[Congressional Record Volume 156, Number 48 (Thursday, March 25, 2010)]
[Senate]
[Pages S2069-S2089]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010

  The PRESIDING OFFICER. Under the previous order, the Senate will 
resume consideration of H.R. 4872, which the clerk will report.
  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).

  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mr. GREGG. Madam President, the Senator from Nevada is going to be 
recognized to offer an amendment at this time. I note that after the 
Senator from Nevada, the plan is to go to Senator Coburn, Senator 
Sessions, Senator Cornyn, Senator Grassley, Senator Brownback, Senator 
Vitter and Senator DeMint, and then maybe Senator Coburn again and then 
maybe Senator Ensign again.
  The PRESIDING OFFICER. The Senator from Nevada.


                           Amendment No. 3593

  Mr. ENSIGN. Madam President, I call up amendment No. 3593.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Nevada [Mr. Ensign] proposes an amendment 
     numbered 3593.

  Mr. ENSIGN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To improve access to pro bono care for medically underserved 
    or indigent individuals by providing limited medical liability 
                              protections)

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

     SEC. 2__. HEALTH CARE SAFETY NET ENHANCEMENT.

       (a) Limitation on Liability.--Notwithstanding any other 
     provision of law, a health care professional shall not be 
     liable in any medical malpractice lawsuit for a cause of 
     action arising out of the provision of, or the failure to 
     provide, any medical service to a medically underserved or 
     indigent individual while engaging in the provision of pro 
     bono medical services.

[[Page S2070]]

       (b) Requirements.--Subsection (a) shall not apply--
       (1) to any act or omission by a health care professional 
     that is outside the scope of the services for which such 
     professional is deemed to be licensed or certified to 
     provide, unless such act or omission can reasonably be 
     determined to be necessary to prevent serious bodily harm or 
     preserve the life of the individual being treated;
       (2) if the services on which the medical malpractice claim 
     is based did not arise out of the rendering of pro bono care 
     for a medically underserved or indigent individual; or
       (3) to an act or omission by a health care professional 
     that constitutes willful or criminal misconduct, gross 
     negligence, reckless misconduct, or a conscious, flagrant 
     indifference to the rights or safety of the individual harmed 
     by such professional.
       (c) Definition.--In this section--
       (1) the term ``medically underserved individual'' means an 
     individual who does not have health care coverage under a 
     group health plan, health insurance coverage, or any other 
     health care coverage program; and
       (2) the term ``indigent individual'' means and individual 
     who is unable to pay for the health care services that are 
     provided to the individual.

  Mr. ENSIGN. Madam President, very briefly, this is an amendment to 
improve the health care system in America. We talk about making health 
care more affordable. One of the ways to do that is to encourage people 
to give away health care.
  In my veterinary practice, I used to give away about 10 to 20 percent 
of my business. I did not have to be worried about being sued. Every 
doctor, every health care provider I have talked with, if they give 
away, if they do it pro bono, if they do it out of compassion, that is 
one of the first times they are going to get sued.
  What this amendment says is, unless there is gross negligence, if a 
health care provider is giving their services away out of the 
compassion of their heart, they cannot be sued. It is a very simple 
amendment.
  We have had this debate on the Senate floor before. This would 
greatly improve our medical system by encouraging people to be 
compassionate for those who cannot afford medical care, but they should 
not have to be worried about being sued if they happen to be 
compassionate enough to give their services away.
  This is a commonsense amendment. I encourage all our colleagues to 
vote for this amendment. This will improve our health care system in 
the United States.
  The PRESIDING OFFICER. Who yields time in opposition?
  Mr. BAUCUS. Madam President, we just now saw this amendment. We have 
to look at it. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BAUCUS. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Madam President, as I said, we were just handed this 
amendment. We have now examined it. This is an amendment that is 
related to medical malpractice and tort reform. There are a lot of 
provisions already in the bill which cover this subject. However, the 
main point of this amendment is not the jurisdiction of the relevant 
committees.
  I raise a point of order that the Ensign amendment would violate 
section 313(b)(1)(C) of the Congressional Budget Act.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. ENSIGN. Pursuant to section 904 of the Congressional Budget Act 
of 1974 and section 4(g)(3) of the statutory Pay-As-You-Go Act of 2010, 
I move to waive all applicable sections of those acts and applicable 
budget resolutions for purposes of my amendment and ask for the yeas 
and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from California (Mrs. Boxer), 
the Senator from West Virginia (Mr. Byrd), the Senator from Washington 
(Ms. Cantwell), and the Senator from New Jersey (Mr. Lautenberg) are 
necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 40, nays 55, as follows:

                      [Rollcall Vote No. 93 Leg.]

                                YEAS--40

     Alexander
     Barrasso
     Bennett
     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
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Wicker

                                NAYS--55

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

                             NOT VOTING--5

     Boxer
     Byrd
     Cantwell
     Isakson
     Lautenberg
  The PRESIDING OFFICER. On this vote, the yeas are 40, the nays are 
55. Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  The point of order is sustained, and the amendment falls.
  Mr. GREGG. Madam President, I understand we will now be having 10-
minute votes. Is that correct?
  The PRESIDING OFFICER. The Senate will be in order.
  Mr. GREGG. I ask unanimous consent that all additional votes on this 
bill be 10 minutes.
  The PRESIDING OFFICER. Is there objection? Without objection, it is 
so ordered.
  The Senator from Oklahoma.


                           Amendment No. 3700

  Mr. COBURN. Madam President, I have an amendment at the desk.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Oklahoma [Mr. Coburn] proposes an 
     amendment numbered 3700.

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

   (Purpose: To help protect Second Amendment rights of law-abiding 
                               Americans)

       At the end, add the following:

                 TITLE III--SECOND AMENDMENT PROTECTION

     SEC. 3001. VETERANS SECOND AMENDMENT PROTECTION.

       (a) Short Title.--This section may be cited as the 
     ``Veterans 2nd Amendment Protection Act''.
       (b) Conditions for Treatment of Certain Persons as 
     Adjudicated Mentally Incompetent for Certain Purposes.--
       (1) In general.--Chapter 55 of title 38, United States 
     Code, is amended by adding at the end the following:

     ``Sec. 5511. Conditions for treatment of certain persons as 
       adjudicated mentally incompetent for certain purposes

       ``In any case arising out of the administration by the 
     Secretary of laws and benefits under this title, a person who 
     is mentally incapacitated, deemed mentally incompetent, or 
     experiencing an extended loss of consciousness shall not be 
     considered adjudicated as a mental defective under subsection 
     (d)(4) or (g)(4) of section 922 of title 18 without the order 
     or finding of a judge, magistrate, or other judicial 
     authority of competent jurisdiction that such person is a 
     danger to himself or herself or others.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of chapter 55 of such title is amended by adding at 
     the end the following new item:

``5511. Conditions for treatment of certain persons as adjudicated 
              mentally incompetent for certain purposes.''.

       (c) Severability.--Notwithstanding any other provision of 
     this Act, if any provision

[[Page S2071]]

     of this section, or any amendment made by this section, or 
     the application of such provision or amendment to any person 
     or circumstance is held to be unconstitutional, this section 
     and amendments made by this section and the application of 
     such provision or amendment to other persons or circumstances 
     shall not be affected thereby.
       (d) Effective Date.--The amendments made by this section 
     shall take effect on the date of enactment of this Act.

  Mr. COBURN. Madam President, 140,000 of our troops have lost their 
second amendment rights as they go through the VA hospital system. They 
are not a danger to themselves or anyone else. This amendment is 
something that has passed this body unanimously, has come out of the 
committee unanimously, but still we have 140,000 of our long-serving 
veterans who have lost their rights to own a gun, hunt with their 
grandchildren, or to hunt birds in North Dakota.
  We have taken it away, not because of anything we did, because the 
bureaucracy did it. This amendment restores that. As they have gone 
through the VA system and the health care system, a bureaucrat has 
taken that right away.
  This is supported by the National Alliance on Mental Illness, AMVETS, 
Military Order of Purple Heart, NRA, Gun Owners of America, Veterans of 
Foreign Wars, and the American Legion.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, this is a health care reform----
  Mr. COBURN. They lost it under their health care.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. This is a health care reform bill, and we should keep all 
amendments to that subject. When we were sworn in as Senators, we took 
an oath of office to support the Constitution of the United States, 
which clearly includes the second amendment. All of us have a strong 
belief in the second amendment to our Constitution. But whatever you 
think about second amendment rights and the application of the second 
amendment, whatever you think about veterans and the relationship to 
questions of competency, I think we all should agree that neither what 
anybody thinks about second amendment rights or what veterans' 
relations should be to that should be in this bill. This is a health 
care bill.
  I note this bill already explicitly protects the rights of gun 
owners. Therefore, because this amendment is nearly entirely composed 
of matter outside the jurisdiction of the reconciled committees, I 
raise a point of order that the Coburn amendment violates section 
313(b)(1)(C) of the Congressional Budget Act.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. COBURN. Pursuant to section 904 of the Congressional Budget Act 
of 1974 and section 4(g)(3) of the Statutory Pay-as-you-go Act of 2010, 
I move to waive all applicable sections of those acts and applicable 
budget resolutions for purposes of my amendment.
  I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There appears to 
be a sufficient second.
  The question is on agreeing to the 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) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 45, nays 53, as follows:

                      [Rollcall Vote No. 94 Leg.]

                                YEAS--45

     Alexander
     Barrasso
     Bayh
     Bennett
     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
     Lincoln
     Lugar
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Pryor
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Webb
     Wicker

                                NAYS--53

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

                             NOT VOTING--2

     Byrd
     Isakson
  The PRESIDING OFFICER. On this vote, the yeas are 45, the nays are 
53. Three-fifths of the Senators duly chosen and sworn having not voted 
in the affirmative, the motion is not agreed to, the point of order is 
sustained, and the amendment falls.
  Mr. DURBIN. Madam President, I move to reconsider the vote and lay 
that motion upon the table.
  The motion to lay upon the table was agreed to.
  The PRESIDING OFFICER. The Senator from Alabama.


                           Amendment No. 3701

  Mr. SESSIONS. Madam President, President Obama made a promise to the 
American people that health care legislation would not provide benefits 
to those illegally in the country.
  The PRESIDING OFFICER. Does the Senator wish to call up his 
amendment?
  Mr. SESSIONS. I would call up my amendment.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Alabama [Mr. Sessions] proposes an 
     amendment numbered 3701.

  Mr. SESSIONS. I ask unanimous consent that the reading of the 
amendment be dispensed with.
  The amendment is as follows:

  (Purpose: To ensure that Americans are not required to pay for the 
  health benefits for those here illegally by requiring the use of an 
effective eligibility verification system, consistent with existing law 
  for other Federal health related programs, and to also maintain the 
current, and well-established requirement of law, that legal immigrants 
    should not become a ``public charge'' or burden to the American 
 taxpayers, to reduce the cost of this bill, and to reduce the deficit 
                        and for other purposes)

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

     SEC. 1006. PROVISIONS TO ENSURE EFFECTIVE ELIGIBILITY 
                   VERIFICATION SYSTEM.

       (a) Eligibility for Credits and Cost-Sharing Reductions.--
       (1) Credits.--Section 36B of the Internal Revenue Code of 
     1986, as added by section 1401 of the Patient Protection and 
     Affordable Care Act, is amended--
       (A) in subsection (c) (1), by striking subparagraph (B) and 
     by redesignating subparagraphs (C) and (D) as subparagraphs 
     (B) and (C), respectively, and
       (B) by striking paragraph (3) of subsection (e).
       (2) Reduced cost-sharing.--Section 1402 of the Patient 
     Protection and Affordable Care Act is amended--
       (A) by striking the last sentence of subsection (b),
       (B) by striking paragraph (3) of subsection (e), and
       (C) by adding at the end of subsection (f) the following:
       ``(4) Subsidies treated as public benefit.--Notwithstanding 
     any other provision of this Act or any other provision of 
     law, for purposes of section 403 of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996 (8 U.S.C. 1613), the following shall be considered a 
     Federal means-tested public benefit:
       ``(A) The ability of an individual to purchase a qualified 
     health plan offered through an Exchange.
       ``(B) The premium tax credit established under section 1401 
     of this Act (and any advance payment thereof).
       ``(C) The cost sharing reductions established under this 
     section (and any advance payment thereof).''.
       (b) Eligibility Determinations.--Section 1411 of the 
     Patient Protection and Affordable Care Act is amended--
       (1) in subsection (a)--
       (A) by striking so much of such subsection as precedes 
     paragraph (1) and inserting:
       ``(a) Verification Process.--The Secretary shall ensure 
     that eligibility determinations required by this Act are 
     conducted in accordance with the following requirements, 
     including requirements for determining:'', and
       (B) by inserting ``eligible'' before ``alien'' in paragraph 
     (1),
       (2) in subsection (b)(1)--
       (A) by inserting ``the Exchange with the following'' after 
     ``provide'',
       (B) by striking ``and'' at the end of subparagraph (A), by 
     redesignating subparagraph (B) as subparagraph (C) and by 
     inserting after subparagraph (A) the following:

[[Page S2072]]

       ``(B) a sworn statement, under penalty of perjury, 
     specifically attesting to the fact that each enrollee is 
     either a citizen or national of the United States or an 
     eligible lawful permanent resident meeting the requirements 
     of section 1402(f)(3) of this Act and identifying the 
     applicable eligibility status for each enrollee; and'', and
       (C) by inserting ``and documentation'' after 
     ``information'' in subparagraph (C) (as so redesignated),
       (3) by striking subparagraphs (A) and (B) of subsection 
     (b)(2) and inserting the following:
       ``(A) In the case of an enrollee whose eligibility is based 
     on attestation of citizenship of the enrollee, the enrollee 
     shall provide satisfactory evidence of citizenship or 
     nationality (within the meaning of section 1903(x) of the 
     Social Security Act (42 U.S.C. 1396b)).
       ``(B) In the case of an individual whose eligibility is 
     based on attestation of the enrollee's immigration status--
       ``(i) such information as is necessary for the individual 
     to demonstrate they are in `satisfactory immigration status' 
     as defined and in accordance with the Systematic Alien 
     Verification for Entitlements (SAVE) program established by 
     section 1137 of the Social Security Act (42 U.S.C. 1320b-7), 
     and
       ``(ii) any other additional identifying information as the 
     Secretary, in consultation with the Secretary of Homeland 
     Security, may require in order for the enrollee to 
     demonstrate satisfactory immigration status.'',
       (4) by striking so much of subsection (c) as precedes 
     paragraph (3) and inserting the following:
       ``(c) Verification of Eligibility Through Documentation.--
       ``(1) In general.--Each Exchange shall conduct eligibility 
     verification, using the information provided by an applicant 
     under subsection (b), in accordance with this subsection.
       ``(2) Verification of citizenship or immigration status.--
       ``(A) Verification of attestation of citizenship.--Each 
     Exchange shall verify the eligibility of each enrollee who 
     attests that they are a citizen or national of the United 
     States, as required by subsection (b)(1)(A) of this section, 
     in accordance with the provisions of section 1903(x) of the 
     Social Security Act.
       ``(B) Verification of attestation of eligible immigration 
     status.--Each Exchange shall verify the eligibility of each 
     enrollee who attests that they are eligible to participate in 
     the exchange by virtue of having been a lawful permanent 
     resident for not less than 5 years, as required by subsection 
     (b)(l)(B) of this section, in accordance with the provisions 
     of section 1137 of the Social Security Act.'',
       (5) by striking subparagraph (B) of subsection (c)(4),
       (6) by striking subsection (d) and redesignating 
     subsections (e) through (i) as subsections (d) through (h), 
     respectively, and
       (7) by striking ``under section 1902(ee) of the Social 
     Security Act (as in effect on January 1, 2010)'' in 
     subsection (d)(3) (as redesignated under paragraph (6)) and 
     inserting ``in accordance with the secondary verification 
     process established consistent with section 1137 of the 
     Social Security Act (as is in effect as of January 1, 
     2009)''.

