[Congressional Record Volume 157, Number 15 (Wednesday, February 2, 2011)]
[Senate]
[Pages S434-S475]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    FAA AIR TRANSPORTATION MODERNIZATION AND SAFETY IMPROVEMENT ACT

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of S. 223, which the clerk will report 
by title.
  The legislative clerk read as follows:

       A bill (S. 223) to modernize the air traffic control 
     system, improve the safety, reliability, and availability of 
     transportation by air in the United States, provide for 
     modernization of the air traffic control system, reauthorize 
     the Federal Aviation Administration, and for other purposes.

  Pending:

       Stabenow amendment No. 9, to repeal the expansion of 
     information reporting requirements for payments of $600 or 
     more to corporations.
       McConnell amendment No. 13, to repeal the job-killing 
     health care law and health care-related provisions in the 
     Health Care and Education Reconciliation Act of 2010.

  Mr. ROCKEFELLER. Madam President, this is, in fact, the aviation 
bill. As everybody knows, that is what we are doing; we are doing the 
aviation bill. We are talking about health care, but secretly we are 
doing the aviation bill. So I thought it would be interesting to talk 
about the aviation bill, to sort of bring people's minds back to that 
very important subject. It is interesting, because we want 
transparency, no filling up of the tree, everybody could offer all of 
the amendments they want. We immediately got amendments to repeal 
health care and other kinds of things but nothing about aviation. So as 
manager of that bill, I am going to talk about aviation. I do not 
guarantee it will be a scintillating speech, but it is going to be 
about aviation, because that is the bill we are on.
  I rise to speak about--which I did a little bit yesterday--the 
modernization of the Nation's air traffic control system. It is kind of 
important to New York and New Jersey.
  I cannot emphasize enough to all of my colleagues the importance of 
this issue to the United States. It is an issue I care deeply about, 
one Senator Hutchison cares deeply about, one I am completely committed 
to getting done. We have to. It is a sine qua non. It will make air 
traffic safer, more efficient, provide numerous economic and 
environmental benefits.
  I touched on air traffic modernization in my opening statement 
yesterday. But I want to spend a short time, knowing that my colleague 
Senator Hutchison is here and wants to talk, on the air traffic 
modernization. It just has to be discussed in a tiny bit greater detail 
so people understand how important it is.

  There will be some technical stuff in here, and I apologize for that, 
but people have to understand this. I know this subject is very 
technical. It is very confusing. It has lots of acronyms, unmemorable 
acronyms, but the technology will change aviation in truly amazing 
ways, and it is of overwhelming importance to the country.
  Every time I get in my car, I find it implausible that so many 
automobiles navigate using more sophisticated global positioning 
systems than aircraft. Well, that is amusing, except it is horrifying, 
actually. It is horrifying. We can do it in Detroit with automobiles 
that sell for $15,000, $25,000, but we cannot do it on a multimillion-
dollar aircraft because we have not decided to do it aggressively in 
our legislation. So we have to upgrade our system now or we are going 
to face absolutely enormous consequences.
  I continue to believe that the modernization of our Nation's 
antiquated air traffic control system has to be one of the Nation's 
highest priorities. We have fallen behind, as is now--it is actually 
kind of interesting. It has become a mantra: We have fallen behind 
Mongolia. People like to talk about that. I am the original author of 
that startling fact--this tiny little nation ahead of us. But it does 
not make any difference. Everybody should steal the line because it 
makes the point: They have it. They are building it from scratch. We do 
not. So if we recognize the benefits of using the most advanced 
technology and if they do, perhaps it is something we might think 
about.
  The United States, of course, has a much larger and more complex 
airspace system than Mongolia or any other country in the world, but 
this is precisely the problem: that we are so big and we are so 
complicated; there are 36,000 flights in a day. There are airplanes 
during the day, all day long, all over the country, at different 
altitudes, coming in, avoiding weather, avoiding each other, facing 
delays or not. Our aviation system actually moves 30,000 flights a 
day--I would say 36,000, but it says 30,000--and nearly 800 million 
people per year--a lot tougher than Mongolia. But we face gridlock if 
we do not make significant progress on modernization and make it very 
soon. The FAA's most recent forecasts estimate demand for air travel 
will be about 1 billion people within the next decade. That is a 40-
percent increase. That is horrific.
  Senator Isakson has just come on the floor. His airport in Atlanta is 
one of the most complicated and busy in the entire world. He needs, as 
do we all, an air traffic control system which is digitalized, which 
makes communication between air traffic controllers and pilots much 
more accurate so they can see terrain, they can see mountains, they can 
see weather, all in streamingly live exactitude.
  The economic downturn of the past several years has actually, in a 
quirky way, bought us some time to reform our system. We have declined 
to use it, but this will quickly change as the economy rebounds. Our 
present air traffic control system is stretched to its limits already. 
Anyone who flies on a regular basis has experienced the system's 
congestion and delay problems. We talked about that yesterday. We will 
talk more. This system will not meet the projected growth of the next 
decade.
  So we have this choice. An industry that employs 11 million people 
and several more in indirect jobs, that traffics 800 million people 
around the country to all kinds of places large and small, very 
complicated--runway problems, gateway problems, all kinds of problems--
if we do not have this up to speed, we are a nation in trouble and 
people will start dying.
  The Next Generation Air Transportation System, NextGen, will create 
significantly more capacity by allowing aircraft to move more 
efficiently and take more direct routes. I talked about that yesterday. 
It is so important. Planes now, because of the sort of radar ground-
based system, wind their way to their destination, avoiding planes, 
avoiding weather, and how quickly can they see it, how accurately can 
they see it, are they aware of the altitude of other planes above them 
and below them? Probably not very accurate. So they don't take direct 
routes. So these improvements, if they do take direct routes, will save 
our economy billions annually.
  The technology will also allow the FAA to safely allow the closer 
spacing of aircraft. More aircraft can land and do so more safely 
because of the reality of the digitalization of everything is so clear 
to the pilot and to the air traffic controller. They are in sync for 
the first time with a highly sophisticated system. And the Northeast 
corridor probably will be the greatest beneficiary of all of that. It 
will be.
  Greater operational efficiency will also create substantial 
environmental benefits. Drastic reductions in fuel consumption--taking 
more of a straight line from one place to another rather than going all 
over the place--saves a

[[Page S435]]

lot of fuel, and that means less carbon emissions, and it also 
significantly lowers noise emissions. Almost every community near an 
airport will greatly benefit from this effort, and this will also save 
airlines millions of dollars annually in fuel costs.
  Airlines, you have to remember--people just assume they are always 
there. Well, they are almost always in trouble financially. They merge. 
Sometimes they merge not because they want to but because they have to 
because one of them is declining financially. They have to be able to 
meet payroll.
  Most importantly, NextGen will dramatically improve the safety--the 
safety--of our air transportation system. It will provide pilots and 
air traffic controllers with better situational awareness. The military 
uses that term--SA it is called. It is called SA, situational 
awareness. Pilots and controllers will be able to see other aircraft 
and detailed weather maps and other things such as mountains in real 
time. If they are flying low, they need to have a very good sense of 
what the terrain holds. So just as in battle, better SA--situational 
awareness--will save lives.
  Modernizing our air traffic control system will require sustained 
focus and a lot of money. Our bill takes concrete steps to make sure 
the implementation of this system begins now. And there is some of it 
out there in a few airports, and where it is out there, it is working 
very well, just as Senator Hutchison and I have described.
  The bill directs the FAA to move forward on dedicated timelines to 
implement key NextGen technologies. In particular, it requires clear 
deadlines for the adoption of existing GPS navigation technology. All 
of this has to be calibrated. Carriers have been very excited about 
using this; it is just that we have not made it available to them. And 
they are a part of it because as we build it they are going to have to 
have corresponding avionics and systems within their own cockpits, 
which they will pay for. They want to do that because they want to have 
this safer system so they are not harassed so much and so they can save 
fuel and just do better in general. Why do something out of the 19th 
century when you can do it out of the modern era that will last for 
years?
  It also requires the FAA to move forward on developing air traffic 
procedures to make certain airlines will reap the benefits of equipping 
aircraft in their fleet.
  These technologies are as follows. They are called area navigation 
and required navigation performance, RNP. That will permit aircraft to 
fly more precise routes in both the en route environment and enable 
aircraft to land more efficiently and safely at airports. Our 
legislation requires the FAA to develop the procedures that accompany 
this technology at the Nation's 30 largest airports by 2014--Senator 
Hutchison said that yesterday--and at all commercial airports across 
this country by 2018, if we do our work here. Then the whole thing will 
be done in the county by 2018 and all the biggest ones by 2014.
  The bill accelerates the timeframe for the integration of automatic 
dependent surveillance-broadcast--ADS-B--technology by requiring the 
use of ADS-B Out on all aircraft by 2015 and the use of ADS-B In on all 
aircraft by 2018. This technology will significantly improve the safety 
of our system by providing pilots and air traffic controllers with more 
precise information on their location. That is everything in air 
traffic control--where people are, how high, how low, how close, how 
far. The FAA has moved forward on the requirement for ADS-B Out for all 
aircraft operating in our airspace, and we plan to work with them to 
make sure this is a success.
  The bill--coming to the end--takes further steps to make certain that 
implementation of NextGen continues at the FAA, including the creation 
of an air traffic control modernization oversight board. Oh, wonderful, 
another board. Well, this is a really complicated system, and you need 
to have an advisory group that oversees, gives oversight--as we in the 
Commerce Committee will do--of FAA's modernization activities.
  It establishes a Chief NextGen Officer position at FAA. Oh, another 
person to oversee something at FAA. Well, we have not done this. We are 
not doing it. And to have an officer dedicated to that I think is very 
important.
  It requires the development of processes to include representatives 
of Federal employees in the planning of NextGen projects. Why is that 
important? Because it means that people who are working the towers, who 
are actually involved in the system as it is now--and if you go out to 
other places--Herndon--you can see these enormous rooms of computers 
with air traffic controllers and these sort of vague shapes. We want to 
turn those into precise shapes. That is what our bill would do.
  It establishes a new process to make certain labor disputes at the 
FAA are adequately resolved through mediation and arbitration if 
necessary.
  So our future as the world's leader in aviation, our safety, our 
economy--all depend on a successful modernization of our air traffic 
control system. An FAA-funded study determined that our economy lost 
$33 billion in 1 year as a result of delays attributed to the air 
traffic control system. That is not smart and it is not safe. Of this 
total, $8 billion was from the airlines themselves. They are not in the 
position to lose $8 billion--an amount that would go a long way toward 
giving them a healthier bottom line and making other improvements. The 
other $25 billion in losses was borne by the traveling public--they had 
to pay for it--and business.
  So this overdue FAA reauthorization takes the necessary steps to make 
certain we begin to implement this critical upgrade of our airspace 
technology right now. We must follow through on these efforts or face 
dramatic challenges. This is not a song and dance effort; this is life 
and death for the future of our air system, in literal terms and 
symbolic terms.
  Madam President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Texas.
  Mrs. HUTCHISON. Madam President, I commend the chairman of the 
Commerce Committee. He and I have been working on this bill since 2007.
  As we mentioned when we began consideration of the bill yesterday, 
this is the 18th short-term extension we are on. I think any person in 
America, any person who flies in America, any person who is subject to 
FAA regulation, and certainly any businessperson in America knows you 
cannot do long-term planning and ensure that your agency is doing its 
work knowing what they can expect in support from Congress in short-
term extensions for over 4 years. That is not good business, it is not 
good management, and it is certainly not the way government should 
run. So I am in agreement with Senator Rockefeller, our chairman, that 
we need to act on this bill. I hope it is going to be an effort that is 
bipartisan, that we will address the issues that have held up the bill 
in the past in a reasonable way so we can get on with, hopefully, a 3-
year authorization of the FAA, and especially so we can start next 
year.

