[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.
____________________