  Mr. SESSIONS. I would note that loopholes do remain in the health 
care legislation. My amendment would simply ensure that the promise 
that has been made to the American people would be kept. It sets up an 
effective eligibility verification system consistent with that for 
other Federal health-related programs.
  The amendment maintains current law, which prohibits legal immigrants 
from becoming a public charge on the taxpayers. It also prohibits the 
Secretary from drafting any regulation that would amend or alter these 
principles, principles that the President, the Congress, and the 
American people have said they support. The amendment would reduce 
fraud and the financial burden of the legislation on the American 
taxpayers.
  I reserve the remainder of my time.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. Madam President, I urge my colleagues to oppose the 
Sessions amendment. It does two things. First, it requires legal 
permanent residents in the United States to produce documentary proof 
of their legality. We tried this under Medicaid and found out that many 
people in our country, the elderly and others, found it difficult to 
produce documentation though they were clearly eligible and clearly 
legal and entitled to basic assistance.
  Instead, our bill that we passed, health care reform, verifies that a 
person is legal by declaration of their Social Security number, which 
is verified. So we go through a good process here to make sure only 
those eligible will receive, and, secondly, what Senator Sessions' 
amendment does, is say to legal permanent residents paying taxes, they 
cannot use the Tax Code like other citizens for deductions and credits 
for 5 years. They are paying taxes under the Tax Code. They should be 
allowed the same tax credits as other Americans, other people living in 
this country.
  I urge my colleagues to defeat it for those two reasons, and the fact 
that this is an attempt to derail this bill.
  I move to table the Sessions amendment and ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the 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) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 55, nays 43, as follows:

                      [Rollcall Vote No. 95 Leg.]

                                YEAS--55

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

                                NAYS--43

     Alexander
     Barrasso
     Bayh
     Bennett
     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)
     Pryor
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Wicker

                             NOT VOTING--2

     Byrd
     Isakson
       
  The motion was agreed to.
  Mrs. MURRAY. Madam President, I move to reconsider the vote.
  Mr. INOUYE. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from Texas.


                           Amendment No. 3698

  Mr. CORNYN. Madam President, I call up amendment No. 3698 and ask for 
its consideration.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Texas [Mr. Cornyn] proposes an amendment 
     numbered 3698.

  Mr. CORNYN. I ask unanimous consent that reading of the amendment be 
dispensed with.
  The amendment is as follows:

 (Purpose: To ensure that health care reform reduces health care costs 
        for American families, small businesses, and taxpayers)

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

     SEC. 1__. LIMITATION ON APPLICATION OF ACTS.

       Notwithstanding any other provision of law, the Secretary 
     of Health and Human Services shall not implement the Patient 
     Protection and Affordable Care Act and the Health Care and 
     Education Reconciliation Act of 2011 until the Office of the 
     Actuary at the Centers for Medicare & Medicaid Services 
     certifies to Congress that such Acts will reduce National 
     health expenditures relative to the level of such 
     expenditures under current law.

  Mr. CORNYN. Madam President, this amendment would ensure that health 
care reform costs are lowered by this piece of legislation. If 
independent actuaries for the Centers for Medicare and Medicaid 
Services cannot certify that this health care reform legislation lowers 
national health expenditures, this bill will not go into effect.
  I reserve the remainder of my time before the vote.
  The PRESIDING OFFICER. The Senator from Montana.

[[Page S2073]]

  Mr. BAUCUS. Madam President, this amendment is a thinly disguised 
attempt to kill health care reform. Let me explain why. I remind my 
colleagues that the Congressional Budget Office has told us that in the 
first 10 years the bill actually will reduce the deficit by a 
significant amount. CBO also informs us that health care reform will 
lower premiums for 97 percent of Americans, improve benefits for many 
who are underinsured, and health care reform will bend the growth curve 
of health care spending. The CMS Actuary also says that national health 
care spending will be lower under the law than it will be without 
reform. In 2019, health spending will be 6.7 percent, compared to 7.2 
without reform.
  To prohibit implementation unless all these projections bear out is 
just another attempt to kill the bill. For that reason, I urge 
colleagues to resist this amendment.
  The PRESIDING OFFICER. The time of the Senator from Montana has 
expired.
  The Senator from Texas.
  Mr. CORNYN. Madam President, if you raise taxes enough and if you cut 
Medicare enough, you might be able to claim, through phony bookkeeping, 
that somehow this cuts the deficit. The administration's own actuaries 
have concluded this law will raise health care costs. That is why it is 
important we pass this amendment, so that the central purpose of this 
legislation--to bend the cost curve down--is actually realized.
  I urge colleagues to support the amendment.
  The PRESIDING OFFICER. The majority leader.
  Mr. REID. Madam President, we need to move these amendments more 
quickly. We have an agreement. We want to make sure everyone continues 
working in good faith. I ask unanimous consent that all future votes, 
starting with this one, be 10 minutes, and we will only have 2 minutes 
for the penalty period, so to speak. After 12 minutes, the votes are 
going to be cut off. Everyone should understand.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Madam President, I move to table the Cornyn amendment and 
ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER (Mr. Menendez). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 58, nays 40, as follows:

                      [Rollcall Vote No. 96 Leg.]

                                YEAS--58

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

                                NAYS--40

     Alexander
     Barrasso
     Bennett
     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
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Wicker

                             NOT VOTING--2

     Byrd
     Isakson
       
  The motion was agreed to.
  Mr. SCHUMER. Mr. President, I move to reconsider the vote.
  Mr. DODD. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from Iowa.


                           Amendment No. 3569

  Mr. GRASSLEY. Mr. President, I call up amendment No. 3569.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from Iowa [Mr. Grassley] proposes an amendment 
     numbered 3569.

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

  (Purpose: To amend title XVIII of the Social Security Act to ensure 
 Medicare beneficiary access to physicians, eliminate sweetheart deals 
   for frontier States, and ensure equitable reimbursement under the 
                 Medicare program for all rural States)

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

     SEC. __. REVISIONS TO THE PRACTICE EXPENSE GEOGRAPHIC 
                   ADJUSTMENT UNDER THE MEDICARE PHYSICIAN FEE 
                   SCHEDULE.

       Effective as if included in the enactment of the Patient 
     Protection and Affordable Care Act, subparagraph (H) of 
     section 1848(e)(1) of the Social Security Act (42 U.S.C. 
     1395w-4(e)(1)), as added by section 3102(b) of the Patient 
     Protection and Affordable Care Act, is amended to read as 
     follows:
       ``(H) Practice expense geographic adjustment for 2010 and 
     subsequent years.--
       ``(i) For 2010.--Subject to clause (iii), for services 
     furnished during 2010, the employee wage and rent portions of 
     the practice expense geographic index described in 
     subparagraph (A)(i) shall reflect \1/2\ of the difference 
     between the relative costs of employee wages and rents in 
     each of the different fee schedule areas and the national 
     average of such employee wages and rents.
       ``(ii) For 2011.--Subject to clause (iii), for services 
     furnished during 2011, the employee wage and rent portions of 
     the practice expense geographic index described in 
     subparagraph (A)(i) shall reflect \1/4\ of the difference 
     between the relative costs of employee wages and rents in 
     each of the different fee schedule areas and the national 
     average of such employee wages and rents.
       ``(iii) Hold harmless.--The practice expense portion of the 
     geographic adjustment factor applied in a fee schedule area 
     for services furnished in 2010 or 2011 shall not, as a result 
     of the application of clause (i) or (ii), be reduced below 
     the practice expense portion of the geographic adjustment 
     factor under subparagraph (A)(i) (as calculated prior to the 
     application of such clause (i) or (ii), respectively) for 
     such area for such year.
       ``(iv) Analysis.--The Secretary shall analyze current 
     methods of establishing practice expense geographic 
     adjustments under subparagraph (A)(i) and evaluate data that 
     fairly and reliably establishes distinctions in the costs of 
     operating a medical practice in the different fee schedule 
     areas. Such analysis shall include an evaluation of the 
     following:

       ``(I) The feasibility of using actual data or reliable 
     survey data developed by medical organizations on the costs 
     of operating a medical practice, including office rents and 
     non-physician staff wages, in different fee schedule areas.
       ``(II) The office expense portion of the practice expense 
     geographic adjustment described in subparagraph (A)(i), 
     including the extent to which types of office expenses are 
     determined in local markets instead of national markets.
       ``(III) The weights assigned to each of the categories 
     within the practice expense geographic adjustment described 
     in subparagraph (A)(i).

     In conducting such analysis, the Secretary shall not take 
     into account any data that is not actual or survey data.
       ``(v) Revision for 2012 and subsequent years.--As a result 
     of the analysis described in clause (iv), the Secretary 
     shall, not later than January 1, 2012, make appropriate 
     adjustments to the practice expense geographic adjustment 
     described in subparagraph (A)(i) to ensure accurate 
     geographic adjustments across fee schedule areas, including--

       ``(I) basing the office rents component and its weight on 
     occupancy costs only and making weighting changes in other 
     categories as appropriate;
       ``(II) ensuring that office expenses that do not vary from 
     region to region be included in the `other' office expense 
     category; and
       ``(III) considering a representative range of professional 
     and non-professional personnel employed in a medical office 
     based on the use of the American Community Survey data or 
     other reliable data for wage adjustments.

     Such adjustments shall be made without regard to adjustments 
     made pursuant to clauses (i) and (ii) and shall be made in a 
     budget neutral manner.
       ``(vi) Special rule.--If the Secretary does not complete 
     the analysis described in clause (iv) and make any 
     adjustments the Secretary determines appropriate for 2012 or 
     a subsequent year under clause (v), the Secretary shall apply 
     clause (ii) for services furnished during 2012 or a 
     subsequent year in the same manner as such clause applied for 
     services furnished during 2011.''.

[[Page S2074]]

     SEC. __. ELIMINATION OF SWEETHEART DEAL THAT INCREASES 
                   MEDICARE REIMBURSEMENT JUST FOR FRONTIER 
                   STATES.

       Effective as if included in the enactment of the Patient 
     Protection and Affordable Care Act, section 10324 of such Act 
     (and the amendments made by such section) is repealed.

  The PRESIDING OFFICER. The Senator from Iowa is recognized for 1 
minute.
  Mr. GRASSLEY. Mr. President, this is about geographical equity for 
all States. The Senate health reform bill just signed into law includes 
a frontier sweetheart deal that improves Medicare payments for five 
rural States at the expense of the other 45. The special deal is for 
North Dakota, South Dakota, Montana, Utah, and Wyoming. The Washington 
Post calls these deals the ``Candy Land'' of the health care bill. 
Repealing this provision will not kill the bill because it has to go 
back to the House anyway.
  My amendment also ensures that Health and Human Services cannot undo 
the formula fix that my amendment established in the Senate health care 
bill that is now law.
  The PRESIDING OFFICER. The time of the Senator has expired.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, I have the highest regard for my good 
friend from Iowa. We work very closely together. We want to make sure 
our States are fully incorporated, involved in the national health care 
delivery system; that is, rural States. We also want a balance between 
urban and rural. It is the only fair solution. This bill has that 
balance.
  I might say, there are some--I chuckle a little bit--I have talked to 
some of my friends in the East who talk about rural America--rural New 
York or rural Illinois or rural Indiana--and I appreciate that very 
much. But we are talking here, with frontier States, with what is 
really rural: only about six people per square mile.
  So I say to my friend from Iowa, we have the balance in the bill. We 
should maintain that current balance. I think this amendment is 
inadvisable, and I urge us to not support it.
  Mr. President, I move to table the amendment, and I ask for the yeas 
and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: 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 53, nays 45, as follows:

                      [Rollcall Vote No. 97 Leg.]

                                YEAS--53

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

                                NAYS--45

     Alexander
     Barrasso
     Bayh
     Bennett
     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
     Lincoln
     Lugar
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Pryor
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Webb
     Wicker

                             NOT VOTING--2

     Byrd
     Isakson
       
  The motion was agreed to.
  The PRESIDING OFFICER. The Senator from Kansas is recognized.


                           Amendment No. 3697

  Mr. BROWNBACK. Madam President, I call up, on behalf of myself and 
Senator Murkowski, amendment No. 3697 and ask for its immediate 
consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Kansas [Mr. Brownback], for himself and 
     Ms. Murkowski, proposes an amendment numbered 3697.

  Mr. BROWNBACK. 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 index tax thresholds imposed under the legislation to 
 prevent the government from using inflation to impose those taxes on 
  individuals currently making less than $200,000 and families making 
                          less than $250,000)

       At the end of section 1402(a), insert the following:
       (5) Inflation adjustment.--Section 1411 of the Internal 
     Revenue Code of 1986, as added by paragraph (1), is amended 
     by adding at the end the following new subsection:
       ``(f) Adjustment for Inflation.--In the case of any taxable 
     year beginning after December 31, 2013, each of the dollar 
     amounts under paragraphs (1) and (3) of subsection (b), 
     subparagraphs (A) and (C) of section 3101(b)(2), and clauses 
     (i) and (iii) of section 1401(b)(2)(A) shall be increased by 
     an amount equal to--
       ``(1) such amount, multiplied by
       ``(2) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which such taxable 
     year begins by substituting `calendar year 2012' for 
     `calendar year 1992' in subparagraph (B) thereof.
     If any increase determined under this subsection is not a 
     multiple of $1,000, such increase shall be rounded to the 
     next lowest multiple of $1,000.''.

  Mr. BROWNBACK. Madam President, this is a very simple but very 
important amendment in the sense that the new surtaxes on Medicare, on 
wages, and on unearned income are not indexed for inflation. All of my 
colleagues are familiar with the problem we have had with the 
alternative minimum tax being not indexed for inflation, and with that 
being a problem, it is now built into this bill. This new surtax is not 
indexed for inflation.
  If I can show my colleagues for a moment, on this chart, we can see 
how quickly, with a 4-percent rate of inflation, the people who are 
getting the subsidy today will be taxed as high income in a few years. 
This is a problem we are very familiar with. We fight with it 
regularly. It is part of the funding base of this bill. It needs to be 
taken out. The bill should not be paid for with inflation, and we are 
all too likely to have significant inflation.
  So I urge my colleagues to support this amendment.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, I have a lot of sympathy with the 
amendment. We don't want to get into an AMT situation. The AMT was not 
indexed when the AMT was enacted. We are now paying the price today. It 
is very possible that if this level is not indexed, we may be paying 
the price later on, in several years' time, but this is not the time or 
place.
  I might also say there are other provisions in the bill that are not 
indexed, such as the affordability provisions. That is not indexed. I 
don't think it is fair to index only for upper income and others whose 
incomes are below $20,000. But it is an issue, and we will address this 
at a subsequent date because it must be.
  In the meantime, I move to table the amendment and ask for the yeas 
and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There appears to 
be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 56, nays 42, as follows:

                      [Rollcall Vote No. 98 Leg.]