  America is the premier user of air traffic control systems. Our 
system is based on the 1960s technology of ground operations and use of 
radar. We want to move to a satellite-based system that will increase 
the capacity at our clogged airports--the bigger airports that have 
more traffic than they can accommodate--and where the traveling public 
is in the most need. We need the efficiency and we need the modern 
technology. That is what this bill will set us on the path to do.
  So I agree with the chairman in that respect, and I look forward to 
working with my colleagues on their amendments that pertain to this 
bill going forward.
  I wish to take a few moments to speak to the amendment that is at 
hand, which is not an amendment about the FAA authorization, but it is 
a very important amendment. Basically, it is Senator McConnell's 
amendment that would repeal the health care reform that was passed over 
a year ago. He is trying to say: Let's stop right now. We have seen 
every signal that the concerns we had when we spoke against this bill 
in December of 2009 are coming home to roost. In fact, the concerns we 
raised are now being shown to be a huge problem in this country.
  The health care reform bill that was passed cost $2.6 trillion. Over 
6,000 pages were added to the Federal Register to implement this law. 
All of this

[[Page S436]]

indicates the bill does a whole lot more than my colleagues are 
referencing right now in the floor debate because when I hear the floor 
debate, the people who supported this bill are saying all we did was 
fix a few problems with our health care system that we all agree on. 
But in reality, this is a bill that costs $2.6 trillion, $500 billion 
in new taxes on business and on individuals, and it cuts $500 billion 
out of Medicare, a program that isn't working to the maximum extent 
possible. It is certainly not considered the most efficient program. 
Now we are putting $500 billion out for a new government entitlement 
program that puts the Federal Government between patients and their 
doctors.
  Here are a few of the provisions that are in the 2,000 pages of the 
health reform law. First, if you don't buy government-approved health 
insurance for you and your family, the health reform bill says you must 
pay a new tax. That is the individual tax.
  If you own a business and don't buy government-approved health 
insurance, which is going to have a formula and a requirement for how 
much businesses have to pay and what has to be in it, then you must pay 
a new tax. If business owners want to grow their employees over the 50 
mark where it kicks in for businesses, then there will be costly new 
Federal regulations with which they will have to comply.
  So here we are in an era where unemployment is at all-time highs, and 
we are putting a cap on employees for businesses that are going to 
incur huge expenses if they go over 50. So if an employer is in the 40-
to-45 range, they are looking very carefully at not going above 50. Is 
that really what our economy needs right now? I don't think so.
  What we want is to encourage businesses to hire. That is what every 
one of us in this body should want, and we should be passing laws that 
would ensure that businesses have the freedom to hire, not a stifling 
effect on that kind of effort. We need to get the government off the 
backs of our job creators and not put up miles of redtape and more 
bureaucracy and more regulations and more taxes and fees that would 
curb the ability to hire and still make a profit.
  Next, it was said during the health care reform debate that if you 
like your current health plan, you will be able to keep it. But 
everything that has happened since the bill passed says you can't keep 
it because even the administration is now admitting that when it issued 
the rules that employers now have to follow when deciding what health 
care plan it will offer, that because of health reform, by 2013 as many 
as 80 percent of small businesses will no longer offer the same health 
care plans they offer today.
  Families who rely on their health savings accounts or flexible 
spending accounts, which have been a wonderful boon for families to be 
able to put money aside before taxes to be able to use on the health 
care expenses they have that are not covered by insurance, that is 
being used by more and more people--in the millions. But in the health 
care reform bill there is now a restriction, a cap, on how much you can 
put aside, and you have to have a prescription drug to be able to pay 
for it with your pretax dollars. You can no longer buy a bottle of 
Tylenol or aspirin off the counter and have your health savings account 
help you pay for that. So here we are.
  The Presiding Officer and I have children. Are we going to stop and 
call the doctor or run and get a prescription if we have a health 
savings account to buy aspirin or Tylenol? That is not helpful.
  Why would we put a restriction on what people can set aside for their 
own health care costs? Why wouldn't we make it easier for them? 
Instead, the health care reform bill makes it harder to use those 
pretax dollars. There is no reason for it. I will have an amendment 
that will try to take the caps off and take the restrictions off so 
that people can provide for their health care out-of-pocket expenses 
with pretax dollars. That is the kind of incentive we need, not the 
opposite, which is in the health care reform bill.
  If you are a woman under 50, whether you have access to routine 
mammograms is going to depend on a task force that was granted new and 
unchecked powers by the health care reform bill. The same task force 
that is going to have that power has already given the indication that 
mammograms under the age of 50 are not necessary to be covered. The 
women of the Senate stood firm years ago when the Clinton 
administration was trying to pass a health care reform bill to say we 
are absolutely not going to stand in the way of a woman and her doctor, 
knowing her history and her family, from having a mammogram whenever it 
is needed. There is not one person in this body who doesn't have a 
friend or a relative who has had breast cancer before the age of 50 and 
probably before the age of 40. So that is in the health care reform 
bill, and it needs to come out.
  This week, another Federal court announced that the Federal 
Government could not force individual Americans to purchase a private 
product--even health care. The judge in the most recent case in Florida 
said when Congress passed health reform it exceeded its constitutional 
power and, therefore, the court voided the entire law. This is the 
second court that has found the health reform bill unconstitutional.
  Now, this lawsuit is going through the judicial process. Yet even 
though it is being appealed by the Obama administration, it will most 
likely go to the Supreme Court of America. We shouldn't have to wait 
for the Supreme Court to rule that this law is unconstitutional. We 
shouldn't have to wait for them to reassure the American people that 
Congress most certainly shouldn't be regulating anything and everything 
just because the Federal Government says so. We don't have to spend 
millions more in taxpayer dollars implementing a bill that ultimately 
could be struck down by the highest Court in the land.
  The Senate has the opportunity, and I believe the responsibility, to 
say: Moratorium. Let's wait until the Supreme Court has ruled on this 
enormous bill and the enormous cost that is being incurred for 
implementation right now. Let's wait. Let's repeal this bill now and 
start all over so we do not have to spend taxpayer dollars that we know 
are being borrowed to implement a bill that may be unconstitutional, 
and we have now had two Federal courts that have said so. Why not 
repeal and support this amendment? Some of what is in the bill could be 
reenacted because it is good, but some of the things I have just talked 
about should be repealed immediately.
  Most certainly we could repeal items such as the 1099 which will be 
another amendment we can vote on. That 1099 form is the biggest thing I 
hear about from my small businesses in this country, and certainly 
those in Texas have said: What are you all doing up there? Well, of 
course, I am happy to say I didn't support this bill. But these are the 
kinds of things we can repeal today and start all over. We can take the 
good parts of the Obama health care. Let's do away with the bad parts 
instead of spending millions of dollars to make a mom have to get a 
prescription from a doctor to get Tylenol with her health savings 
account.
  The American people have made their opinion on this bill known loudly 
and clearly. They spoke at the ballot box: Enough is enough. That is 
what the voters said. Enough deficit spending; enough government 
intrusion into our businesses, our families, our lives, and our health 
care decisions. The people of America support the repeal of this bill, 
and they will work with us to substitute responsible health care reform 
that will allow them to have health savings accounts to provide for the 
costs not covered, that will give them affordable coverage which we all 
want to have, but not with the government prescription, not with a 
government task force that can tell a woman that she doesn't need a 
mammogram before the age of 50. We don't need a task force to tell us 
that. We need the doctor who is looking at this patient and her family 
history.
  Those are the things that need to come out right now. Repeal and 
replace. That is what this Senate could do, and we can move forward on 
a bill that we can get a bipartisan consensus to pass that I think 
would show the American people we heard what they said. We know we can 
do better, and it is our responsibility to do so.
  Thank you, Madam President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from West Virginia.

[[Page S437]]

