that 
point.
  Mr. GREGG. Reserving the right to object, I do not believe any time 
has been consumed on this motion.
  Mr. BAUCUS. I think that is correct. When the time is consumed.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The clerk will report the motion.
  The legislative clerk read as follows:

       The Senator from Idaho [Mr Crapo] moves to commit the bill 
     H.R. 4872, to the Committee on Finance with instructions to 
     report the same back to the Senate within 3 days with changes 
     that provide that the combined effect of this Act, and the 
     Patient Protection and Affordable Care Act, shall not result 
     in an increase in Federal tax liability for any individual 
     with adjusted gross income of less than $200,000 or any 
     married couple with adjusted gross income of less than 
     $250,000.

  Mr. CRAPO. Mr. President, could I ask how much time remains on our 
side?
  The PRESIDING OFFICER. There is 1 hour, equally divided, on the 
motion.
  Mr. GREGG. Mr. President, I believe we were functioning under an 
agreement where the Republican side had one-half hour and the 
Democratic side had one-half hour. How much time is available under 
that agreement to our side?
  The PRESIDING OFFICER. There is 9 minutes remaining.
  Mr. GREGG. I thank the Chair.
  Mr. CRAPO. Mr. President, I would ask, at this time, if my colleague 
from Tennessee or any of our other colleagues have anything further to 
say at this point on the motion.
  Mr. BROWNBACK. Mr. President, I do. If we are going to grow the 
economy of the United States, we need to provide some sort of tax 
certainty. We have learned over our history that when we deal with 
taxes, people don't react if they think things are up in the air--if 
they look at it and they say: I don't know, my taxes may go up or down, 
I will sit on the sideline.
  One of the things the Crapo amendment does that provides some 
certainty to it is to say: OK, if you are in this category, this is 
what your taxes are going to be. It isn't going to go up on you. When 
people can provide a level of certainty on tax policy, typically, then 
people are more willing to act. Because they say: Yes, maybe I will go 
out and I can invest and I will do this as a small business. This will 
help investment. We have a climate right now where people are not 
willing to invest because they don't know what the rules are. They 
don't know what their tax rates are going to be, so they are sitting 
back. This will help provide that level of certainty. So I hope we will 
do this as a way to help the economy, as a way to fulfill the 
President's promise, as a way to help fix the bill and do what the 
President said he wanted to see done and to help grow the economy and 
give some certainty on our tax policy.
  With that, I yield back to my colleague from Idaho.
  Mr. CRAPO. Mr. President, I thank the Senator from Kansas. I wish to 
go back and summarize now as we conclude, unless the Senator from New 
Hampshire has any comments to make at this point.
  Mr. GREGG. I wish to congratulate the Senator from Idaho for bringing 
this forward because there has been a lot of representation as to what 
this bill does, and much of it has been, regrettably, inaccurate. 
Certainly, one of the most inaccurate representations is that people 
over $250,000 are the only people who are going to pay for this.
  The Senator from Idaho is absolutely right. This is going to be paid 
for by people who have incomes well under $200,000. There is going to 
be a significant tax increase for a lot of Americans. Equally 
important, premiums are going to go up for a lot of Americans, which is 
the equivalent of a tax increase.
  I can't understand how anybody could vote against his motion, which 
essentially says: Let's hold the administration to its language, which 
says if you have income under $200,000 for an individual and $250,000 
as a couple, you will not be required to pay taxes under this bill.
  They have represented that is their position. They should have no 
problem at all with supporting the Senator's motion, and it makes it 
legally binding. I congratulate the Senator for his motion.
  Mr. President, how much time is remaining on our side?
  The PRESIDING OFFICER. There is 7 minutes remaining.
  Mr. GREGG. Mr. President, I believe the way we are proceeding is we 
proceed on our side.
  Mr. BAUCUS. Yes.
  Mr. CRAPO. Mr. President, I would conclude in the last 7 minutes. If 
any of my colleagues wish to jump in, please let me know.
  I wish to go back to where we started. As I indicated, when I brought 
this very same motion to commit during the debate on the health care 
legislation in December in the Senate, the response was not that these 
taxes aren't in the bill but that to take these taxes out of the bill 
would kill the bill. Why would those taxes being taken out of the bill 
kill the bill? Because it would expose the cost of the bill, because 
the argument that the bill is not a deficit--that it actually reduces 
the deficit--would evaporate if you take out the massive taxes that are 
included in the bill. That is why it was considered to be such a 
dangerous amendment then.
  I personally believe that for us to adopt legislation the President 
has signed into law that grows the Federal Government by $2.6 trillion, 
dramatically increases the role and control of the Federal Government 
over our health care economy, cuts Medicare by $500-plus billion, and 
then engages in gimmicks of trying to adjust the numbers in the budget 
in order to make it appear that there is no deficit increase is the 
wrong way to approach this legislation, regardless of one's opinion of 
the merits otherwise of the substance of the bill.
  The bottom line is, this is a massive growth of the Federal 
Government, massive increase in control by the Federal Government, 
financed by hundreds and hundreds of billions of dollars of taxes that 
are going to be paid by the middle class in America as defined by the 
President: those who make less than $250,000 as a family or $200,000 as 
an individual. Again, all this motion would do is to say: Let's take 
out those taxes. If they don't exist, then it would not do anything to 
the bill. If they do exist--and, as I said, they do--then they would be 
taken out of the bill and we would not be putting the massive cost of 
this phenomenally large growth of the Federal Government on the backs 
of the middle class in America. Again, the argument that was made in 
December cannot fly today because today the bill is law. It cannot be 
argued that to support this motion would kill the bill.
  The bill has passed the Senate, passed the House, and has been signed 
into law by the President. What we need to do now is to make sure the 
bill does not violate the President's pledge that nobody in America 
will see their taxes go up.
  I wish to again read that pledge: The President's own words were:

       I can make a firm pledge . . . No family making less than 
     $50,000 will see their taxes increase . . . Not your income 
     taxes, not your payroll taxes, not your capital gains taxes, 
     not any of your taxes . . . You will not see any of your 
     taxes increase one single dime.

  Well, that is simply not the case, and it is not the case to the tune 
of hundreds and hundreds and hundreds of billions of dollars that this 
class of people--the middle class as defined by the President--are 
going to be called upon to pay.
  That is only during the first 10 years of this bill. If you start 
looking further

[[Page S1841]]

out, as we get into the second 10 years of this bill, the amount of 
taxes the American people will pay rises exponentially into the 
trillions and trillions of dollars as you get further out. Yet we are 
expecting them to carry the burden of this bill, when they were 
promised--and I am sure many voted in the last election on the basis of 
this--they would not see their taxes go up.
  Again, it is a very simple motion. The motion simply says: Let's take 
the bill back to committee and take out any of the taxes that apply to 
individuals making less than $200,000 and families making less than 
$250,000. I urge all my colleagues to support this motion.
  If there is any time left for any of my other colleagues who wish to 
make a statement----
  Mr. RISCH. Mr. President, how much time does the minority have?
  The PRESIDING OFFICER. There is 1 minute remaining.
  Mr. RISCH. Very briefly, I wish to speak about one of these tax 
increases for 73 million people. This morning when the President signed 
the bill, he bragged about how they were going to give subsidies to 13 
million people so they can buy insurance. He is absolutely right. But 
as frequently happens, we didn't get the whole story. The whole story 
is there are 163 million Americans who are not going to get that 
subsidy and whose taxes are going to go up. How many of those make 
under $200,000 a year? There are 73 million Americans who make under 
$200,000, from that little sleight of hand, who will see a tax 
increase.
  Thank you.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, in the spirit of back and forth, I ask 
unanimous consent that the next hour be equally divided, one-half hour 
on each side, and the first half hour to be allocated to the majority 
side and the next half hour to the Republican side.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. BAUCUS. Mr. President, I yield myself 3 minutes to speak on the 
motion.
  I wish to make clear that this bill reduces taxes in the amount of 
about $460 billion for Americans who will get tax credits for buying 
health insurance. That is a huge, big tax reduction: about $460 billion 
in tax credits to people buying insurance. I don't think I have heard 
much about that from the other side of the aisle, but it is a fact.
  In addition, small business gets very large tax credits for offering 
health insurance--large, very large incentives. It is up to 35 percent, 
if I recall correctly, the first couple years, and then it moves up to 
a 50-percent tax credit for the employers' half of the health insurance 
that the employer will be providing. Those are huge, big tax cuts.
  One other point that I think is very important to make. It is true, 
in certain cases, taxes will go up for some Americans who may be making 
less than $200,000. But why? Because they have more money in their 
pocket. When you earn more money, your taxes go up, and you can earn 
more money because health insurance is going to be less expensive. 
Companies are going to compensate you with health insurance that is 
less expensive and reward you with more wages. That is what CBO says. 
Don't take my word for it. That is what the Congressional Budget Office 
says. So when wages go up, guess what. Sometimes taxes go up when wages 
go up. On a net basis, Americans are going to be better off. They are 
going to be wealthier. Their health insurance is going to be less 
expensive. For those, we are finding that because health insurance is 
less expensive, their employers want to compensate the employees, so 
they compensate them with higher wages, and higher wages will mean some 
increase in income taxes. So I wish to be very clear, that is what is 
happening.
  Also, I wish to make a third point, basically that gets lost 
esoterically, but the reconciliation bill lowers the high-premium 
excise tax in the underlying bill. By doing so, that means those wages 
will not increase as much as they otherwise might but, rather, it is 
offset with an increase under an income but only for Americans earning 
above $200,000 individually and families above $250,000. I wish to make 
it clear this is a big tax cut for Americans.
  CBO has also said--not directly on point--but CBO also said there 
will be a big reduction in deficits and debts this decade and the next 
decade.
  The other side likes to make it sound as if it is a big tax increase. 
It is not. It is a tax cut. It is a tax increase for some Americans, 
but those Americans in the main earn more than $200,000.
  I yield 15 minutes to the Senator from Vermont from the time on the 
bill.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. LEAHY. Mr. President, this is the dawn of a new day of hope for 
tens of millions of Americans who have fallen through the cracks--or 
who worry with good reason that they may fall through the cracks--of 
our broken health insurance system.
  The signing into law of comprehensive health insurance reform by 
President Barack Obama is a defining moment in our history, ranking 
with the creation of Social Security and Medicare.
  Reforming the health insurance system has been talked about for 
decades. This has been an arduous process, but it has proven that 
change is possible, even with the pitched opposition of entrenched and 
powerful special interests. America again has risen to meet one of its 
foremost challenges and to renew its promises.
  America has some of the best health care in the world, if you can 
afford it. Millions of families in Vermont and across the Nation worry 
that they are just one paycheck away from medical and financial 
disaster. This is a new dawn for them.
  Wherever I travel in Vermont, I am often stopped in the grocery 
store, at church, on the street or at the gas station to listen to 
personal, wrenching stories, like the woman from Winhall who needs to 
spend $500 a month on prescriptions but who would be uninsured if not 
for her husband's job. She is working two jobs just to make ends meet 
and to afford their health care costs. Or the small business owner who 
works 6 and 7 days a week but still can't afford the blood tests her 
doctor recommended. If she becomes sick she will lose her business and 
her home. Or the man from central Vermont who told me of his sister-in-
law who lost parts of both her feet because she did not have health 
insurance. When she needed medical attention, she waited, hoping things 
would get better. By the time her family was able to step in, she had 
to be rushed to the emergency room for amputations. This is a new dawn 
for them.
  I grew up in my family's small business in Montpelier. I know that 
business owners want to attract and keep good workers and many want to 
be able to offer health insurance options. Spiraling insurance costs 
are rapidly taking that option away. Some of the most immediate and 
far-reaching reforms in this new law are the tax credits that will help 
small businesses continue to offer insurance to their employees. This 
is a new dawn for small business owners and for those who are self-
employed.
  This week the Senate is already working on improvements to this 
legislation. These include closing the Medicare donut hole in the next 
several years, making coverage more affordable, and creating a more 
equitable distribution of Medicaid reimbursements to States like 
Vermont that have acted early on reform.
  Health insurance reform has prevailed through the grueling gauntlet 
of obstructionism erected by defenders of the status quo. One remaining 
gauntlet remains in the Senate, where partisan opposition has prompted 
an effort to derail these further improvements to this law--
improvements that many of these opponents say they support. Opponents 
of reform already have wasted much of the public's time over the last 
year by provoking arguments over their distortions about what health 
reform really means. Last summer the American people endured myths 
about ``death panels'' and other falsehoods about what reform would 
mean for families across the country.
  It is no wonder that while Americans vastly support the individual 
components of these bills they remain skeptical when asked about the 
hazy concept of ``comprehensive reform.''
  The building blocks of health reform are more popular than the sum of 
the plan's parts. Polls show public unease

[[Page S1842]]

about the hazy concept of ``comprehensive health reform'' but solid 
support for what is in the plan.
  This paradox recently was put to a real life test, with a vote on a 
reform I proposed to repeal health insurance companies' antiquated 
exemption from the antitrust laws. These are the pro-competition rules 
that apply to virtually all other businesses, to help promote vibrant 
markets and consumer choice. Competition and choice help lower costs, 
expand access and improve quality.
  I launched this effort last fall, built a hearing record to examine 
its merits and worked to build bipartisan support. House leaders late 
last year added it to their plan. And last month it became the first 
stand-alone part of the health reform package to pass on its own, in a 
strong bipartisan vote of 406 to 19. To me this is the latest proof 
that, appearances aside, there is much common ground in the health 
reform plan--more than partisan opponents or the insurance industry 
would have the public believe.
  Insurance companies, of course, will continue to lobby like crazy to 
keep from being covered by the antitrust laws. No surprise there. The 
rules they have operated under have been stacked in their favor.
  Some have argued that doing nothing is the ``safe,'' option, but it 
is anything but safe. Health policy experts and economists across the 
political spectrum agree that the rapidly increases in health costs 
will hurt everyone--costing us more, driving up Medicare's budget, 
cutting back coverage, and preventing businesses from being able to 
afford offering insurance to their workers. Without reform, in the next 
decade half of all nonelderly adults at some point will find themselves 
without coverage. If we do nothing, the same insurance coverage a 
family had in 2008 will nearly double to $24,291 by 2016, soaking up a 
whopping 45 percent of median family incomes.
  We have seen all too well what would have happened if we had not 
acted to pass comprehensive reform. Just last month, insurance 
companies planned a series of premium hikes as large as 39 percent in 
one State. Last year the five largest for-profit insurance companies 
booked $12.2 billion in profits, and they raised the average family 
premium three times faster than wages. One company alone, WellPoint, is 
hiking rates by double digits in 11 States, while their profits are up 
91 percent. Meanwhile, even with soaring profits, insurers continue to 
drop sick people from their rolls, spend less on care, and avoid 
competition.

  Vermont, a State that has led the way on many health insurance 
reforms, is not immune from the rising costs of health insurance. On 
Town Meeting Day a few weeks ago in Vermont, town officials in Hartford 
reported that the community's health insurance rates last year jumped 
by a third, forcing them to lay off town workers.
  Despite dire warnings of ``government takeovers'' and other charged 
rhetoric, this bill in reality is a solidly American solution to our 
health insurance crisis. The new law largely builds upon our current 
system and reforms parts that are not working well, while maintaining 
much of what Americans like.
  Now that this bill is law, annual caps on coverage are eliminated. 
Insurance companies are now barred from dropping people from their 
plans, even if they have paid their premiums, simply because they have 
gotten sick. Denying children health insurance coverage because of 
preexisting conditions is now illegal, and parents are now allowed to 
keep their children on their health insurance policy until a child's 
26th birthday. And now that comprehensive reform has become law, a down 
payment has been made toward completely closing the so-called donut 
hole for seniors on Medicare, by providing a $250 rebate for those in 
the Medicare Part D coverage gap.
  In addition to the immediate improvements to our health insurance 
system, over time this bill will make further improvements and also 
will eventually insure 95 percent of our population, while making a 
substantial investment in our economic vitality in the years ahead. In 
addition to ending the discriminatory insurance company practices of 
denying coverage because of preexisting conditions and canceling 
coverage when beneficiaries get sick, the new law will lower costs for 
small businesses and will help prevent medical bankruptcies by removing 
any arbitrary limit on annual or lifetime ``caps'' on medical expenses. 
This bill also is the largest deficit reduction measure many in 
Congress have ever cast votes on. The Congressional Budget Office 
estimates that comprehensive reform will reduce the federal deficit by 
$143 billion through 2019, and by more than $1 trillion in the decades 
to come.
  These comprehensive reforms also will test ways to reduce health care 
costs while improving quality. The bill contains pilot initiatives for 
efforts like Vermont's Blueprint for Health, under which patient care 
is coordinated to reduce unnecessary hospital visits and to keep 
patients healthy. Other programs will test various ways to pay doctors 
and hospitals that could be more efficient than the current fee-or-
service structure. A greater emphasis on prevention--long championed by 
the late Senator Edward Kennedy and Senator Tom Harkin on the Health, 
Education, Labor, and Pensions Committee--will reduce preventable 
deaths and hospitalizations.
  I am also proud that the bill explicitly prohibits discrimination on 
the basis of race, color, national origin, sex, disability or age in 
any health program or activity receiving Federal funds. These 
protections were necessary to remedy the shameful history of invidious 
discrimination and the stark disparities in outcomes in our health care 
system based on traditionally protected factors such as race and 
gender. The nondiscrimination provision makes clear that the 
enforcement mechanisms from other statutes prohibiting discrimination 
in federally funded programs, such as title VI of the Civil Rights Act 
of 1964 and title IX of the Education Amendments of 1972, apply with 
equal force to federally funded health programs and activities. I 
worked closely with Majority Leader Reid to include these protections 
in the Senate bill to ensure that all Americans are able to reap the 
benefits of health insurance reform equally, without discrimination.
  The bill the President signed into law and that I supported is not 
without its problems. But it succeeds in adhering to the core 
principles I sought at the beginning of this debate. It gives Americans 
affordable access to health care coverage, it reduces costs for 
families, businesses and government, and it protects consumers' ability 
to choose doctors, hospitals and insurance plans. Many other 
substantial social policy reforms such as Medicare and Social Security 
were improved through actual experience after they were first enacted. 
For instance, Social Security as passed did not contain disability 
insurance--a significant oversight, which was rightly remedied later. 
While this plan might not make every reform we think necessary, we have 
the ability to modify and improve it in the months and years ahead.
  In fact, the reconciliation bill now before the Senate includes a 
series of improvements to comprehensive reform that I strongly support. 
The bill will fully close the prescription donut hole that forces 
thousands of seniors across the country and in Vermont to pay out of 
pocket for necessary prescriptions until their expenditures reach a 
catastrophic level. Immediately, Medicare beneficiaries who fall within 
the hole will receive a $250 rebate in 2010. By 2020 the donut hole 
will be closed completely, and beneficiaries will receive 75 percent 
discounts on brandname and generic drugs. The reconciliation package 
eases the cost-sharing for individuals purchasing insurance on the 
exchange, and it offers more generous tax credits for those with the 
lowest incomes who still have trouble affording health insurance. The 
largest employers will be fined more heavily for the failure to offer 
insurance to their workers.
  The reconciliation package furthers the strong antifraud provisions 
Senator Kaufman and I worked to incorporate into the Senate-passed 
bill. Among other steps, it increases our investment in fighting health 
care fraud by providing $250 million over the next decade to 
investigate and prosecute the people who drain our health care system 
of billions of dollars each year, driving up costs and risking patient 
lives. It also streamlines procedures to review Medicare payments 
before they

[[Page S1843]]

are made to ensure that we identify and stop fraud as quickly as 
possible. These antifraud initiatives build on the impressive steps the 
Obama administration has already taken to improve health care fraud 
prevention and enforcement, and on the real progress represented by the 
antifraud provisions adopted by the Finance and HELP Committees. I was 
pleased to be able to contribute to all of these efforts.
  Like many sweeping reforms of our history, this legislation will 
likely be improved in the coming years as these reforms are 
implemented. For example, I will continue to push for a public option 
and for repeal of the health insurance industry's antitrust exemption, 
in order to promote competition, choice and lower prices.
  The people of Vermont have given me the honor of representing them in 
the Senate for 35 years. I have joined in many debates that were 
contentious, yet ultimately productive. As we leaf through the pages of 
history, we can read of the many times when Congress has shown its 
remarkable ability to rise up to reflect the conscience of the Nation.
  As many here have noted, our dear friend Senator Ted Kennedy would 
have been remarkably proud of the President and this Congress for 
passing reform that was unachievable for so many before us. Ted 
reminded all of us in a letter written to President Obama what the 
stakes are in this debate. He wrote, ``What we face is above all a 
moral issue; that at stake are not just the details of policy, but 
fundamental principles of social justice and the character of our 
country.''
  When the dust settles and emotions are calmed, I believe this effort 
will be viewed as a credit to this good and great Nation and its 
people. This President and this Congress have responded to a pressing 
national issue and have proven once again our ability rise above 
partisanship and act with the purpose of advancing a pressing national 
interest.
  I am proud of this latest proof that change is possible in this great 
country when a pressing national interest is at stake. And I am proud 
to have had the honor that Vermonters have given me to represent and 
advance their interests in this effort.
  This really is a new day of hope for tens of millions of Americans 
who have fallen through the cracks or who worry they may fall through 
the cracks of our broken health insurance system.
  When President Barack Obama signed the comprehensive health insurance 
reform bill this morning, I could not help but think as I sat there 
that this ranks with the creation of Social Security and Medicare. We 
have talked about reforming health insurance for decades, but it has 
not been done. Of course, it has been an arduous process, but it has 
proven that change is possible even when you have had the pitched 
opposition of entrenched and powerful and, I might say, very wealthy 
special interests. America rose to meet one of its foremost challenges 
and to renew its promises.
  America has some of the best health care in the world if you can 
afford it. Millions of families in America and in Vermont worry that 
they are just one paycheck away from medical and financial disaster. 
This is a new day for them.
  I ask all those Members of Congress who fought so hard against this 
health care and voted against it, are they willing to give up the great 
health care system they have as Members of Congress, that they can buy 
as Members of Congress, and trade places with the millions of Americans 
who cannot buy the great health care system Members of Congress have? I 
have not heard a single one of them who voted against giving help to 
these millions of Americans say they would give up their own.
  Whenever I travel in Vermont, whether it is at the grocery store, 
church, on the street, or at a gas station, I often stop to listen to 
personal and wrenching stories, such as the woman from Winhall, VT, who 
needs to spend $500 a month on prescriptions but who would be uninsured 
if not for her husband's job. She is working two jobs to make ends meet 
and to afford the health care costs, or the small business owner who 
works 6 and 7 days a week but she still cannot afford the blood tests 
her doctor recommended--if she becomes sick, she will lose her business 
and her home--or the man from central Vermont who told me of his 
sister-in-law who lost parts of both of her feet because she could not 
afford the simple care that would have saved her feet because she did 
not have health insurance. When she needed medical attention, she 
waited, hoping things would get better, knowing she could not afford to 
go to the doctor. By the time her family was able to step in, she had 
to be rushed to the emergency room, not for a cure but for amputations. 
This is America. I do not hear a single Member of Congress saying they 
are ready to give up their insurance they are able to buy through the 
Senate or the House of Representatives and trade places with this 
woman.
  I grew up in my family's small business in Montpelier, a printing 
business. I know small businesses want to try to keep good workers, and 
many want to offer health insurance options, as my parents did, but 
spiraling insurance costs are taking that option away. Some of the most 
immediate and far-reaching reforms in this new law are tax credits that 
will help small businesses continue to offer insurance to their 
employees.
  Health insurance has prevailed through the grueling gauntlet of 
obstructionism erected by the defenders of the status quo--worse than 
anything I have seen in my years in the Senate. One gauntlet remains in 
the Senate, where partisan opposition has prompted efforts to derail 
these further improvements to this law. It is no wonder that while 
Americans vastly support the individual components of these bills, they 
have been skeptical when asked about the hazy concept of comprehensive 
reform.
  Some have argued that doing nothing is a safe option. Last month, 
insurance companies planned a series of premium hikes, as large as 39 
percent in one State. Last year, the five largest for-profit insurance 
companies booked $12.2 billion in profits and they raised the average 
family premium three times faster than wages. One company alone, 
WellPoint, is hiking rates by double digits in 11 States, while their 
profits are up 91 percent. Meanwhile, even with soaring profits, 
insurers continue to drop sick people from their rolls, spend less on 
care, and because they have an exemption in antitrust laws they avoid 
competition.
  Now that this bill is law, annual caps on coverage are eliminated. 
Insurance companies are now barred from dropping people from their 
plans, even if they paid their premiums, simply because, gosh, they got 
sick--the reason for which they bought health insurance. Denying 
children health insurance coverage because of preexisting conditions is 
illegal. Parents can keep their children on their health insurance 
policies until they are 26 years old.
  I think of the people who worked so hard on this legislation. I see 
Chairman Baucus and Chairman Dodd on the floor. We would not be here 
without the two of them. I think we must continue and we must be able 
to make this final step.
  The people of Vermont have given me the honor of representing them in 
the Senate for 35 years. I have joined in many debates that were 
contentious yet ultimately productive. As we leaf through the pages of 
history, we can read the many times when Congress has shown its 
remarkable ability to rise up and reflect the conscience of the Nation. 
This body especially should reflect the conscience of our Nation.
  As many here have noted, our dear friend Senator Ted Kennedy would 
have been remarkably proud of the President and this Congress for 
passing reform that was unachievable for so many years before. He 
reminded all of us in a letter written to President Obama what the 
stakes are in this debate. He wrote:

       What we face is above all a moral issue; that at stake are 
     not just the details of policy, but fundamental principles of 
     social justice and the character of our country.