                                YEAS--56

     Akaka
     Baucus
     Begich
     Bennet
     Bingaman
     Boxer
     Brown (OH)
     Burris
     Cantwell
     Cardin
     Carper
     Casey

[[Page S2075]]


     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Franken
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (NE)
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Warner
     Whitehouse
     Wyden

                                NAYS--42

     Alexander
     Barrasso
     Bayh
     Bennett
     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
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Webb
     Wicker

                             NOT VOTING--2

     Byrd
     Isakson
       
  The motion was agreed to.


                           Amendment No. 3665

  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. VITTER. Madam President, I ask unanimous consent that amendment 
No. 3665 be called up and immediately considered.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The legislative clerk read as follows:

       The Senator from Louisiana [Mr. Vitter] proposes an 
     amendment numbered 3665.

  Mr. VITTER. I ask unanimous consent that the reading of the whole be 
waived.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

   (Purpose: To prevent the new government entitlement program from 
              further increasing an unsustainable deficit)

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

     SEC. ___. SUSPENSION OF THE ACT.

       If at the beginning of any fiscal year OMB determines that 
     the deficit targets set forth in the CBO report of March 20, 
     2010 will not be met, the provisions of this Act and the 
     Patient Protection and Affordable Care Act shall be suspended 
     for that year.

  Mr. VITTER. Madam President, I was very happy to hear the 
distinguished chairman of the Finance Committee absolutely promise that 
the ObamaCare bill will reduce the deficit, and the CBO projects that. 
The problem is, I think the American people have a very different view 
based on their gut common sense. There was a recent national scientific 
poll that showed significantly more Americans think there is life on 
Mars than think that the bill will reduce the deficit.
  My amendment is a simple, straightforward way to settle the question. 
It says for any fiscal year when those CBO costs or deficit reduction 
projections are busted, the entire ObamaCare bill is suspended. So, in 
fact, if this is ballooning spending and ballooning the deficit, we 
will stop it in its tracks. I urge a ``yes'' vote.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, we have had all sorts of amendments this 
morning. We have had amendments on malpractice, we have had amendments 
on guns, we have had amendments on immigration. Even last night we had 
amendments on some very interesting subjects, but this is the return of 
the killer amendment. We had a few killer amendments yesterday, and 
this is the return of the killer amendment.
  Why is it a killer amendment? Basically because this would suspend 
health care reform if certain arbitrary budget targets are not met. It 
is on again, off again, wondering about the other. It is clearly 
designed to kill the bill. Therefore, Madam President, I raise a point 
of order that the Vitter amendment violates section 313(b)(1)(c) of the 
Congressional Budget Act.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. VITTER. Madam President, my amendment only kills the bill----
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. VITTER. If the bill busts the budget.
  Pursuant to section 904 of the Congressional Budget Act of 1974 and 
section 4(g)(3) of the Statutory Pay-As-You-Go Act of 2010, I move to 
waive all applicable sections of those acts and applicable budget 
resolutions for purposes of my amendment, and I ask for the yeas and 
nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question occurs on agreeing to the motion. The clerk will call 
the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. 
Byrd), the Senator from Louisiana (Ms. Landrieu), and the Senator from 
Colorado (Mr. Udall) are necessarily absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Georgia (Mr. Isakson) and the Senator from Utah (Mr. Bennett).
  The PRESIDING OFFICER (Mrs. Hagan). Are there any other Senators in 
the Chamber desiring to vote?
  The yeas and nays resulted--yeas 39, nays 56, as follows:

                      [Rollcall Vote No. 99 Leg.]

                                YEAS--39

     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
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Wicker

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

                             NOT VOTING--5

     Bennett
     Byrd
     Isakson
     Landrieu
     Udall (CO)
  The PRESIDING OFFICER. On this vote, the yeas are 39 and the nays are 
56. Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  The point of order is sustained, and the amendment falls.
  Mrs. MURRAY. Madam President, I move to reconsider the vote.
  Mr. REID. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from South Carolina.


                            Motion to Commit

  Mr. DeMINT. I have a motion at the desk.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from North Carolina. [Mr. DeMint] moves to 
     commit the bill H.R. 4872 to the Committee on Finance of 
     the Senate with instructions to report the same back to 
     the Senate within 1 day with changes that ensure that the 
     Patient Protection and Affordable Care Act (including the 
     amendments made by such Act) does not prohibit Americans 
     from purchasing health insurance across State lines.

  Mr. DeMINT. Madam President, this motion will ensure that the new 
government health regime that has just been made law will not prohibit 
Americans from purchasing private health insurance plans across State 
lines without going through a government exchange.
  Throughout this yearlong health care debate, we have talked about the 
importance of competition between insurance companies, how it could 
bring accountability and lower costs. Yet the laws of the land have 
actually created State-by-State monopolies that have not been 
responsive to the American people and have run up costs.
  This motion could change that, creating hundred of choices, for 
Americans all across our Nation, with insurance companies competing for 
their business. CBO says this would lower their costs at least 5 
percent; other folks say much more, particularly if you are in a State 
with a lot of mandates.
  I encourage my colleagues to support my motion.

[[Page S2076]]

  The PRESIDING OFFICER. The time of the Senator has expired.
  The Senator from Montana.
  Mr. BAUCUS. This is a motion to commit to the Finance Committee 
obviously designed to kill the bill. Clearly, there is inadequate 
competition among insurance companies in most of our States. In fact, 
in most States I think there are maybe just two major companies. We 
want to encourage much more competition.
  Allowing them to sell across State lines is in concept a good idea, 
but it must be done responsibly. The underlying bill--the bill that 
passed, actually--does allow for interstate compacts. States can 
compact to sell across State lines. Once the exchange is open in 2014, 
insurance companies will automatically be able to sell across State 
lines. But to allow sales now would be irresponsible because it would 
encourage a race to the bottom. By that, I mean that irresponsible 
companies will be inclined to go to States with the lowest standards 
and then sell health insurance to other parts of the country, so people 
in other States will have virtually no remedies.
  It makes sense to have health care reform provisions in place, and 
then we can sell across State lines with compacts through the 
exchanges.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. BAUCUS. I move to table the DeMint motion, and I ask for the yeas 
and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There is a 
sufficient second.
  The question is on agreeing to the motion. The clerk will call the 
roll.
  The legislative clerk called the roll.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 56, nays 43, as follows:

                      [Rollcall Vote No. 100 Leg.]

                                YEAS--56

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

                                NAYS--43

     Alexander
     Barrasso
     Bayh
     Bennett
     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
     Lincoln
     Lugar
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Wicker

                             NOT VOTING--1

       
     Isakson
       

  The motion was agreed to.


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

  
  On page S. 2076, March 25, 2010, the Record does not contain a 
vote result.
  
  The online Record has been corrected to read: The motion was 
agreed to.


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



                           Amendment No. 3710

  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. ENSIGN. I call up amendment No. 3710.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Nevada [Mr. Ensign], for himself and Mr. 
     Brown of Massachusetts, proposes an amendment numbered 3710.

  Mr. ENSIGN. Madam 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 strike the penalty for failure to comply with the 
                          individual mandate)

       Strike section 1002 and insert the following:

     SEC. 1002. REPEAL OF PENALTY FOR FAILURE TO MAINTAIN MINIMUM 
                   ESSENTIAL COVERAGE.

       Section 5000A of the Internal Revenue Code of 1986, as 
     added by the Patient Protection and Affordable Care Act, is 
     amended by striking subsections (b), (c), (e), and (g).

  Mr. ENSIGN. I call the attention of the Senate to this clever 
cartoon. This cartoon has captured a very important part of this health 
care bill. It is a Trojan horse that says ``health care reform'' on it. 
You see a bunch of IRS agents coming out.
  My amendment goes to the heart of one of the problems with this bill. 
There is an individual mandate that puts fines on people that can also 
attach civil penalties. And 16,500 new IRS agents are going to be 
required to be hired because of the health care reform bill.
  Do we want IRS agents showing up at people's houses, not only to 
audit them because of their taxes but because now they are not paying 
an individual mandate fine? I do not think America wants expansion of 
the IRS. We should be focusing on jobs, not new jobs for IRS agents.
  I encourage my colleagues to vote for this amendment that would 
eliminate the individual fines on the individual mandates and civil 
penalties.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, the whole premise, the theory of health 
care reform is that it is a shared responsibility--employers, 
employees, American citizens, companies, a shared solution here.
  The bill already waives any criminal penalties. That is taken out of 
the bill. No criminal penalties. A person cannot go to jail. That is 
provided for in the bill that was signed a couple of days ago. The bill 
also limits collection activities. It is very sensitive to the points 
made by the Senator from Nevada. It has a good balance of 
responsibility and accountability. But there must be some consequence 
of somebody not living up to his or her shared responsibility. It is 
very sensitive to doing this in the right way. I think it is a good 
balance. Their amendment goes way too far by eliminating any 
consequences.
  I move to table the amendment and ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Delaware (Mr. Kaufman), 
is necessarily absent.
  I further announce that, if present and voting, the Senator from 
Delaware (Mr. Kaufman) would vote ``aye.''
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 58, nays 40, as follows:

                      [Rollcall Vote No. 101 Leg.]

                                YEAS--58

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

                                NAYS--40

     Alexander
     Barrasso
     Bennett
     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
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Wicker

                             NOT VOTING--2

     Isakson
     Kaufman
       
  The motion was agreed to.
  Mr. GREGG. Madam President, I move to reconsider the vote and to lay 
that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from Alaska.


                           Amendment No. 3711

  Ms. MURKOWSKI. I call up my amendment at the desk.

[[Page S2077]]

  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Alaska [Ms. Murkowski] proposes an 
     amendment numbered 3711.

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

    (Purpose: To provide an inflation adjustment for the additional 
            hospital insurance tax on high-income taxpayers)

       On page 94, between lines 20 and 21, insert the following:
       (2) Inflation adjustment.--
       (A) FICA.--Paragraph (2) of section 3101(b) of the Internal 
     Revenue Code of 1986, as added by section 9015 of the Patient 
     Protection and Affordable Care Act and amended by section 
     10906 of such Act and paragraph (1), is amended--
       (i) by striking ``In addition'' and inserting the 
     following:
       ``(A) In general.--In addition'', and
       (ii) by striking ``and which are in excess of'' and all 
     that follows and inserting ``and which are in excess of--
       ``(i) in the case of a joint return, $250,000,
       ``(ii) in the case of a married taxpayer (as defined in 
     section 7703) filing a separate return, one-half the dollar 
     amount determined under clause (i), and
       ``(iii) in any other case, $200,000.
       ``(B) Inflation adjustment.--In the case of any taxable 
     year beginning after 2013, the $250,000 and $200,000 amounts 
     under subparagraph (A) shall each be increased by an amount 
     equal to--
       ``(i) such dollar amount, multiplied by
       ``(ii) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins, determined by substituting `calendar year 2012' 
     for `calendar year 1992' in subparagraph (B) thereof.

     Any increase determined under the preceding sentence shall be 
     rounded to the nearest multiple of $1,000.''.
       (B) SECA.--
       (i) In general.--Paragraph (2) of section 1401(b) of the 
     Internal Revenue Code of 1986, as added by section 9015 of 
     the Patient Protection and Affordable Care Act and amended by 
     section 10906 of such Act, is amended by redesignating 
     subparagraph (B) as subparagraph (C) and by inserting after 
     subparagraph (A) the following new subparagraph:
       ``(B) Inflation adjustment.--In the case of any taxable 
     year beginning after 2013, the $250,000 and $200,000 amounts 
     under subparagraph (A) shall each be increased by an amount 
     equal to--
       ``(i) such dollar amount, multiplied by
       ``(ii) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins, determined by substituting `calendar year 2012' 
     for `calendar year 1992' in subparagraph (B) thereof.

     Any increase determined under the preceding sentence shall be 
     rounded to the nearest multiple of $1,000.''.
       (ii) Conforming amendment.--Subparagraph (C) of section 
     1401(b)(2) of such Code, as added by section 9015 of the 
     Patient Protection and Affordable Care Act and redesignated 
     by subparagraph (A), is amended by inserting ``(after the 
     application of subparagraph (B))'' after ``subparagraph 
     (A)''.
       (C) Replenishment of general fund through rescission of 
     certain stimulus funds.--Notwithstanding section 5 of the 
     American Recovery and Reinvestment Act of 2009 (Public Law 
     111-5; 123 Stat. 116), from the amounts appropriated or made 
     available under division A such Act (other than under title X 
     of such division A), there is rescinded $1,600,000,000 of any 
     remaining unobligated amounts. The Director of the Office of 
     Management and Budget shall apply the rescission in a pro 
     rata manner with respect to such amounts. The Director of the 
     Office of Management and Budget shall report to each 
     congressional committee the amounts so rescinded within the 
     jurisdiction of such committee.

  Ms. MURKOWSKI. Madam President, the amendment I offer is simple. What 
we are doing is indexing for inflation the Medicare tax increase the 
majority has levied on the American people through this health care 
bill. Under the bill that is now law, Medicare taxes are going to jump 
.9 percent for certain income groups. This is about an $86 billion tax 
hike. My amendment aim is to contain the damage by indexing for 
inflation the wage thresholds for those subject to the tax increase. 
The amendment is very similar to what my friend from Kansas offered not 
too many amendments ago. It is a reminder that we have gone down this 
path before with the AMT. The AMT was not indexed for inflation. Today 
we have nearly 30 million taxpayers hit by the AMT tax. We deal with it 
every year through the AMT patch. I wish to make sure we are not 
repeating history.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, as I said on the Brownback amendment, 
there is much to be said for indexing this provision. It is true we 
don't want to get back into the situation we now face with the AMT 
because the AMT was not originally indexed. Unfortunately, the current 
amendment will be offset with unspent, unallocated mandatory spending 
of stimulus funds. Unemployment is still hovering close to 10 percent. 
There is growing evidence the recovery package is working. I don't 
think we want to stifle the stimulus now. Over the last 6 months of 
2009, the economy grew at an annual rate of 4 percent. The fourth 
quarter grew at a higher rate, but that was due to an inventory 
situation. By and large, it is not proper to offset this with stimulus 
dollars. We will find some time at a later date to deal with this 
issue. I do think it is a serious issue.
  I raise a point of order that the Murkowski amendment violates 
section 313(b)(1)(c) of the Congressional Budget Act.
  Ms. MURKOWSKI. Pursuant to section 904 of the Congressional Budget 
Act of 1974 and section 4(g)(3) of the Statutory Pay-As-You-Go Act of 
2010, I move to waive all applicable sections of those acts and 
applicable budget resolutions for purposes of the amendment, and I ask 
for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion. The clerk will call the 
roll.
  The assistant legislative clerk called the roll.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 42, nays 57, as follows:

                      [Rollcall Vote No. 102 Leg.]

                                YEAS--42

     Alexander
     Barrasso
     Bayh
     Bennett
     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
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Webb
     Wicker

                                NAYS--57

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

                             NOT VOTING--1

       
     Isakson
       
  The PRESIDING OFFICER. On this vote, the yeas are 42, the nays are 
57. Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected. The point of order is 
sustained, and the amendment falls.
  The Senator from Texas.


                           Amendment No. 3634

  Mrs. HUTCHISON. Madam President, I call up amendment No. 3634.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from Texas [Mrs. Hutchison] proposes an 
     amendment numbered 3634.