  Mr. ROCKEFELLER. Madam President, I ask if the Senator from the State 
of Washington would grant me 30 seconds to say one thing.
  Mrs. MURRAY. Of course, I will.
  Mr. ROCKEFELLER. Madam President, yesterday Senator Hutchison raised 
a very good point about slots. Slots are kind of the hidden problem in 
the FAA bill. What I think I would like to put forward--and I wish she 
were here to hear me--is that I recognize the majority of the 
population growth in this country, and, therefore, the need for more 
flights, is in the West. It is not in the East. That is extremely 
important. We deny it, but a lot of people are east coast centric, and 
we have to learn how to be equally west coast centric.
  So one of the things that occurs to me is that maybe we are thinking 
too much about airlines and not enough about the people who take those 
airlines to go to various places in the West.
  It cannot stand that Los Angeles has a flight a day to DC. It cannot 
stand. They need at least four or five. They can bear that traffic.
  I want to lay before the Congress--and the Senator from Texas made 
this point yesterday and I totally agree with her--the growth of 
population in this country and the need for air flights, yes, is in the 
East but it is more now in the West. As we go through this bill and 
come to the matter of slots, it is important we keep that in mind and 
that we think about the public flying as individuals, not necessarily 
is it United, is it USAir, is it American, is it whatever. It is the 
question, Can we get them to where they want to go.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Texas.
  Mrs. HUTCHISON. Madam President, will the Senator from Washington 
allow me to make a couple minutes response to the Senator from West 
Virginia?
  Mrs. MURRAY. I will.
  Mrs. HUTCHISON. Madam President, I appreciate so much what the 
chairman has just said. That is a major statement because what he says 
is true. There is one flight from Washington National to California. 
That is all we have, one direct flight. That is not fair. It is not 
fair to the people in the West, certainly in the largest State in 
population in America--California.
  I hope what he has said will lead us to a table to negotiate this 
issue so we can be fair to the entire western half of the United 
States, so that we are also taking into account the people who live in 
and around the Washington metropolitan area, which is what I think the 
Western Senators have tried to do. But let's talk about it, let's get 
something on the floor, let's negotiate this because with that, this is 
a bill that, with a few tweaks perhaps, ought to pass for the right 
reasons for our country and for the traveling public.
  I thank the chairman for his leadership, and I thank Senator Murray.
  The ACTING PRESIDENT pro tempore. The Senator from Washington.
  Mrs. MURRAY. Madam President, we are here today to debate the FAA 
reauthorization bill, very important legislation. It will create 
thousands of jobs and put in place the infrastructure for us to make 
sure we are competitive in the future.
  It is disheartening to me that this bill has now been hijacked by a 
political debate, an amendment to repeal health care reform. Not every 
bill has to become political. Unfortunately, that is what we have today 
because we have an offer of an amendment to repeal health care reform. 
Let me speak to that amendment.
  Last year, I watched as President Obama signed health care reform 
into law with a young man by the name of Marcelas Owens. He stood just 
a few feet away from the President. I met Marcelas a few months earlier 
at a rally in Seattle, and he told me a story that stayed with me 
throughout the health care debate. I want to mention it again.
  Marcelas, a little boy, came up to me at this health care rally. He 
leaned in close to me and he said he wanted to tell me about his mom 
named Tifanny. She was a single mom, working hard. She got sick and 
lost her job. Because she lost her job, she lost her health care. 
Because she lost her health care, she lost her life. Little Marcelas 
looked up at me and said: Please don't let this happen to any other 
little boy. Please pass health care.
  I was proud when that health care reform law was passed and is now 
working to make sure Marcelas and thousands of other little kids do not 
get into that terrible situation through which he has lived.
  He was not alone. I heard from thousands of people from my home State 
of Washington who were demanding reform to the system we have. I heard 
from small business owners who wanted to cover their employees but they 
could not continue to do it because of the skyrocketing premiums. I 
heard from moms and dads who wanted to cover their children but they 
were getting rejected because their son or daughter had a preexisting 
condition. I heard from seniors who were desperate because they had 
fallen into the doughnut hole. They did not know how they were going to 
afford the drugs they needed to take so that they could have dignity of 
life in their senior years.
  I heard from men and women in every part of my State, some barely 
holding on to their health insurance and a lot with no coverage at all. 
Each one of their stories had a common thread: The health care system 
we have in this country did not work for them. It failed their families 
one way or another, and they wanted it to change.
  That is why I fought so hard with so many of my colleagues to reform 
that broken health insurance system, to fight for our families who 
needed help and were desperate and to level the playing field for 
people who needed a little bit of support.
  We got that done for our families, and we can never go back. We 
cannot go back to a time when millions of Americans stayed up at night 
worrying about what would happen to them and their families if they 
lost their job and their health insurance; when insurance companies put 
unreasonable and unfair lifetime caps on coverage for our families; 
when women were not able to get equal access to coverage; when small 
businesses could not afford health care; and when so many seniors who 
could not afford it had to pay the full cost of expensive medications. 
We cannot go back to that situation.
  My question for Republicans today is, why would they want us to?
  The changes we made require insurance companies to cover preventive 
services with little or no cost sharing on the part of patients. It 
gives families access to new streamlined assistance to help them appeal 
services they have been denied or not covered adequately, something so 
many families got lost in prior to passage of this legislation.
  It helps anyone who has ever been buried under a blizzard of forms 
from their insurance company and denials for coverage they need to 
have. It helps our small businesses to afford care for themselves and 
their employees who are now getting a tax deduction. As they fill out 
their forms, they say: I did not know this was in the health care bill. 
And we are going to vote to take that away?
  I ask, why do Republicans want to take away the benefits as part of 
the business of the Senate as we just get started to get our economy 
back on track?
  In my home State of Washington, the Republicans' plan would mean 
nearly 900,000 seniors who have Medicare coverage will be forced now to 
pay more for regular checkups and important preventive services. It 
would mean they will lose out on the 50-percent discounts on some of 
their prescription drugs. And it would mean that insurance companies 
would no longer be required to allow young people to stay on their 
policies until they are 26 and that, by the way, is going to be 
especially harmful now when so many of those young people today are 
having trouble finding a job.
  Our families are depending on the changes we made within this health 
care reform law. It is why I supported reforming our health care 
system. It is why I fought so hard for so long to make sure it worked 
for our families and small business owners. And it is why I am going to 
keep fighting to make sure we do not go back to the way things were, 
that we continue to make progress and do this right.
  I am happy to work with anyone--Democrat or Republican--to improve

[[Page S438]]

this law, but I will do everything I can to fight a full repeal that 
will devastate our families and small business owners across America. I 
urge my colleagues to vote no against this full repeal of health care 
reform.
  One final point. We hear so many people talking about the deficit 
today and how important it is that we get our hands around the budget 
and our budget deficit. It is astonishing to me that this first 
amendment brought by the Republicans will cost our Federal Government 
$1.5 trillion and put us deeper into a deficit hole.
  Progress is important. Getting our families back on track is 
important. Making sure that our economy is moving within the FAA bill 
we are talking about on the floor is important. And it is important 
that we continue to make sure the health care reform insurance system 
we put in place works for our families. That is what I will be voting 
on later today.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Arizona.
  Mr. KYL. Madam President, yesterday I spoke on one of the reasons for 
the repeal of this legislation; that is to say, the support for the 
amendment to repeal the health care legislation that is pending before 
us. Today I wish to speak about a couple other reasons to support that 
amendment.
  One of the things that was said in the campaign to pass the health 
care bill was that those who liked their current health care would be 
able to keep it. But as we know now and as we pointed out prior to the 
bill's passage, provisions in the law would cause many Americans and 
will cause many Americans to lose their coverage. That is why the 
administration is now giving out waivers for some of the bill's most 
burdensome provisions.
  I wish to speak for a moment about these waivers the administration 
has granted and the problems that the waivers reveal with the bill as a 
whole.
  So far, the administration has granted 729 waivers. All of these are 
temporary. They protect companies and labor unions from one of the 
bill's most onerous mandates--the phasing out of annual caps on costs 
paid by insurers. Another four waivers were granted to States applying 
on behalf of insurers. According to the administration, waivers may be 
granted if the applicant can show that a ``large increase in premiums'' 
or a ``significant decrease in access to coverage'' would occur absent 
a waiver.
  So far, the waivers cover 2,283,106 people. That is more than 2 
million people whom the administration has had to protect from its own 
bill.
  All of these waivers were granted to limited benefit plans, or so-
called mini-med plans. About 1.4 million Americans have these mini-med 
plans, including many part-time employees who work in the restaurant 
and retail industries. These plans are low cost and usually have an 
annual cap on costs the insurer would pay out.
  Under the Obama plan, these plans would be outlawed. A phaseout on 
annual caps begins this year. Starting this year, plans cannot impose 
an annual limit of less than $750,000. That threshold gets 
progressively higher, until 2014 when ObamaCare will prohibit annual 
caps altogether.
  What this does, of course, is create an incentive for employers who 
currently offer mini-med plans below the $750,000 threshold to drop 
their coverage completely until the employer mandate and penalties 
become effective in 2014. They can either comply with the requirements 
of the health care law or pay a fine for each employee.
  The employees caught in this mess who currently have coverage through 
mini-med plans will have to hope in the meantime that their employer 
can get a waiver; otherwise, those employees will have to wait until 
2014 and buy a government-approved policy from the new insurance 
exchanges or hope that their employer is in compliance with the many 
employer requirements in the bill.
  McDonald's, for example, which offers mini-med plans to many of its 
employees, received a 1-year waiver. The company warned that absent a 
waiver, 30,000 employees could lose their current coverage and would be 
left ``without an affordable, comparably designed alternative until 
2014.''
  It is not clear what will happen when the 1-year waiver expires. That 
is another part of the problem. The waivers are often given on the 
condition that the recipient brings itself into compliance during the 
waiver period. Whether the waiver renewals are available is unclear. As 
with many other provisions of ObamaCare, the uncertainty for businesses 
surrounding annual cap waivers is immense.
  While the waivers are welcomed by those who benefit, they represent a 
poor way to run the government or health care. When the government 
picks which entities will have to abide by the law and which ones will 
not, it is literally picking winners and losers. That is not the recipe 
for objective or wise policymaking. It is called discrimination.
  I will note that a large number of these waivers were being given to 
the administration's political allies. Unions, for example, many of 
which praised the bill's passage, are a major beneficiary. Of the 733 
waivers granted, 182 went to unions. That is a quarter of all the 
waivers, even though unionized workers make up only 7 percent of the 
private workforce.
  Many of the unions applying for waivers are the very same that were 
full of praise upon passage of ObamaCare. In its press release praising 
passage of the bill, the Service Employees International Union gushed 
that ``it is a new day.'' About 6 months later, Local 25 SEIU applied 
for a waiver from the annual limits limitation for 31,000 of its 
members. It was granted 2 weeks later. Apparently, it is a new day--
just not for 31,000 SEIU members.
  Similarly, when the bill was enacted, the American Federation of 
Teachers referred to it as an occasion where ``morality trumped 
greed.''
  Six months later, its New York City affiliate obtained a waiver 
affecting 351,000 individuals.
  In the recent column in Forbes magazine, law professor Richard 
Epstein explains the dangers of administrative discretion related to 
waivers and how the waiver process can undermine the rule of law:

       Waivers are by definition an exercise of administrative 
     discretion that benefits the party who receives its special 
     dispensation. Nothing in Obamacare explains who should 
     receive these waivers or why. The dangers from this 
     uncertainty are enormous. . . . Without major steps to 
     overhaul or repeal Obamacare, government by waiver will 
     become standard operating procedure to the detriment of us 
     all.