  When emotions are calmed, I believe this effort will be viewed as a 
credit to this good and great Nation and its good people. The President 
and the Congress have responded to a pressing national issue. They have 
shown we can rise to the challenge before them.
  I am proud to have had the honor Vermonters have given me to 
represent and advance their interests in this effort. I am glad to say 
to my fellow Vermonters: Now the day comes when

[[Page S1844]]

you have the opportunity to have the kind of insurance we Members of 
Congress have. I am sorry some have voted to deny that to you. This 
Senator votes to give it to you.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I yield 15 minutes to the chairman of the 
Banking Committee, also the de facto chairman of the HELP Committee, 
the great Senator from Connecticut, who has devoted countless time and 
creativity in helping shape the HELP Committee version of health care 
reform. Along with the Finance Committee, we have the HELP Committee. 
Chairman Dodd has been terrific.
  Mr. LEAHY. Mr. President, I ask unanimous consent that what time I 
did not use be yielded back to the chairman.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DODD. Mr. President, let me first of all thank my great friend 
from Montana, Senator Baucus. We arrived in the Congress of the United 
States together on the same day, back about 35 years ago. We have been 
friends for 35 years. We arrived in the Senate at different times. He 
got here a little before me. We have been in this institution for 30 
years. I cannot describe in the limited time I have what a difference 
he has made--the fact we are here debating, finally, the last piece of 
this legislative effort to give the Americans what they have sought for 
more than a century, and that is the basic right to health care.
  I always found it somewhat ironic in a way that we in this country 
provide for those accused of criminal offenses the right to a lawyer, 
the right to an attorney. I believe in that. I think it is correct. But 
isn't it somewhat ironic that the same country that would provide you 
with a right to a lawyer if you are charged with a criminal defense 
cannot provide you with a doctor if your child is sick? There is 
something fundamentally wrong with that, in my view.
  For the first time, we are on a track that will correct that error. 
Henceforth, in the years to come, they can mark the calendar date of 
March 23, 2010, when for the first time in American history an American 
President signed into law a bill that will provide Americans the 
opportunity to live free from the fear that they or their loved ones 
will be faced with a health care crisis and they will not have the 
capacity, without bankrupting themselves or watching a loved one lose 
their life or become chronically or permanently ill or sick because 
they could not afford it, to see a doctor.

  I rise today on this very historic day to thank my friend from 
Montana, to thank the terrific staff of the Finance Committee, to thank 
the members of the Health, Education, Labor, and Pensions Committee, 
chaired by my great pal and friend Ted Kennedy for so many years. I was 
asked to take over last summer and to work through the efforts of that 
committee to participate and contribute to our part of this bill. On 
July 16 last summer, we completed our work.
  I see my friend Mike Enzi here. We worked together on issues over the 
years. Lamar Alexander, my friend from Tennessee, as well is part of 
that committee. While we did not come together on final passage of that 
bill, I wish to express my gratitude to them and their staffs as well 
for the contributions they made to this product. Even though they might 
not be anxious to acknowledge the contributions, they made 
contributions. I am grateful to them and, of course, my staff as well--
Tamar Magarik Haro and Jeremy Sharp, as well, who is with me on the 
floor today, along with many others who did a fabulous job in providing 
us with support and assistance.
  We heard the word ``historic'' with regard to this legislation. 
Sometimes those words are thrown around a little too lightly, in a 
little too cavalier fashion to describe other events. Today truly is 
historic. I have been here 30 years, and I cannot think of another day 
quite like it in the annals of our Nation to provide, at long last, the 
ability to have a national health care plan. For tens of millions of 
ordinary citizens, the passage of this bill means more than just a page 
in history, of course. It means real security for older Americans who 
rely on Medicare and still need help paying for prescriptions. It means 
relief for small business owners who are forced to choose between 
cutting off benefits and laying off the workers they need so much in 
their operations. It means an end, more than anything else, to the 
sleepless nights when fathers and mothers worry about how to pay for a 
cancer treatment or a child's checkup.
  My colleagues know I am a late bloomer in the father business. I have 
a 5-year-old and an 8-year-old. I started a little late in this 
business of parenthood.
  Two weeks ago, my little 5-year-old was pretty sick. She got a 
stomach virus. She was throwing up quite a bit, about every 20 minutes 
or so. We called our family doctor. He said I should get her up to 
Children's Hospital emergency room, about 7 o'clock on a Saturday 
night. She was terribly dehydrated--not uncommon when this happens. She 
spent the next 18 hours in the hospital getting hydrated.
  I wanted to share with my colleagues what that emergency room was 
like that evening. Again, I have a health plan. All of us do--8 million 
Federal workers. We have pretty good coverage. I am grateful for that. 
I walked in, put that card on the table, and things began to move. My 
daughter was going to get the kind of treatment she needed.
  But that room was filled with a lot of people that night, people with 
no health care, people showing up well beyond a point you would want to 
see a physician because they did not have the resources to do it. That 
goes on every single night and day all across our country. If anybody 
has doubts about it, I urge you, in the break coming up, the 2 weeks, 
if you have a chance, to go by late in the evening to an emergency room 
in a hospital in your area. You will encounter what I did a few 
Saturday nights ago when I took my young daughter to receive the kind 
of help she needed.
  I kept on thinking that night that my daughter was not unique in 
getting a stomach virus and getting dehydrated. How many other children 
in this city or across America that night had parents sitting around, 
sleepless, wondering whether that child was going to get better, 
knowing they were getting more dehydrated and putting them at great 
risk of spiraling down, putting them at greater and greater risks, not 
knowing what to do, not having the resources to do it, not having that 
kind of health care, not having the money and insurance to pay for it, 
and wondering when they were going to show up in the emergency room to 
take care of that child. That goes on every single day in America, in 
the United States of America, in the 21th century.
  This bill does not solve all of those problems, but the idea that we 
can lift the burden of fear from those families, those people who work 
hard--remember, a majority of all the bankruptcies last year occurred 
because of a health care crisis in that family, and a majority of those 
people who went bankrupt because of a health care crisis had health 
insurance. These were not people without insurance; it is just the 
copays were so high, the deductible so high that they were going to get 
in financial trouble before the insurance would even kick in. We are 
not just talking about the uninsured. Even people with some insurance 
find themselves in that situation. So my daughter is fine today and 
doing well because I didn't have to worry about the cost of her care. I 
have a good health care plan. But for other families across this 
country who don't have that security, that sense of confidence that if 
their loved ones end up ill or need attention or care, that unless they 
have the kind of coverage and the ability to pay for it, their child 
might not have had the same outcome that mine did. That shouldn't 
happen in this country.

  So for us in Congress, the passing of this legislation represents 
more than just the culmination of a century-long movement for reform. 
It began with Teddy Roosevelt. I regret today that President Obama 
didn't mention Richard Nixon. He mentioned Roosevelt and Truman and 
Bill Clinton, but Richard Nixon tried as well to get national health 
care. He is not recognized often for it. People only talk about him in 
a negative sense. But Richard Nixon tried this. It was Democrats and 
Republicans who tried to get this done.
  What this effort represents is proof that while progress is not easy, 
neither

[[Page S1845]]

is it impossible, and that, maybe more than anything else, is important 
about what we saw today.
  As President Obama said, we didn't come here to the Senate, to the 
Congress of the United States to fear the future; we came here to try 
to shape it. And despite the complexity of the problems, the political 
power of those stubbornly defending the status quo, and even the 
refusal of many in this community to acknowledge the urgency of reform, 
that is exactly what we have done.
  A broken health care system is not the last challenge we are going to 
face now as a nation or as a Congress. Far from it. Today, our Union 
became a little more perfect, but is still far from it. There is still 
much to do to help American families build better lives for themselves. 
But, Mr. President, I hope when we again find ourselves at moments of 
great national import--and we will and we are--we can look back not at 
the polls or the petty partisan fights that too often contaminate our 
debates and that always seem to stand in the way of progress, but 
rather at the fact we rose above them and we acted--and we acted, Mr. 
President.
  We have a chance again to act this evening or tomorrow, as soon as 
this process comes to an end, by voting up or down on the legislation 
designed to make this good law even a better one. If you strip away the 
overheated rhetoric, the false claims that have become commonplace 
during this debate, this bill is nothing more than a set of commonsense 
fixes. Let me quickly remind my colleagues and others what they are.
  The commonsense fixes will extend the solvency of Medicare. The bill 
will fill the so-called prescription drug doughnut hole and lower 
premiums for seniors. Another commonsense fix will extend to all 
insurance plans the consumer protections in the newly passed health 
care reform law. It will end the lifetime caps on benefits to people. 
It will also provide the guarantees that your coverage would not be 
taken away if you get sick and includes a prohibition on excessive 
waiting periods, and the extension of coverage to adult children up to 
the age of 26. It will ban discrimination against people with 
preexisting conditions. These commonsense fixes will increase the tax 
credits that help low- and middle-income families pay for insurance, 
boost funding for community health centers, strengthen provisions for 
cracking down on waste and fraud in the Medicare and Medicaid systems.
  Mr. President, these commonsense fixes will improve the shared 
responsibility of policies, ensuring that employers and individuals do 
their part to keep the country healthy, both physically and 
economically. It includes valuable protections as well for hospitals 
and physicians, and more fairly distributes Federal funding among the 
States so that State governments aren't overburdened at a time when it 
is already rather difficult to balance those budgets. It revises 
revenue provisions in the law to take some of the burden off middle-
class families and put it on the pharmaceutical industry, which can 
afford to bear those burdens.
  On top of all these commonsense fixes, it includes a badly needed, 
fully-paid-for investment in Pell grants enabling more Americans to go 
to college and get the education they need to compete in the 21st-
century world in which these children will face. The bill increases 
Pell grants, I know my colleagues know, up to $6,000 by 2017. Hardly 
enough, in many cases, to pay for the ever-growing cost of education, 
but it can make a difference. It links scholarship amounts to the cost 
of living so they never again have to fall behind, and all of us know 
how valuable that can be. Because the legislation switches to the far 
less expensive direct loan program, it will also reduce our deficit by 
more than $10 billion over 10 years.
  Now, that is what is in this bill. Those are the commonsense fixes. 
If you don't like the health care bill, fine; but don't tell me what we 
are doing is a bad idea. I think it takes a good law and makes it a 
better law, and I hope we can get broad-based support for these 
provisions.
  I know some of our friends have made plans to spend the rest of the 
week delaying passage of this bill. I would hope they not engage in 
that. I don't think it serves our interests. Vote against it, if you 
want, and let us get on with the other business we have before us. To 
go through some marathon voting for the sake of delaying the process I 
don't think does a great service to this great institution. That is not 
what we are sent here to do.
  That is all you are going to witness, unfortunately, Mr. President, 
if this goes on for a protracted basis over the next couple of days--
one cute little amendment after the other to see if it can embarrass 
colleagues to vote on something that may cause people to worry about 
their sense of sanity in all of this. Yet all it is designed to do, and 
nothing else, is but one thing: to delay voting for the provisions 
included in this commonsense fix.
  Mr. President, I hope, again, that we can move on to other business; 
that the large issues in front of us require us all to work together. 
As the chairman of the Banking Committee, I have the responsibility of 
trying to bring to this floor some reforms in financial services. I am 
blessed with wonderful members on my committee--Democrats and 
Republicans. There is a growing desire in our committee, I think, to do 
just that. My intention is to try to do just that in the coming weeks, 
working with my friends on the Republican side as well as my colleagues 
on the Democratic side of the aisle. It is a big set of important 
issues, and that is what we ought to be doing.
  That is what we did on this bill. Unfortunately, we were forced to do 
it as one party, not as a Senate acting together, and I am saddened by 
that fact. But my sadness is overwhelmed by the sense of joy that I 
have that this Congress, this President, was able to sign into law one 
of the most historic pieces of legislation ever adopted by any Congress 
in the 200-plus-year history of our Nation. I urge my colleagues to 
support this reconciliation bill.
  With that, I yield back any time I may have to Senator Baucus for 
some later consideration that he may need.
  I see the chairman has arrived back out here, and I yield the floor.
  Mr. BAUCUS. Mr. President, how much time remains?
  The PRESIDING OFFICER. There remains 3\1/2\ minutes.
  Mr. BAUCUS. Mr. President, I would like to speak a few minutes on the 
amendment offered by the Senator from Arizona with respect to the 
declaration of a public health emergency.
  Under the 1980 Superfund law, an administration has the authority to 
issue a public health emergency whenever it determines based on science 
that there is a certain part of the country for which that declaration 
makes sense. It applies to anyplace in the country. An earlier 
administrator, Christine Todd Whitman, was about to declare a public 
health emergency in Libby, MT, because the conditions were so dire. 
Frankly, I read the e-mail traffic between her office--HHS--and the 
Bush administration in the White House.
  The White House put the kibosh on that declaration. The EPA, based on 
the science, was going to make that declaration. Administrator Jackson 
has now made that declaration based on the science.
  There is more asbestos contamination in Libby, MT, on a per capita 
basis than any other place in the country. It is appalling. People are 
dying of asbestos-related diseases and mesothelioma. Tremolite is the 
form of asbestos that is present. It is so sad. It is a small town, a 
poor town. The company, W.R. Grace, has left them high and dry. There 
was a criminal trial against its officers for intentionally 
contaminating Libby. Frankly, that did not result in a successful 
criminal prosecution but, in my judgment, having read lots of 
transcripts of hearings, it is clear a declaration of a public health 
emergency is not only valid, but this is a company, frankly, that 
should have been brought to justice. In fact, they moved assets off the 
books so they would be judgment proof. W.R. Grace is a very bad 
company, in my judgment.
  Anyway, this law applies to all States in the Nation--all States--
where, based on the science, the EPA Administrator thinks a public 
health emergency should be declared at a certain site that is then 
required by the law. Screenings are then allowed and medical treatment 
is allowed to people who would otherwise not get any, or get very 
little because the company has cut back on any health care benefits 
they had.

[[Page S1846]]

  So this is, in a sense, health care reform. These are people who 
don't get health care. They have been left without health care. There 
is no coverage, frankly. They have this so-called preexisting condition 
because they have asbestos-related disease. I think it is only proper 
these people in Libby finally get their due.
  My time has probably expired, but I could go on and on and on about 
this sad situation and how much these people deserve to have at least 
some health care that they would otherwise not receive.
  Mr. President, I believe now the time is to be allocated to the 
Republican side.
  The PRESIDING OFFICER. The majority time has expired.
  The Senator from Wyoming is recognized.
  Mr. ENZI. Mr. President, I am going to rise to offer an amendment in 
a while to protect American workers from the punishing job-killing 
taxes in this reconciliation bill. My amendment would send this flawed 
bill to the Finance Committee with instructions to report back a bill 
without an employer mandate and with an offset.
  Mr. BAUCUS. May I inquire of my good friend if he has a copy of his 
amendment so we could see it. Before I make a request to set the 
current pending amendment aside, I would like to see the amendment.
  Mr. ENZI. I thought a copy had been delivered to you.
  Mr. BAUCUS. Maybe it has. Let's just check to be sure we have it.
  Mr. President, I suggest the Senator proceed with his argument on his 
amendment.
  Mr. ENZI. That is all I was going to do for the moment, is present 
the argument and then offer the amendment.
  Mr. BAUCUS. OK.
  Mr. ENZI. Of course, this process we are going through seems like 
Groundhog Day to me. I worked on health care with Senator Kennedy for 3 
years. We came up with some principles that translated into what is on 
my Web site: 10 steps that would actually solve health care and do what 
the President promised.
  I am the ranking member on the Health, Education, Labor and Pensions 
Committee, so I went through the markup on that. As far as any 
predesign or drafting prior to the markup, I had no opportunity to do 
that. We were given a bill and told: Here it is. If you want, you can 
do amendments. Well, it was put together pretty fast, so there were 
typos in it. We thought maybe we ought to help solve those, and as a 
result there were 150 amendments that were accepted, but none of 
substance except a couple.
  One of those amendments accepted was one that Senator Harkin and I 
both cosponsored. It became a part of the bill, and that was the 
Safeway plan that would have provided some prevention. It would have 
given companies the ability to provide incentives to their employees to 
do prevention.
  Like I say, it wound up in the bill. But when it was printed on 
September 17, it was not in the bill anymore and we never had a vote on 
it. I don't understand how that can happen, and that is why I say this 
feels a little like Groundhog Day because we keep trying to get things 
in there.
  I was part of the group of six, and one of the things I asked for was 
the Gregg amendment that we had earlier, which said Medicare money 
ought to just go to Medicare. And I keep seeing these side deals made, 
which is the amendment Senator McCain did.
  Each time we have been presented with the bill and they said: Here it 
is, take it or leave it. We tried to do amendments. The amendments 
don't wind up in it. The way it gets passed is by having side deals 
made. I am not familiar with that kind of legislating. It is foreign to 
me and I don't think it is the right thing to do.
  I also went to the White House summit. Again, the President said: 
Tell us your ideas. And we did. Every time a Republican presented ideas 
they were rebutted immediately. My idea of a listening session is the 
person putting it on does a little preamble and explains the format 
they are going to do and then they actually listen. At the end after a 
listening period, when people have had a chance to voice their 
opinions, the leader, which in this case would have been the President, 
says: Here is what I learned today or: Here is what I didn't learn 
today. Instead, what we got was a pitch for why we ought to accept the 
bill the way it was and that is exactly the way it has progressed every 
step of the way.
  Here we are again, another Groundhog Day, trying to do some 
amendments that will make this a better bill. In fact, it will make it 
a bill that will work; a bill that will be sustainable. Right now I am 
trying to save business in America, particularly small business, at a 
time when our Nation's unemployment rate is 9.7 percent. Millions of 
Americans have lost their jobs and millions more go to work every day, 
worried about keeping the job they have. Many States are seeing double-
digit jobless rates which are weighing heavily on their local 
economies. Businesses of all sizes are struggling to keep their doors 
open and are finding it harder and harder to make payroll.
  When our Nation's businesses struggle, workers and their families 
struggle just as much if not more. American workers depend on a strong 
economy to create jobs that help them feed their families and build 
their dreams. Unfortunately, the employer mandate in the reconciliation 
bill will only make it more difficult for America's businesses to hire 
and pay their workers.
  This reconciliation bill being pushed through the Senate contains $52 
billion of new taxes--that used to be big money--$52 billion of new 
taxes on business, businesses that cannot afford to provide health 
insurance, especially at the higher rate being required. The bill has 
in it a Federal minimum standard that is better than 50 percent of the 
insurance that Americans already have. If you don't think your rate is 
going to go up, if you have something that is below that Federal 
minimum standard and you like it, too bad. We are going to force 
businesses to buy better insurance than what they already have, and if 
they do not, they get to pay $52 billion in new taxes. Most employers 
do provide insurance for their employees, but there are some that 
cannot afford to.
  What does health care reform mean to those businesses that cannot 
afford health insurance? Unfortunately, health care reform for them 
will mean higher taxes. These are the same businesses that are barely 
making it today, they are the same businesses that are currently laying 
off workers in order to keep the company afloat. They are the same 
businesses that are cutting shifts to prevent further layoffs and 
cutting wages to keep their employees on the payroll--and much of that 
is with the agreement of the employees. They understand. They are with 
a small business. It is more like a family. They understand what the 
consequences are of new taxes and new requirements and new regulations 
and it scares them. They make concessions so they can continue to work. 
They are working fewer hours than they used to work. Productivity is up 
but there are less hours.
  The problem we have is that Congress doesn't understand business, 
especially small business. I go and visit Wyoming most weekends. I 
travel a different part of the State and one thing I like to do is get 
into some businesses and find out about them. I found out most 
businesses look pretty simple until you scratch the surface a little. 
We get a completely different opinion here because we print our own 
money, but that doesn't happen out there in the business world. They 
have a lot to take into consideration. They have to figure what it 
costs them to be in business and they have to make sure they bring in a 
little more revenue than it costs them if they are going to stay in 
business.
  An example of that is, if you take a six-pack of soda, the store 
charges you $2. They didn't make the soda and it didn't appear 
magically out of thin air. The store had to buy it from a distributor. 
That costs money. The distributor had to buy it from a bottler and the 
bottler had to buy the water, the sugar, and the flavoring to make the 
soda. You add up all those purchases plus the costs of renting and 
heating space, paying people and paying taxes, and you get the price. 
They have to come up with that kind of price in order to stay in 
business.
  Nobody sells it for cost, not for very long. They can't. If they sell 
a product at the price that is the same as it costs them to buy the 
product, rent the space, pay the employees, and pay the taxes, they 
don't make any money. They go out of business.