  Mrs. HUTCHISON. Madam 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 strike the 2-year limitation on the small business tax 
           credit for taxable years after the Exchanges open)

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

     SEC. 1006. REPEAL OF TAXABLE YEAR LIMITATION ON SMALL 
                   BUSINESS TAX CREDIT.

       (a) In General.--Section 45R of the Internal Revenue Code 
     of 1986, as added by section 1421 of the Patient Protection 
     and Affordable

[[Page S2078]]

     Care Act and amended by section 10105(e) of such Act, is 
     amended--
       (1) by striking ``in the credit period'' in subsection (a),
       (2) in subsection (e), by striking paragraph (2) and 
     redesignating paragraphs (3), (4), and (5) as paragraphs (2), 
     (3), and (4), respectively,
       (3) in subsection (g), by striking paragraph (1) and 
     redesignating paragraphs (2) and (3) as paragraphs (1) and 
     (2), respectively, and
       (4) by striking ``to prevent the avoidance of the 2-year 
     limit on the credit period through the use of successor 
     entities and'' in subsection (i).
       (b) Effective Date.--The amendments made by this section 
     shall take effect as if included in the provisions of the 
     Patient Protection and Affordable Care Act to which the 
     amendments relate.

  Mrs. HUTCHISON. Madam President, our small businesses are struggling. 
We all know that. We are trying to encourage small businesses to hire 
and help our economy. Yet when this bill passes, our small businesses 
are going to have a tax credit if they offer health care to their 
employees, but what we are not telling the American people is that tax 
credit is limited to 2 years once the bill becomes fully effective. 
When the exchange opens, then the tax credit will last for 2 years.
  My amendment assures this is not going to be a bait-and-switch to our 
small businesspeople; that they will be able to have the tax credit 
permanently if they offer health care to their employees and they are a 
business of 25 employees and under.
  I hope our colleagues will support this amendment to help these small 
businesses. That is what will encourage them to offer health care to 
their employees.
  The PRESIDING OFFICER (Mr. Burris). The Senator's time has expired.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, in an effort to help small business, there 
are many provisions in this bill to accomplish that result. One is $37 
billion in tax credits that are in this bill already for small 
business.
  I do agree with the Senator from Texas, though, that it would be 
better if the credit, which is available for 2 years beginning in 2014 
when the exchange is up and running, was extended. That would be my 
preference. But right now, in 2010, we are short on money, frankly, and 
we can't find all the money that is necessary to make that permanent to 
accomplish the wishes of the Senator from Texas. But I do say I am 
sympathetic with extending that 2 years, and we will work to try to 
find ways in the future to accomplish that.
  In the meantime, I move to table the amendment, and I ask for the 
yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Indiana (Mr. Bayh) is 
necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 55, nays 43, as follows:

                      [Rollcall Vote No. 103 Leg.]

                                YEAS--55

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

                                NAYS--43

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

                             NOT VOTING--2

     Bayh
     Isakson
       
  The motion was agreed to.
  The PRESIDING OFFICER. The Senator from Texas is recognized.


                           Amendment No. 3712

  Mr. CORNYN. Mr. President, I ask unanimous consent to call up 
amendment No. 3712, and I ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from Texas [Mr. Cornyn] proposes an amendment 
     numbered 3712.

  Mr. CORNYN. 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 give States incentives to reduce fraud, waste, and abuse 
                      in their Medicaid programs)

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

     SEC. 1207. FMAP REDUCTION FOR HIGH PAYMENT ERROR RATE.

       Section 1905 of the Social Security Act, as amended by 
     section 1202(b) of this Act, is amended by adding at the end 
     the following:
       ``(ee) Decreased FMAP for High Payment Error Rate 
     Measurement.--Notwithstanding any other provision of this 
     title, beginning January 1, 2014, in the case of a State for 
     which the payment error rate measurement (commonly referred 
     to as `PERM') is at least 10 percent, the Federal medical 
     assistance percentage otherwise applicable to the State with 
     respect to payments for medical assistance for individuals 
     enrolled in the State plan under subclause (VIII) or (IX) of 
     section 1902(a)(10)(A)(i) or subclause (XX) or (XXI) of 
     section 1902(a)(10)(A)(ii) shall be reduced by 1 percentage 
     point until the date on which the Secretary determines that 
     the PERM for the State is below 10 percent.''.

  Mr. CORNYN. Mr. President, this amendment will lower the deficit 
while attacking the scourge of fraud and waste in our Medicaid Program. 
The $3.4 trillion Medicaid Program is riddled with waste, fraud, and 
abuse, and improper repayment rates that range roughly in the 10-
percent range for the Nation. Some States and some cities are even 
worse.
  In Washington, DC, 19.3 percent of Medicaid payments are classified 
by Health and Human Services as improper payments. In Oregon, one out 
of every five people on Medicaid is not even eligible to be on 
Medicaid. That is 20 percent.
  This amendment takes the $434 billion that we are putting into the 
health care coverage, much of it in Medicaid, and it provides a 
financial incentive for the States to reduce their improper payment 
rates.
  Since the Medicaid expansion does not go into effect until 2014, this 
provides a more than adequate period of time for the States to comply 
with bringing their improper payment rates down under Medicaid and thus 
to avoid any penalty under this amendment.
  I ask my colleagues for their consideration.
  The PRESIDING OFFICER. Who yields time in opposition?
  The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, we all want to fight fraud, waste, and 
abuse. In fact, there are many provisions in this bill which so 
provide. To add to that, when we negotiated the bill, the White House 
came up with even stronger provisions. They have the screening, time to 
check for payments, and so forth.
  I talked with the Senator from Florida, Mr. LeMieux, who also has 
good ideas. I pledge to him to do what we can to get some of that 
passed this year. However, the amendment before us is much too 
punitive. It is arbitrary in its numbers. I think it would be 
counterproductive, especially at a time when States are already 
struggling with their Medicaid Programs. I think it would be 
inappropriate for us to lay this arbitrary punitive measure on them.
  Mr. GREGG. Mr. President, if the Senator will allow me to make a 
quick statement just for the edification of our colleagues.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mr. GREGG. This is our last amendment, I believe and hope--genuinely

[[Page S2079]]

hope. After this amendment is completed, I understand there will be a 
colloquy between the ranking member of the Finance Committee and the 
chairman of the Budget Committee. Then we will proceed to raising 
points of order relative to the bill.
  Mr. BAUCUS. And other measures.
  Mr. GREGG. Then we will proceed to final passage at 2 o'clock. That 
is the general outline of where we are.
  Mr. BAUCUS. I might reconfirm, this is the last amendment. There will 
be points of order raised and other business will transpire before we 
get to the points of order, which I understand will begin about quarter 
of 2. We are going to finish at 2 o'clock. We are right there. It is 
going to work.
  Mr. President, I move to table the Cornyn amendment and ask for the 
yeas and nays.
  Mr. CORNYN. Is there time remaining?
  The PRESIDING OFFICER. All time has expired.
  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 bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 57, nays 41, as follows:

                      [Rollcall Vote No. 104 Leg.]

                                YEAS--57

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

                                NAYS--41

     Alexander
     Barrasso
     Bennett
     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
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Webb
     Wicker

                             NOT VOTING--2

     Byrd
     Isakson
       
  The motion was agreed to.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, that was the last vote on amendments. I 
wish to repeat that statement: That was the last vote on amendments.
  Mr. UDALL of Colorado. Mr. President, I was unable to cast a vote for 
rollcall No. 99 in the second session of the 111th Congress--the motion 
to waive the Budget Act point of order against Vitter amendment No. 
3665 to H.R. 4872, the Health Care and Education Reconciliation Act. 
Had I been present, I would have voted ``no'' on the motion.
  Mr. KAUFMAN. Mr. President, I was unfortunately off the Senate floor 
when the Senate conducted rollcall votes Nos. 68 and 101 and, 
therefore, missed those recorded votes. I wish to state for the record 
that had I been prsent for rollcall vote No. 68, I would have voted 
``yea'' on the motion to table Senate amendment No. 3582, and if I had 
been present for rollcall vote No. 101, I would have voted ``yea'' on 
the motion to table Senate amendment No. 3710.


                      Lawfully Present Immigrants

  Mr. MENENDEZ. Mr. President, I rise to speak about an issue affecting 
some of the most vulnerable families living in our society. Under 
health reform, tax credits are provided to families between 100 percent 
and 400 percent of the Federal poverty line in order to purchase health 
insurance. Families below 133 percent of the poverty line become 
eligible for Medicaid. Certain lawfully present immigrants however are 
not eligible for Medicaid due to their immigration status. Fortunately, 
health reform does not leave them in the cold. Mr. Chairman, am I 
correct in saying that lawfully present immigrants, who are otherwise 
ineligible for Medicaid, are eligible for premium tax credits in the 
exchange?
  Mr. BAUCUS. That is right. Due to the Senator's leadership and hard 
work, we were able to make sure those here legally had a place to find 
affordable health coverage.
  Mr. MENENDEZ. I believe it is important to clarify that the Senate 
bill's treatment of certain lawfully present immigrants as having an 
income at 100 percent of the Federal poverty level was intended to 
pertain only to their eligibility for the affordability credit--not the 
size of the actual tax credit. Plainly put, a legal immigrant whose 
income is at 50 percent of the poverty line should not have to pay the 
same premium amount as someone whose income is at 100 percent of the 
poverty line. Was this the intent of this provision in the health 
reform legislation?
  Mr. BAUCUS. The Senator is exactly right. The health reform 
legislation that was signed into law allows immigrants who are here 
lawfully, who are otherwise ineligible for Medicaid to receive tax 
credits in the exchange. However, the size of those tax credits should 
be based on the families' actual income, not an artificial level of 100 
percent of the poverty line. I expect this provision will be 
implemented as such. I look forward to working with Senator Menendez to 
ensure that these families receive access to affordable health 
insurance coverage.
  Mr. MENENDEZ. I thank the Chairman.
  Mrs. FEINSTEIN. Mr. President, I rise today to speak about a specific 
section of the health insurance reform bill.
  There has been some concern that language in the bills could be 
misinterpreted to create new causes of action or claims that would 
interfere with existing State medical malpractice laws.
  As Representative Henry Waxman clarified on the floor of the House of 
Representatives, it has never been the intent of the bill to create any 
new causes of action or to preempt any State medical malpractice law.
  Section 10201(j) of H.R. 3590, which added Section 3512 to subtitle F 
of title III of the act, calls for the Comptroller General to conduct a 
study of whether the development, recognition or implementation of any 
guideline or other standards under a list of enumerated sections of the 
Senate bill would result in a new cause of action or claim.
  It is important that this language requesting such a study not be 
interpreted in any way as creating any inference or implication that 
the enumerated sections of the bill will create any new action or 
claim.
  Additionally, it is important to understand that Congress has no 
intent in this legislation to modify or supersede any State medical 
liability law that governs legal standards or procedures used in 
medical malpractice cases.
  Mr. LEAHY. Mr. President, in addition to important improvements to 
the health reform bill President Obama signed into law this week, the 
reconciliation measure before the Senate also provides a significant 
investment in higher education.
  I have always strongly believed in the importance of a college 
education. Unfortunately, in recent years, average college tuition 
rates have increased faster than inflation, and have far outpaced 
student financial aid. Skyrocketing tuition is making it increasingly 
difficult for families to afford higher education. Many students are 
forced to take on significant debt, and too often are not able to 
complete college because of soaring costs.
  Especially during these difficult economic times we need to be doing 
more to address the rising costs of higher education and the growing 
need for student financial aid. I am glad to see that the measure in 
front of us today streamlines our student lending system and no longer 
subsidizes banks to lend to students risk free. By requiring that all 
future student loans be made directly to students through the Federal 
Government, this bill will save $61 billion over 10 years. Not only 
will this provision save the government money,

[[Page S2080]]

but the Direct Loan Program is projected to save students millions of 
dollars in fees and interest payments.
  A portion of the savings from this bill will be used to fund the Pell 
Grant Program, which is facing a significant shortfall this year. The 
measure provides $13.5 billion in mandatory appropriations for Pell 
grants, and will provide additional mandatory funding to the program by 
tying increases to inflation. Combined with the investment in Pell 
grants in the American Recovery and Reinvestment Act last year, which I 
was proud to support, the maximum Pell grant award will double as a 
result of this bill. Unfortunately, Pell grants cover less than half as 
much tuition at a public college or university as they did just a few 
decades ago, so a significant investment in the program's growth is 
necessary to help the more than 8 million students who participate. I 
met with students who attended school in Vermont this week and they 
shared their stories about how important this program was to them, and 
how it was critical to their ability to attend college. No student 
should be denied the opportunities of a college education because of 
financial burdens.
  I am also pleased the changes to student lending in the 
reconciliation bill will help nonprofits to provide important loan 
servicing and counseling services to students and their families. 
Several States have established not-for-profit State agencies to 
administer financial aid and to provide their residents and students 
attending their schools with quality counseling services and low-cost 
loans. Vermont pioneered this movement by creating the Vermont Student 
Assistance Corporation, VSAC, more than 40 years ago. Since then, VSAC 
has worked hard to establish and maintain strong and longstanding 
working relationships with Vermont's higher education institutions as 
well as K-12 schools to provide outreach programs critical to the 
economic vitality of Vermont.
  The reconciliation bill will prohibit anyone other than the Federal 
Government from originating new Federal loans, but unlike the lending 
measure the House passed in July, the reconciliation package will help 
nonprofits continue to provide important college access and completion 
activities. This measure will double the funding directed to Vermont, 
which will help VSAC continue to counsel students and their families 
about entering and completing college. Additionally, the reconciliation 
legislation will allow non-profits to contract with the Federal 
Government to continue to service loans at a competitive market rate.
  I have heard from countless Vermonters about the invaluable services 
VSAC provides to help students attend and complete college. Just 
recently, a father of twins attending college in Vermont contacted my 
office to share with me the support that VSAC provided. If not for 
VSAC, he said, he did not think he could have made it through the 
paperwork or learned about the scholarships that were available.
  I am glad that Congress has recognized the importance of these 
services in States across the country and will allow for a continued 
role to help more students access and complete college. I look forward 
to continuing to work with VSAC to ensure their place as an important 
part of students' college experience.
  Mr. BAYH. Mr. President, included within this budget reconciliation 
bill are provisions that make significant changes to the federal 
student loan programs. Like others, I strongly support the provisions 
that increase funding for Pell grants. These grants form the foundation 
of Federal student aid, and do much to increase college access.
  Other provisions in the bill and the Higher Education Act also are 
important to students. As students increasingly look to Federal student 
loans to cover the costs of their college education, they are in need 
of federally supported services that help students to make well-
informed financial decisions. In this bill, section 2103 extends and 
roughly doubles the authorization, to $150 million annually, for the 
college access challenge grants, CACG. The CACG authorizes States who 
receive funding under the CACG to provide subgrants to guaranty 
agencies to assist students and families with such services as early 
awareness and outreach, financial literacy, debt management, and loan 
counseling to impact the ability of students to successfully manage 
their student loan obligations and start off their postcollege and 
professional lives on the right foot. Congress should encourage the 
States to continue to work with their designated guarantors to use the 
opportunity of continued authorization and increased funding of the 
CACG to utilize the expertise of guaranty agencies in providing such 
services. I agree with the comments of the chairman of the House 
Committee on Education and Labor during House consideration of this 
bill--Congress intends that states receiving grants under the college 
access challenge grant program should partner with entities, including 
guaranty agencies and their nonprofit subsidiaries, to provide 
financial literacy, delinquency and default aversion activities, and 
other loan counseling activities for borrowers.
  I also share the House chairman's view that the Secretary of 
Education has existing tools to ensure students have access to borrower 
and school services for financial literacy and default prevention. 
Under the Direct Loan Program, the Secretary is authorized to contract 
with guaranty agencies for services that ensure the successful 
operation of the program. As we move to require all institutions of 
higher education to participate in the Federal Direct Loan Program, 
students should continue to have access to the borrower and school 
services provided so well over the past 40 years by guaranty agencies. 
In my State of Indiana, our guaranty agency has a distinguished history 
of providing comprehensive services to help borrowers repay their loans 
and avoid default. Along with the House chairman, I, too, expect the 
Department of Education to ensure the availability of these services by 
exercising the Secretary's authority to contract with guaranty agencies 
for the provision of these services for students and schools.
  Mr. DURBIN. Mr. President, our colleagues on the other side of the 
aisle have confused some statements made by the President and made by 
me regarding whether the new health law will cause premiums to go down.
  The President has spoken forcefully about the impact of the new 
reform law on health insurance premiums. He has contrasted the effect 
of reform with the effect of doing nothing. He made it clear that if we 
passed a reform bill, premiums would go down compared to the status quo 
of not enacting a reform law.
  A couple of weeks ago, I said on the Senate floor that no one claims 
premiums will go down tomorrow when we pass this legislation. I was 
speaking in absolute terms. Premiums have been rising at a high and 
unsustainable rate. With these reforms, premiums will rise more slowly.
  The President and I were saying the same thing, using different 
words. The point is the same. With this new law, American families and 
businesses can have hope that their premiums will not rise as fast as 
they have been in the past.
  The days of 39 percent premium increases, as we have seen in 
California, will be over once this law is fully implemented.
  The days of 60 percent premium increases, as we have seen in my home 
State of Illinois, will be over once this law has been carried out.
  And if we repeal this new law, as the Senators on the other side of 
the aisle advocate, premiums will continue to rise at an unsustainable 
rate with spikes like those we have seen this year.
  Senators on the other side of the aisle are right to ask what will 
happen to premiums.
  Every American wants to know, ``What is going to happen to the cost 
of my healthcare?'' And they are right to ask that question.
  But the obstructionists and naysayers on the other side of the aisle 
are wrong when they oppose this bill and the new law based on the false 
claim that it will cause premiums to rise faster than the status quo. 
That is simply not true.
  And you don't have to take my word for it. Just ask the nonpartisan 
Congressional Budget Office--the congressional ``umpire'' when it comes 
to questions of what legislation will cost or save.