  This is a bill that was written behind closed doors, creates a huge 
uncertainty and problems for job-creating businesses and their 
employees, and now waivers are being dispensed by the administration to 
protect almost 2.3 million people from the very law it fought so hard 
to get passed.
  These developments are yet more confirmation that the law is deeply 
flawed and one more reason why it should be repealed in its entirety.
  The second issue I would like to speak to is the fact that under this 
law, there are substantial increased costs, but they are being masked 
by the way the bill has been written, and the calculations, therefore, 
some have suggested, would actually result in a savings of $230 
billion. This is only plausible if you believe the way this bill was 
written was an honest way of stating its costs. It is not that the CBO 
has done anything wrong in its calculations, it is that it was told how 
to calculate certain things. The bill's authors said: Never mind what 
the reality or truth is, here is how you will calculate the cost of it. 
The CBO, as a functionary, did exactly that to come up with a number.
  But former CBO Director Douglas Holtz-Eakin recently cowrote an 
article, along with Joseph Antos and James Capretta, explaining that 
the bill's purported deficit reduction is based on ``budget gimmicks, 
deceptive accounting, and implausible assumptions used to create the 
false impression of fiscal discipline.'' The fact is, repeal will not 
add to the deficit. The bill itself is the budget buster, not repeal.
  I am in favor of full repeal of the so-called Affordable Care Act. 
There are many problems with this bill and many reasons to support 
repeal. Today, I want to talk about cost.
  A central talking point from the bill's supporters has been that the 
bill, intended to cover 32 million Americans, will reduce the deficit 
by about $230 billion, according to the Congressional Budget Office. 
Therefore, repeal

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will increase the deficit by the same amount.
  Maybe this sounds plausible--but only until you study these numbers 
more closely. Only in Washington could the ``cost'' of repealing a 
massive entitlement program add to the deficit.
  This is not because of anything the Congressional Budget Office did 
wrong. Remember, when the Congressional Budget Office calculates these 
estimates, it is required to accept every assumption it is given, 
however unrealistic such assumptions are. That's how the authors of 
ObamaCare got CBO to produce such a favorable number.
  Indeed, former Congressional Budget Office director Douglas Holtz-
Eakin recently cowrote an article, along with Joseph Antos and James 
Capretta, explaining that the bill's purported deficit reduction is 
based on ``budget gimmicks, deceptive accounting, and implausible 
assumptions used to create the false impression of fiscal discipline,'' 
and that repeal will not, in fact, add to the deficit. The bill itself 
is the real budget buster. Not repeal.
  Let me walk through the false assumptions and gimmicks Holtz-Eakin 
and his co-authors describe.
  First, as Republicans pointed out again and again before the bill's 
passage, the bill's original $938 billion pricetag does not reflect the 
true 10-year cost. That estimate was generated using 10 years of taxes 
to pay for 6 years of subsidies. Remember, while the taxes begin this 
year, the subsidies don't kick in until 2014. So, the 10-year cost of 
the bill's full implementation is actually about $2.3 trillion.
  Second, there is an additional entitlement program within this new 
entitlement: the so-called CLASS Act, a new, government-run, 
government-funded program for long-term care, intended to compete with 
long-term care plans provided by private insurers.
  Participants would pay into the system for 5 years before they start 
collecting benefits. So, for at least the first 5 years, the program 
would generate surplus receipts for the government. But eventually, 
outflows would exceed receipts. This is why the chairman of the Senate 
Budget Committee referred to the CLASS Act as ``a Ponzi scheme, the 
kind of thing that Bernie Madoff would have been proud of.''
  This is a bailout waiting to happen. As Holtz-Eakin, Antos, and 
Capretta write, ``CLASS Act hitched a ride on the Affordable Care Act 
for one reason only: Premiums are collected in the first 10 years, but 
no benefits are provided. Voila, it creates the perception of a $70 
billion deficit reduction. . . . Only in Washington could the creation 
of a reckless entitlement program be used as an `offset' to grease the 
way for another entitlement program.''
  Third, is the illusory savings from cuts made to Medicare's health-
care providers, which would bring payments below those made to Medicaid 
providers. We know that the network of doctors and hospitals willing to 
see Medicaid patients is constrained in part because of low 
reimbursement rates.
  Accordingly, about 15 percent of America's hospitals and physicians 
would have to stop seeing Medicare patients to help curtail their 
losses, although the bill assumes that seniors would not see any change 
in their care. Holtz-Eakin, Antos, and Capretta write, ``The idea that 
Medicare could pay less than Medicaid is such sheer folly that Congress 
will rapidly reverse course. The truth is these cuts cannot be relied 
upon for anything.''
  In addition, the bill double counts these so-called Medicare 
``savings,'' claiming that they can both shore up Medicare's solvency 
and help pay for ObamaCare.
  Fourth, ``a central CBO assumption'' about how many Americans will 
get federal health care subsidies ``could be disastrously off the 
mark.''
  Today, about 111 million Americans are eligible for subsidies through 
the new insurance ``exchanges'' if they don't have an employer-based 
plan. But the bill assumes that only 19 million would receive these 
subsidies. This assumption fails to take into account the incentive the 
bill creates for certain employees to find their way onto the 
exchanges, rather than accept coverage from their employers, if 
offered. As the authors note, ``the new subsidies are so generous that 
low- and moderate-income workers come out way ahead if they get paid in 
cash, not benefits, and move to the new entitlement.''
  If only the 35 million lowest paid workers jump onto the new 
entitlement, Federal spending will rise by another $1 trillion in the 
first decade alone.
  So, those are four reasons that the purported cost estimates for this 
bill are simply wrong or misguided. It's clear that the claims that the 
bill will reduce the deficit, or else increase it upon repeal, do not 
hold up upon close inspection. Repeal is not a threat to the budget; to 
the contrary. The real budgetary threat is ObamaCare itself.
  For these reasons, and many others, I support full repeal of this 
bill.
  Again, there were four basic false assumptions that were built into 
the legislation in the way it was drafted, which theoretically 
demonstrate a savings of money through the adoption of the legislation, 
as the authors point out, but which actually result in not a savings 
but an increase in the Federal budget deficit.
  One of these has to do with the fact that taxes are collected for 10 
years, but costs only accrue over 6 years. Obviously, you are going to 
get some money that way. But after that first 6 years, you have to 
count the costs as well as the revenue taken in.
  Another is the inclusion of the so-called CLASS Act, which has been 
described by some as a Ponzi scheme--actually, by the chairman of the 
Senate Budget Committee--because it collects all the money upfront and 
doesn't pay out any benefits. Once you have to pay out benefits, there 
will be a cost. That is a way to show that you are taking in money and 
you are not spending it. But it is a dishonest way to write the bill.
  Third, the way the cost of Medicare was calculated. The $500 billion 
savings is not a savings at all but rather goes to pay for other parts 
of the bill. It doesn't help Medicare at all. It only works if, as the 
Congressional Budget Office said, Congress actually follows up with the 
cuts to hospitals and physicians, which nobody believes Congress would 
have the courage to do.
  Finally, there are the subsidies and exchanges calculations, which, 
as I pointed out in these comments, are woefully understated, as a 
result of which it is likely we will have a significant budget deficit 
rather than a savings as a result of this legislation.
  In fact, repeal of the bill is going to save taxpayers money. The 
legislation is what costs money. Think about this: How can you cover an 
additional 30 million people--or however many will be covered by this--
without increasing costs? It can't be done. It would not be done under 
this legislation. In addition to the reason I talked about yesterday--
the cost of Medicaid to the States--and the two points here today and 
the fact that these waivers are being granted in a discriminatory way 
only demonstrates that the underlying bill is not a good idea and that 
the cost calculations are way off.
  I hope my colleagues will take this opportunity to follow the advice 
of the American people and vote to repeal ObamaCare.
  The ACTING PRESIDENT pro tempore. The Senator from Montana is 
recognized.
  Mr. BAUCUS. Madam President, we, unfortunately, are in a period where 
we are going to be redebating health care reform. We had long debates 
on health care reform in the last couple years. I cannot think of 
legislation that has occupied so much time in this body, as well as the 
other body. But, regrettably, we are going to redebate health care 
reform, even though legislation was passed last year, and even though 
the legislation was signed by the President. The law is enacted. 
Nevertheless, this body, regrettably, is going to spend, it looks like, 
a lot of time redebating health care reform. Why? Basically, because 
the other side of the aisle wants to do so--wants to not admit health 
care reform is the law of the land. It wants to repeal it.
  The other side knows there are not sufficient votes to repeal health 
care reform. That is a well-known fact. The other side knows and those 
who have covered health care debate reform know the votes are not 
there. It is the law of the land, signed last year, and it will remain 
the law of the land.
  So then, you might ask, if it is the law of the land today and if 
everybody knows Congress will not repeal health care reform, why in the 
world are we going to debate this for another who

[[Page S440]]

knows how many weeks, months or maybe even years? To be honest, I think 
it is because the other side thinks--and I will pick the charitable 
explanation first. They don't like health care reform, for whatever 
reason, even though I strongly disagree with their reasons. But in 
addition to that, they think it is a political issue. They think they 
can score political points by mentioning points which, in the main, are 
not accurate but say them anyway, and they will say it over and over, 
and unless those points are refuted or those myths are busted, many of 
the American people will start to believe some of that stuff.
  There is another reason, which is a bit regrettable, and that is 
because there have been lawsuits filed in Federal district courts 
around the country, alleging that the law is unconstitutional--the 
health care law. It looks like those decisions will eventually make 
their way up to the Supreme Court of the United States, and I expect 
the Supreme Court will not rule for, I don't know, maybe 1 year, which 
means we will further debate health care reform, waiting to see the 
outcome of the U.S. Supreme Court.
  I heard one that I think is a very ill-advised argument a few minutes 
ago, which is that because the Supreme Court has not yet decided on the 
constitutionality of health care reform, we should, in effect, pass a 
moratorium. We should forget the provisions of the law because we don't 
know how the Court will rule.
  That is one of the most specious and inadvisable arguments I have 
heard in a long time. That, in effect, means that whenever any law is 
passed and there is a lawsuit filed, that law is invalid because the 
suit is filed. If we are to follow that line of reasoning, then anytime 
we enact a law, anybody who doesn't like it could rush off and file a 
lawsuit, and that would mean we don't follow the law. I think the 
better course, by far, is to assume the law is the law of the land, 
until it is overturned on a statutory basis or a constitutional basis. 
That is the way we should operate.
  The Senator who suggested, about one-half hour ago, that we should 
enact a moratorium, in effect, I think should rethink her position. If 
she wants that to be the precedent, I think she would recognize that 
pretty soon the country could not function because anybody could file a 
lawsuit on maybe something passed 10 years ago. They could say: I don't 
like that law, so I will file a lawsuit. Following the Senator's line 
of reasoning, we can't enforce that law because somebody doesn't like 
it. That makes no sense.
  One of the myths that has been discussed many times, and as was said 
by the previous speaker in his argument for repeal of health care 
reform, is that repeal will save money. He thinks the health care bill 
adds to the deficit.
  You and I have been around here long enough, Madam President. We have 
lived long enough to know that anybody can come up with any set of 
figures or statistics that he or she wants. That is a fact of life. So 
if somebody asserts this and that, I think it is wise to see what that 
person's authority is. Who says that? Where does that come from? Who 
verifies or validates that? We well know there is one organization that 
has studied health care reform and has concluded that health care 
reform saves, I think, about $240 billion; it reduces the deficit by 
$240 billion in the first 10 years, and it reduces the deficit by north 
of $1 trillion in the next 10 years. That is the Congressional Budget 
Office.
  The CBO, I remind my colleagues--and for anybody listening--is a 
nonpartisan, professional organization that analyzes legislation for 
both Republicans and Democrats for the House and the Senate. They are a 
very professional outfit. They work very hard. No one has ever even 
hinted that this outfit, the Congressional Budget Office, is 
unprofessional or that it has a partisan bias. Nobody has suggested 
that. Everybody knows they work very hard and do the best they can, 
under difficult circumstances--I say ``difficult'' because it is 
difficult to predict the future, to know exactly how any request they 
are given will actually score. It is a complicated process. You have to 
build models. It takes a long time to build a model and to know what 
goes into the model.
  I wish to make it very clear to anybody listening that repeal of the 
health care law will actually increase the deficit by about $240 
billion over 10 years and increase the deficit by over $1 trillion in 
the next 10 years. That is what the CBO says. That is the organization 
that all Members of Congress must live by. Different Members of 
Congress might have different points of view. They may belong to some 
different organization--very liberal or very conservative--that has an 
ax to grind, and they can come up with some other figure. But they 
usually have an ax to grind, a bias they want to perpetuate.
  The one arbiter in the middle, which is professional, the one 
organization nobody has ever accused of being partisan or 
unprofessional is the CBO. They conclude, again--and they have written 
letters to us in the Congress--that repeal would essentially add about 
$\1/4\ billion to the deficit over 10 years. It would add; that is what 
repeal would do. It will add to the deficit over $1 trillion in the 
next 10 years.
  That should end the argument right there because it is the one 
neutral professional organization that has looked at this. Other 
organizations can have their points of view, but the one that is 
professional, the CBO, has ruled, and we have to go by those numbers 
anyway in passing legislation here. That should be the end of the 
argument. That has been settled. That is what the effect of repeal 
would be. That is it, as anybody knows when he or she is spouting off 
numbers that are not the CBO's but some other organization--I don't 
know which--maybe Heritage or some other organization. First of all, 
they are not neutral. They are not unbiased. Second, we can't go by 
those numbers anyway under the rules of the Senate. So it is kind of 
silly, frankly. They may be scare tactics. That is one of the scare 
tactics used on this floor to try to score political points, but it is 
inaccurate. It is just plain simply inaccurate.