[[Page S1847]]

  One of the things we hear about around here is all the greedy 
businessmen there are. That is not how you get to set your price. There 
is competition out there that forces you into the lowest price you can 
charge and stay in business. If that were not the case, if greed were 
the answer, why doesn't a loaf of bread cost $10 or $50? The simple 
answer is no one would pay that price. You have to be able to sell the 
product in order to stay in business and it has to come in at a cost 
that you can afford.
  One of the things we are doing here with this employer mandate is 
piling more costs on the businesses. Economists have told us repeatedly 
that the new job-killing taxes in the reconciliation bill will be paid 
on the backs of workers. The Congressional Budget Office has repeatedly 
said that workers will bear the brunt of an employer mandate. In fact, 
CBO has said that the $52 billion in new job-killing taxes will result 
in a corresponding reduction in wages, and if the worker doesn't make 
enough money to cover the new taxes, that worker will be at risk of 
losing his or her job.
  Low-income workers have been particularly hard hit by the current 
economic conditions. Low-income workers are typically employed by small 
businesses and see the demand for their services fluctuate wildly with 
the ups and downs of the economy. These low-income workers typically 
have less formal education and have an even harder time trying to find 
any job. In fact, workers without a high school diploma have a 50-
percent higher unemployment rate than workers with higher education 
levels.
  The current economic situation for young, relatively unskilled 
workers is dire. They are facing an increasingly difficult job market 
that is flooded with older, more qualified workers. Unfortunately, the 
job-killing taxes in the reconciliation bill will actually make their 
situation worse.
  The bill creates incentives against hiring low-income workers and 
unskilled workers. In fact, we have a problem in this country right now 
with businesses being concerned about what kind of additional 
regulations are going to come out of this body and the one at the other 
end of the building. So they are not hiring people. They are waiting to 
see what it is going to cost them. If the cost is too high, they will 
not hire people so we will not be able to absorb those people who are 
already without jobs.
  According to the Congressional Budget Office, employer mandates such 
as those included in the reconciliation bill would ``reduce the hiring 
of low-wage workers.'' Harvard Professor Kate Baicker reported that as 
a result of an employer mandate, ``workers who would lose their jobs 
are disproportionately likely to be high school dropouts, minority and 
women.''
  So with the unemployment rate highest among high school dropouts and 
minorities, this bill would actually make their situation worse. The 
job-killing taxes in this bill fall disproportionately upon the people 
who are struggling the most, putting their jobs at risk and making it 
even more difficult to find a new one. At a time when Americans across 
this country are looking for signs of an economic recovery, the Senate 
should be debating a bill that helps the situation, not makes it worse.
  I offer this amendment to protect American workers from new job-
killing taxes that will lower wages and cut jobs. Senators can make a 
statement right now and support American workers who are facing the 
toughest job market since the Great Depression. I urge my colleagues to 
vote in favor of my amendment.
  My motion is at the desk. I ask to call it up.
  The PRESIDING OFFICER. Is there objection?
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, reserving the right to object, I ask once 
the time on the Enzi motion has expired, the motion be set aside until 
a time to be determined by the leaders.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. BAUCUS. I thank the Chair.


                            Motion To Commit

  The PRESIDING OFFICER. The clerk will report the motion.
  The assistant legislative clerk read as follows:
       The Senator from Wyoming [Mr. Enzi] moves to commit the 
     bill H.R. 4872 to the Committee on Finance with 
     instructions to report the same back to the Senate within 
     1 day with changes that strike the employer mandate that 
     will lower wages and increase unemployment and add an 
     offset.

  Mr. ENZI. I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. BOND. Mr. President, I am proud to take the floor to support the 
motion from my good friend, the Senator from Wyoming. I can understand 
his frustration, having been through what he described in the process 
in the committee where this bill allegedly was marked up--although it 
is unrecognizable. The things that he was able to get in and thought 
were in disappeared. He also has another committee on which I join him 
and that is the Small Business Committee. So there is no one better 
than an accountant from Wyoming who has small business experience and 
who has served on the HELP committee in drafting this legislation to 
outline the problems with this bill.
  We have not even heard him speak at great length about his background 
in accounting, but this bill, filled with gimmicks, 10-year taxes and 
6-year spending, is overwhelming. But he is correct when he says that 
the cost, according to CBO, will fall on the backs of the workers, the 
costs of the employer mandate, and they will fall disproportionately on 
young workers, teenage workers, particularly minority teenage workers 
who have a very high unemployment rate now. He said, and I would have 
to agree with him, it appears that Congress doesn't understand how 
small business works. Clearly the administration doesn't.
  When you look at how this bill was done on Sunday, House Democrats 
accomplished what we thought was unimaginable--they successfully passed 
the health care boondoggle that the Democrats passed here on Christmas 
Eve where they stuffed our stockings with a partisan 2700-page bill 
chock-full of political payoffs, kickbacks, and sweetheart deals, some 
of which my friend from Arizona mentioned.
  But this Sunday the House Democrats ignored the will of the American 
people and on a party-line vote passed this $2 trillion bill that will 
increase health care costs, raise taxes, and cut Medicare for seniors. 
Despite the story Democrats are now trying to sell to the American 
people, this $2 trillion bill is one the President has now signed into 
law containing the ``Louisiana purchase,'' a sweetheart deal for 
Connecticut hospital, and several more deals on the side, in exchange 
for votes and so on. It is one that the American people do not want. 
They say no to this government takeover.
  I stand with the American people who say repeal the bill and replace 
it with the things we need. We need to repeal the bill and enact real 
health care reform that will lower health care costs and not break the 
banks of taxpayers or take Medicare from seniors. That is exactly what 
we propose to do. I joined several colleagues in cosponsoring a bill 
that would repeal this monstrosity because we need to get back to 
business, to give the American people the health care reform they 
deserve--not the bill they don't want.
  This Christmas Eve health care bill is not the only legislation to 
which the American people have said no. They also do not want the so-
called reconciliation bill which is going to force the American people 
to reconcile themselves to even higher taxes, even more cuts in 
Medicare. This is the kind of thing that will not fix the problems of 
the American people, it will make them worse. If you thought cuts to 
seniors in the previous bill were bad enough, this reconciliation will 
cut services even more and taxes will go up. But as my colleague from 
Wyoming said, right now we need jobs. That is what the American people 
are telling me they want. They cannot be any clearer. One in ten 
Americans is unemployed. A fellow Missourian, Harry Truman, once said, 
for those people it's not a recession but a depression.
  With these kinds of dismal unemployment numbers it is no surprise 
that polls keep telling us that they want jobs created, not the 
government to take over health care.
  It is not just the people in Missouri who have been stopping me on 
the street. I get e-mails, phone calls, and

[[Page S1848]]

letters to my office. But they stop me wherever I go, from a grocery 
store to the post office to restaurants. They do not want this job-
killing bill. They want a job-creating effort.
  They do not want this monstrosity of a health care bill. 
Unfortunately, the majority in this body and the other body have 
ignored their demands. This bill undermines the employer's ability to 
create jobs and by extension it extends the recession and all of the 
misery associated with it.
  Most people, I would hope, would recognize that small business is the 
engine that creates the jobs in the United States. People who are 
informed, as we would hope Members of this body are, know that most 
small businesses are taxed as individuals, as proprietorships, 
partnerships, or sub-S corporations. That is why the small business tax 
relief in 2003 cut taxes and led to the creation of 8 million new jobs.
  Despite what some of my colleagues on the other side believe, it is 
not the government, not a massive government stimulus bill that creates 
jobs in the private sector. In fact, the massive stimulus bill 
discouraged it, and the reconciliation bill will be even a bigger blow 
to job creation.
  And the timing, when unemployment is still too high, is a perfect 
storm because the 2003 tax cuts are expiring. So these small businesses 
are already facing one boost in their taxes, and now they are going to 
get several more. Pair these two and the effect is that Congress is 
piling an overwhelming burden on small business.
  The tax on health insurance will result in increased premiums. 
However, these who are self-insured, like big businesses and not-for-
profits, like labor unions, are exempt from this tax. It is not going 
to hurt them. This means those who are forced into the fully insured 
market, such as small businesses, will bear the burden of the premium 
increases.
  The President and the majority may tell you they are giving tax 
credits to help small business. Well, they are not going to be fooled 
by that. The tax credit expires after only 5 years. If you have 11 
employees and hire another one, it starts phasing it out, so you cannot 
have your business grow. If you raise the salaries, you lose the 
benefits.
  The reconciliation bill makes things worse. It increases the penalty 
under the employer mandates from $750 to $2,000 per employee, on top of 
all of the other taxes. If you are already offering your employees 
insurance in this high-cost market and the government decides it is not 
good enough, they hit you again, if it is too expensive. If that was 
not bad enough, both full-time and part-time employees will be counted. 
The majority wants the American people to think they are not really 
hurting business with this reconciliation bill. They like to talk about 
sticking it to or raising the taxes on the wealthy.
  They want the American people to believe--and I believe the American 
people are too smart and know--that these new taxes are going to just 
hit the CEOs of Fortune 500 companies or professional athletes or 
entertainers, wealthy lawyers, Hollywood moguls, and international 
finance speculators. That is what they charge.
  But what my colleagues on the other side of the aisle will not tell 
you is the collateral damage will destroy small businesses. Who are the 
``rich'' the Democrats want to target? As high as 79 percent, some 
figures say, of those paying taxes at the highest rate have a large 
part or at least a small part of their income from small business. 
Small business is the backbone of the country and represents 99.7 
percent of all employer firms; over half of all private sector 
employees are in small business; 44 percent of the total U.S. private 
payroll; and small business generated over 64 percent of the net new 
jobs over the past 15 years.
  Despite this importance of small business, we are facing a new 
employer mandate which the Enzi-Bond amendment would strike. I urge my 
colleagues to have a heart. Understand that the people they are hurting 
are not just small businesses, it is the people who work for small 
businesses or who would work for small businesses who will be denied 
the chance to get a job in small business because of the increasing 
costs this bill puts on them.
  This bill takes away incentives for small businesses to keep the 
workers they have, to hire and expand. Some of these small business 
owners who think now is not a good time to expand their business or 
hire more people cite the political climate as the second most cited 
reason they are not doing it, after poor sales.
  The government is literally prohibiting economic growth. Small 
businesses are struggling. They are struggling in this economy to be 
able to offer affordable health insurance. I have worked for years with 
people such as Senator Enzi and other colleagues to get small 
businesses permission to go together in nationwide purchasing pools and 
buy their insurance in the national market like the big employers and 
the unions do so they can get better rates, get the administrative 
savings.
  Well, we cannot get it through. This would be the time to do that. It 
would not cost the taxpayers anything. It would save taxpayers money. 
Allow people to purchase health care across State lines. You can see 
auto insurance advertised, and they cut through competition to get you 
the best deal. Would not my folks in Missouri who are having trouble 
affording health care like to look for a national health plan? They 
would love it.
  If you care about the jobs in this country and the future of the 
economy, you cannot vote for this reconciliation bill which would 
further devastate one of our most important job-creating sectors. It is 
not only a bad bill, it will make the struggling market worse.
  Mr. President, how much time is remaining on this side?
  The PRESIDING OFFICER. There is 6 minutes remaining.
  Mr. BOND. I want to add one other thought. In the 20 years I have 
been in the Senate, I have traveled around the world. I have seen 
remarkable changes that have come from countries throughout the world, 
particularly after the fall of the Soviet Union. With the fall of 
socialism and communism, countries around the world immediately began 
to look to the United States as the economic model.
  They saw our progress. They saw what we were doing because of the 
system we had. Our free enterprise system demonstrated that successful 
businesses, successful entrepreneurs can provide opportunities. This is 
a classic case of a rising tide lifting all boats. That is why 
countries from some of the least developed to the reasonably well 
developed want to mimic our system. They are not looking to Denmark or 
Sweden with their very high tax rates as a model; they see the 
difference between a government-controlled economy and a free economy 
with appropriate government regulation.
  They know in the free economy, the free marketplace, entrepreneurs 
can go forward and come up with an idea, take a risk, risk their 
fortune, risk their ideas, and go out and make money that will allow 
them to hire more people and provide benefits for the community.
  Unfortunately, when our President says health care should be the 
model for the role of the government in the economy, I am afraid he is 
talking about the European Socialist model which has demonstrated that 
the economy does not grow as quickly as the U.S. economy. They have 
high levels of unemployment.
  What does government-created high unemployment do? It generates more 
social welfare and transfer payments. These transfer payments put 
pressure on governments to raise taxes even higher, make more people 
dependent on the largesse of the Federal Government, and further 
depress the incentive for entrepreneurs, men and women with good ideas 
who want to build a job and want to hire people.
  Last year's stimulus program did a tremendous job of putting more 
people on government payrolls; that is, the Federal, State, and local 
level. But did not do much to create jobs in the private sector. I 
believe the private sector in America has historically been vibrant. It 
will create jobs despite increasing government taxation, deficits, and 
regulations. They may do that for a while, but I can tell you that the 
number of jobs will necessarily be far less than what the free market 
system could create if it were not inflicted with this increasing 
government burden on businesses.

  Using history as our guide, health care and the reconciliation bill 
and the other proposals the majority has

[[Page S1849]]

planned are likely to lead to a longer recession, continued high 
unemployment, and a lower standard of living for all Americans than 
would otherwise be possible. That is the source of the anger among the 
public.
  No one is against health care reform. You can tell that from the 
angry people. I have met the clerks in a store, in a hardware store, 
who say: Do not take away my health care. I want some reforms, but I do 
not want to lose my health care. That person, I told her, she would 
lose her health care. She would not be able to use the same plan. I 
said: I agree with you. I want to stop this bill. I want to get 
commonsense reforms that will really help more people get insured, get 
better deals, and do it without raising costs, and cutting Medicare.
  Americans understand what this type of health care reform will do to 
the good health care system we have now, what it will do to our 
economy. There is a real danger. The people understand. That is why 
they are angry. I will tell you, they are angry. They are angry at me. 
They call my office and they are yelling at me.
  I said: I am on your side.
  They said: I know, but we are angry. We do not want to see it go 
through.
  They are concerned and we are concerned about our families, about the 
economic prospects for our children and grandchildren because they are 
going to be carrying the burden on their backs of the heavy spending we 
do today.
  I see my colleague from Wyoming rising. I will end my remarks here.
  Mr. ENZI. I thank the Senator from Missouri for his passionate 
remarks. He was the former chairman of the Small Business Committee 
before he moved to the chairman of the Intelligence Committee. You can 
see the passion and his understanding, former Governor, and one of 
Jaycee's ``10 outstanding young men.'' I appreciate him raising the 
issue of small business health plans. We have exchanges, we have the 
Shop Act, we have some other things, co-ops, in the bill. But we should 
have put in more opportunities for competition. Increased competition 
brings prices down. So I thank the Senator for mentioning that.
  I believe our time has expired?
  The PRESIDING OFFICER. The minority's time has expired.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the next hour 
of debate be equally divided, as we have been doing, back and forth, 
with the first half under the control of the majority, the second half 
under the control of the Republican side.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Mr. President, I yield 10 minutes to the Senator from 
Illinois from the time on the Enzi amendment.
  Mr. DURBIN. I thank the chairman of the Finance Committee for his 
leadership on this issue and I thank my colleagues for joining in this 
debate. We are now starting the end of the fourth hour, into the fifth 
hour of this debate.
  I have listened to many of the speeches that have been given. They 
are not only good, they are familiar. They are familiar because most of 
the speeches which we have heard on the floor are critical of the 
Health Care Reform Act which passed the House of Representatives on 
Sunday night and was signed into law by the President this morning.
  Now, I can understand why some on the other side of the aisle did not 
like that. They did not vote for it. But the fact is, to come before us 
in this Chamber and to attack that now law of the land is to ignore why 
we are supposed to be here. We are here with a reconciliation bill that 
is basically designed to reduce the budget deficit.
  We have several provisions in this reconciliation bill which have not 
been addressed by most of the speakers on the other side. For example, 
did the Republicans oppose the reconciliation provision that makes 
health insurance premiums more affordable for those in lower income 
categories? That is what is in the reconciliation bill. If they oppose 
that, then they should come out and say just that.
  Do they oppose the expansion of community health clinics across 
America, more than doubling the number of community health clinics so 
there is more primary care so every family has a family doctor? Do the 
Republicans oppose that? Do they oppose family doctors for every 
family? If they do, step up and say so.
  Do they oppose the efforts in this bill to close the doughnut hole; 
in other words, to make sure that seniors under Medicare have help in 
paying for prescription drugs they do not have today? I have yet to 
hear the first Republican say he opposes it. Yet that is what the bill 
is before us.
  So the news flash to the Senate Chamber is, this morning the 
President of the United States of America signed into law the health 
care reform bill. To come before us and renew this debate is to ignore 
the measure that we are supposed to be considering, the reconciliation 
bill.
  I haven't heard all the speeches on the floor, but I want to know if 
the Republicans oppose the provision in the reconciliation bill that 
ends a $60 to $80 billion subsidy for banks across America on student 
loans. Do you think that subsidy for banks is good? If it is, stand and 
say so. I think it is bad. It adds to the cost of loans. It adds to the 
debt of young people. We eliminate it. If they think banks should enjoy 
this subsidy, let's hear it. Stand and address the provisions in this 
bill. But they haven't done it.
  Instead, what they have done is to file, at latest count, some 22 or 
24 amendments. Remember, this is a reconciliation bill about reducing 
the budget deficit. I leave it to those following this debate to decide 
whether these Republican amendments are serious efforts to address the 
budget deficit or something else. Here is one we have seen so many 
times before by one of the Republican Senators, attacking the ACORN 
organization. Unfortunately, this Senator's newspapers have not been 
arriving on a timely basis because if they had, he would know this 
organization is going bankrupt. But he wants us to stop on this health 
care debate, stop on this budget deficit debate, and go back and flog 
ACORN again, as they languish in bankruptcy court. Common sense tells 
us that doesn't have a thing to do with health care reform or budget 
deficit reduction. It is a political amendment.
  Here is an amendment by a Republican Senator to prohibit prescription 
coverage of Viagra for child molesters and rapists. I am not making 
this up. There is a fertile mind somewhere on the staff of the other 
side of the aisle dreaming up gotcha amendments. Here is one, Viagra 
for child molesters. Let's see if they will vote against that. Common 
sense tells us that doesn't have anything to do with health care reform 
or reducing the budget deficit. It is a political amendment. It is 
unfortunate.
  Here is one Members should be held accountable for, but the question 
is, Why would you debate it on this bill? An amendment to require all 
Members of Congress to read a bill before voting on the bill. I have 
been asked repeatedly: Did you read the health care reform bill? The 
answer is yes. I think our constituents should ask us that question. 
But are we going to make it the law of the land? Who is going to 
monitor the reading of these amendments and bills to make sure every 
page is read by every Member of Congress? Is this a commonsense 
amendment or is this a political amendment?
  Here is an amendment by a Republican Senator. You tell me what this 
has to do with health care reform or budget deficit reduction: to call 
for a referendum in the District of Columbia on gay marriage. What does 
that have to do with health care reform? The answer is nothing.
  What we are going to face in the next few hours or days, whatever it 
happens to be, are more and more amendments such as this that are not 
serious amendments. They don't deal with health care reform. They don't 
deal with the budget deficit. They deal with somebody's idea of a 
political gotcha, to offer an amendment to try to trap Members.
  I don't think we are going to fall for that. I think Members on this 
side of the aisle realize what is at stake. We need to pass this 
reconciliation bill so we can help pay for health insurance premiums 
for those in lower income categories, extend the reach of community 
health clinics, close the doughnut hole, make sure we are helping 
States pay for the new Medicaid burden they will face. I thought the 
Republicans were in support of that. Obviously, they are not.

[[Page S1850]]

  There is one point I would like to add. I have heard so many speeches 
by Republican leaders, including the Republican minority leader, that 
the reason why this whole effort is wrong is because the American 
people oppose health care reform. Another news flash: I wish to share 
with the Members of the other side of the aisle a poll announced today. 
When people were asked, after passage of the health care bill in the 
House of Representatives, whether they believe it is a good thing or 
bad thing that Congress passed the bill, good thing, 49, bad thing 40. 
By a 9-percentage margin, the American people say it was a good thing 
to do. America's emotional reaction on the bill, 50 percent 
enthusiastic or pleased, 42 percent angry or disappointed. I wonder if 
my Republican colleagues are now going to amend the premise that we 
should follow the opinion polls of America, now that the bill is passed 
and the American people, a majority, support this. Are they now going 
to change their position on whether opinion polls should drive our 
votes? I thought that was a pretty simplistic analysis to start with.
  Here is what it come down to. Many of us went to the White House 
today to watch the President sign a bill that will be historic in 
nature. Similar to Social Security and Medicare, it extends the reach 
of health care protection and peace of mind to millions of Americans 
who don't have it. It was a hard-fought battle; I will concede that 
point. The fact is, at the end of the day, we won that battle. The 
President signed that bill, and it is the law of the land. The so-
called Republican repealers, the ones who are going to run down in the 
next election to repeal it, better come and explain to small businesses 
across America, almost 4 million that are going to qualify for tax 
credits to help pay for health insurance. I heard all the comments from 
the previous speaker from Missouri, the Senator talking about be 
sensitive to small business. By opposing that bill, he opposed tax 
credits for almost 4 million small businesses. That bill will also 
extend health insurance to 30 million Americans who don't have it, 
Americans who, when they get sick and get treated, pass their bills 
along to other people. Those 30 million will have health insurance. 
That means less of a burden on those of us with health insurance to 
pick up their cost.
  I say to my colleagues on the other side of the aisle: The political 
amendments don't make sense. Most of the American people have had 
enough of them, amendments about ACORN and gay marriage on a bill on 
health care. It doesn't fit. Common sense tells us we should not be 
delaying the Senate's final decision on a critically important bill. If 
the Republican side of the aisle was waiting for American public 
opinion to express itself, the American people have spoken. They think 
we did the right thing in passing this bill on health care reform, and 
the President did the right thing signing it into law this morning. 
They don't want to repeal this help. They want all the help they can 
get for affordable health insurance for quality care.
  I yield the floor.
  Mr. BAUCUS. Mr. President, I yield 10 minutes off the bill to the 
Senator from Michigan, Ms. Stabenow.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, I thank the chairman of the Finance 
Committee, with whom I am honored to serve, and colleagues who have 
been working very hard on this initiative, as all our colleagues have. 
I wish to talk first about what is in front of us because it is true 
that today is a historic day. The President signed a very important 
bill, passed by the House and the Senate, that lays the groundwork for 
what we all believe should happen in terms of making sure every family 
has a family doctor and that we tackle the costs that are crippling 
businesses and the country. What we have in front of us now is a bill 
to make a good bill better. That is what we are doing. We are making a 
good bill better with what we are doing right now. It is tackling the 
issue of cost.
  We are saving money in this bill we will be voting on, saving money 
for middle-class families by making health care more affordable, saving 
money for seniors by making their prescription drugs more affordable, 
and saving money for our children and grandchildren because this is the 
largest deficit-reduction effort we have seen in many years--in fact, 
since President Clinton brought us into balance when the Democrats were 
last in charge.
  We know from the Congressional Budget Office and we now have 43 
leading health economists who all agree that health care reform will 
reduce the deficit, about $143 billion in the first 10 years and over 
$1.2 trillion in the next 10 years. This is important, as we go forward 
and get our House in order, to bring down the deficit and focus on 
jobs and other parts of the economy that are so important.