[[Page S2081]]

  Early in the health reform debate, throughout most of last year, we 
had useful data from the Congressional Budget Office--but it was not 
definitive. It was easily distorted by the opponents of reform and the 
defenders of the insurance companies, who want to stop all action and 
allow premiums to be increased by 10, 20, 39, 60 percent each year.
  The initial CBO reports compared premiums in today's market with the 
cost of a more generous health plan that is likely to be offered in the 
insurance exchanges of a reformed market.
  That is not a fair comparison, but it is all we had.
  It showed that people would pay more if they chose better coverage. 
But it didn't clearly say that for coverage comparable to what is 
available today, premiums would be lower.
  And so there was confusion.
  In January, when no one was paying attention and the debate on the 
Senate floor had shifted to jobs, we received some important additional 
information from CBO.
  The new data, from the people who know the numbers best at CBO, backs 
our conclusion that the Senate health reform bill will reduce the 
premiums people will pay for health insurance, compared to current law.
  That clear answer came in response to a request from the senior 
Republican Senator from Maine, Ms. Snowe.
  At the request of Senator Snowe, CBO estimated the premiums for a 
Bronze plan under the Senate reform bill.
  Bronze plans will cover roughly the same proportion of an individual 
or family's total health care costs as the average plan sold in the 
individual market today.
  So using Bronze plans to compare the Senate reform bill to current 
law provides an ``apples to apples'' comparison. It tells you what 
premiums you can expect if the bill passes, compared to what premiums 
you can expect for a similar policy if the bill is defeated. That is a 
fair comparison.
  Here's what CBO tells us:
  A Bronze plan in 2016 will cost an individual between $4,500 and 
$5,000 a year.
  Earlier, CBO estimated that under current law, with no health reform 
in place, an average plan in 2016 will cost an individual $5,500.
  So, under reform, the cost of a typical plan will be considerably 
less than the cost if we do nothing. In fact the savings will be 
roughly $500-$1,000 a year.
  We see the same story for family coverage. According to CBO, under 
the Senate reform bill, a family can expect to pay between $12,000 and 
$12,500 for family coverage. If we do nothing, a family can expect to 
pay $13,100.
  That is a savings of $600-$1,100 a year for American families.
  So now we have the answer that many Senators, and many Americans, 
sought.
  CBO's analysis provides a fair assessment of the effect of reform on 
the individual and family pocketbook.
  And the answer is savings of $500 to $1,100 a year, from 2016 on.
  But only if we preserve the reforms the President signed into law.
  And that is just the direct effect on premiums. Millions of Americans 
will be eligible for subsidies that will dramatically reduce their 
costs beyond these basic reductions available to everyone.
  But even people who don't receive subsidies will have lower premiums. 
Lower than if we don't implement the reform law.
  Not because of assistance from the Federal Government, but because 
health reform legislation will give people buying power and will take 
the necessary steps to rein in health care costs.
  The changes included in the new law will make a difference in the 
health care system and those changes will reap benefits for all of us.
  This is confirmation that the reform bill represents an important 
victory for Americans struggling with the high cost of health 
insurance.
  And now we can put a value on the savings: $500 to $1,000 a year for 
individuals and $600 to $1,100 a year for families.
  The Senators on the other side of the aisle haven't been talking 
about this report, which was provided by the CBO to a member of their 
own party, because they don't want the American people to know that 
premiums will go down relative to doing nothing.
  So instead, they try to find alleged discrepancies between the 
President and me that simply do not exist on this issue.
  The evidence is clear. The Congressional Budget Office has weighed 
in. The facts are plain.
  The health reform bill will reduce premiums compared to the do-
nothing outcome pursued by the obstructionists.
  Similarly, there has been some confusion about the magnitude of the 
tax cuts in this bill.
  The tax cuts in the reform bill passed by the Congress and signed 
into law by the President are the largest middle-class tax cut for 
health care in the history of our Nation.
  No Congress has provided greater tax assistance to American families 
and individuals and small businesses to help them afford the cost of 
health care.
  There have been larger tax cuts unrelated to health care--not all of 
them wise.
  But American businesses and families need help to deal with the high 
cost of health care, and this Congress has responded.
  The new law, combined with the improvements in the reconciliation 
bill, will provide refundable tax credits to people with incomes up to 
400 percent of the poverty level--around $88,000 for a family of four--
so that they can afford their health insurance premiums.
  Ordinarily, a tax credit is provided when you file your tax return 
after the end of the year. The new law allows the credit to be paid to 
the insurer month by month, so that you can afford your monthly 
premiums. That is a good thing if you live month to month and can't 
wait until the end of the year to receive the tax credit and still pay 
your monthly premiums.
  The new law also provides tax credits to small businesses--available 
starting right now--to help them pay for health insurance.
  These provisions will give nearly $500 billion of tax cuts and cost-
sharing assistance to middle-class Americans. That is what makes this 
the largest middle-class tax cut for health care in the history of our 
nation.
  We received no help from the Members on the other side of the aisle 
in enacting these tax cuts. This Democratic Congress did it anyway. We 
provided the largest middle-class tax cuts for health care ever, and we 
are proud to have done so.
  Mr. HARKIN. Mr. President, we are concluding an historic week here in 
the Nation's Capital and in the U.S. Senate. Health reform is no longer 
a bill. It is the law of the land.
  Just as the history books remember 1935 as the year FDR signed Social 
Security into law, and 1965 as the year Lyndon Johnson signed Medicare 
into law, they will now remember 2010 as the year President Barack 
Obama signed comprehensive health reform into law.
  Of course, not only is health reform the law of the land, but, thanks 
to the reconciliation bill, we have also passed a landmark reform of 
the student lending program, permitting a major increase in Pell 
grants.
  Appropriately, Members have cited the historic contributions of key 
leaders here in the Senate, including Majority Leader Reid, Senator 
Conrad, Senator Baucus, Senator Dodd, and, of course, for his 
commitment to this cause spanning decades, the late Senator Ted 
Kennedy.
  It is also important to etch into history, in our Congressional 
Record, the names of Senate staff members who have done so much to get 
us to this point. I have often cited the old saying that ``Senators are 
a constitutional impediment to the smooth functioning of staff.'' We 
laugh at that, but we also know that there is a lot of truth. Were it 
not for skilled, talented, dedicated staff members, willing to spend so 
many evenings and weekends away from their families, we would not have 
arrived at the historic triumph of passing comprehensive health reform.
  I am especially grateful to the extraordinary efforts of staff 
members on the Committee on Health, Education, Labor and Pensions, 
which I chair. I would like to thank Dan Smith, Pam Smith, Michael 
Myers, Mark Childress, David Bowen, Jenelle Krishnamoorthy, Connie 
Garner, Portia Wu, John McDonough, Topher Spiro, Stacey

[[Page S2082]]

Sachs, Tom Kraus, Terri Roney, Craig Martinez, Taryn Morrissey, Brian 
Massa, Andrea Harris, Caroline Fichtenberg, Bethany Little, Luke 
Swarthout, David Johns, Maria Worthen, Thomas Showalter, Paulette 
Acevedo, Abby Bartine, Ches Garrison, Sarah Whitton, Robin Juliano, 
Lory Yudin, and Evan Griffis.
  On the staff of Majority Leader Reid, I want to thank Gary Myrick, 
Kate Leone, Jason Unger, Carolyn Gluck, Jacqueline Lampert, Bruce King, 
David Krone, Rodell Molineaux, and Randy DeValk.
  On Senator Dodd's staff, I thank Jim Fenton, Tamar Magarik Haro, 
Monica Feit, Brian DeAngelis, Madeline Gitomer, and Averi Pakulis.
  On Senator Baucus's staff: Liz Fowler, Bill Dauster, Russ Sullivan, 
John Sullivan, Scott Mulhauser, Kelly Whitener, Cathy Koch, Yvette 
Fontenot, David Schwartz, Neleen Eisinger, Chris Dawe, and Hun Quach.
  On Senator Conrad's staff: Mary Naylor, John Righter, Joe Gaeta, 
Robyn Hiestand, Matt Mohning, Purva Rawal, Sarah Kuehl, Joel Friedman, 
Jim Esquea, and Jennifer Hanson-Kilbride.
  On my personal staff, I want to thank Beth Stein, Lee Perselay, Kate 
Cyrul, Bergen Kenny, Dan Goldberg, Lindsay Jones, and Jim Whitmire.
  Mr. President, I also want to salute the great skill and 
professionalism of the Senate Parliamentarian Alan Frumin, as well as 
Assistant Parliamentarians Elizabeth MacDonough, Peter Robinson and 
Leigh Hildebrand.
  In addition, we owe an enormous debt of gratitude to the staff of the 
Congressional Budget Office. They are an extremely knowledgeable and 
capable team, willing to work late nights and through the weekends to 
model and estimate the budgetary effects of the complex provisions in 
this bill.
  Finally, I want to thank staff members in the Senate Legislative 
Counsel's office. They also worked many long hours to assist my HELP 
Committee in drafting the language and working out the technical issues 
in the bill.
  To all of these dedicated members of our Senate family, I say thank 
you for your service to this body, and thank you for your selfless 
service to our Nation.
  Mr. DODD. Mr. President, I wish to spend a couple of minutes to 
express my gratitude to a lot of people. I begin by thanking my 
colleagues here, both Democrats and Republicans. Obviously, all of us 
would have liked to have had a health care bill that was more than a 
partisan vote. It didn't turn out that way. I am glad we ended up with 
the result we did.
  I thank the members of the HELP Committee on which I serve, both 
Democrats and Republicans. Although we didn't end up with a bipartisan 
vote on that committee, there was a very vibrant, active, civilized 
discussion over many days last summer regarding the HELP Committee's 
portion of this health care product. Obviously, having been the acting 
or temporary chair of the committee in the absence of our friend and 
colleague from Massachusetts who was obviously ill and could not be 
there, I begin by thanking Tom Harkin. You have heard people talk about 
him already. He has taken over the reins of that committee and has done 
an excellent job. I thank Barbara Mikulski, my long-time friend and 
colleague, who did a tremendous job in dealing with various aspects of 
the health care debate, as Tom Harkin did, Jeff Bingaman, Patty 
Murray--again, seasoned members of the committee and Members of this 
body who have contributed to many pieces of legislation over the years. 
Jack Reed, my neighbor and great friend from Rhode Island, was 
tremendously helpful on the committee, as well as Bernie Sanders of 
Vermont, Sherrod Brown of Ohio, who played a critical role working with 
people like Senator Hagan of North Carolina, working with Sheldon 
Whitehouse, who was on our committee at the time and played a critical 
role in fashioning our public option. Jeff Merkley and Bob Casey were 
very productive and serious members of the committee effort. Al Franken 
and Michael Bennet have since joined the committee, and Sheldon 
Whitehouse has moved on. But I want the record to reflect my deep 
appreciation for their work.
  Let me also thank Mike Enzi and the people such as Tom Coburn and 
others, Judd Gregg, from the committee. I can't go down the whole list, 
but the Republicans on the committee, while they don't necessarily like 
to admit it, made a contribution to the bill. One hundred sixty-one 
amendments--I know they are tired of hearing me talk about over the 
last several months--were their additions to the HELP Committee final 
product.
  I have talked about Max Baucus, my friend. We have served together, 
along with Tom Harkin in this Chamber and the other, for 35 years 
together. The work of the Finance Committee, which bore a tremendous 
share of this responsibility, dealing with very complicated issues that 
are within the jurisdiction of that committee, was tremendously 
important. I won't go down and list all the members of the Finance 
Committee. In fact, we had several on our committee who served both on 
Finance and on the HELP Committee: Jeff Bingaman on the Democratic 
side; I know there were several Republicans as well who filled a dual 
role by serving on both committees.
  I thank my friend from Montana as well for his work. He has been 
recognized and acknowledged by many and deservedly so over the last 
number of days.
  I commend, if I may, the staff members of the Finance Committee, 
beginning with Liz Fowler and the group I ask unanimous consent to 
include for the Record. They did a wonderful job. Senator Baucus has 
referred to them already, but I also wish to thank them this afternoon 
for their work.
  On the Budget Committee, again you have heard Senator Kent Conrad 
talk about the Budget Committee staff. I ask unanimous consent that 
their names be printed as well at this juncture in the Record, if I 
may.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                           finance committee

       Liz Fowler, David Schwartz, Yvette Fontenot, Neleen 
     Eisinger, Shawn Bishop, Chris Dawe, Andrew Hu, Bill Dauster, 
     Russ Sullivan, Cathy Koch, Jon Selib.


                            budget committee

       Sarah Kuehl, Purva Rawal, Jim Esquea, Mary Naylor.