  Now, a couple of other points. What do we spend on health care in 
America today all together? We spend about $2\1/2\ trillion a year on 
health care, we Americans do. About half of that is public--that is 
Medicare, Medicaid, children's health insurance--and about half of that 
is private--the commercial insurance industry. That is the American 
way. That was the division before health care reform was enacted.
  What is the division after health care reform was enacted? It is 
about the same. It is about 50-50. So this is no government takeover. 
This is no government takeover. It is still about the same. Maybe it is 
a percentage point or so different, I don't know, but it basically is 
the same. There is no government takeover. Half of it is still private 
commercial insurance, as it always has been.
  Also, in America we spend much more per person on health care than 
the next most expensive country. I don't know the exact number. I think 
it is 50 percent, 60 percent more per person on health care than the 
next most expensive country, but we are not 50 percent to 60 percent 
more healthy per person than the next most expensive country.
  In fact, all the international health care data ranked us pretty low. 
We are not No. 1; we are not No. 2 in health care. We are way down 
there. I have seen statistics--I haven't looked at it recently--that 
show us being maybe 14th and 20th in terms of health. Our infant 
mortality rate is much higher than many countries. Our death rate is 
higher than many countries. I don't know about our diabetes rate, but I 
expect that is high compared to other countries, and maybe cardiac and 
other chronic care is high compared to other countries. But we are not 
No. 1 in terms of health care. We are No. 1 in per capita cost of 
health care.
  So I would think we should begin to reduce the rate of growth of 
health care expenditures in our country, and that is what this 
legislation does. It starts to reduce the rate of growth of health care 
costs in this country. That is probably why the Congressional Budget 
Office reaches the conclusion that it actually reduces the deficit by 
$\1/4\ trillion over 10. It is probably why the Congressional Budget 
Office says it reduces the deficit over $1 trillion over the next 10 
years. And it is probably also why the Congressional Budget Office says 
that compared with prior law, I think it is 90 percent of Americans' 
premiums will be lower--90 percent of people's premiums will be lower.

[[Page S441]]

  Again, that is the Congressional Budget Office. That is a neutral 
organization. They do the best they can. They are professionals. Some 
Members of Congress criticize them because they do not come to the 
conclusions they like. Other Members of Congress criticize the CBO 
because the CBO doesn't come up with the conclusions they like. It is 
tough what they do, but they have always been praised for doing the 
best job they can, and they have never been criticized for any 
partisanship or unprofessionalism. They are a very good outfit.
  I have had my problems with the head of CBO, Mr. Elmendorf. I have 
talked to him many times on the phone. Most of the time it is saying: 
Can't you get your numbers to us more quickly? Why does it take so 
long?
  He does his best. He is very professional. He says: Senator, I am 
just doing the best I can. And I know he is, but still I am a little 
frustrated, but I know he is, and I think he does a pretty decent job.
  Now, you might ask: Why are American health care costs so high? Why 
is that? Why are American health care costs so high? Well, there are a 
lot of reasons for that. Essentially, it is waste. It comes down to 
waste. There is a lot of waste in the American system, and this 
legislation, among other things, is designed to root out a lot of the 
waste.
  What is some of the waste? I am not going to go into great detail, 
but I am struck with an article written by Dr. Guandi on June 1, 2009, 
in the New Yorker magazine comparing El Paso, TX, with McCallum, TX. 
What conclusion did he reach? This is an article that many in the 
health care industry cite because most people think this fellow got the 
nub of the issue right.
  Health care costs in El Paso are about half per person as compared to 
health care costs in McCallum, TX. They are both border towns so it has 
been adjusted for immigration and so forth. The outcomes in El Paso are 
higher. People do better in El Paso than they do in McCallum, TX.
  Why, one might ask. The basic conclusion of this article is that it 
is because of the way we in America reimburse doctors and hospitals and 
providers. It is a way which allows a culture in a community to spend a 
lot of dollars on health care, if it wants to, and it is a way it 
allows a culture in a community to spend fewer dollars and focus more 
on a patient, if it wants to. That is the culture of a community. That 
is because we pay providers in America; that is, doctors, hospitals, 
the pharmaceutical companies, medical equipment manufacturers, and so 
forth, on the basis of quantity and volume, not on the basis of 
quality.
  So there is a bias in the system. Doctors want to do the right thing, 
but there is a bias for a doctor to order an extra procedure. There is 
a bias to order an extra drug for this or that. There is a bias to get 
this new equipment, and I might say, too, though it is awfully 
technical, but when we reimburse hospitals there is something called 
DRGs, the DRG purp, and it is according to procedure in a hospital, but 
it does not include the medical equipment. So there is no real fix on 
what is the cost of that medical equipment. So the medical equipment 
manufacturers can charge virtually what they want, and they charge a 
lot.
  We have read lots of stories about how you can go to Walmart and get 
the same little small whatever it is for about one-tenth of the cost 
that a hospital is going to charge, and it is because the providers are 
purchasing through DRGs. That is an example of a lot of the waste that 
occurs in the system.
  Let me give another example. I think there are excessive procedures 
in America. You can do a lot with anecdotes, but this is one that I 
think gives some indication of one of the problems we face in America.
  I know a doctor, he is a neurosurgeon, and a very reputable, very 
good one. He said to me: Max, you know, there is another neurosurgeon 
group that wanted me to join their practice. So I went to talk to them. 
We talked a while. I have my own practice, and they have their 
practice. After a while, the negotiations kind of cooled a little bit. 
Why? It turned out the group who was seeking to have my friend join 
them did an audit on my friend's neurosurgical practice, and it was 
that audit which kind of cooled the ardor of the group having my friend 
join them. Why? Well, the group said: Our hit rate is 2 to 1, and your 
hit rate is only 20 to 1.
  Those were the exact words they used--``hit rate.'' What does that 
mean? That means in the practice of the several neurosurgeons, for 
every two patients they see, they perform one procedure. They have a 
hit rate of 2 to 1. My friend's hit rate is 20 to 1. For every 20 
patients he sees, he performs 1 procedure. Those doctors in that group 
love procedures. They want to do everything under the Sun. You have a 
back pain, it is an operation, a procedure, and all that; whereas, 
often you don't have to have the most expensive procedures.
  But our system in America, because it compensates doctors and 
hospitals on the basis of volume and quantity, has a bias toward 
excessive procedures. That is one reason we have waste in America 
today. Nobody disputes that. It is one reason we have waste in America 
today.
  Something else. There is something called the Atlas study by a guy 
named Jack Wennberg. This is from a few years ago. He looked at health 
care costs across the country, and what did he conclude? By the way, 
this study has not been refuted in any significant way over the years. 
He concluded basically--and I am exaggerating now--if a person lives, 
say, in a Wheat Belt State, say Montana, the Dakotas, or the Northern 
Plain States, that person's health care costs per person are roughly 
one-half of what they would be if that person were in a Sun Belt 
State--you know, Miami, Denver, Los Angeles, Phoenix, or Dallas. The 
outcomes in the Wheat Belt States versus the Sun Belt States are 
better. People have better outcomes; that is, they are cured better, 
faster than are people in the Sun Belt States where the cost is twice 
as much per person.

  Well, you might ask, why is that? The reason is because, basically, 
it is supply driven; that is, in the South there are a lot more doctors 
per person. There are a lot more hospitals per person. People like to 
live in the South. They like the sunshine weather. When you have more 
doctors and more hospitals, that is supply driven, and that tends to 
push up costs because those doctors and those hospitals want to do 
things. They want to order procedures for their patients, to make them 
worthwhile, and that is what happens.
  Now, most doctors around the country, including the South, are good 
doctors. They want to do the right thing. But I can tell you, I have 
run into individuals--one cataract surgeon, an ophthalmologist, told 
me--and I couldn't believe it because he was very upset--he was only 
getting paid $2 million a year. Basically, he had people come in and 
rotated people in his office to do more cataract procedures--more 
cataract--and he was upset that he was only getting paid $2 million a 
year.
  So this health care bill is trying to address that basic problem, and 
it is called health care delivery reform. We are going to move slowly 
toward reimbursing doctors and hospitals a little more on the basis of 
quality as opposed to quantity. It is hard to measure quality. How do 
we measure quality? It is hard, very hard. But there are some 
provisions in this legislation--which have been criticized by people 
unfairly--designed to help both the doctor and the patient have a 
better idea of what the right procedure is and how to get the highest 
quality health care. That is what it is designed to do. There are lots 
of names for it--bundling, ACOs, and all kinds of things--but that is 
the whole purpose of it.
  The key is this: It is not at all intended to tell the doctor or the 
patient what to do, as has been claimed. It is not that at all. Rather, 
it is just the opposite. It is to help the doctor and the hospital have 
better, more information so the doctor and the patient can decide for 
themselves what procedures should next be performed or not. It is more 
information to the patient, it is more information to the doctor so the 
patient and the doctor can make their own decision.
  There are implications by some on the other side of the aisle that 
this legislation destroys or significantly undermines the doctor-
patient relationship. There is not a whit of truth to that. It is just 
the opposite. It helps with information to the doctors and information 
to the patients so they are