  What are we talking about, as our colleagues talk about the broader 
bill that has already been signed into law? What does that bill mean 
for families and businesses? First, starting right now, today, I was 
very pleased to author a provision to make the small business tax cut 
immediate. So as of today, for this year, small businesses are going to 
receive up to a 35-percent tax cut to help them afford health 
insurance. In my State, health care is very much about saving jobs. 
Health care costs are costing us jobs. We have too many small 
businesses getting a 20- or 30- or 40-percent premium increase notice. 
They are deciding: Do I keep people employed and cut the health 
insurance or do I pay the health insurance increase and lay people off?
  That is what is happening all across America. Our bill this year now 
begins a 35-percent tax cut for businesses that have 10 or fewer 
employees and a tax cut for those up to 25 employees. Four years from 
now, that tax cut goes up to 50 percent. So it starts at 35 percent and 
goes up to 50 percent of the cost for small businesses to help them pay 
for health insurance.
  Right now we are going to begin to see the largest effort to provide 
community health centers that our country has seen. Approximately 
10,000 neighborhoods, communities across the country will have the 
opportunity and funding to create a community health center so people 
who have lost jobs don't lose their health insurance, so people who 
don't today have health insurance will have a place to go to take their 
children to see a family doctor rather than to an emergency room. It is 
estimated we will be able to serve 25 million people by this effort 
that is starting today.
  Starting today, seniors are going to receive immediate help for their 
prescription drugs, if they are caught in that gap in coverage that has 
been called the doughnut hole. We are going to be closing that doughnut 
hole over time.
  What happens next? We are going to see lower costs for early 
retirees. This is a very important matter in the State of Michigan and 
other places where we have people being required or forced to retire at 
55 because of losing their job or because of cost-cutting efforts. I 
was proud to join with Senator Kerry in an effort to create a way to 
lower the cost for employers that have early retirees on their health 
insurance or for early retirees themselves, between 55 and 65. We will 
be bringing down the cost of health insurance for people. That is very 
important.
  No preexisting conditions for children. Insurance companies will not 
be able to block parents from getting insurance for their children. 
That is pretty important. Young people are going to be able to stay on 
their parents' insurance until age 26. I wish that one was a little bit 
higher. I kind of missed that one myself. But the reality is, for a lot 
of young people and a lot of parents, this is a very big deal. It is 
very important. I am surprised colleagues would want to repeal 
something that would take that away.
  We have, starting this year, a set of insurance reforms that will say 
the insurance companies can't cancel your insurance if you get sick. I 
have so many people who have said to me: I have insurance, but then all 
of a sudden somebody gets sick, and they find out a technicality. They 
get dropped. We are going to hold insurance companies accountable in a 
way that has not happened before in this country. We are going to 
eliminate lifetime limits on coverage. It is not your fault if you have 
cancer and you need treatments for a long period or you have some other 
kind of disease. There should not be artificial caps and lifetime 
limits.
  What this is about for us is that it is time to stand for middle-
class families

[[Page S1851]]

and small businesses. That is what we are doing. That is what we are 
doing by lowering costs, by saving money for families, saving money for 
seniors, saving money for future generations, for our children by 
lowering the deficit, by focusing on small businesses, where most of 
the people who don't have insurance are working. They are working in a 
small business that can't find affordable insurance.
  In the short run, we will help them with tax cuts and, 4 years from 
now, a larger insurance pool so they can buy from the private sector in 
a larger pool, such as big business does. That will bring down costs. 
This is about standing for middle-class families, standing for small 
businesses.
  What we are seeing, unfortunately, on the other side of the aisle, as 
the distinguished assistant majority leader informed us, are all kinds 
of amendments. First, they have nothing to do with health care, nothing 
to do with this bill. They are all about games. I say to colleagues on 
the other side of the aisle: Don't play games with Americans' health 
care. Do not play games with the lives of Americans who are counting on 
us to finish the job--to pass the bill in front of us, to make a good 
bill better, to be able to save money for Americans, and to be able to 
get this job done.

  We do not need more political games. I think the American people have 
seen enough. Frankly, I do not blame them for being frustrated about 
what happened and all that we have gone through in the last year. I 
share that frustration. They expect us to get things done. Frankly, 
they are not caring what configuration gets that done in terms of the 
vote. They want us to get things done.
  So I would ask colleagues to drop the games. We are going to get a 
lot of different kinds of amendments that are designed to embarrass, 
designed to hold things up. I would ask colleagues to please stop the 
games. Do not play games with Americans' health care.
  In conclusion, I would simply say again, health insurance reform is 
about a family doctor for every family. Isn't that what we want--the 
ability to know that when you tuck the kids in tonight, if one of them 
gets sick, you are going to be able to call the doctor, you are going 
to be able to care for your children, you are going to be able to get 
insurance for them, and you are going to be able to know that your 
children are going to get the care they need because you have a family 
doctor?
  That is what this is about, fundamentally. It is about a set of 
values that starts from the premise that everybody in America, every 
family, should have a family doctor. This bill in front of us completes 
that task and sets us on the road to fulfill that vision. I urge 
colleagues to vote for this bill, put aside the games, and let us get 
on with the business of our country.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I yield 10 minutes to the Senator from 
California, Mrs. Boxer, off the bill.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Thank you, Mr. President.
  In 1912, a Republican President named Teddy Roosevelt ran for the 
Presidency on a platform that promised national health care reform. 
Today, I had the privilege of watching President Barack Obama sign into 
law a landmark bill that is being perfected today in the legislation 
now before the Senate. It was quite a moment. The Senate health care 
reform bill the President signed today gives small businesses tax 
credits to help them purchase insurance for themselves and their 
employees. In my State of California, that is 400,000 businesses that 
will have access to tax credits.
  The new law is very important to early retirees because it will 
ensure lower insurance rates, and we will see a high-risk pool so that 
in my State, and all States, adults who cannot get insurance because of 
a preexisting condition will be able to do so.
  The bill the President signed prohibits preexisting condition 
exclusions for children. So if you have insurance, but your child has 
asthma or diabetes or something else, and they cannot get covered, that 
discrimination is over. It ended today. The new law will cover 
preventive services such as mammograms and vaccinations at little or no 
cost.
  This bill is so important--I should say this law because it is now 
the law--is so important for our people. It will create new community 
health care centers throughout our States, and we will see primary care 
doctors serving in those community health care centers, and nurses. It 
will require 80 percent of premium income to be spent on our health 
care--not on outrageous bonuses for the CEOs. They cannot say that 
overall they have spent 50 percent on us, the policyholders, and 50 
percent on themselves. That is called medical loss ratio, and we have 
fixed it in this law.
  Seniors on Medicare will get free preventive care, and we have a new, 
voluntary, long-term care insurance program that people can buy into 
starting in 2011.
  In 2014, even more things are added to this extremely important list 
of benefits. Health insurance exchanges will open so that there is a 
marketplace for businesses, families and individuals to go. It is going 
to help us make better choices and have more choices. It provides tax 
credits to help individuals and families with incomes below $88,000 to 
purchase insurance through the exchange. So this has a lot of benefits 
for our working families and our middle-class families. We go up to 
$88,000 for a family of four. It expands Medicaid to cover families 
earning less than $29,000. Now it is a much lower level. So these are 
very good things.
  The bill before the Senate now--this is our unfinished business. We 
need to make a good bill better, and that is what we are doing today. 
How do we do it? The bill before us entirely closes the gap in Medicare 
drug coverage. It starts with a $250 rebate to those senior citizens 
who are in that doughnut hole, that payment gap. In my State, it is 
about 800,000 senior citizens. Imagine, 800,000 senior citizens in my 
State, when we pass the bill, will get $250--each one of them, if they 
have fallen into the coverage gap.
  It allows young people to stay on their parents' insurance until they 
are 26. That happens this year. How many stories have we heard about 
young people who may have--I use asthma as an example--who get kicked 
off their parents' health care? They have to. An insurance company 
says: We are not going to insure you, and they are in deep trouble. The 
bill before us today says to an insurance company: No more rescissions. 
That is a cancellation of a policy when you get sick. You can not do 
that anymore. And no more lifetime limits on your plans. Because a lot 
of times when people get sick--they did not read the fine print--they 
find out they are up against a limit. If they have a serious condition 
such as cancer, they may reach that limit. What happens is, they have 
to, in many cases, sell their home, sell their possessions, and they 
declare bankruptcy. No more. Insurance companies cannot do that--once 
we pass this bill tonight, and once it is signed.
  So there are many good things in the bill the President signed 
today--things that are very important to our families and very good 
things to make that bill better in the bill before us.
  I hope we are not going to see the kind of tactics that some on the 
other side have said they are going to use, by offering amendments that 
have nothing to do with anything except killing this very important 
bill.
  I want to say, there are so many improvements in this bill. For 
example, Medicaid. My State will be able to put millions of people on 
to Medicaid--1.7 million people, to be exact. And my State, as all 
other States, will get 100 percent reimbursement for that in the years 
2014, 2015, and 2016.
  We are going to see 32 million more people in our Nation have access 
to health insurance. The Medicare trust fund will be extended by 9 
years. My State benefits greatly. There are many ways I have already 
discussed. But I want to lay this out. By 2014, up to 7 million 
Californians will finally have access to health insurance, and it will 
reverse a horrible trend, year after year people not able to get it.
  I want to spend a moment to address Republican concerns that the 
process was partisan. I think it is important to note over and over 
again that the bill that was signed by the President today, that is 
going to help so many of our people, contains 147 Republican 
amendments. Let me repeat that. The

[[Page S1852]]

bill the President signed today contains 147 Republican amendments.
  For example, there is an amendment by a Republican colleague that all 
Members of Congress and their staff have to enroll in the exchanges. 
That is in the law. There is an amendment by another Republican Senator 
to allow premium rates to vary by tobacco use. That was accepted and is 
now law. There is an amendment to ensure that the voluntary long-term 
insurance program, the CLASS Act, remains solvent over 75 years. We 
have taken those amendments. They are now law.
  Now my Republican friends are saying they want to repeal the bill. 
This is going out all across the airways. They want to repeal the bill. 
And they say if a lot of us lose, and they can get more votes here, 
they are going to repeal the bill. So I want to ask a few rhetorical 
questions.

  Which of the protections in the bill do they want to repeal? Do they 
want to repeal the end of gender rating, where women have had to pay 
much more than men? Do they want to repeal the protections for our 
children, who will now have coverage even if they have a preexisting 
condition? Do they want to repeal free prevention services, such as 
vaccinations or mammograms? Do they want to repeal the prohibition on 
lifetime caps on insurance policies? Or maybe they want to repeal the 
$250 rebate for prescription drug costs to seniors.
  Well, do they want to repeal other things? There is a law now that 
says you cannot get kicked out of your insurance plan when you get 
sick. That is the one I described before: no rescissions. Do they want 
to repeal that? Or maybe they want to repeal generous tax credits for 
small businesses.
  I guess they want to repeal all of these things because they said 
they want to repeal the entire law. But I would urge them to stand up 
and tell their constituents exactly which of these provisions they want 
to repeal. I want to put it on the Record that I look forward to that 
battle because I can tell you the letters to my office are saying: 
Please, please protect us. We feel vulnerable.
  I wish to state at this time that this bill reduces the deficit in 
addition to doing all these other things. In closing--and I would ask 
how much time I have?
  The PRESIDING OFFICER. Thirty seconds.
  Mrs. BOXER. OK. I would say, in closing, that a lot of fear has been 
injected into this debate. And you are going to get a barrel of it 
coming up. There is one thing to fear, and that is doing nothing. It is 
unsustainable. Mr. President, 14,000 people lose their health insurance 
every day; 1,400 in my State. Sixty-six percent of bankruptcies are 
linked to a health care crisis. Mr. President, 45,000 Americans die 
every year because they have no health insurance.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mrs. BOXER. So let's do something. Let's do this. Let's finish the 
job.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized.
  Mr. BARRASSO. Thank you, Mr. President. I ask unanimous consent to 
proceed in a colloquy with a number of my colleagues.
  The PRESIDING OFFICER. Against which block of time will this be 
charged?
  Mr. BARRASSO. The next 30 minutes for the Republicans.
  The PRESIDING OFFICER. Off the bill?
  Mr. BARRASSO. Yes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BARRASSO. Thank you, Mr. President.
  I come to discuss an amendment that has to do with the fact that--as 
I read this bill, as I talk to my colleagues who are physicians, as I 
talk to Senators--I believe this bill that was signed into law, as well 
as the reconciliation bill that is before this body right now, is going 
to significantly increase the cost of health insurance premiums paid by 
American citizens.
  I am bringing up an amendment tonight that says if the Department of 
Health and Human Services certifies that premiums will rise faster 
under this Democratic health care bill signed into law, and the 
reconciliation bill, than they would under current law, then the 
provisions of the bill will sunset. Because we have been promised--the 
American people have been promised--that by passing this law, what 
would happen is that the cost of their own health insurance premiums 
would go down. The President of the United States promised it. The 
President of the United States, while campaigning, talked about that, 
made that promise, and then early in his term said he would actually 
lower the premiums for families by an average of $2,500 per family for 
the cost of their health care insurance. That is what the President 
said.

  So then the bill is written behind closed doors. People had very 
little input. That bill came out, and then Senator Richard Durbin, the 
Democrat from Illinois, the majority whip, comes to the floor on March 
10 and says: Anyone who would stand before you and say, Well, if we 
pass health care reform, next year's health care premiums are going 
down--which is what the President has said--anyone who says that I 
don't think is telling the truth. He went on to say: I think it is 
likely they would go up--they would go up. What we are trying to do, he 
said, is slow the rate of increase.
  Well, only 2 days before Senator Durbin said that on this floor, the 
President was in Glenside, PA, and he said: Our cost cutting measures 
mirror most of the proposals in the current Senate bill which reduces--
he said--reduces most people's premiums.
  Mr. McCAIN. Mr. President, may I ask my colleague whether he recalls 
when at Blair House our colleague from Tennessee began the discussion 
with the President and our Democratic colleagues, and he said at that 
time that the Congressional Budget Office said premiums would increase 
from 10 percent to 13 percent for individuals purchasing health 
insurance? That comes out to $2,100 more for a typical family. The 
President challenged that, as you may recall, and said: Well, we are 
going to settle this before the end of this--what later turned out to 
be 7 hours of fun.
  So what was the answer to that, I ask Dr. Barrasso. What was the 
answer? Was Senator Alexander correct when he quoted the Congressional 
Budget Office that premiums would increase by 10 percent to 13 percent 
for individuals purchasing health insurance or was the President 
correct by saying that was not true?
  Mr. BARRASSO. Well, Senator Enzi, who has joined us on the floor, was 
also sitting with us that day at Blair House, and my recollection and 
from doing the research afterward and the press reported that Senator 
Alexander was correct. Individuals buying health insurance in the 
individual market would see their health insurance premiums go up by 10 
percent to 13 percent if this bill becomes law, and the President 
signed it into law today.
  So the American public needs to know that their insurance premiums 
are going to go up as a result of what the President signed today, and 
I am bringing up an amendment opposed to that.
  Mr. ENZI. That is exactly what was concluded in that Blair House 
meeting. It was supposed to be a listening session, but nothing appears 
to have been listened to. Nothing was included from any of the multiple 
suggestions the Republicans made there.
  About the 10 percent to 13 percent that premiums are going to 
increase, there is a very important addition to that. It is 10 percent 
to 13 percent more than if we did nothing. The President keeps talking 
about how we need to do this bill because health care costs are 
escalating dramatically. And they are. But they are going to escalate 
even faster--10 percent to 13 percent more--than if we did nothing.
  Mr. McCAIN. Could I ask Senator Enzi, then, what was the President 
referring to? In fairness to the President, what was he referring to 
when he challenged the assertion of the Senator from Tennessee that 
individual premiums would go up by some 10 percent to 13 percent?
  Mr. ENZI. I am not exactly sure what he was referring to. He has used 
that in the numbers speeches, just as they keep using the number that 
this bill will reduce the deficit by $138 billion. Again, you have to 
read the rest of the sentence and find out that is if we don't take 
care of all of the things we normally take care of, such as the doc 
fix, which is going to cost $300 billion, which more than uses up that 
money.

[[Page S1853]]

  Mr. McCAIN. So it seems to me pretty legitimate to hold the President 
and the sponsors of this legislation to their word; that is, if it 
doesn't increase the premiums, then they are true to their word, but if 
it does increase premiums, then the American people have not been told 
the truth. Therefore, this legislation should be scrapped and we should 
start all over.
  By the way, may I add one point? I have grown a little weary--a lot 
weary--about when they say to do nothing will do X, Y, and Z. We are 
not talking about doing nothing. We are talking about medical 
malpractice reform. How does anybody excuse the fact that there is not 
medical malpractice reform in this legislation? There is only one 
answer. It is that the trial lawyers control this legislation, and that 
is disgraceful.
  Mr. GREGG. If the Senator will yield, I think it is important to 
understand why the premiums go up so that the argument that they don't 
go up can be pointed out as being really transparently inaccurate. The 
reason the premiums go up is because under this bill, Americans who 
have health insurance will be forced to buy more expensive health 
insurance. They are going to be forced to buy health insurance which is 
at a much higher level of coverage for a lot of things which many 
Americans simply don't need and therefore don't buy it today. They are 
going to be required to buy that higher cost health insurance, and that 
is going to force up the premiums.
  This is a classic, top-down you do what the government says relative 
to what type of health insurance plan you are going to be able to buy 
plan, which we should expect from this administration. But we should 
not deny that it has an immediate impact on the cost of that health 
insurance and that CBO has said--as both Senators from Wyoming have so 
accurately pointed out, CBO has scored this as increasing the premiums 
for individuals because of that; is that not correct?
  Mr. BARRASSO. That is absolutely correct. The nonpartisan 
Congressional Budget Office says it is going to go up. The Joint 
Committee on Taxation says people are going to have to end up paying 
more in health care premiums than if there was no bill at all. The 
Chief Actuary for the Centers for Medicare and Medicaid Services said 
the same, as did eight additional private sector studies. They all 
confirm that the health care reform bill signed into law today will 
drive insurance costs up greater than if there was no bill at all 
signed into law.
  There are mandates we are putting on young people who are going to be 
forced, many of whom are going to be forced to buy insurance, forced by 
this law--all of them are going to be forced to buy insurance that many 
of them don't need, many of them don't want, and many of them can't 
afford, because they are going to have to buy levels that are far in 
excess of what they might want. It is going to be very expensive, as 
many of them are going to be subsidizing others because of what is 
called the community rating and the way this whole program has been set 
up.
  Mr. McCAIN. May I ask the Senator from New Hampshire--just a personal 
point. Suppose we had decided to do away with the tax benefit for 
employer-provided health insurance and given every American family a 
$5,000 refundable tax credit. Would we have then been able to provide 
the ability to acquire insurance to some 30 million Americans?
  Mr. GREGG. Yes, I think the Senator is right, and the type of 
insurance they would have gotten would have been the type of insurance 
they wanted. If you are a young person today and you are not buying 
health insurance, it is probably in many instances not because you 
can't afford it. In fact, it is estimated that of the uninsured 
population, of the 47 million uninsured, approximately 20 million have 
incomes over $70,000, and they can afford insurance. They just simply 
decided they are not going to buy it.
  If you gave them this refundable tax credit, what they could buy is a 
catastrophic plan so they could assure themselves of coverage in the 
case of that accident or that catastrophic disease that might wipe them 
out financially, and it would probably be more tailored to what they 
want as opposed to what some bureaucrat here in Washington wants or 
what the President of the United States wants or what somebody here on 
the other side of the aisle decided they should have.
  Mr. LeMIEUX. If my colleague will yield, this is really a bait-and-
switch. During the campaign, President Obama said this is about 
lowering the cost of health insurance. We know the cost of health 
insurance has gone up 130 percent in the past 10 years. The debate was: 
Don't you want your health insurance to be lower? And the American 
people said: Sure, yes. Of course they did. The switch is what this is 
all about, which is putting more people into Medicaid. It will put 15 
million more people into a program that is failing; a program where 
Walgreens in Washington State is no longer taking Medicaid; a program 
where doctors are no longer taking Medicaid. It is not health care 
reform if the doctor is not in. But for the rest of Americans, the 159 
million people who have health insurance, their costs aren't going to 
go down. In fact, their costs are going to go up.
  I ask my friend, the Senator from Arizona, who comes from a State 
where there is a population just like Florida with a lot of seniors, 
what do we say to our seniors, our seniors who are now going to have a 
cut in Medicare of $500 billion-plus to finance this big expansion in 
Medicaid? How do we justify that to them?
  Mr. McCAIN. And the program, I am sure Dr. Barrasso and Senator Enzi 
would agree, that is going to be cut the most is a program called 
Medicare Advantage where seniors do have some relative choice as to 
what type of care they wish to receive. Fortunately, the 800,000 
enrollee carve-out has been removed because of the national attention 
it got.
  Mr. BARRASSO. There is an advantage to Medicare Advantage. That is 
why people signed up for it, as 11 million Americans have. The 
advantage works with coordinating care, prevention of illness and 
disease. That is why people want to be in that program. But now the 
President is eliminating it.
  My colleague from Florida talked about the 15 million people dumped 
onto Medicaid, and the New York Times reports that as Medicaid payments 
shrink, patients and doctors drop out. The President is not only 
dumping on 15 million through the health care bill, with the bill we 
are discussing right now, the reconciliation bill, it also adds another 
million people to those rolls dumped into Medicaid.
  Mr. McCAIN. So perhaps the worst fraud being perpetrated in this 
entire legislation is the doc fix. No one who is an expert on health 
care believes we are going to cut physicians' payments for treatment of 
Medicare enrollees by 21 percent. No one. Yet that is calculated in so 
there can be this phony actual reduction in the deficit.
  Mr. BARRASSO. And for the ginned-up numbers we have been presented by 
the Democrats to work where they say we have actually helped lower the 
deficit, for it to work, in the next couple of months they would have 
to cut doctors' fees for all of the Medicare patients they take care of 
by 21 percent and then keep those fees frozen at that low level for the 
next 10 years. Now, is that going to happen? But if it doesn't happen--
and I ask the accountant from Wyoming as opposed to the surgeon from 
Wyoming--from an accounting standpoint, can you do that?
  Mr. ENZI. The Senator from Wyoming not only is correct that we are 
going to have a huge problem, but something that is new in the 
reconciliation bill besides this 21 percent that, of course, we are 
going to have to fix and that is going to cost us $300 billion--and all 
of the proposals so far have not paid for that proposal--they slipped 
in a little cliff in there for Medicaid this time, too, and in 2 years 
we are going to drop off a cliff with Medicaid just the same way as 
Medicare. Does anybody believe we won't fix that? That is going to 
drive up the deficits too.
  Wasn't everybody promised catastrophic care as one of the 
Presidential promises? It kind of fascinates me that Medicare doesn't 
have catastrophic care unless you buy Medicare Advantage, and then you 
can have the catastrophic care. But we are trying to get rid of 
Medicare Advantage now and force all of those people into a different 
kind of insurance.
  I appreciate the Senator from New Hampshire mentioning mandates. Yes,

[[Page S1854]]

they are going to require you to have a lot more different kinds of 
insurance than you might want to have. We are going to say: The Federal 
Government knows best, and this is the minimum insurance you can have, 
and you are going to have to buy it or we are going to put a mandate on 
you--another mandate.
  This is the mandate for what you have to get in health care, but 
there is also going to be a mandate that says every single person has 
to buy insurance. There are a lot of people right now who make a good 
living, who are healthy, who don't think they need insurance and won't 
buy it. They will pay the penalty up until the time they have a 
preexisting condition, and then they will jump into the market and that 
will drive up the price for everybody else.
  So there is a whole lot of accounting finagling that is going on to 
make different statements possible. But it is going to drive up the 
premiums, it is going to cause people to get more insurance than they 
want to get, and it is going to cause everybody to have to get 
insurance whether they want to or not.
  In the history of the United States, we have never had the Federal 
Government tell anybody they had to buy something. We have set up 
safety measures in their purchasing to protect them, but we haven't 
said you have to buy it. In this case, we are going to say you have to 
buy it, and there are a whole bunch of people who say that is 
unconstitutional.
  Mr. LeMIEUX. If the Senator will yield on a point made by my friend 
from Wyoming, isn't it amazing that the Federal Government is going to 
penalize--send an IRS agent to tax you if you don't buy health 
insurance, if you fail to take it out. Has the Federal Government ever, 
in the history of our country, penalized a person for failing to 
act? That is why we have these folks around the country who are experts 
in the Constitution, folks such as my attorney general in Florida, Bill 
McCollum, who is going to bring a lawsuit against this bill because the 
commerce clause has never been interpreted to say your failure to do 
something is in the realm of Congress. Imagine this, if you can say to 
somebody: Your failure to purchase health insurance is within the role 
of the Federal Government. Why can't the Federal Government say you 
have to go to the gym or you have to eat your broccoli? What can the 
Federal Government not do if it can do this? It is beyond the Framers' 
intention. It is beyond any of the Supreme Court law.