  Mr. DODD. I want to make particular reference to the members of my 
staff, beginning with Jeremy Sharp and Tamar Magarik Haro who did a 
wonderful job. Jeremy Sharp's father is former Congressman Phil Sharp. 
He was part of the class with Max Baucus and Tom Harkin and me, Henry 
Waxman and George Miller, who played a critical role in the debate in 
the House. Both Tamar and Jeremy were tireless in this effort, going 
back many months. I am deeply grateful to them. Jim Fenton is my 
legislative director and played a very important role as well in those 
efforts.
  Then, of course, there are the other members of the HELP Committee, 
many of whom, of course, were staff members of Ted Kennedy. I inherited 
their expertise, their knowledge, their great abilities when Ted was 
laid up. They continued to work with us, beginning with Carey Parker 
who is, of course, legendary in this institution, having served with 
Senator Kennedy since the day he arrived 47 years ago. While not 
directly on the HELP Committee staff, I can't tell you what a critical 
role Carey Parker played time and time again during the rough spots. 
Michael Myers, Pam Smith, Connie Garner, Stacey Sachs, David Bowen--all 
were tremendously influential in the process. Mark Childress, who 
worked with Tom Daschle before, was at the White House for a while, 
came back up and stayed with us on that effort. Mark was invaluable in 
understanding the rhythms of the Senate, understanding the White House, 
and we are deeply grateful. Jenelle Krishnamoorhty, who worked with Tom 
Harkin, I have gotten to know her very well, and the members of Tom's 
staff. I want Jenelle to know how much I appreciate her work. She did a 
tremendous job for us as well.
  I want to thank the leader's staff as well, who were so valuable to 
us: Kate Leone, obviously; Carolyn Gluck; Bob Greenawalt; Bruce King; 
Randy Devalk; Jacqueline Lampert; and Gary Myrick, who we see here all 
the time pacing this Chamber at all hours of the day and night, keeping 
an eye on the movements of the Senate and what is occurring, keeping 
the leader well informed, about as knowledgeable as

[[Page S2083]]

anyone you will meet in understanding exactly what is happening at all 
moments. To Gary and the leader's staff, I apologize if I left anybody 
out, but I thank them for their work as well.
  This bill also included the work on education issues. There were a 
number of people who played a very important role in that. In my 
office: Maddy Gitomer, Averi Pakulis, Joe Caldwell, and Anna Staton 
were all part of our efforts in that regard. I should have mentioned 
earlier Tom Kraus, Topher Spiro, and Andrea Harris who worked on HELP 
Committee efforts as we moved forward on the bill.
  Those were a lot of names I have just recited. I said them so quickly 
that they may fly by. It hardly reflects the recognition they deserve 
for the time and effort they have put in. They will never be standing 
before a bank of microphones or getting their picture taken, probably 
won't have articles written about them and what they did or didn't do 
during their tenure in the Senate. But this place only functions and 
runs, the floor staff who are here and the respective cloakrooms who do 
the work every single day that make this institution work as well as it 
does, spending the hours, the weekends crafting ideas and compromises 
that allow us to move forward.
  While there are a lot of people deservedly, in a very public way, 
getting credit for the work that has transpired over these many months, 
I didn't want this moment to pass without at least expressing my 
gratitude to them and others whose names I, unfortunately, have not 
mentioned, who have made this day possible.
  To them, to my colleagues, to Senator Reid, Speaker Pelosi, House 
Members who valiantly took up a Senate-passed bill that they had strong 
reservations about and yet understood the value of the moment.
  And to President Obama, who understood the importance of this issue 
and insisted it come up. I remember Daniel Patrick Moynihan. Max Baucus 
and I served with Dan Moynihan, and Max had served with him on the 
Finance Committee when he chaired that committee, a very wise man who 
understood the movements of the executive branch and the legislative 
branch. He once told me that American Presidents, whether they get one 
or two terms, only get somewhere between 18 and 24 months to do 
anything really meaningful. It is those first days from January 20, 
Inauguration Day, to maybe as late as Election Day of the midterm 
elections in their first term. If they are going to do anything really 
important, that is the window in which they have to try. After that, it 
gets harder. You campaign for reelection. If you are reelected, you are 
a lame duck. Your ability to affect huge issues narrows.
  I thank our President. Whether you agree or disagree with his 
politics or his policies, the fact that he took on a major issue that 
had been crying out for decades for resolution is testimony to his 
willingness to put a political administration, a political campaign on 
the line. For those who work with him, from his chief of staff to his 
advisers on these various matters, history will be and should be deeply 
grateful to President Barack Obama for having the courage to take up a 
big issue that deserved and needed resolution by the Congress for the 
American people. Whatever else transpires in the remaining tenure of 
his office, whether he serves one term or two, in large measure he will 
be defined by his willingness, his courage to raise this issue, when 
many others suggested this was a worthless task to take on, we couldn't 
succeed, he would be wiser to follow a course where less significant 
issues might be at stake.
  So to the President, I thank you immensely for having the courage to 
take this on. I believe in the long call of history the American people 
will thank you as well for having the courage to bring up this 
important issue.
  With that, again, this is one of those very few rare days we get in 
this institution historically, but it is one in which I am deeply proud 
to have been involved. I thank all who made it come to pass.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. REED. Mr. President, I had the great privilege of observing 
Senator Dodd as he stepped into the breach for Senator Kennedy and did 
an extraordinary job--hour after hour after hour--listening to the 
comments, the suggestions of both sides of the aisle. I think about 400 
amendments were filed, and 161, or so, were accepted. In that process, 
his leadership was extraordinarily effective and critical. So the 
praise he rightfully accords to others he must share in a major way. We 
would not be here today if Senator Dodd had not stepped in while 
simultaneously also doing financial reform and getting us to this 
moment.
  So I say to the Senator, thank you.
  I concur, obviously, with his comments about Senator Baucus and 
express the respect I have for Senator Baucus. As chairman of the 
Finance Committee, Max had an extraordinarily important role to play, 
and he played it with great wisdom and great judgment throughout.
  Again, we are here today because of these two gentlemen, and my 
colleagues in the House.
  I, too, commend the President. It would have been easy at any time in 
this process to fold up the book and say: Well, I have joined the ranks 
of all my predecessors since Franklin Roosevelt. I have tried and have 
not succeeded. I think at moments he might have come tantalizingly 
close to that conclusion. But he pressed on. Ultimately, it was his 
decision more than anyone else to try to do this that got it done.
  As Thucydides said: The bravest of the brave are those who, seeing 
both the glory and the danger, go forth to seize it. These gentlemen--
particularly the President--saw the danger and the glory and refused to 
retreat and went forward. We have a historic victory today. But our 
work is not done.
  Mr. BYRD. Mr. President, I support the Health Care and Education 
Reconciliation Act. America has 47 million people without health 
insurance, including more than 240,000 West Virginians, and the number 
grows every week. More than half of West Virginia's uninsured are 
between the ages of 19 and 49. Health care consumes more than 15 
percent of our national gross domestic product. Health care reform 
should matter to every West Virginian.
  When the health care debate began last year, I urged the Senate to 
forgo using the budget reconciliation process to shield a comprehensive 
reform bill from debate and amendment. I am pleased that the Senate 
heeded that call, and opted to consider the Patient Protection and 
Affordable Care Act under the cloture rule and the regular procedures.
  When amendments to that measure were proposed by the President, to be 
enacted through the budget reconciliation process, I insisted that 
those amendments be considered in a manner consistent with the 
Congressional Budget Act and section 313 of that act, the Byrd rule. 
The reconciliation bill must not address extraneous matter, and it 
must--absolutely must--reduce the deficit. This measure meets that 
test. I applaud the Senate for bringing the health care debate to a 
close in a manner that is balanced, fair, and equitable. The rights of 
the minority have been protected, and the Senate has upheld its 
historical role as a forum for debate and amendment.
  While this bill as passed may not satisfy the individual concerns of 
each and every constituent or member of Congress, it does begin to 
satisfy the growing needs of millions of Americans who find themselves 
without access to the medical services and attention they need. Access 
to proper health care for every American citizen should not only be 
held as a necessity, it should be considered the commensurate right of 
any and every citizen of the mightiest and most advanced Nation the 
world has ever known.
  Mr. President, in order to clarify for the record, I want to make it 
known that section 1556 of the Patient Protection and Affordable Care 
Act is intended to apply to all claims filed after January 1, 2005, 
that are pending on or after the date of enactment of that act.
  It is clear that the section will apply to all claims that will be 
filed henceforth, including many claims filed by miners whose prior 
claims were denied, or by widows who never filed for benefits following 
the death of a husband. But section 1556 will also benefit all of the 
claimants who have recently filed a claim, and are awaiting or 
appealing a decision or order, or who are in the

[[Page S2084]]

midst of trying to determine whether to seek a modification of a recent 
order.
  Section 1556 applies immediately to all pending claims, including 
claims that were finally awarded or denied prior to the date of 
enactment of the Patient Protection and Affordable Care Act, for which 
the claimant seeks to modify a denial, or for which other actions are 
taken in order to modify an award or denial, in accordance with 20 CFR 
725.309(c) or 725.310. Section 1556 applies even if a final order is 
modified, or actions are taken to bring about the modification of an 
order, subsequent to the date of enactment of the Patient Protection 
and Affordable Care Act, in accordance with the sections of Part 725 
that I mentioned. I look forward to working to ensure that claimants 
get a fair shake as they try to gain access to these benefits that have 
been so hard won.
  Mrs. HAGAN. Mr. President, I rise today to speak in support of the 
education provisions in H.R. 4872, the Health Care and Education 
Affordability Reconciliation Act of 2010.
  Over 40 years ago, Congress passed the Higher Education Act of 1965 
with the conviction that no qualified student should be denied the 
opportunity to attend college simply because of the cost. Who knew that 
today, in the year 2010, this concern would still ring true? The 
passage of this legislation will provide greater access to higher 
education for thousands of American students.
  The Health Care and Education Affordability Reconciliation Act 
represents the single largest investment in college affordability in 
history. From increasing the maximum Pell grant for low-income students 
to eliminating excessive subsidies for banks, this bill makes 
significant improvements to Federal student loan programs. Also, as 
students and their families look to Federal loans to pay for their 
post-secondary education, this legislation will allow non-profit 
student loan servicers in states like mine to continue servicing 
student loans.
  This legislation provides funding for the college access challenge 
grant program, a program created in the College Cost Reduction and 
Access Act of 2007. This program was designed to assist states working 
in partnership with organizations with expertise in improving access to 
college. These guarantee agencies ensure that students have access to 
high-quality, affordable higher education. In my home State, the 
College Foundation of North Carolina serves as our State guarantee 
agency and plays a critical role in providing students and families 
with financial literacy, debt management, and loan counseling 
information.
  I fully support the intent of the access and completion challenge 
grants included in this legislation. They will allow State guarantee 
agencies to continue the important work that they do. The College 
Foundation of North Carolina has done extraordinary work in this regard 
and, as a result, has had a default rate consistently below the 
national average for the past several years. As a strong advocate for 
financial literacy education, I can think of nothing more important 
than ensuring that students and families are armed with the tools they 
need to understand the dynamics of their student loans.
  In North Carolina, we have 58 community colleges and 10 historically 
Black colleges and universities. The students at these institutions of 
higher education stand to benefit greatly from the passage of this 
legislation. A $2.55 billion investment over the next 10 years for 
Minority Serving Institutions, and more specifically Historically Black 
Colleges and Universities, is unprecedented. While HBCUs only make up 3 
percent of all colleges and universities across the country, they 
graduate 40 percent of African-Americans with degrees in science, 
technology, engineering and mathematics, 50 percent of African-American 
teachers, and 40 percent of African-American health professionals. 
Community colleges play an instrumental role in our education and 
workforce systems by providing postsecondary education and job 
training. We need to keep our community colleges open and thriving. I 
can't think of a better investment as we encourage people to get the 
training and skills necessary to get back to work.
  Making the commitment to create greater access to higher education, 
and ensuring that our students have the tools that they need to 
complete their postsecondary education is at the core of the education 
provisions in the Health Care and Education Affordability 
Reconciliation Act, and I am proud to support this legislation.
  Mr. FEINGOLD. Mr. President, the Senate has considered dozens of 
amendments and motions to the reconciliation bill this week. The vast 
majority of these proposals were flawed, either because they would have 
undermined the important consumer, business and taxpayer protections in 
the health care reform bill signed into law Tuesday, or because they 
were not offset and thus would have reduced the savings in the 
reconciliation bill.
  Some of these proposals, however, did have merit. In particular, 
amendment No. 3564 by Senator Grassley would have clarified that all 
congressional employees, as well as certain other Federal employees, 
must receive their health insurance through the new health insurance 
exchanges. The health care reform bill already requires ``Members of 
Congress and congressional staff'' to receive care through the 
exchanges, but I support efforts to remove any ambiguity about who is 
covered. Another amendment by Senator Grassley, No. 3569, would have 
slightly increased reimbursements for rural physicians in Wisconsin, 
building on important provisions in the new law. And I strongly support 
efforts to remove the unjustified ``sweeteners'' that remain in the 
health care reform law; unfortunately, the amendment offered by Senator 
McCain, No. 3570, to remove those provisions also would have eliminated 
provisions that were entirely legitimate.
  Two other amendments addressed legitimate concerns that Congress is 
already working to address. I am a cosponsor of legislation to clarify 
that coverage provided by TRICARE will be treated as minimum essential 
coverage under the health care reform bill. The amendment offered by 
Senator Burr, No. 3652, addressed this topic. Similarly, the chairman 
of the Veterans Committee is already seeking a legislative fix to 
protect the Second Amendment rights of veterans, as Senator Coburn 
proposed to do, No. 3700.
  However, all of these amendments and motions--even the more appealing 
sounding ones--had the same purpose: to delay and obstruct 
reconciliation legislation that will fill the Medicare Part D doughnut 
hole, make coverage more affordable and in other ways improve the new 
health care reform law. I opposed these efforts to undermine health 
care reform, and I will continue fighting to ensure Wisconsinites get 
the affordable and dependable coverage they deserve.
  Mr. BAUCUS. I now ask unanimous consent that Senators Grassley and 
Conrad be permitted to engage in a colloquy and inquiries of the Chair 
for up to 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, parliamentary inquiry.
  The PRESIDING OFFICER. Will the Senator state his inquiry.
  Mr. GRASSLEY. Mr. President, I have submitted a list of provisions 
for review by the Chair. It is my understanding that these provisions 
of the bill have been reviewed and further, if points of order were 
raised against these provisions, the Chair would have ruled that the 
various points of order would not have been taken. Is this the opinion 
of the Chair?
  The VICE PRESIDENT. That the points of order would not have been well 
taken, yes. That is the decision of the Chair.
  Mr. GRASSLEY. I thank the Chair. I ask unanimous consent to have 
printed in the Record the list of provisions just referred to.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

     Section 1002--Insurance Mandate
     Subject to (b)(1)(D)
     Merely incidental to non-budgetary components of the 
         provision

     Section 1203--DSH Methodology
     Page 70 Line 4 through Page 71 Line 12
     Subject to (b)(1)(A)
     No budgetary effect

     Section 2301--grandfathering
     Subject to (b)(1)(D)
     Merely incidental to non-budgetary components of the 
         provision

     Section 1401--High cost plans tax

[[Page S2085]]

     Subject to 310(g)

     Section 1401--indexing
     Pg 84 lines 3 through 17
     Subject to (b)(1)(A)
     No budgetary impact


   List of Points of Order Submitted to the Chair by Senator Grassley

       1. A point of order under Section 313(b)(1)(D) of the 
     Budget Act against Section 1002 of the bill.
       2. A point of order under Section 313(b)(1)(A) of the 
     Budget Act against Section 1203, page 70 line 4 through page 
     71 line 12 of the bill.
       3. A point of order under Section 313(b)(1)(D) of the 
     Budget Act against Section 2301 of the bill.
       4. A point of order against the bill under Section 310(g) 
     of the Budget Act.
       5. A point of order under Section 313(b)(1)(A) of the 
     Budget Act against Section 1401, page 84 line 1 through 15 of 
     the bill.