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in a lot better position to know what they should and should not do.
  I have talked to a lot of doctors. They want to learn more. Right 
now, the drug rep comes into their office and pedals this drug, and the 
doctor wonders: Gee, is this the right drug? We are trying to get a 
little more objective source of information so that the doctor and the 
hospital and the patient have better information.
  Let me go back to the earlier point. I mentioned that health care 
costs, according to the Dartmouth study, are much lower in the Northern 
High Plains States than the Southern States. The Congressional Budget 
Office--people don't like this because it is the Congressional Budget 
Office. People on one side of the aisle may not like it because it is 
the Congressional Budget Office. But they concluded that if the entire 
country's health care system were applied, nationwide, in the way that 
it is applied in Wheat Belt States; that is, Montana and other Northern 
High Plains States, the cost of health care in America would be reduced 
by 29 percent. Remember, the outcomes in the Wheat Belt States are 
better than are the outcomes in the Sun Belt States.
  I said earlier that we spend $2.5 trillion on health care. Thirty 
percent of $2.5 trillion is a lot of money. What is that--north of $800 
billion a year? I do not stand here to say we are going to save all 
that money, but I am saying that is some indication of some of the 
waste that occurs in the current system. Others will say there is waste 
because too many doctors have to practice defensive medicine. I do not 
deny that. I think too many docs do have to practice defensive 
medicine, and that has to be addressed. But that is waste. That, by and 
large, is waste. It must be addressed.
  I know there are other Senators who wish to speak, but there are a 
couple of points I want to make.
  Preexisting conditions is really a big deal. In my State of Montana, 
about 425,000 people have preexisting conditions. That is nearly half 
the population. That means that without health care reform, most of 
those 425,000 would not get quality health insurance. They would not 
get health insurance--certainly not quality health insurance. They may 
get it, but they will have to pay too much in premiums to get coverage.
  This legislation moves us toward that day where a health insurance 
company cannot deny coverage based on preexisting conditions. We have 
already done it for kids. We have a pool for kids. In a couple of 
years, all Americans will be able to get quality health insurance. They 
will not be denied coverage based upon preexisting conditions.
  What is the consequence today of denial based on preexisting 
conditions? Part of it is people do not have health insurance, but also 
it is this: In my State of Montana--this is true in all States--a lot 
of people go to the emergency room. They go to the doctor--they get hit 
by a truck or get cancer--and they don't have insurance. If you don't 
have insurance, what do you do? You go to the ER, that is what you do. 
You have a good ER doc, and he or she takes care of you, and you see 
another doc.
  If you can't pay the hospital bill because you don't have insurance, 
what happens? You get the care. But the cost of the doc, the ER doc, 
and the other physicians and the drugs in the hospital--somebody has to 
pay for it. So who pays? All the rest of us who have health insurance, 
we pay. It is all transferred to the rest of us who pay. Our health 
care bills, our premiums, are higher today because of the people who do 
not have health insurance. It is called uncompensated care. In Montana, 
the bill is about $2,100 a year--the premium in Montana, $2,100, family 
health care premium in Montana, due to uncompensated care. If people 
had health insurance, if the whole country had health insurance, we 
would not have that cost transfer to the rest of us who have to pay for 
you.
  Then you say: Gee, how do you get those other people to pay for 
health insurance? That is one of the questions that comes up in this 
bill. It is an honest question. This bill says two things. People must 
have health insurance. They can do two things. If they are poor, they 
can go to Medicaid. That is expanded a little bit. Then there are 
issues such as, that costs too much, aren't States having to pay big 
bills, and so forth. The answer is, there is no increase in bills to 
the States for 3 years. Then the match is reduced from 100 percent down 
a little bit--that is after several years--which is much higher in 
Federal dollars than it is for other Medicaid. We can have that 
discussion and figure out ways to help States legitimately needing 
help. But still it is more insurance for people because if they need 
health care, those bills are not passed on to the rest of us.
  The other way is to give assistance to people who cannot afford 
health insurance. It is through a rebate in the Tax Code. That is where 
a lot of the money goes. But it is clear that some people who would 
have too much money to qualify for Medicaid but not enough to buy 
health insurance are going to need some assistance, so this legislation 
is designed to help those people get assistance, and the wealthier they 
are, the less assistance they get. Some say that is why this bill costs 
so much.
  I think it is important to remind people here that according to the 
Congressional Budget Office--again, the neutral group that we trust. 
Nobody questions their integrity. It says this bill does not cost a 
thin dime. A lot of people like to say it is $1 trillion. It does cost 
$1 trillion, but it raises $1 trillion, so on that basis it doesn't 
cost anything. The dollars are raised because the rates we pay 
providers are cut back a little bit. There are also some fees on some 
of the providers. That is true. That is true. That is how this bill is 
paid for.
  But let's remember, almost all those providers, all those people who 
are paying a little higher taxes, and all those groups whose 
reimbursement rate is a little lower favored the bill. They are in 
favor of it. You might ask, why in the world do they favor this bill? 
The answer is, because more people have insurance. If more people have 
insurance, their margins might drop a little, but their volume will 
increase. They can make money. They figure they are going to make money 
under health insurance reform. Hospitals, pharmaceutical, medical 
equipment manufacturers, most of the insurance industry, you name it, 
they think they can make some money.
  I don't want to take too much of my colleagues' time here, although I 
do have one other point, and that is Medicare. It is stated on this 
floor: This hurts Medicare. It takes money out of Medicare. That is a 
red herring--a red herring in the sense that somebody says something 
that on the face of it is true, but it is irrelevant to the main point. 
It is true that reimbursement rates to providers is a little lower, but 
it is also true that this legislation extends the life of the Medicare 
trust fund by about 120 years. The trust fund under this legislation is 
extended. The life of the trust fund is extended by 12 years compared 
to what it would be before this law was enacted. Some people want to 
repeal that. They want to cut back the life of the Medicare trust fund.
  What else do they want to cut back with repeal? Repeal gives many 
seniors--4 million Americans I think is the number--a drug benefit in 
the doughnut hole of $250 a year. In my State of Montana, it is 9,000 
Montanans. After a period of time, that doughnut hole will be closed, 
so seniors will not have to pay for excessive costs on prescription 
drugs. Repeal would repeal that. Repeal would say: Oh, all you seniors, 
4 million seniors, we are going to send you a $250 bill. We want you to 
pay $250, in effect, for drugs. We don't want you to get any break. 
That is what repeal does. I don't think Americans want health care 
reform repealed--certainly those 4 million seniors do not want it 
repealed.
  I have a lot to say. I will finish up. All I ask is this. We are 
going to have this debate, regrettably, for about a year until the 
Supreme Court finally decides. I ask that we all stick with the facts. 
Stick with the facts and don't indulge in histrionics, scare tactics, 
and so forth. ``Just get the facts, ma'am,'' because facts generally 
control. You can't change facts. The fact is, what does CBO say? There 
are lots of facts here. I urge us to stick with the facts. We could 
argue what they mean, but let's stick with the facts. Let's not 
manufacture the facts. You can't manufacture facts and have a good-
faith debate. I assume this is going to be a

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good-faith debate, so let's stick with the facts.
  I have one more small thing. A person once stood here years ago in 
the Senate--it was Mike Mansfield from Montana. He was majority leader 
in the Senate for 17 years. No other leader served for as many years as 
Mike Mansfield. I ran across a statement by him which he gave in 1989 
to a bunch of wide-eyed students. I can't remember exactly what he 
said, but the main point of it is this--he was a very reasonable guy, 
revered in Montana--in all efforts to be constructive, you have to 
listen. Listen very well, very closely to the other person's point of 
view. He went on to say: You are not always right. They are not always 
wrong. The more you listen and the more they listen, you will see where 
you are not right and you will see where they are not wrong. You also 
see where you are right and they are wrong. But you have to listen to 
try to find that common ground where somebody is right and somebody is 
not right in an objective sense of the term and then use that 
information constructively and with knowledge and with good faith.
  I ask all of us to do just that.
  The PRESIDING OFFICER (Mr. Franken). The Senator from South Carolina.
  Mr. DeMINT. Mr. President, I ask unanimous consent that at the 
conclusion of my remarks, Senator Johanns be allowed to speak.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DeMINT. Mr. President, I think any American who heard the 
explanation of what ObamaCare does for Americans will realize that the 
complexity of the health care system, the importance of the patient-
physician relationship cannot be managed from the Federal level. I had 
difficulty really determining exactly what was being said there.
  I do want to talk about health care, but before I do, I need to make 
a couple of comments about the FAA perimeter rule that is part of the 
discussion to which the health care amendment will be attached.
  The perimeter rule is an antiquated policy adopted in the 1960s that 
prohibits aircraft flying in and out of Reagan National originating or 
departing anywhere beyond an arbitrary 1,250-mile limit. Congress 
imposed this limitation five decades ago in an attempt to help the 
Dulles Airport in Virginia when it was first being opened. The 
rationale was that the best way to ensure growth at Dulles was to limit 
the growth at National Airport, and so, by federal fiat, a short-haul 
airport was created at National and a long-haul airport created at 
Dulles. At the time, Congress assumed government could create an 
efficient aviation system and the government would best decide prices, 
routes, and schedules.
  The perimeter rule is outdated today. Americans out West want to fly 
directly into downtown DC. Travelers from downtown DC do not want to go 
to Dulles to fly to the west coast. The government needs to do away 
with the perimeter rule, just as it did with the regulation of the 
aviation system long ago.
  Dulles is now an international airport and can easily compete with 
National or any other airport in the country. The Federal 
transportation policy should be based on competition and consumer need, 
but the existing perimeter rule is denying consumers choice in air 
travel and frustrating market forces that could accommodate these 
consumers.
  Consumer choices in the markets should govern the schedule and 
flights out of Reagan National, not the Federal Government.
  This week, President Obama gave a speech about health care--or 
actually I guess it was last week now. The speech was at a fancy hotel 
here in Washington. He told jokes to make everyone laugh and sad 
stories to endear his audience further to his cause.
  The President said, as he has many times before, his law will lower 
the cost of health care. President Obama knows how to give a good 
speech. He also knows how to tell it like it isn't. While President 
Obama was busy selling his policies on the stump, others were busy 
analyzing the real effects of his health care law. It is not limiting 
cost.
  We have heard some of the figures given by the Democrats here from 
the Congressional Budget Office. But we have to expose that they are 
playing with numbers. If you tell the Congressional Budget Office to 
take $500 billion from Medicare, which is already bankrupt and cannot 
pay doctors to see patients, you take $500 billion and call that 
``savings'' that are created by ObamaCare, that is part of where they 
get their money. The other part is to raise taxes on a lot of health 
care products and services and call that new revenue creating by 
ObamaCare.
  Any thinking American knows you cannot create a trillion-dollar new 
health care entitlement and it actually saves us money. When the 
Congressional Budget Office looks at our whole health care spending at 
the Federal level, it tells us, without all of those funny assumptions, 
that the Federal spending on health care is going to double over the 
next 10 years. That is not saving us money.
  This is the same office that found, without these funny assumptions, 
that ObamaCare would cause premiums to rise an average of $2,100 per 
year for families in the individual market. That is telling it like it 
is.
  It was not that long ago that some of the country's largest insurance 
carriers sent a letter to their enrollees warning them that ObamaCare 
was going to drive up the cost of premiums. They told it like it is. 
The Obama administration did not want this information to get out. So 
the Department of Health and Human Services sent a letter back to the 
insurance carriers saying their claims were not true, and HHS would 
have zero tolerance for this type of misinformation. They want to keep 
on telling it like it isn't.
  Richard Foster, the Chief Actuary for Medicare, an independent 
economic expert, recently testified before the House Budget Committee. 
He was asked if it was true or false that Obama's health care bill 
would lower cost. A true-or-false question. He said: I would say false 
more than true. He told it like it is. False more than true is a very 
polite way of saying no, it will not lower health care costs. That 
claim is false.
  President Obama also promised that if you would like to keep your 
health care plan, you can keep it. Richard Foster was also asked if 
those who liked their health care plans would be able to keep their 
coverage. He said: Not true in all cases.
  It certainly is not true if you live in one of the 34 States where 
health insurance insurers stop selling child-only policies. It is not 
true if you live in Colorado and have Aetna Insurance. Politico 
reported Monday evening that the health insurance carrier was pulling 
out of the individual markets. Many Americans will lose their health 
plans with ObamaCare.
  But you can keep your health care plan if your union or company got 
one of the 733 ObamaCare waivers so far. The waivers cover almost 2.2 
million people. You can get your health care or you can keep it if you 
are a member of the six chapters of the Service Employees International 
Union which got waivers, and whose political action committee spent 
more than $27 million helping Barack Obama get elected, or if you are 
one of the 8,000 members of the United Food and Commercial Workers 
Union that got waivers. Their PAC has spent millions helping Barack 
Obama and Democrats get elected.
  These are the unions that supported cramming ObamaCare down the 
throats of the rest of America. Even though labor unions represent less 
than 7 percent of the private workforce, they have received 40 percent 
of the waivers. They do not want the health care they want other 
Americans to have to accept. Most Americans do not play these political 
games. They do not have lobbyists and PACs. But I think they should all 
get a waiver too.
  I think we should name this repeal bill that we will vote on today 
the Great American Waiver. Every Republican in the Senate is committed 
to repealing this bill. Every American gets a waiver when we repeal 
this bill. Soon, we will have a vote to repeal ObamaCare here in the 
Senate. I strongly urge my colleagues to follow the House in repealing 
it and returning it to the sender in the White House.
  I am aware the President currently in the White House might want to 
veto our repeal. There is, however, going to be a Presidential election 
in 2012, and this health care bill, this health care