  When you think about our relationship to our government, we are 
supposed to have the rights. Our Declaration of Independence says we 
have the rights and we give them up to the government. The government 
is with the consent of the governed. But in this situation, it seems 
the Democrats believe the government knows best.
  I wish to make one other point about this cost issue. In the last 10 
years, health insurance has gone up 130 percent. The reason why this 
bill will not control the cost of health care is because it takes the 
consumer out and keeps the consumer out of the equation. The consumer 
has no motivation to reduce the cost of health care.
  We did not do the tax credit idea that the Senator from Wyoming 
mentioned, which would put the consumer back in the game, make the 
consumer conscious of prices, and make a competitive environment that 
would actually reduce health care costs.
  I wonder if my colleague and friend from Wyoming might speak to that 
point because I know he was very much involved as author of this idea 
of giving us tax breaks.
  Mr. ENZI. I appreciate the Senator from Arizona bringing that up 
because when he mentioned tax credits in his campaign, he was chastised 
by now-President Obama, saying that cannot happen, that is terrible. 
You will find that slipped into the bill anyway. So far, it just 
catches the top insurance people. They are going to be taxed--no, they 
are not going to be taxed because it is shoved in as a hidden tax, so 
it does not expose they are actually doing what the Senator from 
Arizona was suggesting. It is going to be a hidden tax the company is 
going to have to pay, but the company is going to take it out on the 
employee. It is another way they are going to tax and tax, raise prices 
or lower benefits.
  The price on insurance is going to go up because right now the 
insurance companies are trying to protect themselves. On the one hand, 
they have been protected a lot in this bill. We are accused of helping 
out the insurance companies, but take a look at some of the stuff that 
helps out the insurance companies with the individual mandates, the 
employer mandates and those things. At the same time, they are being 
threatened that they are going to be price fixing.
  I was in the shoe business with my wife. When we first went into the 
shoe business, Nixon was talking about fixing prices. In response, the 
companies immediately raised the price of shoes 50 percent, and then 
every time they were allowed to raise the price again, they did. Within 
1 year, shoes cost twice as much as before. That is what happens when 
government interferes. This is government interference. It is going to 
cause premiums to go up and prices to go up.
  The other side says: Don't worry about it, there are subsidies. From 
where are the subsidies coming? Oh, yes, we are going to take $\1/2\ 
trillion from Medicare and put it in new programs which are subsidies, 
and besides that, we are going to come up with $\1/2\ trillion in taxes 
and that is going to go for the new subsidies. Does anybody in America 
believe you can put in new programs at a cost of $1 trillion and it is 
not going to cost any of us a dime? Of course not. The seniors know it 
and the people who will be paying the premiums are going to know it and 
the companies are all going to know it.
  Whom are they going to be mad at? They are not going to be mad at 
Republicans because not a one of us voted for it. On this 
reconciliation bill, I don't think they are going to be mad at us on it 
either. They can see what is happening. Premiums are going to go up, 
just as the other Senator from Wyoming mentioned.


                           Amendment No. 3582

  Mr. BARRASSO. If I may interject, that is why I have an amendment at 
the desk that deals with this specific aspect in the bill that is going 
to cause premiums to go up higher, in my opinion, than if nothing were 
done at all. If that actually happens because the President and the 
Democrats have promised something different, then we ought to sunset 
the entire bill. With that, I call up the amendment that is at the 
desk.
  The PRESIDING OFFICER. Is there objection?
  The Senator from Montana.
  Mr. BAUCUS. I ask unanimous consent that once the time on the 
Barrasso amendment expires----
  The PRESIDING OFFICER. The Senator from Montana does not have the 
floor.
  Mr. BAUCUS. Can the Senator from Montana ask unanimous consent for 
the floor?
  The PRESIDING OFFICER. The Senator from Wyoming has the floor. There 
is a unanimous consent request pending to offer an amendment. Is there 
objection?
  Mr. BAUCUS. Reserving the right to object, will the Senator agree to 
modify as follows: that once the time on his amendment expires, the 
amendment be set aside until a time to be determined by the leaders.
  The PRESIDING OFFICER. Does the Senator so modify his request?
  Mr. BARRASSO. Yes.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS. No objection.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report.
  The legislative clerk read as follows:

       The Senator from Wyoming [Mr. Barrasso] proposes an 
     amendment numbered 3582.

  Mr. BARRASSO. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

 (Purpose: To ensure that Americans can keep the coverage they have by 
                      keeping premiums affordable)

       At the end of subtitle B of title II, insert the following:

     SEC. 2__. AFFORDABLE PREMIUMS AND COVERAGE.

       The implementation of the Patient Protection and Affordable 
     Care Act (and the amendments made by such Act) shall be 
     conditioned on the Secretary of Health and

[[Page S1855]]

     Human Services certifying to Congress that the implementation 
     of such Act (and amendments) would not increase premiums more 
     than the premium increases projected prior to the date of 
     enactment of such Act.

  Mr. BARRASSO. Mr. President, how much time do we have remaining?
  The PRESIDING OFFICER. There is 7\1/2\ minutes remaining.
  Mr. BARRASSO. Mr. President, we have a number of colleagues on the 
floor, and we believe absolutely this amendment is critical because it 
goes specifically to the heart of the promises that have been made to 
the people of our home States and the people of the country.
  The promise made to the 85 percent of Americans who have coverage 
they like is that their costs would actually go down. But yet as I 
travel around my State and around the country, I see people are very 
worried that this bill that cuts Medicare for our seniors, raises taxes 
on all is loaded with sweetheart deals, is going to cause their health 
insurance premiums to go up at a time when they believe the quality of 
their care will go down.
  Mr. GREGG. Will the Senator yield?
  Mr. BARRASSO. Yes.
  Mr. GREGG. I wish to make one point I hope is obvious to everyone. 
This amendment simply says that if the premiums rise faster than what 
they would under current law, then the bill will not go into effect. 
Isn't that what it says?
  Mr. BARRASSO. That is exactly what it says.
  Mr. GREGG. It is basically reinforcing what the other side of the 
aisle claims and what the President claims. Why should there be any 
opposition to something that basically puts into place the language 
which enforces what the President has claimed he is doing and what the 
other side of the aisle is claiming they are doing? Can the Senator 
from Wyoming think of why there would be opposition to this amendment?
  Mr. BARRASSO. It should be unanimously accepted, with all sides 
agreeing because that is what the promise was to the American people 
when this bill was brought forth and when the President first addressed 
the Nation, that he wants to get the cost curve down, the cost of 
insurance down to $2,500 per American family. We just want to hold 
folks to the promises that have been made to the American people.
  The American people have spoken overwhelmingly and loudly in 
opposition to the bill that has come out from behind closed doors for 
them to finally see and try to understand all the machinations and 
maneuvers. They ultimately looked at it and in overwhelming numbers 
said: We don't want this for ourselves, for our families, for our 
neighbors or for our country. Yet it was crammed down the throats of 
the American people.
  I bring up this amendment tonight to say that I wish to hold those 
who voted for this bill to the promises they made to the American 
people. If, in fact, insurance premiums go up faster because this bill 
has become law than they would have gone up without this bill, then the 
law is no longer in effect.
  As I look to colleagues from other States, I imagine this is what you 
hear in Florida when you head home for the weekend: What have we been 
promised? What are we going to get? How are we going to hold people to 
the promises made?
  Mr. LeMIEUX. I thank my good friend and doctor for bringing up that 
point. My constituents in Florida say we care about the rising cost of 
health insurance, so I think the Senator's amendment is exactly on 
point.
  If this bill makes the situation worse, it should not go into effect. 
Why would any of the 100 of us not support the Senator's amendment if 
we are not going to control the cost of health insurance? That is what 
we are supposed to be about. That was supposed to be the No. 1 goal.
  It is a great amendment. I certainly will support it. I hope all our 
colleagues do. I think the challenge to our colleagues on the other 
side of the aisle is I know they do not want to take any of our 
amendments. I know they just want to cram this through and get it done 
so it does not have to go back to the House of Representatives. But the 
duty of our friends on the other side of the aisle is as always, as it 
is our duty, to enact good laws and make things better.
  If there is an amendment such as this one that is good for the 
American people, it is their duty, I respectfully suggest, to vote in 
favor of it, even if it has to be sent back to the House of 
Representatives. Because when we go home to our constituents, they are 
going to ask us: Did you lower the cost of health insurance?
  I am going to have to go home to more than 3 million Floridians on 
Medicare who continue to question me and say: Why are they taking $\1/
2\ trillion out of our Medicare? Why is there now $200 billion coming 
out of the Medicare Advantage? Over the next 12, 24, 36 months, I am 
not going to enjoy the conversations with my constituents, even after 
my time in the Senate is through, who come to me and say: Why can't I 
go to Medicare Advantage anymore? Why did they shut down that program? 
Why can't I keep the health insurance the President told me I could 
keep? Why did my employer drop me?
  The estimate is that 33 percent of folks on Medicare Advantage by 
2015--this is Rick Foster saying this--are going to lose it. We have 
more than 1 million people on Medicare Advantage in Florida--more than 
1 million. These are going to be tough questions to answer.
  I applaud my colleague, the good doctor, for bringing this forward. 
It is exactly the right thing to do. I hope our colleagues on the other 
side of the aisle will have the courage to accept these amendments that 
are in the best interests of the people of the country.
  Mr. President, how much time do we have remaining?
  The PRESIDING OFFICER. There is 2 minutes remaining.
  Mr. BARRASSO. Mr. President, we continue tonight to bring forth to 
the American people our concerns about a bill that I believe from my 
years of practice in medicine, taking care of families in Wyoming, and 
now as a Senator for the last several years, is going to be bad for 
patients, it is going to be bad for providers, the nurses and the 
physicians who take care of those patients, and it is going to be bad 
for payers, people who pay for their health insurance, people who pay 
taxes in this country, the taxpayers of this country as a bill 
continues down the road which is going to contribute to the debt, 
contribute to the deficit and, as I hear, week after week at home in 
telephone and townhall meetings, the debt is the threat.
  Our spending at this point is unsustainable. It is irreversible. It 
is irresponsible. I bring this up to say we cannot pass bills in the 
Senate and have them signed into law which promise one thing and do 
something very different--promises to help people and ends up hurting 
our Nation, hurting our economy, hurting our jobs, hurting the 
opportunity to hire more people with mandates, hurt young people who 
are trying to buy insurance because their rates are going to go up.
  This is a bill that is going to cost all of America in ways in the 
decades to come that, from a financial standpoint as well as a health 
standpoint, are going to be detrimental to our Nation.
  I say with my colleagues on the floor, please, take a very serious 
and close look at this amendment because the American people should not 
be promised one thing during a campaign and during a bill being written 
and then when it comes into law, they are going to see something very 
different, which is going to be detrimental to them, much more 
expensive for them, for their families, and impact on the kind of care 
they want for themselves and their families. That is why when I have 
townhall meetings in Wyoming and other States and people raise their 
hand, they think the cost of their own care is going to go up and the 
quality of the care is going to go down.
  I yield the floor.
  The PRESIDING OFFICER. The Senator's time has expired.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that we have an 
additional hour available, one-half hour each side, as has been the 
practice.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. I yield 10 minutes to the Senator from Washington, Mrs. 
Murray, off the bill.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, throughout this debate, I have come to

[[Page S1856]]

the floor to share the stories of families and small business owners 
from my home State of Washington who were suffering under our broken 
health care system.
  I talked about Washington State small business owners, from Kitsap 
and Kennewick--good people who wanted to cover their employees but who 
could not afford to continue to pay the skyrocketing premiums. I spoke 
about mothers and fathers in Seattle and Spokane, grandmothers and 
grandfathers east of the Cascades and the west--men and women from 
every part of my State, some barely holding on to their health 
insurance and some with no coverage at all.
  I told the stories of so many people from so many different 
backgrounds, but each one of them shared a common thread: the health 
care system we have today didn't work for them. It failed our families 
one way or another over and over again.
  I have received well over 10,000 letters from Washington State 
residents, and too many of them share that theme: stories of coverage 
dropped when they needed it most, premiums going up at rates of 20 or 
30 or 40 percent, seniors struggling after falling into the doughnut 
hole. Terrible stories--stories of loved ones who were lost, of 
children and patients, brothers and sisters, stories about what they 
had to go through before they passed away--battling insurance 
companies, losing their coverage, fighting for their care, never giving 
up but fighting against powers too great for them to bear.
  That is why I have fought so hard to reform our broken health 
insurance system--to fight for our families who need help, to level the 
playing field for people who just need a little support--for families 
with real struggles and real problems that we can work together to 
help. And that is why I am so proud to stand here today and say to 
those families, and so many others, that although we have not fixed 
everything that is wrong with our health care system overnight, we have 
taken a real step forward for people across my home State of Washington 
and across America.
  Today, when President Obama signed health insurance into law, a 
number of significant improvements kicked in, and some of the worst 
practices of those insurance companies were tossed into the dustbin of 
history. Great changes went into effect immediately for families and 
small business owners, for children and seniors in Washington State and 
across the country.
  Now that this bill is signed into law, if you ever worried about 
losing your coverage when you or a family member got sick, you don't 
have to worry anymore. It is no longer allowed. Now that this bill is 
signed into law, no family ever has to worry about the unreasonable and 
unfair lifetime caps on coverage that we have seen from insurance 
companies in the past. Now that this bill has been signed into law, 
never again will families have to fight for the preventive services 
they paid for and they deserve--families such as the Labrums, from Port 
Orchard, WA. Joseph Labrum sent a letter to me about his wife who went 
to her doctor complaining of pain in her breast. A mammogram failed to 
show anything, but she personally wasn't convinced. She knew something 
wasn't right and she knew there was a history of breast cancer in her 
family. So she asked for an MRI, but her doctor told her that her 
insurance company wouldn't pay for it, and she just couldn't pay for it 
on her own. After 3 years of fighting with her insurance company, 3 
years of pain and uncertainty, she was finally able to convince them to 
take that test. By that time, her cancer had grown to 8 centimeters and 
required a full mastectomy, chemotherapy, and 8 weeks of radiation.
  Joseph told me that he is convinced if his wife's care had been up to 
her doctor and not her insurance company she would have been cured with 
a minor lumpectomy and wouldn't have had to go through so much pain and 
suffering.
  The bill President Obama signed into law today makes sure that 
starting today insurance companies will be required to cover preventive 
services with little or no cost on the part of Washington State 
patients. Starting today, Washington State families will have access to 
new streamlined assistance to help them appeal services that have been 
denied or not covered adequately by their insurance companies. This is 
going to help anyone who has ever felt buried under a blizzard of forms 
and denials, and it will start helping our families right away.
  For small business owners, starting today, the health insurance 
market will begin working better for them. Starting today, people such 
as Mark Peters, the owner of a small technology company in Port 
Townsend, WA, will be able to better afford care for his employees. 
Months ago, Mark wrote to tell me that he offers insurance to his 
employees. He does the right thing. But last year, he got a letter from 
his insurance company raising rates by 25 percent. Mark told me his 
small business can't sustain increases like that. No business today 
can.
  In our current health insurance system, small businesses are often at 
the mercy of the insurance company. They lack the leverage, they lack 
the negotiating power of larger firms, and they can't afford to hire a 
human resource department to spends days fighting and haggling for 
better rates. But those days are coming to an end. Starting today, 
thanks to the bill President Obama signed, small business owners such 
as Mark will immediately qualify for the first phase of a tax credit 
program to help them purchase insurance for their families and for 
their employees. That credit that will kick in immediately is up to 35 
percent of the employer's contribution to coverage, which is going to 
make a huge difference for almost 100,000 small business owners in my 
State of Washington right away.
  Starting today, if you are a young person or a senior citizen, you 
will also be helped immediately. Over 159,000 Washington State seniors 
who fall into that doughnut hole are going to have their brand-name 
prescription drug costs cut in half starting right away. The law that 
passed begins to close this destructive coverage gap, and the bill we 
are discussing today finishes the job and closes that doughnut hole 
once and for all.
  Starting today, insurance companies are going to be required to 
permit young people to stay on family policies until the age of 26, 
which is especially important, I must say, now that so many young 
people are having trouble finding that first job. Again, real help for 
real people right away. That is why I supported this law, and that is 
why I fought so hard to get it.
  We have been talking about reforming the health insurance system for 
a long time. Many leaders in this country have tried to fix this broken 
system. Each of them has failed. But today, thanks to the bill 
President Obama signed, we begin the move toward real reform--reform 
that will help families such as the Labrums and small business owners 
such as Mark Peters, and seniors and young people in Washington State 
and across the entire country; reform that will help people 
immediately, starting today, and that will move our families one step 
closer to lower premiums, more choices, and, at long last, the health 
care security and stability Americans deserve.
  Starting today, things are looking brighter for millions of Americans 
who have waited far too long for the help they need and deserve.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I yield 10 minutes to the Senator from New 
Jersey, Mr. Menendez.
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. MENENDEZ. Mr. President, I thank the distinguished chairman of 
the Finance Committee for his work on this bill and the bill the 
President signed earlier today.
  Mr. President, the time has come--historic health care has passed 
this Congress, the President has signed it into law, and the American 
people will live healthier, safer, more secure lives because of it. Now 
we come to the floor again, called upon once more, to finalize this 
historic legislation and make it even better. Once again I ask my 
colleagues on the other side of the aisle to take their place on the 
right side of history and end the obstructionism, stop the fear 
mongering, the apocalyptic predictions, and think about what they are 
about to do through the long lens of history.

[[Page S1857]]

  Think of the legacy you want to leave. Think of your grandchildren. 
Think of all those who will look back a generation from now, maybe two 
generations, as we did with Social Security and Medicare, the Civil 
Rights Act, the Voting Rights Act, and ask: How did you vote? Think of 
what you will say then, and think of what you will tell your children 
and your grandchildren.
  Will you look them in the eye and say you stood up for our families 
against the big insurance companies and voted for one of the greatest 
pieces of reform legislation in history? That is exactly what this bill 
will do. It will change the lives of millions of Americans, just as 
Social Security and Medicare changed the lives of Americans, and thank 
God they did. Those two pieces of legislation defined who we are as a 
people and the strength of the American community, each of us working 
for the betterment of all of us. It is our obligation, it is our duty, 
it is our call to history to leave a legacy of hope and health security 
for every American family.

  Now, there are those who stood steadfast against Social Security at a 
time when millions of seniors were facing ruin in this country--when 
old women were selling apples on street corners, and seniors who had 
played by the rules and worked hard all their lives found themselves 
with nothing and no health care at a time in life when they needed it 
the most. The concept of Social Security and Medicare, as we know, was 
a long time coming, but it was the right thing to do. It was a 
Democratic proposal derided by those who used the same arguments then 
that they are using today against this legislation: Beware, a 
government takeover, socialism; the insurers will do the right thing.
  Well, they have not. The difference between us then and now is that 
our friends on the other side of the aisle believe the business of 
government is to protect big insurance companies. But we believe the 
business of government is about our people--their lives, their hopes, 
their dreams for a better, safer, healthier, more secure life for 
themselves and their families. This is the debate on the floor today, 
just as it was when we debated Social Security, Medicare, and every 
other major piece of historic legislation that benefitted people over 
big business.
  The health care needs of our families must prevail over what we see 
on the floor still today--the delay, the obstructionism, the almost 
irrational fervor to stand in the way of change that is being driven by 
talk shows and tea partiers in unacceptable outbursts of demeaning 
language and behavior such as we saw on the steps of the Capitol this 
past weekend against an American hero such as John Lewis, which will be 
judged harshly by history.
  Let us be clear: Republicans have said no for a century, and once 
again we hear a resounding no to changing a broken system. I want to 
say yes. I want to say yes to the people of New Jersey, and let that be 
our legacy to those we represent. I want to tell the 1.5 million people 
of New Jersey who are uninsured and the 326,000 who have individual 
market insurance that they will now have access to affordable health 
care coverage.
  I want to say to the 854,000 New Jerseyans that they will now qualify 
for tax credits to purchase the health coverage they need and deserve.
  I want to say yes to preventive services for 1.3 million seniors in 
New Jersey who don't have those services today. I want to say yes to 
the 227,000 seniors in my State who will finally have their drug costs 
under the Medicare Part D doughnut hole covered over time.
  I want to say yes to the tax credits for 107,000 New Jersey small 
businesses that will be eligible for tax credits to offset their 
premium costs.
  I want to say yes to $14 billion in tax credits and cost-sharing tax 
credits for New Jerseyans to purchase private health insurance, many 
for the first time.
  I want to say yes to an estimated $9 billion more for Medicaid that 
New Jersey would receive in this reconciliation bill, which is $580 
million more than the original Senate-passed version.
  I want to stand and say yes to basic commonsense protections that 
stop insurance companies from making health care about the bottom line 
and not the lives of people.
  I want to say yes to stopping insurers from denying coverage for 
preexisting conditions--something that you have no control over, 
something that happened to you in your health and now stops you from 
getting health insurance.
  I want to say yes to stopping companies from canceling policies when 
people get sick.
  I want to say yes to ending lifetime limits on coverage.
  I want to say yes to all of that and leave a legacy of hope to all 
the families who would benefit from this legislation. Yet it seems the 
only answer we get from those who have been against this legislation 
from the beginning is, let's start over. But we are not starting over. 
It is the law of the land now.
  Not only do they want to say no to it, well, they want to repeal it. 
They want to repeal all of those things. They want to take away those 
rights that now exist for all Americans as a result of the President's 
signature. They want to take that away from you. The fact is, hard as 
it may be for some to realize or accept, Americans voted for change in 
their lives, change so that they would not have all of these obstacles 
to the health care of their families and themselves, and that is the 
change that is being delivered.
  Affordable, accessible health care is now the law of the land, and 
this reconciliation bill makes it even fairer and more affordable for 
middle-class families. It helps seniors, protects consumers, it 
eliminates waste and fraud, and it further reduces our national 
deficit. This bill will eliminate special deals no matter how many 
times we hear bumper sticker slogans shouted from those who see health 
care reform in terms of their own political future rather than what is 
right for America. It makes health care insurance accessible to low- 
and moderate-income families who never thought they would be able to 
afford health care for themselves and their children.
  It extends the prohibition on dropping people when they get sick and 
they need it the most and the requirement to provide coverage for 
nondependent children up to their 26th birthday, starting 6 months 
after enactment.
  It attacks waste and fraud in Medicare and Medicaid by cracking down 
on abusive billing practices for hospitalization services, and it 
strengthens Medicare prepayment reviews to reduce abuses in the system 
and therefore help build the system.
  The time has come once again to be counted. The time has come to take 
a historic vote once again, to take our place before the lens of 
history as our predecessors did on Social Security and Medicare and 
think of what we will tell our grandchildren. History will judge whose 
side you were on and the legacy we will leave. Voting yes gives young 
people, such as 24-year-old Christopher Joyce of Old Bridge, NJ, who 
had no insurance from work and suffered a massive stroke in January 
that left him paralyzed, barely able to speak, an opportunity to be on 
their family's policy instead of leaving the family on the verge of 
losing their home.
  Vote yes and never again will a mother and father in America awaken 
in the middle of the night with a sick child and look at each other 
knowing they cannot afford the medical care their child needs.
  Vote yes and never again will a man, woman or child in America be 
discriminated against because they are sick or once had something an 
insurance executive decided was a disqualifying preexisting condition.
  Vote yes and never again will an insurance executive be able to make 
medical decisions instead of a doctor to manage risk for shareholders 
and hold the bottom line above the lives of people.
  Vote yes and Christopher Joyce would have the health insurance he 
needed to save his family's home.
  Vote yes and we will change things for the better for every American 
family. That is what this bill is all about. It is about a legacy of 
hope and opportunity and health care security and that is why I will be 
casting a ``yes'' vote on reconciliation.
  I yield the remainder of any time I have and yield the floor.
  The PRESIDING OFFICER (Mr. Brown of Ohio). The senior Senator from 
Montana is recognized.