  The VICE PRESIDENT. The Senator from North Dakota.
  Mr. CONRAD. Mr. President, my staff, working with the staff of the 
Finance and HELP Committees, has spent an enormous amount of time 
ensuring that this bill complies with the rules of the reconciliation 
process. The majority and minority staffers have spent long hours going 
over this bill in excruciating detail with the Parliamentarian. We just 
heard the Parliamentarian's determinations on some of those issues.
  The Parliamentarian has further advised us that two provisions do 
violate the Byrd rule. The first provision concerns the formula setting 
the maximum Pell grant amount annually and is considered out of order. 
Basically, it provides an insurance policy on how that level is 
calculated.
  The second provision says this, in its entirety: ``(D) by striking 
subparagraph (E); and(E) by redesignating subparagraph (F) as 
subparagraph (E),'' and is also considered out of order.
  CBO has concluded that the two provisions do not score for budgetary 
purposes. The Parliamentarian gave great weight to this in making his 
determination.
  While I wish these provisions were not being stricken, removing them 
would not affect the score of the program or prevent the bill from 
achieving the goals of the new Pell grant policy.
  Mr. President, we think it is important for the historical record to 
have these matters laid out on the record. I thank Senator Grassley and 
his staff for the work to make certain that the historical record is 
clear, and I want to thank my staff as well, and the staff of the 
Finance Committee for an extraordinary effort. I hope the people of 
this country recognize that these staffs have worked on both sides, 
minority and majority, weekend after weekend after weekend, night after 
night after night, and they deserve our commendation and our thanks.
  I thank the Chair.
  Mr. BAUCUS. Mr. President, there are a flood of emotions going 
through all of us today as we pass this reconciliation bill which 
improves upon the bill the President signed 2 days ago. I would like to 
focus only on one part--a very important part but only one part--and 
that is to thank the people who have worked so hard, especially in this 
body, to help accomplish this result.
  I thank especially my friends Senator Dodd, the chairman of the 
Banking Committee, who many times acted in the capacity as chairman of 
the HELP Committee, and Senator Harkin, chairman of the HELP Committee, 
working so hard with their staffs. As well, I thank Senator Conrad, 
especially for his acumen, his budgetary acumen. I don't know anybody 
who knows this stuff better than Senator Conrad. We all rely on him 
very much.
  I thank Leader Reid for his strategic vision--he helped put the 
Finance Committee bill together; he saw a path forward--and his staff, 
who are so competent--Kate Leone, Bob Greenawalt, Randy DeValk--his top 
three staff.
  I also thank my friend from New Hampshire, Senator Gregg, for his 
courtesy in managing this bill. He was very decent and a very good 
person to work with.
  We all want to thank so many people. Once we start mentioning a 
couple or three names, we run the danger of offending people whose 
names are not mentioned. We all know that. There will be an appropriate 
time for us to make all the thanks, and I will make mine so sincerely 
because I am so grateful for all the hard work my staff has put into 
this.
  I wish to single out one person, and that one person is sitting next 
to me. Her name is Liz Fowler. Liz Fowler is my chief health counsel. 
Liz Fowler has put my health care team together. Liz Fowler worked for 
me many years ago, left for the private sector, and then came back when 
she realized she could be there at the creation of health care reform 
because she wanted that to be, in a certain sense, her profession 
lifetime goal. She put together the White Paper last November--2008--
the 87-page document which became the basis, the foundation, the 
blueprint from which almost all health care measures in all bills on 
both sides of the aisle came. She is an amazing person. She is a 
lawyer; she is a Ph.D. She is just so decent. She is always smiling, 
she is always working, always available to help any Senator, any staff. 
I thank Liz from the bottom of my heart. In many ways, she typifies, 
she represents all of the people who have worked so hard to make this 
bill such a great accomplishment.
  I will have printed in the Record the names of all my professional 
staff. There are more than I realized, so I can't name them all. I ask 
unanimous consent to have that list printed in the Record and just 
regret that I cannot thank everybody personally.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

            Committee on Finance Majority Professional Staff

       Ryan Abraham, Joseph Adams, Sarah Allen, John Angell, Randy 
     Aussenberg, Mary Baker, Scott Berkowitz, Shawn Bishop, Mark 
     Blair, Pat Bousliman, Joe Carnucci, Tony Clapsis, Alan Cohen, 
     Blaise Cote, Amber Cottle, Tim Danowski, Bill Dauster, Chris 
     Dawe, Jennifer Donohue, Neleen Eisinger.
       Danielle Edwards, Andrew Fishburn, Yvette Fontenot, Liz 
     Fowler, Jim Frisk, Christopher Goble, Michael Grant, Jewel 
     Harper, Diedra Henry-Spires, Laura Hoffmeister, Andrew Hu, 
     Matt Kazan, Ayesha Khanna, Tom Klouda, Cathy Koch, 
     Christopher Law, Josh Levasseur, Richard Litsey, Carla 
     Martin, Kerra Melvin.
       Bob Merulla, Rory Murphy, Scott Mulhauser, Kelcy Poulson, 
     Holly Porter, Hun Quach, Russell Quiniola, Tom Reeder, Matt 
     Schmechel, Athena Schritz, David Schwartz, Erin Shields, 
     Michael Smart, Meaghan Smith, Tiffany Smith, Challee Stefani, 
     Greg Sullivan, Russ Sullivan, Chelsea Thomas, Kelly Whitener, 
     Erin Windauer.

  Mr. GREGG. I join the chairman of the Finance Committee in thanking 
so many people who participated in the process. I especially thank the 
staff on the dais and staff in the cloakroom who were here so late last 
night and do such an exceptionally professional job; otherwise, we 
could not move this type of legislation in a coherent way.
  Obviously, I thank the chairman and I thank his staff and I thank the 
chairman of the Budget Committee and his staff because really there has 
to be cooperation across the aisle to handle something this complicated 
and do it in a reasonably efficient way, by Senate standards, which we 
did.
  I especially, of course, thank the people on our side who played such 
a large role, our leadership but especially my staff on the Budget 
Committee--Cheri Reidy, who runs the committee, who does such an 
exceptional job; Jim Hearn, her partner; and Allison Parent. I will 
submit for the Record, as the Senator from Montana has, other members 
of our committee staff who have done such an exceptional job. But it 
seems you have to be named ``Liz'' around here to really understand 
health care because I have Liz Wroe on my staff, who really did such an 
extraordinary job for us here.
  Again, I thank everyone who was so cooperative. There were an awful 
lot of amendments, and we could not have been successful without 
cooperation on both sides of the aisle.
  Mr. CONRAD. Will the Senator yield?
  Mr. GREGG. Yes, I will.
  Mr. CONRAD. May I just say I really owe it to several people on my 
staff, especially my staff director, Mary Naylor. I don't know that 
there has been a person more dedicated to public service than Mary 
Naylor. What an extraordinary effort she has made, along with Bill 
Dauster of the Finance Committee and also my deputies, John Righter, 
Joel Friedman; my counsel, Joe Gaeta; and Sarah Kuehl, who led my 
health care team. We owe deep thanks to this staff. This has been a 
year-and-a-half long effort by so many;

[[Page S2086]]

lost weekends with their families, lost evenings.
  Thank you. Thank you.
  The VICE PRESIDENT. The majority leader.
  Mr. REID. Mr. President, we have a few more items of business that 
must be taken care of, but I didn't want the time to go by without 
saying something to the American people.
  We all know the importance of this legislation. It is a Thursday 
afternoon, about 2 o'clock. We are all tired. But this has been a 
legislative fight that will be in the record books. I am grateful for 
everyone who has worked on this to make this happen.
  First of all, I have had a number of people on my staff who have 
worked very hard--Randy DeValk, who is kind of the resource of all the 
Senators, Republicans and Democrats. He is a utility man. He can do 
anything. He is a very accomplished, fine human being and a great 
person to have working for you.
  Kate Leone has been such a stalwart in helping me work through these 
issues. We started this a number of months ago. We got together every 
week because I didn't know a lot about health care. She and I would sit 
and talk for an hour every week so I became more accomplished in 
knowing at least the framework of this legislation we looked forward to 
dealing with. I have so much appreciation for her. Like Randy, they 
left their families at home. She left her baby at home. A lot of the 
times, it was very difficult for a young mother to do that. I have such 
respect and admiration for her skill and her being such a nice person.
  Bob Greenawalt, my tax guy, has done a remarkably good job--very 
quiet but someone whom everyone knows in the Senate. He is someone you 
can go to and get a straight answer.
  Senator Baucus, the chairman of the Finance Committee, has had a 
tremendous burden. It has gone on for well more than a year. He has 
been criticized, he has been praised, but he has always been there 
trying to move this ball forward, always having the idea that we could 
get this done when a lot of people around him said, ``It can't be 
done.'' I personally appreciate Max Baucus and the good work he has 
done for these many years for the State of Montana, but in recent 
months America has come to know the great work he has done on this bill 
which is now law.
  Tom Harkin--what a wonderful human being. When I had a very difficult 
election in 1998, no one called more often to find out how I was doing, 
both before the election and after the election. He is my friend. I 
care a great deal about him. He has some big shoes to fill, those of 
Ted Kennedy. He has been so easy to work with.
  Chris Dodd--even though he was no longer running the committee 
because Senator Kennedy died, Tom Harkin never got involved in it. He 
left everything involved with health care that the committee had up to 
Chris Dodd. It worked out well. We were able to do reconciliation, and 
he moved into something for which he has such great passion, and that 
is education. So thank you very much.
  Kent Conrad and I came to the Senate together. When the history books 
are written, there will certainly be a chapter or two or three talking 
about a person who over the years has come to know more about the 
finances of this country than any other human being--anyone. He and I 
are friends. He is the reason we are here now with so little 
controversy on these points of order. He has been someone whom you can 
really, because he is such a perfectionist--frankly, he can really get 
on your nerves. He is someone who always wants to make sure that the 
``i'' is dotted and the ``t'' is crossed. I am so grateful we are able 
to be where we are as a result of the good work of this honorable man 
from the State of North Dakota.
  Finally, I have seen this man shed tears on so many occasions in the 
last few months. Why? Because his pal is no longer in the Senate, his 
buddy, his soulmate. There could not be two better friends than Ted 
Kennedy and Chris Dodd. I don't know how you can be better friends than 
they were to each other. He has done such a good job filling in for Ted 
Kennedy. I know we want to get to this vote, but I love Chris Dodd. He 
is such a wonderful person, and his family is remarkably good. He got 
home at quarter to 4 this morning, and Grace woke him up at 5 to tell 
her story.
  Chris, thank you very much for what you did.


                           Moment of Silence

  I think it would be very appropriate, and I hope I do not offend 
anyone--if I do, I certainly do not mean to--I think it would be very 
appropriate right now to have a moment of silence for our departed 
friend, one of the great Senators in the history of this country, Ted 
Kennedy.
  I ask the Chair to direct that moment of silence.
  The VICE PRESIDENT. Without objection, the Chair will direct a moment 
of silence.
  (Moment of silence.)
  The VICE PRESIDENT. The majority leader is recognized.
  Mr. REID. Mr. President, I ask that when the vote is called, Senators 
vote from their desks.
  The VICE PRESIDENT. Without objection, it is so ordered.
  The Senator from New Hampshire.
  Mr. GREGG. Mr. President, let me acknowledge the majority leader also 
because he has been under tremendous stress. We all know that, with 
what has happened relative to Landra and his daughter. We appreciate 
the fact that he has been so professional and worked so hard while 
confronted with this extraordinarily difficult situation. We obviously 
wish everyone in his family well.
  Mr. President, at this time I will make two points of order. I submit 
for the Record a statement of those points of order.
  The following provision of the pending bill, H.R. 4872, the Health 
Care and Education Affordability Reconciliation Act, on page 118 at 
line 15 through 25 does not produce changes in outlay or revenues and 
thus is extraneous. Therefore, I raise a point of order under section 
313(b)(1)(A) of the Congressional Budget Act of 1974.
  The VICE PRESIDENT. The point of order is sustained.
  Mr. GREGG. Mr. President, the following provision of the pending 
bill, H.R. 4872, the Health Care and Education Affordability 
Reconciliation Act, on page 120, lines 3 through 5, does not produce 
changes in outlays or revenues and is extraneous. Therefore, I raise a 
point of order under section 313(b)(1)(A) of the Congressional Budget 
Act of 1974.
  The VICE PRESIDENT. The point of order is sustained. Both provisions 
are stricken.
  Mr. GREGG. I thank the Chair.
  The VICE PRESIDENT. The Senator from North Dakota.
  Mr. CONRAD. Mr. President, in keeping with my previous statement, we 
on our side would not further contest either of those provisions.
  The VICE PRESIDENT. The question is on the engrossment of the 
amendments and third reading of the bill.
  The amendments were ordered to be engrossed, and the bill to be read 
a third time.
  The bill was read a third time.
  The VICE PRESIDENT. The Senator from Montana.
  Mr. BAUCUS. Mr. President, is it appropriate to ask for the yeas and 
nays?
  The VICE PRESIDENT. Yes, it is.
  Mr. BAUCUS. I ask for the yeas and nays.
  The VICE PRESIDENT. Is there a sufficient second? There is a 
sufficient second.
  The bill having been read the third time, the question is on passage 
of H.R. 4872, as amended by operation of section 313(e) of the 
Congressional Budget Act of 1974.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Georgia (Mr. Isakson).
  The VICE PRESIDENT. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 56, nays 43, as follows:

                      [Rollcall Vote No. 105 Leg.]