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law, is going to be a defining issue in that election. 2012 is 2 years 
before the law will fully be implemented. We can get a supermajority to 
overturn his veto in the next election or we can get a new President 
who will support its repeal. I think both outcomes are possible. Let's 
all go on record now showing where we stand. I suspect there are some 
Democrats who might want to repeal this law before voters repeal them. 
The question is, do they have the courage to break with their party?
  For now, the President wants us to think his law can be fixed by 
modifying it slightly. It cannot be fixed. Trying to fix it with a few 
good ideas is like pouring a few glasses of fresh water into a polluted 
river. ObamaCare cannot be fixed by tinkering with its provisions, 
because the basic premise is flawed.
  This law is actively creating a government-controlled system that 
relies on high taxes, less choices, and bureaucrats making health care 
decisions for Americans. This is exactly what we are opposed to and why 
we insist on a full repeal. A recent analysis by the Center for Health 
Transformation found it will give the Secretary of Health and Human 
Services 1,968 new powers. Last year the Joint Economic Committee found 
that ObamaCare created 159 new Federal programs and bureaucracies to 
make decisions that should be made between patients and their doctors.
  If the Democrats and Federal bureaucrats are permitted to control our 
health care system, our Tax Code will look simple by comparison. Worst 
of all, in the rush to pass this legislation, none of its proponents 
cared if it was unconstitutional. They were not going to let the 
Constitution get in the way of their health care takeover. Even now, 
when asked about the constitutionality of the bill, the Secretary of 
Health and Human Services has said: I am leaving those arguments to our 
legal team from the Department of Justice.
  So far their legal team is losing. Two judges have told it like it 
is. ObamaCare has been ruled unconstitutional by judges in Virginia and 
Florida. The Virginia court held that the individual mandate requiring 
every American to purchase government-approved health insurance was 
unconstitutional. The Florida court ruled the entire bill was 
unconstitutional because of the individual mandate included in it. In 
his decision handed down on Monday, Florida District Judge Roger Vinson 
compared the law to a finely crafted watch in which one of the pieces 
is defective and must be removed.
  But what happens to ObamaCare when you remove that one piece, which 
is clearly unconstitutional? The rest of the law falls to pieces--as 
the judge might say: The watch will not work. Vinson wrote: ``I must 
conclude that the individual mandate and the remaining provisions are 
all inextricably bound together in purpose and must stand or fall as a 
single unit.''
  An unconstitutional law that touches the most important personal 
decisions Americans ever make must not stand. We must repeal the bill 
in its entirety. Because at the very heart of it, which makes all of 
the other parts work, that very heart, that individual mandate, 
violates the highest law of our land.
  It is already failing Americans. Health care costs and premiums are 
going up, despite the false assumptions we hear on the other side. 
Choices and consumer control over the health care system are going 
down. By continuing to follow a failing plan, the government is 
planning to allow our health care system to fail.
  Obama's broken promises are going to create a broken future for our 
country. If we do not fully repeal this bill, it is going to add nearly 
half a trillion dollars in new health care taxes and raise the Federal 
budget deficit by more than $500 billion in the next 10 years, and 
nearly $1.5 trillion in the next decade.
  Yet the President says this is going to save us money. We know this 
so-called Affordable Health Care Act for America does not live up to 
its label. We must repeal this bill and implement commonsense solutions 
that will lower the cost of health care for consumers and make health 
insurance available to everyone, even with preexisting conditions.
  We should allow Americans to choose affordable plans across State 
lines, and we should end frivolous lawsuits that drive up costs, and 
give equitable tax treatment to those who do not get insurance from 
their employer. ObamaCare does none of this. The facts and figures tell 
it like it is. President Obama tells it like it isn't. It is time for 
Congress to tell it like it is and repeal ObamaCare.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Nebraska.
  Mr. JOHANNS. Mr. President, I had an opportunity during the comments 
of my colleague Senator DeMint to sit here and listen to those. I wish 
to start my comments today by complimenting Senator DeMint. Those were 
very thoughtful comments.
  Many of my friends on the other side of the aisle are now 
acknowledging the problems with the health care law. It was a 
fascinating process, last September and October as we were leading up 
to the November elections, to see Members running to be on the other 
side of the aisle and saying, well, I would have done this differently, 
and if I get there, I will do that differently.
  One such provision designated for repair is my legislation to repeal 
the 1099 reporting mandate that is in the legislation. To be clear, I 
have never argued that that was the start of the unraveling of the 
health care bill. I do not believe that for a moment. What I would say 
is this: That provision should have never been in the health care law.
  I am very pleased to report today that that legislation, after two 
attempts to try to get it repealed, now has the support, bipartisan 
support, of 61 Senators. The President mentioned repealing this 
provision in the State of the Union Address.
  While there is bipartisan agreement on this provision that it needs 
to be taken out and repealed, the rest of the 2,700-page bill is still 
bursting at the seams with flawed provision after flawed provision. 
Months and months ago, as this bill was making its way forward, each 
one of us individual Senators had an opportunity to decide: Can this 
bill be changed enough to be saved? The conclusion I reached is there 
were no amendments that could change this bill enough that I could ever 
support it. It is fatally flawed and you cannot repair the problems.

  The catch phrase these days--the catchy slogan--is that we will 
repair this bill. Well, this bill is beyond repair. We cannot tinker 
around the edges. We cannot just kick the tires and put some air in 
them. A good detailing job on this bill will not save it. Even a major 
overhaul cannot get this bill back on the road. It needs to go back to 
the factory. This bill is a lemon. It is simply beyond repair. That is 
why it is important for all of us to support Senator McConnell's 
amendment to repeal the health care bill in its entirety.
  Let me start out and say what courts are now acknowledging: This is 
an unconstitutional piece of legislation. The underlying foundation of 
the health care law is predicated on a false premise: that the 
Constitution somehow allows us--us, here in Congress--to demand of 
every private citizen that they buy a government-approved product or 
face a penalty.
  Let me repeat that. The premise of this legislation--the false 
premise, the unconstitutional premise--is that somehow we, as elected 
representatives, possess the constitutional power to force every 
individual in America to buy a government-mandated and approved product 
or face a fine. That is an unconstitutional premise.
  Recently, this fundamental flaw was exposed by court rulings in 
Virginia and Florida. As a lawyer, I have read both of them, first word 
to last word. I just finished reading the Florida decision yesterday. 
These courts, in thoughtful opinions, found that this so-called 
individual mandate was simply unconstitutional.
  Judge Vinson, in his Florida ruling, said:

       If Congress can penalize a passive individual for failing 
     to engage in commerce, the enumeration of powers in the 
     Constitution would have been in vain for it would be 
     ``difficult to perceive any limitation on federal power'' and 
     we would have a Constitution in name only.