[[Page S1858]]

  Mr. BAUCUS. I yield 5 minutes to the Senator from Maryland off the 
bill.
  Mr. CARDIN. I thank the Senator for his incredible leadership in our 
successful completion of health insurance and health care reform. This 
was a special day, to be with the President of the of the United States 
when he signed into law the law with which the United States will 
finally join every other industrialized nation in the world in 
providing universal health insurance coverage, universal access to 
health care.
  The best news is, we can improve it. We can improve that legislation 
with the bill that is currently before us. With this bill and the bill 
the President signed, 32 million Americans who currently do not have 
health insurance will be insured; 95 percent of Americans under the age 
of 65 will have health insurance. The good news is, we do this by 
reducing the Federal budget deficit which we need to do. We all know we 
need to do that--$100 billion over the next 10 years, over $1 trillion 
over the next 20 years.
  It provides immediate help to small businesses and individuals so 
people can get insured immediately. For small businesses, if you are 
under 25 employees, you can get help; 10 or under you can get a tax 
credit this year, up to 35 percent of the premiums for covering your 
employees. Then, when the health exchanges come into effect, small 
companies can get credits up to 50 percent of the premiums they pay.
  It provides immediate help for our seniors. I can't tell you how many 
seniors have talked to me about the dilemma of filling their 
prescriptions or paying their food bills or cutting pills in half. This 
year, with the bill the President signed, with the improvements we make 
to the underlying bill today, seniors will receive a $250 check to help 
cover the prescription drug costs if they fall within the doughnut 
hole. Under the bills, we completely eliminate, over time, the so-
called doughnut hole seniors fall into and have to pay 100 percent of 
their prescription drug costs. That will be gone.
  Under this legislation, there will be immediate help for individuals 
who have preexisting conditions to go into a community-based risk pool 
so they can get affordable health care now as a result of the passage 
of these bills. Under this legislation, we take on the abusive 
practices of private insurance companies. Effective within 6 months of 
enactment, no further discrimination against children with preexisting 
conditions; extending coverage for young people up to the age of their 
26th birthday; ending the rescission of a health insurance policy 
because a person gets sick; banning lifetime limits on your insurance 
protection and starting down the path of restricting eliminating annual 
limits that are unreasonable. All that is included in the legislation 
we are talking about, providing immediate help to American families to 
find affordable health care.
  Then we add also access to emergency care. I am particularly pleased 
with these provisions because these were additions, amendments I 
offered to extend this to emergency care, so insurance companies cannot 
deny you coverage for going to an emergency room if you had the 
symptoms where a prudent layperson should go to the emergency room, 
where you can pick your own primary care physician, where you can take 
an independent appeal from a decision of an insurance company that is 
contrary to what you believe is right.
  Then, starting in 2011, we start telling insurance companies there is 
a limit as to how much they can take from your insurance premiums and 
use for their bureaucratic administrative costs or profits, that they 
have to put the money back into benefits for you, between 80 and 85 
percent. If they do not, you get a refund, a rebate from your insurance 
company because they have taken too much in premiums from you. That is 
all in this legislation.
  We build upon the community health centers. I particularly wish to 
thank Senator Sanders for his leadership. Community health centers are 
critical to access to care. That is in this bill and it takes effect 
immediately. These are important changes.
  I am also very pleased about the provisions added to this bill in an 
amendment I offered for minority health that will set up in the 
Department of Health and NIH a division of minority health so we can 
start to deal with the disparity in health care in America in a more 
aggressive way, in a more continuous way, so we can truly provide equal 
access to health care for all Americans.
  The bill the President signed was great. This bill improves upon 
that. I urge my colleagues, let's take pride in what we were able to do 
collectively, let's improve it with the bill that is before us. It will 
help our seniors with prescription drugs, it will reduce the deficit 
further, make health insurance more affordable, and it will help our 
States in payment of Medicaid. I urge my colleagues to support the 
legislation and with that I yield the floor.
  The PRESIDING OFFICER. The time of the Senator has expired. The 
senior Senator from Delaware is recognized.
  Mr. CARPER. How much time do we have on our side?
  The PRESIDING OFFICER. The Senator has 6 minutes 5 seconds.
  Mr. CARPER. Mr. President, I would like to take a few minutes, before 
our Republican colleagues return to the floor, to talk about some 
provisions in the legislation the President signed today that are not 
very well understood but I think could be of real help in reining in 
the growth of health care costs. I have said all along--a number of my 
colleagues have heard me say this before--it is all well and good we 
want to extend coverage to people who don't have it. There are way too 
many people who do not have it. But if all we do is extend coverage 
without reining in the growth of costs, we will not do it for very 
long.
  Among the provisions that I think are especially noteworthy--one, if 
a person turns 65 next month and they become eligible for Medicare, 
they are offered, under current law, at least before today's signing of 
the bill, the opportunity to get a once-in-a-lifetime deal, an annual 
physical. Under the law of the land until today, that was it. Under 
Medicare, if they live to be 105, they would not get another physical 
paid for by Medicare.
  I have been getting annual physicals as a naval flight officer, and 
naval midshipman before that, for 27 years in all. I have had a lot of 
annual physicals. I think one of the reasons I am a fairly healthy guy 
is because of that and the feedback from annual physicals. We have a 
lot of people who never got an annual physical and one of the reasons 
why is it is not covered under your health insurance coverage. Under 
the legislation the President signed today, if a person turns 65 and 
becomes part of Medicare, they get an annual physical; in the next 
year, another one; in the year after that, if they live to 75 or 85 or 
95 or, God bless them, 105, they will get a lot of annual physicals. I 
think that has the potential for addressing one of the real 
shortcomings in our health care system in this country. We don't do a 
very good job in primary care and part of primary care is, frankly, 
physicals from time to time. We are going to address that.
  Another provision in the legislation that has not gotten a whole lot 
of attention--some but not a lot--is what can we do to incentivize 
people to take better care of themselves. It is all well and good that 
we want doctors to get more and nurses and hospitals, and so forth, and 
go after insurance companies, but what are we doing to incentivize 
people to take better care of themselves? If you look at a lot of 
countries where people have better health care than we do, one of the 
reasons is they take better care of themselves.
  Something that has always fascinated me is, how do we figure out how 
to harness market forces for the delivery of health care? How do we 
harness market forces and incentives to drive good public policy 
behavior? We know it is not good for people to be overweight. How can 
we encourage them to lose weight? One of the things in the underlying 
bill is a provision that says, I think starting next year, we are going 
to have a provision requiring menu labeling. What do you mean by menu 
labeling? If you happen to be a restaurant company with 20 or more 
restaurants around--if you have a restaurant company and have 
restaurants in 20 or more sites around the country, you have to start, 
next year, putting on the menu board in the restaurant how many 
calories are in the items they serve. If they have a menu, you have to 
put it on the menu, how

[[Page S1859]]

many calories they serve. It doesn't mean people will not go in and 
order 3 or 4,000 calories to consume, but people are going to start 
thinking about it. It will be a reminder.
  Another provision in the legislation that I think is especially 
noteworthy is to build on something already in the current law but to 
make it, I think, stronger. We all know people who needed to lose 
weight and they go on a diet and join a gym or something. They stop. 
They start. They stop. They exercise for a while, go on a diet and then 
fall off the wagon and go back to their old habits. You know people 
stop smoking and they do it for a while and then they start stealing 
cigarettes from people and eventually they go back full time. What we 
are trying to do with our legislation is to say: Look, if companies 
have employees, they know they are overweight, they want to encourage 
them to lose weight, let them offer a premium discount.
  In the legislation, the President said today employers can offer 
premium discounts of as much as 30 percent for their employees for whom 
they are providing health insurance. If they are overweight, if they 
are losing weight and keep it off, if they are smoking and stop smoking 
and continue to stop smoking, if they have high cholesterol or high 
blood pressure and they can control those and continue to control 
those, they can get premium discounts of as much as 30 percent. 
Everybody in this Chamber today, we all know people who have tried to 
lose weight, lose it for a while and then go back the other way. We 
know people who try to stop smoking, they do it for a while and then 
they go back. What our legislation does is say we want to put more 
money back in the pockets of people who do what is the right thing for 
them to do for their own personal health, and by doing that, they 
actually bring down the health care costs of their group, the place 
wherever they are working. I think those are ideas that make pretty 
good sense.
  Let me ask the Presiding Officer how much time is left on our side.
  The PRESIDING OFFICER. The Senator from Delaware has 50 seconds.
  Mr. CARPER. Fifty seconds? The last thing I want to mention is our 
Presiding Officer is from Ohio. He has been to Cleveland many times. I 
spent some time in Ohio as well. One of my return visits to Ohio last 
year was to go back to the Cleveland Clinic to see how they are able to 
provide better health care for less money than a whole lot of other 
health care delivery systems. It is because they and the Mayo Clinic 
and Geisinger and others focus on the same kind of model, better focus 
on primary care, focus on prevention. All those patients have 
electronic health records. All the docs are salaried employees. They 
don't get more money if they do more tests or more MRIs or more this or 
that. It is a better model. What we do in our legislation signed by the 
President today is we incentivize a lot of other folks providing health 
care to use the same models.
  With that, my time has expired.
  The PRESIDING OFFICER. The time of the Senator from Delaware has 
expired. The senior Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, I ask the pending amendment be set 
aside, if that is necessary.
  Mr. CARPER. Reserving the right to object.
  The PRESIDING OFFICER. Is there objection?
  Mr. CARPER. We just request to see a copy.
  Mr. GRASSLEY. I will discuss the amendment while that is going on.
  The PRESIDING OFFICER. The Senator is recognized.


                           Amendment No. 3564

  Mr. GRASSLEY. First of all, if the amendment can be called up, it is 
3564. I would like to have Senator Roberts added as a cosponsor.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GRASSLEY. Mr. President, I worked for years to pass what is 
called the Congressional Accountability Act, which was signed into law 
by President Clinton in 1995. I worked so hard to get that bill passed 
because I strongly believe that Congress should live under the same 
laws it passes for the rest of the country.
  If you remember, prior to 1995 Congress had exempted itself from 12 
different pieces of legislation, starting with the Fair Labor Standards 
Act of 1938. Now, of course, we in Congress, as employers, have to live 
by the same laws as the ABC Company of Des Moines, IA, as an example. 
So the same principle applies to some parts of this bill.
  That is why I offered an amendment during Finance Committee markup to 
require that Members of Congress and congressional staff get their 
employer-based health insurance through the same exchanges as our 
constituents. Part of that original amendment that I got adopted back 
then is in the bill the President signed today. And that amendment was 
adopted without objection, let me say, so it had consensus support. I 
am hoping the majority will support a similar amendment for the 
President, the Vice President, senior White House staff, political 
appointees from the Cabinet and sub-Cabinet, but, of course, not civil 
servants within the executive branch of government.
  Also, my amendment would close a loophole that was added behind 
closed doors--meaning the closed doors of the majority leader's office, 
Senator Reid, during the time that he was merging the Finance and HELP 
Committee bills. That loophole would exempt staff from committee and 
leadership offices from being required to use the exchanges even though 
individual offices of individual Senators and their staffs and the 
Senators would still be covered.
  Now, you know, it takes a lot of chutzpa behind closed doors to say: 
Well, you know, it is okay for the Members' offices and the Members' 
staff and the individual Senator, but it is not okay for committee 
staff, it is not okay for leadership staff. Somehow, they are a heck of 
a lot better than the rest of us. So it would also bring that back to a 
level playing field for everybody here on Capitol Hill because most of 
our constituents would find it pretty unbelievable that the President, 
his closest advisers, and some staff remain untouched by the reforms 
they pushed for the rest of the country.
  To put it simply, President Obama's health care reform will not apply 
to President Obama or other people, political appointees, within the 
executive branch. The message the White House, then, is sending to the 
grassroots of America is that it is good enough for everybody else but 
not for political appointees in the executive branch of government. So 
is it really any wonder, then, why most Americans oppose this effort?
  Last December, I tried to correct the inequity that I talked about of 
leadership staff and committee staff, but the effort to apply any new 
law to the administration was objected to by the Senate majority leader 
at that particular time. In other words, I didn't get a chance to get a 
vote on it. But there is no justification for such a double standard. 
That is blatantly wrong. It is only fair and logical that top 
administration officials who fought so hard for passage of this 
overhaul of America's health care system experience it themselves. If 
it is as good as promised, they will know firsthand. If there are 
problems, they will be able to really understand those problems, as 
they should, just as the Congressional Accountability Act teaches each 
of us Senators, who have to live under the same laws as the rest of the 
country, that somehow we have to experience them, and then we know what 
it takes for small businesses to live by the civil rights laws, the 
wage and hour laws--I can't remember all 12 laws that we exempted 
ourselves from that we are not now exempted from.
  We need to understand grassroots America. What is wrong with 
Washington is it is an island surrounded by reality, and we have to 
bring some of the common sense of the rest of the country inside here 
where we work all the time because the only business in Washington is 
government, and everybody in government is in the way. Everybody 
outside of Washington is pulling that way. And we have to make sure 
that the people in the wagon at least understand the problems of those 
pulling the wagon, and I think this will be one way to do it.
  I ask unanimous consent request that the pending amendment be set 
aside so that can I offer amendment No. 3564, the amendment I just 
talked about.
  The PRESIDING OFFICER. Is there objection?

[[Page S1860]]

  Mr. CARPER. Reserving the right to object, would the Senator modify 
his unanimous consent request to provide that once all time has been 
used on the Grassley amendment, the amendment be set aside until a time 
designated by the leader?
  The PRESIDING OFFICER. Does the Senator from Iowa so modify his 
request?
  Mr. GRASSLEY. I am fine with that.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Iowa [Mr. Grassley], for himself and Mr. 
     Roberts, proposes an amendment numbered 3564.

  Mr. GRASSLEY. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To make sure the President, Cabinet Members, all White House 
   Senior staff and Congressional Committee and Leadership Staff are 
  purchasing health insurance through the health insurance exchanges 
     established by the Patient Protection and Affordable Care Act)

       At the end of subtitle A of title I, insert the following:

     SEC. 1006. PARTICIPATION OF PRESIDENT, VICE PRESIDENT, 
                   MEMBERS OF CONGRESS, POLITICAL APPOINTEES, AND 
                   CONGRESSIONAL STAFF IN THE EXCHANGE.

       (a) In General.--Section 1312(d)(3)(D) of the Patient 
     Protection and Affordable Care Act is amended to read as 
     follows:
       ``(D) President, vice president, members of congress, 
     political appointees, and congressional staff in the 
     exchange.--
       ``(i) In general.--Notwithstanding chapter 89 of title 5, 
     United States Code, or any provision of this title--

       ``(I) the President, Vice President, each Member of 
     Congress, each political appointee, and each Congressional 
     employee shall be treated as a qualified individual entitled 
     to the right under this paragraph to enroll in a qualified 
     health plan in the individual market offered through an 
     Exchange in the State in which the individual resides; and
       ``(II) any employer contribution under such chapter on 
     behalf of the President, Vice President, any Member of 
     Congress, any political appointee, and any Congressional 
     employee may be paid only to the issuer of a qualified health 
     plan in which the individual enrolled in through such 
     Exchange and not to the issuer of a plan offered through the 
     Federal employees health benefit program under such chapter.

       ``(ii) Payments by federal government.--The Secretary, in 
     consultation with the Director of the Office of Personnel 
     Management, shall establish procedures under which--

       ``(I) the employer contributions under such chapter on 
     behalf of the President, Vice President, and each political 
     appointee are determined and actuarially adjusted for age; 
     and
       ``(II) the employer contributions may be made directly to 
     an Exchange for payment to an issuer.

       ``(iii) Political appointee.--In this subparagraph, the 
     term `political appointee' means any individual who--

       ``(I) is employed in a position described under sections 
     5312 through 5316 of title 5, United States Code, (relating 
     to the Executive Schedule);
       ``(II) is a limited term appointee, limited emergency 
     appointee, or noncareer appointee in the Senior Executive 
     Service, as defined under paragraphs (5), (6), and (7), 
     respectively, of section 3132(a) of title 5, United States 
     Code; or
       ``(III) is employed in a position in the executive branch 
     of the Government of a confidential or policy-determining 
     character under schedule C of subpart C of part 213 of title 
     5 of the Code of Federal Regulations.

       ``(iv) Congressional employee.--In this subparagraph, the 
     term `Congressional employee' means an employee whose pay is 
     disbursed by the Secretary of the Senate or the Clerk of the 
     House of Representatives.''.
       (b) Effective Date.--The amendment made by this section 
     shall take effect as if included in the Patient Protection 
     and Affordable Care Act.

  Mr. CARPER. Would the Senator yield for 30 seconds? One of the things 
Senator Grassley and I have endeavored to do in working on this 
legislation in the Finance Committee is to try to figure out what works 
to rein in the growth of health care costs and improve outcomes.
  Where we agree is on one of the best ideas that is in our bill--the 
idea of large purchasing pools that we modeled after the Federal 
Employees Health Benefits Plan. We know that we as Members and our 
staff have to be part of the exchange. The idea is to create large 
purchasing pools in all of our States and even regional purchasing 
pools as well.
  Mr. GRASSLEY. Without a doubt.
  Mr. CARPER. I am glad that provision has survived so far, and I hope 
it will go on. I wish we could implement it sooner.
  Mr. GRASSLEY. I yield the floor.
  The PRESIDING OFFICER. The Senator from Alaska.
  Ms. MURKOWSKI. I rise this evening in support of the Grassley 
amendment, and I appreciate that my colleague has brought this forward. 
We had an opportunity to discuss this months ago in the HELP Committee.
  The fact is, the health care bill that is now law creates these State 
exchanges where all non-Medicaid and Medicare individuals will go to 
purchase their health insurance. And included in the exchanges are 
Members of Congress and their personal staff, who are required to join 
these exchanges in order to obtain their health care benefit.
  But as the Senator from Iowa has mentioned, the rules that apply 
here--the rule that came to my mind when we were discussing this is 
this rule we were all taught as young children: Do unto others as you 
would do unto yourself. Unfortunately, I think what we see with this 
new health care law is that it fails to adhere to this rule.
  So what you are going to have under this new law is every American 
will have to be part of this new health care exchange. But who is going 
to be left out? Who is going to be excluded? Well, the law itself here 
is pretty clear in terms of the definitions. It says Members of 
Congress, congressional staff. Congressional staff means all full-time 
and part-time employees employed by the official office of a Member of 
Congress, whether in Washington, DC, or outside of Washington.
  But let's think of whom it does not include. It does not include the 
President, it does not include Cabinet members, it does not include 
members of the White House senior staff, it does not include committee 
staff that we may have. As the ranking member on the Energy Committee, 
I have committee staff for that. As the vice chair of the conference, I 
have leadership staff. But neither my committee staff nor my leadership 
staff would be covered under this new law. In other words, many of the 
chief architects of this health care law were apparently, very 
conveniently, omitted from any requirement of being within the health 
exchange.
  So, again, whether it is the Cabinet members, the White House senior 
staff, the committee members, the leadership staff, you have to ask the 
question, Why have they been left out of this? Why is there a double 
standard? And if you are not asking that question, is it just a glaring 
omission or is there something else? Is this yet further evidence of 
what we are seeing that was done in the back rooms, the outcome of the 
late nights, the backroom deals that certain staffers who might perhaps 
work for the majority leader or certain staffers who work for the White 
House get to be treated differently than every other American out 
there? I do not think that is what we intended here.
  As I mentioned, during the HELP Committee markup, I supported an 
amendment that was offered by Senator Coburn that most Democrats on the 
committee did not support. But it would require Members of Congress and 
their staffs to be included in the health care exchange. And the 
conversation that was had at the committee at that point in time, 
certainly by Members on the Republican side, was: Hey, if it is good 
enough for my constituents, if it is good enough for the people of the 
State of Alaska, then it ought to be good enough for me, it ought to be 
good enough for the President. But what we see is the President and the 
House and the Senate leadership offices who have pulled this bill 
together have conveniently left themselves out from being subjected to 
this provision.
  So I appreciate Senator Grassley bringing up this issue, pointing it 
out, pointing out that there are omissions. There are perhaps 
convenient omissions. I am not one to say whether it has been 
convenient or not, but it does raise the question, So what else has 
been left out? What else is contained within this bill that might be 
viewed by others as a special deal?
  Earlier on the floor, Senator McCain came and, along with many of our 
colleagues, kind of outlined some of those special deals about which I 
know people in Alaska are quite concerned.

[[Page S1861]]

They are like, wait a minute, if you are going to move health care 
reform in the manner you have, make sure it is even, make sure it is 
equal, make sure people are treated fairly and in a manner that we 
think and we recognize is consistent.
  So I think we need to ask ourselves certain questions about what is 
in and what is out. We know there is certainly more spending--more 
spending in terms of the proposal. We know we have gone from $200 
billion in spending to now $2.6 trillion in spending. We know there are 
more entitlements, we see that repeated and repeated, $115 billion in 
new entitlement spending, bringing the combined new spending in the 
proposal to $1.2 trillion. We know there are more taxes. We know there 
are more Medicare cuts. We know there are more gimmicks. You know, 
these are why the folks back home are saying: Wait a minute, these are 
the types of things you have promised us, and now you are telling us 
there are some good provisions in this bill, you are going to like this 
bill once you get to know it.
  Some of my colleagues will tell you Medicare patients will now see 
free preventive services. I admit that sounds great. I am all for 
making sure we have screenings, whether they be mammograms or 
preventive services. But I have to ask the question, in a State such as 
Alaska where we face such an incredible crisis when it comes to access 
to care, to primary providers, knowing that we now have this bill 
before us, this new law of the land, how many of the few primary care 
doctors in my State are going to be accepting those new Medicare 
patients to provide them these wonderful preventive services, these 
free preventive services?
  According to experts, not only in Alaska but in many parts of rural 
America, Medicare patients are not going to have a provider who will be 
willing to take them on. We have a think tank in the State, the 
Institute of Socioeconomic Research, that has said that seniors in low-
payment Medicare States are going to be forced to wait in line. They 
have said: Independent of the doc fix, in Alaska, seniors are at risk 
for long lines to see a primary care doctor and overflowing to 
community health centers and hospital emergency rooms where existing 
capacity is highly likely to be quickly overwhelmed and long wait times 
become increasingly common. They go on to say that additional insured 
patients are going to hurt the existing Medicare beneficiaries, again, 
because of the access issue.
  What we will have done is, we will have been able to issue that card, 
we will be able to say, yes, this is now available to you. But if you 
still can't get in to see the provider, then what have we provided for 
these seniors other than the card? That is not access. My mom used to 
tell us: If it sounds too good to be true, it is probably too good to 
be true. We are going to be spending a fair amount of time in these 
next few days and in the next many hours going through so many aspects 
of this reconciliation bill, trying to understand what is in it, what 
is not in it, who it applies to, and how it applies.
  I am hopeful tomorrow I will have an opportunity to talk a little bit 
more about not necessarily the health care side of this reconciliation 
bill but one way in which the health care reforms are going to be paid 
for, and that is on the backs of students; students who have taken out 
loans, who, as we eliminate the Federal Family Education Loan program, 
the FEL program, essentially we are going to be helping to pay these 
young people. These some 19 million young people who take out student 
loans are going to be paying for the cost of the health care provisions 
contained within this bill. Is that right? Is that fair?
  There is so much that needs to be discussed, that needs to be 
uncovered. Because what we have before us within this reconciliation 
bill is more of the same in terms of the bad provision that passed this 
Senate on December 24--more taxes, more cuts to Medicare, more hits to 
our seniors and our small business people. It was not good in the 
Senate bill. It is made worse in the reconciliation provision. Our job 
tonight and in the intervening hours is to make sure that the American 
public fully understands that.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Please tell me how much time remains on this side.
  The PRESIDING OFFICER. The Senator from Iowa has 15 minutes 
remaining.
  Mr. GRASSLEY. I thank the Chair.
  Mr. President, I know many folks look at this week's debate as the 
end of the process. I know some people look at the conclusion of this 
week with relief. I look at it with regret, regret for the opportunity 
squandered and regret for problems that we must now address. Our health 
care system is in need of reform. Our health care system spends too 
much, leaves too many people without coverage, and doesn't provide 
quality care that it should. We had an opportunity to do something 
about it the right way. We could have passed a bill with broad support 
in Congress and among the American people. That opportunity was lost. 
This process started in a bipartisan fashion. In 2008, the Finance 
Committee held a health care summit. The committee brought in experts 
from all over the country and all over the health care spectrum. We 
held numerous hearings. In 2009, the Finance Committee put together 
bipartisan roundtables and walk-throughs of the critical issues in 
creating this health care legislation.
  Throughout the summer of 2009, six of us worked together in a 
bipartisan fashion to try to reach an agreement that could achieve 
broad-based support, because we felt that is traditional of social 
change in America, to be bipartisan. This was a restructuring of one-
sixth of the economy. Doing that ought to be done not on a partisan 
basis, not on a slight bipartisan basis, but on the basis of a broad 
consensus. Somewhere along the line, though, getting it done quickly 
became more important than getting it done right. Was it when the HELP 
Committee produced a partisan draft that would have cost more than $2 
trillion? Was it when the House slammed bills that were outright 
government takeovers through committee? Every year I hold 99 townhall 
meetings, one for each county in Iowa. When I went home last July and 
August, I found anger back home in my State. People were mad. People 
were fearful. They saw a government that took over General Motors, took 
over banks, spent us into mind-boggling debt. My people were worried 
about the direction of this country. Nothing has happened since August 
that has improved that situation.
  While Americans get up every morning worried that the struggling 
economy may cost them their jobs, Congress has been hyperfocused on 
health care reform. This hyperfocus has led Congress to abandon 
bipartisanship and make some very questionable deals in the name of 
just getting it done. Congress had an opportunity to enact something 
the American people could support, but congressional Democrats and the 
White House seemed so focused on making history, they stopped actually 
listening to the American people. All the backroom deals, the budget 
gimmicks, and broken promises made it clear they are willing to go to 
any length to pass any bill, just any bill.
  Health care reform will raise taxes by a half a trillion dollars. It 
will cut Medicare by more than a half a trillion dollars and not 
strengthen Medicare, but doing it solely to create a new and 
unsustainable entitlement program. Of course, it will cause health 
insurance premiums to go up even more than they are already going up. 
Rather than bringing the country together around some commonsense 
reform, it has driven the country farther apart at the very time we 
need to come together, especially for economic recovery efforts and the 
creation of jobs.
  Health care reform legislation should have been done with broad-based 
support. Now, of course, this excessive bill is law. An opportunity has 
been lost. This legislation will raise taxes by a trillion dollars.
  This is not the end, not by a long shot. Now the process of cleaning 
up the mess begins. Hopefully we can get some of these changes started 
this week in this very bill before the Senate. Because Congress will be 
back to fix challenges created by this bill. The Medicare physician 
payment problem, for one, is still out there. It will cost more than 
$300 billion to fix. Neither the bill the House passed Sunday nor this 
reconciliation bill addresses that very major problem. Congress will 
have to come back and fix it.