                                YEAS--56

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

[[Page S2087]]


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

                                NAYS--43

     Alexander
     Barrasso
     Bennett
     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
     Lincoln
     Lugar
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Pryor
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Wicker

                             NOT VOTING--1

       
     Isakson
       
  The bill (H.R. 4872), as amended, was passed.
  Mr. REID. Mr. President, I move to reconsider the vote.
  Mr. DURBIN. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. LEAHY. Mr. President, today's final passage of this Health Care 
and Education Reconciliation Act marks the culmination of a decades-
long struggle to make health insurance affordable to hard working 
Americans. This has been an arduous process, but it has proven that 
change truly is possible. America again has risen to meet one of its 
foremost challenges.
  Still, there is more work to be done to introduce competition into 
the health insurance industry. Today, health insurers do not play by 
the same rules of competition as do other industries. Benefiting from a 
60-year-old special interest exemption, the business of insurance is 
not subject to the Nation's antitrust laws. These laws promote 
competition, which ensures that consumers will pay lower prices and 
receive more choices. We can surely agree that health insurers should 
not be allowed to collude to set prices and allocate markets.
  Last fall, I introduced legislation to repeal the health insurers' 
antitrust exemption. I held a hearing to examine the merits of this 
repeal, and worked to build bipartisan support. A few weeks ago, repeal 
of the antitrust exemption for health insurers became the first stand-
alone part of the health reform package to pass the House, in a strong 
bipartisan vote of 406-19. Today I want to renew my call for the Senate 
to take up and pass this legislation to repeal the antitrust exemption 
for health insurance companies.
  As they begin to implement the measures included in the Patient 
Protection and Affordable Care Act, the Department of Health and Human 
Services, other Federal agencies, and the States can all greatly 
benefit from the competitive analysis provided by both the Department 
of Justice's Antitrust Division and the Federal Trade Commission, FTC. 
The Justice Department and the FTC have the knowledge and experience to 
provide informed assessments of whether a marketplace is functioning 
properly, and when there may be warning signs that competitive abuses 
are taking place. Their expertise will ensure that the basic rules of 
fair competition apply to those reforms included in the new health 
insurance reform law.
  Mr. CONRAD. Mr. President, I want to add to my comments from earlier 
today regarding the passage of H.R. 4872, the Health Care and Education 
Reconciliation Act of 2010. I want to again acknowledge and thank my 
staff for their extraordinary effort and professionalism. My staff has 
worked tirelessly over many months, working late nights and weekends on 
health care reform and reconciliation. I greatly appreciate the 
sacrifices that they--and their families--have made in these efforts.
  On my Budget Committee staff, I want to again thank my extraordinary 
staff director, Mary Naylor, as well as my deputy staff directors, John 
Righter and Joel Friedman, and my counsel, Joe Gaeta. In addition, I 
want to thank my incredible Budget health team, which is led by Sarah 
Kuehl, but also includes Purva Rawal, Jim Esquea, Jennifer Hanson-
Kilbride, and Steve Bailey. They did extraordinary work. I also want to 
thank my Budget education team, Robyn Hiestand and Matt Mohning. 
Education was an important part of the reconciliation bill and college 
students will benefit greatly from the expansion of Pell grants and 
other assistance. I want to thank the remainder of my excellent Budget 
Committee staff, all of whom contributed greatly to this effort. I 
particularly want to thank Craig Kalkut, Ron Storhaug, and Jean Biniek 
for their assistance in this effort.
  Finally, I want to thank the staff in my personal office. They also 
played a key role in this effort and represented the State of North 
Dakota very well. I want to thank Sara Garland, my chief of staff; Tom 
Mahr, my legislative director; Kate Spaziani and Dana Halvorson, my 
personal office health team; and Caitlin Coghlan, my education 
specialist. In particular, I want to thank Tom and Kate for their 
extraordinary efforts. They worked hand-in-hand with my Budget team in 
helping produce a bill that moves this nation in the right direction on 
health care and fiscal responsibility.
  I believe it is important that the American people understand the 
work and sacrifice made by the staff who work here in Congress on their 
behalf. The last year has witnessed an incredible effort by staff on 
both sides of the aisle. I thank them all, and again, thank my staff in 
particular.
  Mrs. BOXER. Mr. President, it is clear to everyone watching the 
debate on the Health Care and Education Reconciliation Act that 
amendments were offered for the sole purpose of derailing health care 
reform. Therefore I voted to table all amendments.
  Under normal circumstances, I would have supported some of the 
amendments offered by my colleagues. For example, last night, an 
amendment was offered to clarify that the health care reform bill would 
not adversely affect VA and military health care programs. I am a 
cosponsor of freestanding legislation that would make that very same 
clarification. However, last night, when Senator Webb asked unanimous 
consent for that legislation to be adopted separate from this bill, an 
objection was raised from my friends on the other side of the aisle.
  I am pleased that the bill passed because it will make life better 
for the people I represent.
  Mr. DURBIN. Mr. President, the reconciliation bill on the floor today 
realizes a dream of my friend and mentor, former Senator Paul Simon--
consolidation of the Federal student loan program entirely into direct 
loans.
  The very first Federal student loans were direct loans provided under 
the National Defense Education Act of 1958--directly from the Federal 
Government to students.
  In 1965, the Federal Government began guaranteeing student loans 
provided by banks and nonprofit lenders through the Federal Family 
Education Loan, FFEL, Program. Through this program, the Federal 
Government would pay banks a certain rate of return on student loans 
and guarantee those loans against default.
  By the early 1990s, it was clear to Paul Simon that incentivizing 
banks through subsidies no longer made sense. The Federal Government 
could make loans more cheaply and more simply directly to students.
  As he said: ``Are we in the business of helping banks and guarantee 
agencies, or are we in the business of helping students?''
  Paul Simon became the leading Senate champion of a new direct college 
loan program, enacted in 1992 as a small pilot program. He and others 
hoped that the Direct Loan Program would be quickly expanded to replace 
the FFEL Program.
  In 1993, during a budget reconciliation fight, lobbyists for the 
banks and Sallie Mae joined forces to try to defeat the effort to move 
the student loan system into direct loans. The result was our current 
system: the Direct Loan Program and the FFEL Program operating side-by-
side.
  This system hasn't worked. Private lenders like Sallie Mae have 
retained the majority of the student loan market through special deals 
with financial aid offices and have continued to make billions off of 
taxpayer-funded subsidies--$6 billion per year. Taxpayers are absorbing 
all the risk of student loan defaults, while private corporations bank 
all the profit.
  Senator Kennedy, a longtime proponent of direct loans, once said: 
``We

[[Page S2088]]

waste billions of dollars in corporate welfare every year on student 
loans, and we cannot afford it any longer.''
  I agree with Paul Simon and Ted Kennedy. And so does Chairman Harkin, 
who led this bill through the HELP Committee. I join him in supporting 
this bill that would finally end corporate welfare in the Federal 
student loan program and put that money back in the hands of students.
  The reconciliation bill will shift all loans into the Direct Loan 
Program that Paul Simon envisioned and use the $68 billion in savings 
to invest in education priorities.
  We will put $36 billion over the next 10 years into the Pell Grant 
Program, a program that we know is essential for many poor families and 
struggling students.
  For the first time, we will index the Pell grant to inflation. We 
will also avert a projected Pell grant budget shortfall caused by 
recent increased demand for Pell grants.
  Without this investment, 8 million students could see their Pell 
grants cut by 60 percent next year, and 600,000 students could lose 
their scholarships completely.
  The bill will cap monthly student loan payments at just 10 percent of 
discretionary income, so that college graduates can pursue careers in 
teaching or public service without the burden of student loan bills 
they couldn't keep up with.
  We will also invest in historically Black colleges and universities, 
minority serving institutions, community colleges, and state-based 
college access programs that help students succeed in college.
  And we will reduce the deficit by $10 billion over 10 years.
  Families and students will benefit enormously from this bill and the 
realization of Paul Simon's vision. And who will suffer? Bank and 
lending executives who have grown rich off of unnecessary taxpayer 
subsidies for decades.
  Paul Simon was right 20 years ago, and he is still right today. It is 
time to take the middleman out of the student loan industry and return 
our focus to students.
  I would like to thank Senator Harkin for his hard work on the student 
loan reform provisions in this bill and for his tireless efforts on 
behalf of college students across the country.
  I strongly support the student loan reform provisions that are 
included in the reconciliation bill and I look forward to seeing Paul 
Simon's full Direct Loan Program finally signed into law.
  Mr. ROCKEFELLER. Mr. President, I have always wondered if this day 
would come, when I could stand on the Senate floor before my colleagues 
and say those words:
  We did it. We passed comprehensive health care reform.
  Many have come before us and we have worked together for years. We 
took on a monumental task and faced obstacles at every corner.
  It wasn't easy--nothing that is worth doing is easy. But we put aside 
our own differences and came together to pass meaningful legislation 
that will transform the way health care works in our country.
  And it was worth every minute and every hurdle. It was worth every 
setback and every step forward.
  Because for all those challenges, for all our debates and 
negotiations, I know that any trouble we faced was nothing in 
comparison to the daily struggle millions of Americans face everyday 
without health insurance. Millions that are without coverage who live 
everyday in terror of becoming sick--parents powerless to provide care 
for a sick child, workers unable to change jobs and pursue a new 
opportunity, families forced to choose between seeing a doctor and 
paying their mortgage.
  When I think about the cause of reform, I think about those people 
and their stories.
  And I want to tell you about some of them today.
  I want to tell you about the Bord family of West Virginia.
  The Bords are two dedicated school teachers--with health insurance, 
through their employer--whose son Samuel had Leukemia and needed 
treatment well beyond the onerous annual insurance limits, they didn't 
even know they had. Samuel's parents were desperate and feared for the 
worst. When he hit his million dollar cap, my office helped his parents 
find more resources.
  But, the Bords were left with two heart-wrenching suggestions--
consider getting a divorce so that Samuel would qualify for Medicaid 
and stop taking their other children--Samuel's twin brothers--to the 
doctor altogether, even if they got sick, in order to save every penny 
for Samuel.
  That's right. Get a divorce and choose one child's health care needs 
over another's.
  Those are the choices our Nation offered to these caring, hard-
working parents with a sick child?
  They did everything in their power but, this fall, Samuel passed 
away.
  It breaks my heart to think of what his parents went through: not 
only the pain of watching their son fight a terrible disease, but also 
the uncertainty of paying for his treatment when the coverage they 
counted--on and paid for--abandoned them.
  And so now, we are creating a more secure and reliable health care 
system that works for every American: where those who are uninsured 
finally have someplace to go for care; where those with health 
insurance know that the coverage they count on--and pay for--will be 
there when they need it; and where a profit driven insurance industry 
cannot play mercilessly with people's lives or steal their hope for a 
healthy future.
  This new law is for all those countless people we have lost to a 
broken system. This is Samuel's law. We will never be able to bring him 
back--but we can make sure no one's health is ever left to the whims of 
annual and lifetime caps or pre-existing conditions or arbitrary rate 
hikes.
  In the course of my Senate Commerce Committee investigations into the 
health insurance industry, I met a wonderful woman named Susan Pearl.
  You see, we knew in the committee that health insurance companies 
were not being straightforward about how much money they were spending 
on actual medical care. Too many people were not getting the care they 
needed, yet health insurance industry profits continued to soar.
  So Susan came to us. Her husband owns his own business, and they had 
coverage--good coverage. And they were glad to have it--their son Ian 
was born with muscular dystrophy, but was doing well with medical 
treatment.
  Unfortunately, Susan's insurance then decided that her son's care--
including the round-the-clock nursing necessary for advanced muscular 
dystrophy--was getting just too expensive for them to continue paying.
  So with the full knowledge of the devastating and fatal effects of 
dropping coverage--Guardian Insurance abruptly rescinded, not just Ian 
Pearl's coverage, but the entire family policy, replacing it with 
another plan that was, quite simply, inadequate.
  With Ian's life-saving care costing upwards of $1 million a year, 
Susan did everything she could to reinstate Ian on his original plan--
the one she had paid into faithfully for years.
  Thankfully, Susan Pearl was able to recover Ian's old coverage--but 
only after Guardian's deplorable practices drew worldwide media 
attention.
  This new law means health insurance companies can no longer gamble 
with people's lives and rescind coverage because it's hurting their 
bottom line.
  You shouldn't need the full focus of a Senate investigation, just to 
be treated fairly by your insurance company.
  I think of small business owners like Kate from my home State of West 
Virginia who shared her story on the White House Office on Health 
Reform's public website www.healthreform.gov. Her 2-year-old son is the 
only person with health insurance coverage in her household.
  Many of us know that it is often hard for small businesses to find 
affordable coverage for themselves and their employees.
  She and her husband are small business owners and they simply could 
not find an affordable policy. Today, small businesses pay up to 18 
percent more than large firms for the same health insurance policy, so 
many just don't even offer it. While small businesses make up 82 
percent of businesses in West Virginia, only 37 percent of them offered 
health insurance coverage to their employees in 2008.
  Kate wished she even had the security of catastrophic coverage. She

[[Page S2089]]

knows she is risking her home and economic security without health 
coverage, but, basic health insurance is a luxury she and her husband 
simply can't afford.
  When it comes to health care, small business owners have been facing 
higher administrative costs, lower bargaining power, greater price 
volatility and fewer pooling options. These are not minor details. They 
are major problems and health care reform includes concrete solutions 
to begin solving them.
  Now, with this new law, West Virginia businesses will have access to 
far more affordable coverage options. In 6 months, as many as 20,000 
small businesses in West Virginia like Kate's will have access to tax 
credits for up to 35 percent of the cost of health coverage for their 
employees.
  And new State-based health insurance exchanges will be designed to 
help small businesses cover their employees in the small group market. 
By expanding the pool and spreading risk across every individual in the 
State exchanges, we can significantly decrease premiums for small 
businesses and lower administrative costs for small business coverage 
by as much as 30 percent.
  Many people have heard about Sarah Wildman, a woman who purchased 
insurance on the individual market right here in Washington, DC.
  Sarah was an informed consumer and specifically chose a policy she 
believed included good maternity coverage--one of the few policies on 
the individual market that cover maternity care at all.
  Of course, her so-called ``Maternity'' coverage didn't cover labor, 
delivery, or even her stay in the hospital. And as a result, Sarah was 
left with a $22,000 bill.
  And, because she gave birth by cesarean section--she now has a 
``preexisting'' condition and can no longer get coverage elsewhere.
  Sarah's situation would seem absurd, if it were not so deadly 
serious. And it begs the question: What is the value of health 
insurance that offers no coverage when it's needed?
  But soon she won't have to worry. This new law will mean the 
elimination of preexisting condition exclusions--right away for our 
children and as soon as the exchanges are up and running for adults.
  Both the House and the Senate have spent more than a year working on 
a meaningful plan to move our health system forward.
  For many of us this journey started in earnest three years ago in our 
effort to reauthorize the Children's Health Insurance Program. 
Protecting that program--which will cover more than 14 million children 
by 2013--represents yet another of this new law's enormous 
achievements.
  But today's achievement is built on more than 50 years of effort and 
incremental change--some quite meaningful, but none truly 
comprehensive.
  At last, our work has brought fundamental changes to a broken health 
care system, and takes an enormous step to begin making people's lives 
better.
  I was so proud to be there with the President when he signed the 
Patient Protection and Affordable Care Act into law--after spending my 
entire career in public service committed to this cause, it was a 
chance to witness history in the making.
  I want to thank my colleagues in the House and Senate who did the 
right thing for the American people. I know we are walking on the right 
side of history. I know many wanted to do even more, and go further. I 
know this bill is not perfect, but it will be transformative and that 
is a good thing.
  I particularly want to thank two courageous colleagues on the House 
side--Congressmen Allan Mollohan and Nick Rahall who took a stand for 
the American people and voted to pass this legislation.
  I want to thank Harry Reid for his leadership, and his unwavering 
vision which helped deliver a final bill to the President's desk.
  And finally, I want to thank the President who came to the White 
House as a champion of change. And now, he has delivered.
  We knew it would not be easy to change our health care system, but we 
persevered. All of us have stories like the ones I told.
  I am enormously proud to have supported this legislation, which, more 
than anything, means a better health care system. It means a better 
America and a better life for families everywhere.
  Mr. REID. I suggest the absence of a quorum.
  The VICE PRESIDENT. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Ms. LANDRIEU. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Burris). Without objection, it is so 
ordered.

                          ____________________