[[Page S1862]]

  Another problem: Medicare is still going bankrupt. Hundreds of 
billions of dollars were taken out of the Medicare Program and were not 
used to improve the solvency of that program. Even the President has 
now acknowledged that you can't count the savings to pay for the new 
entitlement and to improve Medicare solvency, something I tried to tell 
this body many a time. Now the President says it. I hope people who 
avoided this last time are listening to the President. Congress will 
have to come back and fix it.
  There are billions of dollars of cuts to Medicare providers in the 
health care reform bill that are totally unsustainable. Providers will 
not be able to survive if these cuts go into effect. A cynical person 
might suggest some providers supported the bill knowing there would be 
an influx of dollars to pay for new coverage, knowing that they would 
have years to stave off the corresponding payment cuts. So as I have 
said before, Congress will have to come back to this 2,700-page law the 
President just signed and fix it.
  The bill gets half of the new coverage through the Medicaid Program. 
Everybody knows that Medicaid is threadbare to begin with. Adding 16 
million people to Medicaid with tens of billions of dollars of unfunded 
liability for States is not going to improve that program. The 
reconciliation bill has a farcical 2-year payment increase for 
physicians in Medicaid that ends with a 50-percent cliff. No one has 
yet explained to me how that is supposed to improve the program. 
Congress will have to come back and fix it.
  The bill prohibits health plans from denying coverage of preexisting 
conditions for kids under 19, starting 6 months after enactment. Sounds 
very positive; right? But in the rush to get things done, the majority 
failed to notice that prohibiting preexisting condition exclusions but 
allowing insurance companies to still deny kids entirely will end up in 
more kids being denied coverage.
  Finally, the health care reform bill included a long-term care 
entitlement called by the acronym the CLASS Act. The CLASS Act is a 
fiscal disaster waiting to happen. When it starts to run out of money, 
when the insurance death spiral hits the program, the taxpayers will be 
on the hook to fix it. Congress will have to come back and fix it. 
Congress will have hundreds and hundreds of billions of dollars of 
problems to come back and fix.
  I yield the floor.


                    Amendment No. 3567, As Modified

  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mr. GREGG. I ask unanimous consent to call up and modify my amendment 
which is pending at the desk.
  The PRESIDING OFFICER. Without objection, the amendment is so 
modified.
  The amendment (No. 3567), as modified, is as follows:

       At the end of subtitle B of title I, add the following:

     SEC. ___. PREVENTING THE IMPLEMENTATION OF NEW ENTITLEMENTS 
                   THAT WOULD RAID MEDICARE.

       (a) Ban on New Spending Taking Effect.--
       (1) In general.--Notwithstanding any other provision of 
     law, the Secretary of the Treasury and the Secretary of 
     Health and Human Service are prohibited from implementing any 
     spending increase or revenue reduction provision in either 
     the Patient Protection and Affordable Care Act or this Act 
     (referred to in this section as the ``Health Care Acts'') 
     unless the Chief Actuary of the Centers for Medicare and 
     Medicaid Services Office of the Actuary (referred to in this 
     section as ``CMS OACT'') certifies that all of the projected 
     Federal spending increases and revenue reductions resulting 
     from the Health Care Acts will be offset by projected gross 
     savings from the Health Care Acts.
       (2) Calculations.--For purposes of this section, projected 
     gross savings shall--
       (A) include gross reductions in Federal spending and gross 
     increases in revenues made by the Health Care Acts; and
       (B) exclude any projected gross savings or other offsets 
     directly resulting from changes to Medicare made by the 
     Health Care Acts.
       (b) Limit on Future Spending.--For the purpose of carrying 
     out this section and upon the enactment of this Act, CMS OACT 
     shall--
       (1) certify whether all of the projected Federal spending 
     increases and revenue reductions resulting from the Health 
     Care Acts, starting with fiscal year 2014 and for the 
     following 9 fiscal years, are fully offset by projected gross 
     savings resulting from the Health Care Acts (as calculated 
     under subsection (a)(2)); and
       (2) provide detailed estimates of such spending increases, 
     revenue reductions, and gross savings, year by year, program 
     by program and provision by provision.

  Mr. GREGG. I express my appreciation to the Senator from Montana for 
allowing me to do this at this time.
  I understand we will have some agreement; is that correct?
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, I yield 12 minutes off the bill to the 
Senator from Minnesota.
  The PRESIDING OFFICER. The Senator from Minnesota is recognized.
  Mr. FRANKEN. Mr. President, today we took a historic step forward 
toward a healthier America. I am proud that the Senate is debating the 
reconciliation bill this evening, fulfilling our pledge to make some 
crucial adjustments to the Senate bill we passed in December. The 
reconciliation bill before us will make the newly minted reform bill 
even better. It will provide stronger subsidies for low- and middle-
income working families so they can afford insurance. That means fewer 
people getting primary care in emergency rooms. It will limit the 
number of families affected by the excise tax on high-cost plans and 
address geographic disparities in Medicare. It will finally close the 
Medicare prescription drug doughnut hole so that so many of our seniors 
no longer will have to choose between eating or taking medicine.

  But let's be honest, even with these changes, it still is not 
perfect. We will continue to improve it because there are always things 
we cannot foresee. Look, we are still making adjustments to Medicare 40 
years later. When Medicare passed, there was also ample opposition, not 
dissimilar to what we are hearing about this bill. Opponents said 
Medicare would be a government takeover of health care. But today you 
will not find a single senior in Minnesota who wants to give up his or 
her Medicare.
  In fact, just in these past few months, I am so pleased that so many 
of my colleagues on the other side of the aisle have spoken out in 
favor of Medicare and of strong benefits for seniors. I am confident, 
similar to Medicare, support for health care reform--which is already 
strong--will continue to grow with time as people understand how 
helpful it will be to working families.
  Unfortunately, many people have been scared by the misinformation 
that has been used to try to defeat reform. For example, there is an 
important point that has been lost in the overblown and apocalyptic 
rhetoric these past few months: This bill is not a government takeover 
of health care. In fact, it is an expansion of private coverage, with 
millions more Americans covered by private insurance companies.
  Let me say this again. The Patient Protection and Affordable Care Act 
expands private insurance. Since we are giving these companies a huge 
influx of new business, we have to hold them accountable. We do that by 
improving regulation of these companies by making sure they keep 
patients as their highest priority. Our bill ends preexisting condition 
exclusions, no more lifetime and annual caps. Mental health services 
will be covered, and companies will not be able to kick people off 
their plans when they get sick.
  The truth is, in my State, there are a lot of good things happening 
in health care already. But even in Minnesota we need help. We have 
people who cannot afford their coverage, rising costs, and a huge State 
budget deficit.
  I support this bill because it helps Minnesota in all the ways we 
need right now--incentives to advance State innovation and instant 
relief to cover low-income Minnesotans in Medicaid. This is helpful at 
a time when the State legislature is struggling to make ends meet. For 
Minnesota small business owners who are stretched but want to cover 
their workers will have access to tax credits this year, in 2010. I am 
also very pleased that this bill will begin to fix one of the most 
flawed elements of our current system: Medicare reimbursements.
  Our system punishes--punishes--high-quality Minnesota providers, such 
as the Mayo Clinic, by paying them less because they provide efficient, 
low-cost care. The Senate bill includes provisions that I fought for 
with my colleagues, Senators Cantwell and Klobuchar, to reward value 
not volume in Medicare.

[[Page S1863]]

  Thanks to my colleague, Representative McCollum of Minnesota, we have 
a commitment from Secretary Sebelius to continue to expand these 
efforts to hospitals and nursing homes.
  I am proud to represent Minnesota at this historic time and to have 
contributed to improving the health of this country for future 
generations. Our new law, improved by the reconciliation bill, will be 
a major victory for Minnesota families.
  But if this reconciliation bill passes, we will also be scoring a 
double victory for working families. In addition to expanding access to 
health care, this bill will make it less expensive for working families 
to send their kids to college. By cutting out the middleman from the 
student lending system, we are able to increase funding for Pell grants 
and make it easier for college graduates to repay their loans. Not only 
are these measures fully paid for, they will also reduce the deficit.
  Under the current Federal Family Education Loan Program, or FFEL, the 
Federal Government pays lenders enormous subsidies to entice them to 
lend to students. Then, on top of that, the government guarantees the 
loans so there is virtually no risk to the banks--just taxpayer-
subsidized profits. This is not a private enterprise program, as the 
banks would like you to believe. It is corporate welfare, masquerading 
as private enterprise.
  The good news is that there is a better way to run the government 
loan program than keeping banks on the dole. It is called direct 
lending, and it slashes $61 billion in costs by cutting out the 
middleman and lending to students directly.
  This idea is hardly new. In the early 1990s, Senator David 
Durenberger of Minnesota, a Republican, joined with Senator Paul Simon 
of Illinois, a Democrat, in a bipartisan effort to end the wasteful 
practices of the bank lending program. They were able to give colleges 
the option of switching to direct lending, but the bank lobbyists 
thwarted their efforts to eliminate the bank subsidy program 
altogether.
  Today, I am proud to be continuing Senator Durenberger's fight to 
eliminate wasteful bank subsidies. I am also proud that the University 
of Minnesota is leading the way. The U of M was one of the first 
universities in the Nation to switch to direct lending. I recently met 
with students and administrators at several U of M campuses, and they 
told me that the direct lending program is working very well. Not only 
does it provide students with the same benefits as the bank subsidy 
program at a lower cost, but it also reduces the administrative 
headaches of financial aid officers by decreasing the number of 
entities they have to deal with.
  To be blunt, our choice is simple. We can continue to waste billions 
to line the pockets of banks or we can use that money to help low-
income and middle-class kids go to college. I certainly do not want to 
go home to Minnesota next week and explain to my constituents that the 
Senate decided to keep forking over their hard-earned tax dollars to 
banks rather than help their kids go to college.
  For many families, it is the opportunity to send their kids to 
college that is at stake. Most of the money that would be saved from 
switching to direct lending would be used to strengthen the Pell grant. 
Pell grants give over 8 million low-income and middle-class students 
the opportunity to realize the dream of attaining a college education.
  Pell grants hold a special place in my heart because of the 
opportunity they gave my wife and her family. When Franni was 17 months 
old, her father died in a car accident, leaving Franni's mom widowed at 
age 29 with five kids. My brother-in-law Neil went into the Coast Guard 
and became an electrical engineer. But all four girls went to college, 
and they were able to do it with a combination of scholarships and Pell 
grants.
  Unfortunately, since then, the purchasing power of the Pell grant has 
declined dramatically. Thirty years ago, the maximum Pell grant covered 
77 percent--77 percent--of the cost of attending the average 4-year 
public college. These days, it only covers 35 percent.
  This economy has made a bad situation worse. Many of the students and 
families I have met in Minnesota are struggling with high tuition and a 
tough economy. The average Minnesota student graduates from college 
with over $25,000 of debt. Job losses and cutbacks have left many 
middle-class families barely hanging on. That means more students who 
depend on Pell grants have to spend more hours at work and away from 
their studies to help pay for their education.
  Unfortunately, the economic crisis has also increased the demand for 
Pell grants, as more families have fallen on tough times. The increase 
in demand has left us with a $19 billion shortfall in the Pell grant 
program. If we do not fix this shortfall, nearly 600,000 students could 
lose their Pell grants entirely. Another 8 million students could have 
their grants cut by almost 60 percent. This would be catastrophic for 
those students and their families.
  In this economy, it would be an unforgivable failure for Congress to 
allow Pell grants to be cut in half. It would also be shortsighted, 
since we know that within a decade 75 percent of all new jobs will 
require a college education. A national switch to direct lending is 
simply the right thing to do for our students, for our families, and 
for our economy.
  So I wish to urge my colleagues to stand for what is right and 
support this reconciliation package that further improves our health 
care system, puts kids in front of banks, and reduces the deficit.
  I thank the Chair. I yield the floor.
  The PRESIDING OFFICER. The Senator's time has expired.
  The Senator from Rhode Island is recognized.
  Mr. WHITEHOUSE. Mr. President, on behalf of Senator Baucus, I yield 
myself up to 20 minutes and that Senator Brown be recognized for up to 
10 minutes and that the time be charged against the bill.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. WHITEHOUSE. Mr. President, on this historic day, I rise to speak, 
as I have many times before, about our historic opportunity to turn 
away from the path of fiscal crisis and toward the difficult and vital 
work of bringing down the costs of health care.
  After the wild and unsustainable borrowing of the Bush era, we now 
face an era of limited resources, in which every last dollar is needed 
to spur economic recovery, create jobs, and restore economic security 
for all. Economists agree with virtual unanimity that the needless and 
excessive cost of health care is the heaviest weight dragging down 
America's economic growth.
  In 1955, the year I was born, the Nation spent $12 billion annually 
on health care. Last year, we spent $2.5 trillion--$134 billion more 
than the previous year, the largest year-to-year increase in history, 
and 200 times what we spent the year I was born. That spending 
constitutes a stunning 17.3 percent of our Nation's entire gross 
domestic product--also the highest level in our history.
  The cost of our Republican colleagues' desire to do nothing would 
have been impossibly high. In my home State of Rhode Island, a family 
of four would have faced more than $26,000 in premiums for family 
health insurance in 2016. Last year, premiums for Medicare Advantage 
nationally jumped an average of 14.2 percent--just in 1 year. Indeed, 
this escalation is unsustainable, but it is not inevitable.
  A great deal of health care cost is nothing more than waste--waste 
resulting from a status quo that is irrational, disorganized, and often 
downright greedy and mean. The only good news about all this waste and 
excess cost is that we know where to look for savings. In the reform 
bill signed by President Obama today, we deploy every tool at our 
disposal to reap those savings.
  This health care debate has been enveloped in--indeed, sometimes 
blinded by--a blizzard of numbers: CBO reports, actuarial analyses, 
projections upon estimates upon projections. Too often, my colleagues 
on the other side pluck out only those figures that serve their 
purpose--their purpose to delay and ultimately defeat this bill for 
their insurance company friends.
  However, I believe that a fair view of the evidence demonstrates that 
this reform bill will do more to lower health care costs, reduce the 
deficit, and free up precious resources in the private sector than any 
reform has ever done before.

[[Page S1864]]

  Let me start with the budget deficit. In its most recent report, CBO 
projects that the bill, combined with the package of improvements that 
is now before the Senate, will reduce the deficit by $138 billion over 
the next decade. Economists in the Commonwealth Fund have estimated 
that the bill will reduce the deficit even more dramatically by $409 
billion over the next 10 years. In the second decade, CBO projects that 
the combined bills will reduce the deficit by a broad range around one-
half percent of GDP. One-half percent of GDP is $1.3 trillion over 10 
years, a significant achievement in deficit reduction.
  Let's look at another number the critics too frequently ignore: 
savings in Medicare and Medicaid spending from innovative reforms in 
the delivery of health services, particularly increased efficiencies, 
improved quality, and the elimination of wasteful spending. Both CBO 
and the CMS Actuary estimate those savings at roughly $490 billion, 
nearly $\1/2\ trillion over the next 10 years. The economists at the 
Commonwealth Fund peg that number over half a trillion dollars, at $576 
billion. Examples of this are found in CBO's forecast that an 
independent, nonpartisan commission of experts with authority to 
determine payment rates under Medicare will save the Treasury $13.3 
billion over a 10-year period. CBO also credits Medicare payment 
reforms that seek to limit hospital readmissions and hospital-acquired 
infections with $7.1 billion in savings, and incentives that encourage 
physicians to group together in cost-saving organizations with $4.9 
billion in savings. We know these things work because places such as 
the Mayo Clinic in Minnesota are out there doing that right now.
  Not only does this bill protect the Medicare trust fund and preserve 
Medicare benefits, it also reduces spending growth in the outyears. The 
savings I have been talking about are not just a one-off proposition 
and then back on the spending growth ratchet; this bill reshapes the 
delivery system so that Federal health care costs should never grow at 
this outrageous rate again. CBO and Commonwealth Fund economists find 
that the bill reduces the Medicare rate of growth by 2 percent. 
President Obama's Council of Economic Advisers estimates that the bill 
will:

       Reduce the annual growth rate of Federal spending by a 
     percentage point in the upcoming decade and by an even 
     greater amount in the subsequent decade--

which would increase national savings and improve the long-run 
performance of the U.S. economy, in their words.
  Widening the focus from public programs to the economy as a whole, 
the challenge posed by wasteful health care costs expands. The 
President's Council of Economic Advisers recently released an updated 
report in which they concluded that: Annual waste and inefficiency in 
the health care status quo approaches 5 percent of GDP, $700 billion--
billion with a ``b''--$700 billion every year in waste and 
inefficiency. Set aside for a moment duplicative tests, lost medical 
records, unnecessary treatments, and uncoordinated care for chronic 
patients and look just at the administrative overhead of the private 
insurance market. As we know, the administrative costs for Medicare run 
about 3 percent to 5 percent. Overhead for private insurers is an 
astounding 20 percent to 27 percent. A Commonwealth Fund report 
indicates that private insurer administrative costs increased 109 
percent from 2000 to 2006, more than double in 6 years, and my 
colleagues can just imagine the mischievous purposes to which all that 
bureaucracy is being put.
  The McKinsey Global Institute estimates that Americans spend roughly 
$128 billion annually on excess administrative overhead of private 
insurance companies--$128 billion every year. Then, of course, there 
are those duplicative tests: lost medical records, unnecessary 
treatments, and uncoordinated care for patients. Because of all of this 
waste in the system, the Council of Economic Advisers concludes that:

     [i]t should be possible to cut total health expenditures 
     about 30 percent without worsening outcomes . . . which would 
     again suggest that savings on the order of 5 percent of GDP 
     could be feasible.

  Remember, again, that 5 percent of our Nation's gross domestic 
product is $700 billion a year.
  They are not alone. Other experts agree. The New England Health Care 
Institute reports that as much as $850 billion in annual excess costs: 
``can be eliminated without reducing the quality of care.'' Former 
Treasury Secretary O'Neill has written recently that the excess cost is 
$1 trillion a year. And the Lewin Group, which is often cited by my 
colleagues on the other side of the aisle here, finds that we burn up 
over $1 trillion a year through excess cost and waste in our broken 
health care delivery system.
  Whether it is $700 billion a year or $1 trillion a year, it is a big 
savings target--bigger than anything discussed by CBO--and the tools to 
achieve these potential savings are in this bill. Analysts of all 
stripes agree that this bill does more than any previous measure to 
relieve the economy of this dead weight of waste and excess health care 
costs.
  The Commonwealth Fund has projected that our bill will reduce the 
annual growth of national health expenditures--that is the amount that 
the private and public sector spend on health care every year--by 0.6 
percentage points annually--$683 billion over the next 10 years. The 
Council of Economic Advisers writes that ``total slowing of private 
sector cost growth'' will be approximately 1 percentage point per year.
  Why does this happen? This happens because the bill begins to 
restructure, streamline, and modernize our disorganized and illogical 
medical delivery system. It changes outmoded payment systems that you 
will pay for good health care outcomes, not just more procedures. It 
funds comparative effectiveness research so you will know whether 
something works before you pay for it. It creates financial incentives 
for low-quality but high-cost providers to improve their performance, 
and for transparency so you will know who they are and you can avoid 
them. It makes investments in wellness and prevention to reduce costs 
by keeping you healthy in the first place. It improves the coordination 
of care for chronic care and multiple diagnosis patients. Anyone with a 
family member in that situation knows how difficult trying to organize 
their care is. It starts demonstration and pilot projects in Medicare 
to create quality-based efficiencies in health care delivery that will 
spread out to the private sector.
  Such investments in quality of care pay proven dividends. For 
example, I often talk about the Keystone Project in Michigan which 
reduced infections, respiratory complications, and other medical errors 
in Michigan's intensive care units. It didn't even go to all of the 
intensive care units. Just in the participating ones, it saved more 
than 1,800 lives, over 140,000 days that patients would have spent in 
the hospital--140,000 saved patient days--and, of course, over 271 
million health care dollars, saving lives and saving dollars.
  In my home State, the Rhode Island Quality Institute has taken this 
model statewide with every one of our hospitals participating, and we 
are already seeing hospital-acquired infections and costs declining: a 
16.5 percent decrease in mortality and a statewide mortality rate 
almost 21 percent lower than the national average, saving the State's 
health care system $6 million overall so far.
  Analysts agree that there is a big savings opportunity, and many 
agree that we are taking the right approach to tackling it. But they 
also agree that the amount of savings we can achieve is uncertain. Why? 
Why is it uncertain if the tools are in the bill to achieve the 
savings? It is uncertain because administering and applying these tools 
effectively will be essential. Remember: We have never before taken aim 
at this target. We have never launched such a battery of innovative 
reforms, even though experts have been advocating them in some cases 
for decades. Success will depend on the quality of executive 
management, how dynamic we are in bringing these innovative tools to 
bear on a problem. The quality of executive management with innovative 
tools is simply not something that CBO knows how to score. It is not 
something they can do.
  CBO Director Doug Elmendorf has conceded in a letter to Budget 
Committee Chairman Kent Conrad:

       Changes in government policy have the potential to yield 
     large reductions in both national health care expenditures 
     and Federal

[[Page S1865]]

     health care spending without harming health.
       Many experts agree on some general directions in which the 
     government's health care policy should move. Many of the 
     specific changes that might ultimately prove most important 
     cannot be foreseen today and could be developed only over 
     time through experimentation and learning.

  That is Doug Elmendorf: experimentation and learning.
  That sounds an awful lot like the example used by Dr. Atul Gawande, 
one of our most thoughtful commentators on this subject, who analogized 
health care to the agricultural sector. He wrote about the agricultural 
sector:

       That [it] was strangling the country at the beginning of 
     the 20th century . . . The government never took over 
     agriculture, but the government didn't leave it alone either. 
     It shaped a feedback loop of experiments and learning and 
     encouragement for farmers across the country.

  Experiments and learning. How did that work out? To continue with Dr. 
Gawande:

       The results were beyond what anyone could have imagined. 
     Productivity went way up. Prices fell by half. Today, food is 
     produced on no more land than was devoted to it a century ago 
     and with far greater variety and abundance than ever before 
     in history.
       The strategy works because United States agencies were 
     allowed to proceed by trial and error, continually adjusting 
     policies over time, in response not to ideology but to hard 
     measurement of the results against social goals . . . Pick up 
     the Senate health care bill--yes, all 2,074 pages--and leaf 
     through it. Almost half of it is devoted to programs that 
     would test various ways to curb costs and increase quality . 
     . . The bill is a hodgepodge. And it should be.

  Here is how he wraps things up. He says this:

       We crave sweeping transformations. However, all the current 
     bill offers is those pilot programs, a battery of small-scale 
     experiments. The strategy seems hopelessly inadequate to 
     solve a problem of this magnitude. And, yet--history suggests 
     otherwise.

  David Cutler is a widely respected Harvard health care economist. He 
wrote in the Wall Street Journal recently that:

     [o]ver the past year of debate, 10 broad ideas have been 
     offered for bending the health care cost curve. The 
     Democrats' proposed legislation incorporates virtually every 
     one of them.

  Professor Cutler gives the bill ``full credit'' on six of the cost 
control ideas and ``partial credit'' on three, including ideas 
regularly championed by my colleagues on the other side, such as 
combating fraud and abuse in the Medicare system and reform in the 
medical malpractice liability system.
  The only area in which Cutler gives the bill zero credit is in its 
failure to include a public option. It is hard for our colleagues on 
the other size to criticize us for that since it is the thing they 
fought the hardest against. As codrafter with the distinguished 
Presiding Officer, Senator Brown of Ohio, I deeply regret that 
provision was excluded. Perhaps on another occasion we will have the 
chance to revisit that issue. But 9 of the 10 cost control mechanisms 
are in this bill, and the 10th was a public option our colleagues 
opposed.
  David Cutler concludes that ``[w]hat is on the table is the most 
significant action on medical spending ever proposed in the United 
States.'' In spite of the uncertainty described by CBO Director 
Elmendorf, Cutler estimates that the reforms will save ``nearly $600 
billion over the next decade and even more in the subsequent one.''
  Nobel laureate Paul Krugman agrees that ``there's good reason to 
believe that [CBO's] estimates are too pessimistic. There are many 
cost-saving efforts in the proposed reform, but nobody knows how well 
any one of these efforts will work. And as a result, official estimates 
don't give the plan much credit for any of them. . . . Realistically, 
health reform is likely to do much better at controlling costs than any 
of the official projections suggest.''
  Recently, three more respected health economists--Len Nichols of 
George Mason, Ken Thorpe of Emory, and Alan Garber of Stanford--
described the bill's cost controls as vital, a significant improvement 
on the status quo. As Professor Thorpe neatly described it:

       Under the do-nothing scenario, everything gets worse.

  And MIT professor Jonathan Gruber, one of our leading health 
economists, said this of the bill's cost control measures:

       I can't think of a thing to try they didn't try.

  I ask unanimous consent for an additional minute.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WHITEHOUSE. Professor Gruber said:

       I can't think of a thing to try that they didn't try. They 
     really make the best effort anyone has ever made. Everything 
     is in here. . . . You couldn't have done better than they are 
     doing.

  When the do-nothing crowd on the other side argues that this bill is 
a cost disaster, that it has no master plan, I urge that American 
ingenuity, through experimentation and learning, can overcome the 
toughest challenges, not through command and control but through a 
flexible, dynamic, and persistent exercise--experimentation, learning, 
and encouragement.
  I will close by urging President Obama to specify a savings target 
for his administration to achieve. I have before recommended setting 
the target at $200 billion in annual savings by 2014. That should be 
conservative and easy to achieve. But a clear and specific goal will 
wheel the vast apparatus of Federal bureaucracy more rapidly toward the 
comprehensive change we need.
  When President Kennedy announced in September of 1962 that America 
would strive to put a man on the Moon, he set a specific target. He did 
not say he was going to bend the curve of space exploration; he said he 
would put a man on the Moon. What he said about that is this:

       We choose to do such things not because they are easy, but 
     because they are hard, because that goal will serve to 
     organize and measure the best of our energies and skills, 
     because that challenge is one that we are willing to accept, 
     one we are unwilling to postpone, and one which we intend to 
     win. . . .

  Health care cost is a challenge we are indeed willing to accept, it 
is one we cannot afford to postpone, and it is one which we can and 
must and will win.
  I thank the Presiding Officer for his courtesy. I yield the floor.
  The PRESIDING OFFICER (Mr. Whitehouse). The Senator from Ohio.
  Mr. BROWN of Ohio. Mr. President, I thank you for the work you did on 
this bill that the President signed today to bring costs under control 
in our health care system, to do what we need to do to insure 32 
million people, to provide consumer protections this bill offers, and 
to give these tax breaks immediately to America's small businesses.
  One of the most important components of that is the work you and 
others in this Chamber did to bring costs down in this health care 
system, the costs that afflict taxpayers, the costs that afflict small 
businesses, the costs that afflict, in effect, our ability to compete 
around the world, and the costs that come directly out of people's 
pockets, those who have health insurance and those who do not, and the 
huge burdens of costs. We are finally on a track to do the right thing. 
I thank the Presiding Officer, the Senator from Rhode Island, Mr. 
Whitehouse.
  I will speak for just a few minutes. I have come to this floor since 
July, as we voted the health care bill initially out of the Health, 
Education, Labor, and Pensions Committee, night after night mostly for 
the last 7 or 8 months, to share letters from Ohioans with my 
colleagues. There are a couple of things these letters have in common.
  In most cases, these letters are written by people who have had 
significant problems, generally have lost their insurance or are paying 
so much it is hardly insurance. These letters typically come from 
people who a year or two ago would have told you they were satisfied 
with their insurance; they thought it covered what they needed. Then 
something happened. They either lost their job or lost their insurance 
or had a child born with a preexisting condition and could not get 
insurance for her or him or they got very sick and their care was very 
expensive and the insurance company cut them off or the insurance 
company realized they were going to be expensive--they perhaps had a 
preexisting condition and they were getting more expensive--or they 
were getting older and the insurance company found a way by charging 
them so much. They could not cancel the insurance, so they thought 
perhaps they could force the letter writer--the insurer--to cancel the 
insurance.

[[Page S1866]]

  The other thing they had in common so often was so many of the letter 
writers were 60, 61, 62 years old and said: I can't wait until I get on 
Medicare because I can trust Medicare; I know Medicare is stable; it 
will be there for me. It is a strong government program, not socialism. 
Government is simply the insurer. The government has made such a 
difference in the lives of so many senior citizens because the Medicare 
Program worked.
  As the Presiding Officer knows--just a little history of this 
institution and this bill--the same arguments that were used this year 
against this health care bill were used against Medicare in 1965: 
socialism, government takeover. Back then, it was the John Birch 
Society. Today, it is the tea parties. They said: A government 
bureaucrat will get between my doctor and me. It was not true about 
Medicare; it is not true now.
  The public clearly sees through this. That is why this Congress 
passed this bill, and that is why the President today--and one of the 
most important things professionally in my lifetime by a long shot, 
maybe the most important thing as I watched the President of the United 
States today sign this legislation.
  Let me share three or four letters from Ohioans to give you an idea 
what this bill means to people whom it affects. We on this floor hear 
the debate and the partisanship and see the obstructionism from the 
other side, and who is going to win, Republicans or Democrats. The 
reason we are doing this bill is these letters. That is why it matters. 
You will see this.
  David from northern Ohio:

       My best friend's husband is a hemophiliac. He has had a 
     pretty scary life and could be just one bleed away from death 
     or financial ruin. They are about to hit their cap for their 
     employer-provided insurance and have very few choices to seek 
     out other insurance because of his preexisting condition. 
     They have done everything that people should do--they have 
     worked hard, put money aside for retirement, and only used 
     their insurance when it was absolutely necessary. I can't 
     imagine--

  She writes about her friend--

     the fear they must constantly feel. Please stand firm and 
     remember those whose voices are small individually, but are 
     strong standing together.

  Health reform will help families such as David's friend's family 
because it will get rid of lifetime limits and arbitrary annual caps on 
benefits. In this case of the man who has hemophilia and his wife, they 
know if their health care gets too expensive, under the present system 
or at least the system before today, before the President signed the 
bill, they know they can lose their insurance if it gets too expensive. 
They will not have any coverage then. Under this bill, insurance 
companies simply can no longer do that.

  Diane from Cuyahoga County writes:

       We have a small business that has been in the family for 
     many years. But after doing well, our situation is precarious 
     because of the high cost of health insurance.

  In the last few years, we have continually downgraded our health 
insurance coverage. We are struggling to pay our health care bills and, 
of course, have no dental or eye coverage.

       Putting children through college, paying health insurance, 
     and trying to keep the business afloat makes life difficult.

  That is what has happened with so many small businesses. They 
struggle to insure themselves and their employees. In one small 
business, the small business has 10 employees, and if one person gets 
really sick and it is very expensive--cancer or something else--that 
company so often has to cancel their insurance simply because they 
cannot afford it, and their employees, even though they were not very 
sick, lose out.
  In so many cases, as Diane points out, the insurance people do have 
has more and more holes in it. She said: We continually downgraded our 
health insurance.
  This bill, starting tomorrow--the President signed it today--will 
help by offering small businesses tax credits so employers can offer 
coverage to their employees. This is the first major impact this bill 
will have.
  This bill will take a while because we want to implement it correctly 
and quickly enough to help people but not so quickly that we will make 
significant mistakes.
  The first thing this bill does is provide tax incentives to small 
businesses, such as Diane's, so they can actually write good insurance 
policies for themselves if they are self-employed and for themselves if 
they have a business, and with their employees.
  The last letter I will share is from Cynthia from Hocking County, 
Logan, OH, southeast of Columbus:

       My son-in-law is 40 years old with a serious medical 
     condition that makes it extremely difficult to get around. My 
     daughter is 42 years old and on disability. . . .
       Neither of them can work and make supplemental income. They 
     have to spend so much on medication that they are not able to 
     pay their house payments and may have to file for bankruptcy. 
     They also have a 16-year-old son to support. Who doesn't want 
     to send their child to college and help him have a better 
     life? But where will that money come from if they can't pay 
     the bills now?
       Please continue to fight for the middle and lower middle 
     class families who insist that we be treated fairly and with 
     dignity. We just want good insurance like lawmakers in 
     Washington have.

  This plan with the insurance exchange was based on the Federal 
employee plan that most Senators and Congressmen have, that most 
Federal employees have. This bill will provide for those who are lower 
income than we are, significantly lower income than we are, for people 
who are making $10,000, $20,000, or $30,000, or $50,000 a year, even a 
little more than that. It will provide them with subsidies so they can 
afford health insurance. We want everybody to be insured.
  We know right now that every American who has insurance pays about 
$1,000 extra--a tax for all intents and purposes--pays $1,000 extra to 
pay for the care of people who don't have insurance and go to the 
hospital. Somebody has to pay for that. It is being spread around to 
everybody who has insurance. That extra $1,000 will no longer happen to 
any significant degree because as everybody in this country or almost 
everybody gets insurance, people will be paying for themselves. They 
will get subsidies with their low income. If they have a little more 
money than that, they will pay everything themselves. That is why this 
legislation makes so much sense.
  Today, we saw the President of the United States move this country 
forward--tax breaks for small businesses, no more preexisting 
conditions for a child, no more exclusions to keep a family from 
getting insurance. If your 22-year-old son or daughter comes home from 
college and cannot get a job with insurance, that daughter or son can 
stay on the insurance plan of their parents until they are 26.
  There are a whole lot of important things. Senior citizens, starting 
next year, will be able to get a physical every year without a copay, 
making sure our senior population stays healthier longer. We begin to 
close the doughnut hole so seniors, with the bill that was passed a few 
years ago that gave the drug companies a whole lot more money than it 
helped seniors--at least we are fixing that bill so seniors will see 
that doughnut hole closed. All of those things are part of the 
legislation in the next year or so as it takes effect.
  This is the right thing for our country. It is an honor and a 
privilege to represent Ohio and to have an opportunity to vote for this 
legislation and to push it to work for public health.
  If we look back, President Truman, when he spoke to the Congress in 
1946, spoke about the importance of health care. Now 65 years later and 
10 Presidents later, it has happened. It is a good day for our country, 
and we celebrate that. Most importantly, it gives people such as 
Cynthia from Hocking County, Diane, the business owner in Cleveland, 
and David in northern Ohio the opportunity to get on with their lives 
in a much more workable, practical, happier way.
  Mr. President, I yield the floor.
  Mr. CONRAD. Mr. President, section 301(a) of S. Con. Res. 13, the 
2010 budget resolution, permits the chairman of the Senate Budget 
Committee to adjust the allocations of a committee or committees, 
aggregates, and other appropriate levels and limits in the resolution, 
and make adjustments to the pay-as-you-go scorecard, for legislation 
that is deficit-neutral over 11 years, reduces excess cost growth in 
health care spending, is fiscally responsible over the long term, and 
fulfills at least one of eight other conditions listed in the reserve 
fund.
  I find that H.R. 3590, the Patient Protection and Affordable Care 
Act, which

[[Page S1867]]

Congress cleared on March 21, 2010, fulfills the conditions of the 
deficit-neutral reserve fund to transform and modernize America's 
health care system. Therefore, pursuant to section 301(a), I am 
adjusting the aggregates in the 2010 budget resolution, as well as the 
allocation to the Senate Finance Committee.
  I ask unanimous consent to have the following revisions to S. Con. 
Res. 13 printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010--S. CON. RES.
  13; FURTHER REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION
301(a) DEFICIT-NEUTRAL RESERVE FUND TO TRANSFORM AND MODERNIZE AMERICA'S
                           HEALTH CARE SYSTEM
                        [In billions of dollars]
------------------------------------------------------------------------
 
------------------------------------------------------------------------
                        Section 101
(1)(A) Federal Revenues:
    FY 2009................................................    1,532,579
    FY 2010................................................    1,614,208
    FY 2011................................................    1,936,581
    FY 2012................................................    2,140,285
    FY 2013................................................    2,320,247
    FY 2014................................................    2,562,348
(1)(B) Change in Federal Revenues:
    FY 2009................................................        0,008
    FY 2010................................................      -51,778
    FY 2011................................................     -152,050
    FY 2012................................................     -220,108
    FY 2013................................................     -195,090
    FY 2014................................................      -71,310
(2) New Budget Authority:
    FY 2009................................................    3,675,736
    FY 2010................................................    2,906,707
    FY 2011................................................    2,845,376
    FY 2012................................................    2,837,658
    FY 2013................................................    2,988,148
    FY 2014................................................    3,207,977
(3) Budget Outlays:
    FY 2009................................................    3,358,952
    FY 2010................................................    3,015,321
    FY 2011................................................    2,969,841
    FY 2012................................................    2,871,685
    FY 2013................................................    2,992,262
    FY 2014................................................    3,181,127
------------------------------------------------------------------------


 CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010--S. CON. RES.
  13; FURTHER REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION
301(a) DEFICIT-NEUTRAL RESERVE FUND TO TRANSFORM AND MODERNIZE AMERICA'S
                           HEALTH CARE SYSTEM
                        [In millions of dollars]
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Current Allocation to Senate Finance Committee:
    FY 2009 Budget Authority...............................    1,178,757
    FY 2009 Outlays........................................    1,166,970
    FY 2010 Budget Authority...............................    1,237,336
    FY 2010 Outlays........................................    1,237,842
    FY 2010-2014 Budget Authority..........................    6,857,897
    FY 2010-2014 Outlays...................................    6,857,305
Adjustments:
    FY 2009 Budget Authority...............................            0
    FY 2009 Outlays........................................            0
    FY 2010 Budget Authority...............................        8,500
    FY 2010 Outlays........................................        3,130
    FY 2010-2014 Budget Authority..........................       -7,510
    FY 2010-2014 Outlays...................................      -31,710
Revised Allocation to Senate Finance Committee:
    FY 2009 Budget Authority...............................    1,178,757
    FY 2009 Outlays........................................    1,166,970
    FY 2010 Budget Authority...............................    1,245,836
    FY 2010 Outlays........................................    1,240,972
    FY 2010-2014 Budget Authority..........................    6,850,387
    FY 2010-2014 Outlays...................................    6,825,595
------------------------------------------------------------------------

  Mr. CONRAD. Mr. President, section 301(a) of S. Con. Res. 13, the 
2010 budget resolution, permits the chairman of the Senate Budget 
Committee to adjust the allocations of a committee or committees, 
aggregates, and other appropriate levels and limits in the resolution, 
and make adjustments to the pay-as-you-go scorecard, for legislation 
that is deficit-neutral over 11 years, reduces excess cost growth in 
health care spending, is fiscally responsible over the long term, and 
fulfills at least one of eight other conditions listed in the reserve 
fund. In addition, section 303 of S. Con. Res. 13 permits the chairman 
of the Senate Budget Committee to adjust the allocations of a committee 
or committees, aggregates, and other appropriate levels and limits in 
the resolution, for legislation that makes higher education more 
accessible and affordable, including expanding and strengthening 
student aid, such as Pell grants, and that does not increase the 
deficit over either the period of the total of fiscal years 2009 
through 2014 or the period of the total of fiscal years 2009 through 
2019.
  I find that H.R. 4872, the Health Care and Education Reconciliation 
Act of 2010, fulfills the conditions of the deficit-neutral reserve 
funds for health care and higher education. Therefore, pursuant to 
sections 301(a) and 303, I am adjusting the aggregates in the 2010 
budget resolution, as well as the allocations to the Senate Finance 
Committee and the Senate Health, Education, Labor, and Pensions 
Committee.
  I ask unanimous consent to have the following revisions to S. Con. 
Res. 13 printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010-S. CON. RES.
  13; FURTHER REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION
301(a) DEFICIT-NEUTRAL RESERVE FUND TO TRANSFORM AND MODERNIZE AMERICA'S
   HEALTH CARE SYSTEM AND SECTION 303 DEFICIT NEUTRAL RESERVE FUND FOR
                            HIGHER EDUCATION
                        [In billions of dollars]
------------------------------------------------------------------------
 
------------------------------------------------------------------------
                        Section 101
(1)(A) Federal Revenues:
    FY 2009................................................    1,532.579
    FY 2010................................................    1,612.278
    FY 2011................................................    1,939.131
    FY 2012................................................    2,142.415
    FY 2013................................................    2,325.527
    FY 2014................................................    2,575.718
(1)(B) Change in Federal Revenues:
    FY 2009................................................        0.008
    FY 2010................................................      -53.708
    FY 2011................................................     -149.500
    FY 2012................................................     -217.978
    FY 2013................................................     -189.810
    FY 2014................................................      -57.940
(2) New Budget Authority:
    FY 2009................................................    3,675.736
    FY 2010................................................    2,907.837
    FY 2011................................................    2,858.866
    FY 2012................................................    2,831.668
    FY 2013................................................    2,991.128
    FY 2014................................................    3,204.977
(3) Budget Outlays:
    FY 2009................................................    3,358.952
    FY 2010................................................    3,015.541
    FY 2011................................................    2,976.251
    FY 2012................................................    2,878.305
    FY 2013................................................    2,992.352
    FY 2014................................................    3,181.417
------------------------------------------------------------------------


  CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010-S. CON. RES.
  13; FURTHER REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION
301(a) DEFICIT-NEUTRAL RESERVE FUND TO TRANSFORM AND MODERNIZE AMERICA'S
   HEALTH CARE SYSTEM AND SECTION 303 DEFICIT NEUTRAL RESERVE FUND FOR
                            HIGHER EDUCATION
                        [In millions of dollars]
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Current Allocation to Senate Finance Committee:
    FY 2009 Budget Authority...............................    1,178,757
    FY 2009 Outlays........................................    1,166,970
    FY 2010 Budget Authority...............................    1,245,836
    FY 2010 Outlays........................................    1,240,972
    FY 2010-2014 Budget Authority..........................    6,850,387
    FY 2010-2014 Outlays...................................    6,825,595
Adjustments:
    FY 2009 Budget Authority...............................            0
    FY 2009 Outlays........................................            0
    FY 2010 Budget Authority...............................        1,500
    FY 2010 Outlays........................................          500
    FY 2010-2014 Budget Authority..........................       15,400
    FY 2010-2014 Outlays...................................       15,310
Revised Allocation to Senate Finance Committee:
    FY 2009 Budget Authority...............................    1,178,757
    FY 2009 Outlays........................................    1,166,970
    FY 2010 Budget Authority...............................    1,247,336
    FY 2010 Outlays........................................    1,241,472
    FY 2010-2014 Budget Authority..........................    6,865,787
    FY 2010-2014 Outlays...................................    6,840,905
------------------------------------------------------------------------


  CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010-S. CON. RES.
  13; FURTHER REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION
301(a) DEFICIT-NEUTRAL RESERVE FUND TO TRANSFORM AND MODERNIZE AMERICA'S
   HEALTH CARE SYSTEM AND SECTION 303 DEFICIT NEUTRAL RESERVE FUND FOR
                            HIGHER EDUCATION
                        [In millions of dollars]
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Current Allocation to Senate Health, Education, Labor, and
 Pensions Committee:
    FY 2009 Budget Authority...............................      -22,612
    FY 2009 Outlays........................................      -19,258
    FY 2010 Budget Authority...............................        4,529
    FY 2010 Outlays........................................        1,575
    FY 2010-2014 Budget Authority..........................       50,562
    FY 2010-2014 Outlays...................................       44,706
Adjustments:
    FY 2009 Budget Authority...............................            0
    FY 2009 Outlays........................................            0
    FY 2009 Budget Authority...............................         -370
    FY 2010 Outlays........................................         -280
    FY 2010-2014 Budget Authority..........................       -6,780
    FY 2010-2014 Outlays...................................       -1,680
Revised Allocation to Senate Health, Education, Labor, and
 Pensions Committee:
    FY 2009 Budget Authority...............................      -22,612
    FY 2009 Outlays........................................      -19,258
    FY 2010 Budget Authority...............................        4,159
    FY 2010 Outlays........................................        1,295
    FY 2010-2014 Budget Authority..........................       43,782
    FY 2010-2014 Outlays...................................       43,026
------------------------------------------------------------------------

  Mr. CONRAD. Mr. President, as chairman of the Committee on the 
Budget, pursuant to section 313(c) of the Congressional Budget Act of 
1974, I ask that the following list of reconciliation provisions 
considered to be extraneous and subject to the Byrd rule be printed in 
the Record. The inclusion or exclusion of a provision on the following 
list does not constitute a determination of extraneousness by the 
Presiding Officer of the Senate.
  The list follows:

                   Extraneous Provisions of H.R. 4872

       None.

                          ____________________