  You see, according to Judge Vinson's ruling, the entire health care 
law is unconstitutional because it is predicated upon the individual 
mandate. President Obama has argued that. Members have argued that on 
the floor. Now there is

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this attempt to extricate from that argument, and it will not work.
  The law will continue to be debated in other courtrooms, but I 
believe we are looking forward to a day when the Supreme Court of the 
United States says to Congress: You went too far. You went beyond the 
Constitution of this great Nation.
  However, the health care law is flawed, even beyond this 
congressional overreach, this unprecedented congressional overreach. 
The health care law double counts dollars, threatens the health care 
infrastructure of this great Nation, and adds more individuals to a 
system I am very familiar with as a former Governor: the broken 
Medicaid system.
  There is not a Governor in America who would come before any hearing 
of Congress and argue that the Medicaid system is anything but broken.
  This bill is also paid for by over $500 billion in tax increases and 
over $500 billion in real cuts to Medicare.
  Regardless of the claims to the contrary, Medicare cuts simply cannot 
be counted twice. They cannot simultaneously reduce the deficit, extend 
the solvency of Medicare, and then pay for this open-ended entitlement.
  Well, I am sure any American out there would see the fallacy of 
trying to say to them: Well, you can spend the same dollar twice. You 
can, on one hand, pay for your mortgage and, on the other hand, use the 
same dollar to make the car payment. No American would believe that. 
You see, only in Washington could you get away with such Enron-type 
accounting. It is simply budget hocus-pocus.
  Even the administration's own CMS concludes that the law's Medicare 
cuts ``cannot be simultaneously used to finance other federal outlays . 
. . and to extend the trust fund.''
  I have long made the assertion that if Congress makes reductions in 
the Medicare Program, then those dollars need to stay in the Medicare 
Program, to shore up a program that is running out of money, not to pay 
for a new health care entitlement. Instead, here is what we end up 
with. These cuts to Medicare are going to have long-term consequences 
to seniors' access to physician and health care services.
  Let me focus on my own State for a moment. Nebraska home health 
agencies. Under this bill, in just 5 short years, two-thirds of our 
home health agencies will be operating in the red.
  Nebraska nursing facilities, already stretched to the limit, will 
have to endure $93 million in cuts. Does anyone want to argue that is 
not going to force the closing of nursing homes in Nebraska? Of course 
it will.
  Hospitals and hospice--major reductions in funding. Mr. President, 
35,000 Nebraskans who like and receive the advantages of Medicare 
Advantage are going to see reductions in their benefits.
  If Nebraskans are going to endure these cuts, and others across the 
country do the same, they should at least have the security of knowing 
that the sacrifice they are being asked to endure is going to improve 
the Medicare Program.
  If all the tax increases and all the Medicare cuts were not enough, 
the law's projected cost completely ignores the $115 billion it will 
cost to implement the legislation.
  Around here, billions of dollars are thrown around. We, all of a 
sudden in the last 2 years, added new words to our vocabulary, 
``trillions.'' A program is not big enough unless it has a trillion-
dollar pricetag anymore. Well, let us remind ourselves that those are 
hard-earned dollars to somebody out there trying to make a living.
  This is not about funding trillion-dollar programs. This is about 
poor individuals in this Nation who are struggling to get by, nearly 20 
percent of whom are underemployed or completely unemployed.
  All these hidden costs will drive up the pricetag even more for this 
ill-advised statute. However, one of the most troubling aspects of this 
so-called reform is its massive expansion of Medicaid. It simply heaps 
more unfunded mandates onto State budgets. As a former Governor, I do 
not know how Governors are doing it these days. They are in a financial 
meltdown, with few exceptions, and here we are simply heaping more 
unfunded mandates onto State budgets that are already crumbling.
  It puts--get this--16 million more people into the most broken part 
of the health care system: Medicaid. I can attest to the challenge of 
trying to provide quality health services for those on Medicaid today, 
not even addressing the millions to be added. Even now, our offices are 
flooded with frustrated individuals completely unable to find someone 
to provide health care services to them due to the lack of 
participation in the Medicaid Program.
  You see, the story is this: 40 percent of doctors do not take 
Medicaid patients. Why? They cannot afford to. Ask any doctor, any 
hospital administrator in America: Could you keep your office or your 
hospital open on Medicaid reimbursement, and they would laugh at you. 
They would say: Absolutely not. We would go broke.
  So what is the government's solution to that problem? Put 16 million 
more people into a broken system. It is not because they do not want to 
treat these patients, you see. They do. But the Medicaid reimbursement 
rates would drive them into bankruptcy.
  So instead of dealing with that problem--a very serious problem in 
terms of access for poor people--what do we do? We burden our States 
with additional costs with this legislation. We saddle them with little 
flexibility through maintenance of effort mandates and totally 
disregard the big question of how all these new eligible individuals 
ever have a chance of finding care.
  According to a recent study, the Medicaid expansion is going to cost 
Nebraska between $458 million and $691 million over 10 years, depending 
upon participation rates.
  More shocking is that almost one in five Nebraskans will now be 
forced on Medicaid--a system where we cannot find them care. We are not 
unique. This is the true story in every State in the United States.
  The impact on this Medicaid expansion could be profound to many 
hospitals because Medicaid-eligible individuals who are unable to find 
primary care--and there will be millions of them--will turn to the 
emergency ward for their care.
  Recently, the Centers for Disease Control reported detailed 
statistics on nationwide emergency room usage. While only 14.1 percent 
of all households in the United States had Medicaid coverage, Medicaid 
patients comprised more than one-quarter--25.2 percent--of all ER 
visits nationwide.
  This preliminary May CDC report confirmed that the uninsured do not 
visit the ER the most often, which is contrary to the arguments made on 
the very floor I am standing. This preliminary May CDC report confirmed 
that the uninsured do not visit the ER the most often; patients with 
Medicaid do. Specifically, more than 30 percent of Medicaid patients 
under 65 visited the ER at least once, compared to fewer than 20 
percent of uninsured patients and those with private insurance.
  An ER physician put it best:

       High utilization (of the ER) is no surprise; many patients 
     have difficulty finding primary care providers who take 
     Medicaid, so the ER is the only alternative.

  So what does this new law do to solve this problem? Nothing. It 
exacerbates and exaggerates and compounds the problem. I could go on 
and on because the flaws in the law are so abundant and so severe that 
it cannot operate.
  Let me wrap up with this thought: The people of America deserve 
better than this effort. The people of America deserve something better 
than an unconstitutional attempt to say the Federal Government knows 
better than you. No mechanic could get this jalopy running again. They 
would just scratch their head and say: Haul it to the junkyard.
  This health care bill is so fatally flawed, it cannot be fixed. The 
only option, contrary to what happened 1 year ago, is to go back and, 
in a bipartisan way, work to build solutions to the health care 
challenges, a step at a time, for once and for all; instead of 
compounding problems, solve them.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. LAUTENBERG. Mr. President, I hear the requests of people on the 
other side of the political aisle to repeal a health reform bill that 
has been put in place, received majority support in the House and in 
the Senate when developed. Now what we are witness to

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is that within a bill that is planned for the continued support for the 
FAA, which takes care of the conditions under which our aviation 
structure works, there is an amendment put in here that says: We want 
to repeal, recall the health care bill, the health reform bill that was 
signed into law by the President of the United States.
  We have heard that there are challenges in court, but we hear also 
that there are verifications in the courts that say this bill, this 
act, does appear to be constitutionally sound. I am listening, and my 
vantage point is that I grew up in a very poor working-class family 
with all of the ills that follow poverty. I see America through that 
kind of a prism.
  I see an America whose intention is to be fair, to take care of our 
citizens, to provide them with services, to make sure we have military 
forces to protect us from enemies, to make sure we have labor standards 
that try to make conditions healthy for working people so their health 
is protected as they perform their tasks. There is an implicit promise 
that says we are going to educate those in the early years for sure 
with a reasonable education. In other words, there is a distribution of 
the assets this country of ours holds to which almost everyone is 
entitled to.
  We are not talking about differences in income or differences in 
personal material wealth--housing, et cetera--that somehow others don't 
have. I am not talking about that. I am a capitalist. I came up the 
capitalist ladder, working hard, and I will talk about that in a 
minute.
  So when I listen to the rhetoric that is delivered here on a 
continuing basis about government interference in keeping people alive, 
keeping people healthy--why should the government interfere with 
people's chances to be overcome by illness or injury? I consider it an 
outrage that some of our colleagues want to repeal a law that is 
designed to improve the lives of millions of Americans.
  I think the push to repeal health care reform is the worst kind of 
hypocrisy coming from this place and the other end of the Capitol--here 
with 100 people and the other side with 435 people. There are those who 
have voted not to have this health care reform in the first place, and 
now they are jumping on the opportunity to repeal a law that is 
designed to help people's health, to help kids grow healthily, to help 
families be able to maintain a degree of functioning when illness 
strikes their family, to provide services that increase longevity to 
our people. I, for one, speak well for that effort.
  It is so hypocritical to me because the Senators who are advocating 
repeal have access to the best health plan in our country. They get to 
walk down the hall to a clinic with a half dozen doctors, competent and 
skilled people. There are health care aides who work there, 
professionals, and all they have to do is go in there and say: Doc, I 
feel something here or I feel something here or I have this swelling 
here, and they get care. We pay for it; not a lot but we pay for it. 
But it is available. It is available. It is the kind of perk, I will 
call it, that people across this country would be astonished to see how 
well we treat those who make the laws in this country, those who have 
the responsibility of taking care of our people, our constituents. They 
would be astonished to see how easy it is to go into the clinic, and--
yes, we will take you. You need some surgery and we will get you over 
to the hospital in short form and we are going to take care of this 
before your disease gets the better of you.
  When people here--Senators, Congressmen--get sick, they just have to 
walk down the hall to the Senate Physician's Office. They don't have to 
get in the car or anything like that. They don't know the worry or 
understand the worry that comes if medical bills overtake the 
opportunity to buy food or housing or even force people into 
bankruptcy.
  Again, let me say this isn't simple rhetoric for me. I lived through 
these conditions. Yet these people who are up for repeal are fighting 
to take away the lifeline the health care reform law has given to 
families in need. I know firsthand what it is like when your family 
doesn't have access to basic health care. I grew up in a family of 
modest means in Paterson, NJ. It is a mill town. It was typically a 
city that received immigrants on a regular basis. My father spent his 
short life working in local silk mills, and he died of cancer at 43 
years of age when I was still a teenager. My mother was 37 when she 
became a widow.
  I joined the Army. I enlisted in the Army. I attended college under 
the GI bill. I was a soldier. I served in Europe during World War II.
  As a consequence of the opportunity I had to get an education, I was 
able to join a couple of friends and start a company that is known 
across the globe. The company is called ADP. We have more than 40,000 
people working around the world in more than 20 countries, three of us, 
from poor families. Two of them are brothers, and their father was a 
mill worker also. Because of the success I had in business, all my 
family had to do was worry about their good health and not back-
breaking medical bills. But I never forgot what it was like to see my 
mother working so hard behind the counter of the store to pay the 
doctors, the pharmacies, the hospitals, to keep my father comfortable 
for the 13 months he was in bed with cancer, robbing him of his life on 
a daily basis.
  That is why I was proud to vote for the historic health care reform 
law which is holding insurers more accountable and making our system 
more sustainable.
  I looked at the history of the health insurers because we see the 
health care bills constantly taking more of the GDP. But you wonder 
where the health care cost increases take place. I have looked at some 
of the companies. For instance, I took the year 2009. It was a tough 
year for lots of people. Lots of bankruptcies, lots of foreclosures, 
lots of jobs lost in 2009.
  CIGNA had profits of $1.4 billion 5 years earlier and about the same 
in 2009. The company's CEO got $18 million worth of salary, providing a 
commodity service. Humana, in 5 years, went from $270 million worth of 
revenues to $1.3 billion. The CEO got $6.5 million. United Health had a 
heck-of-a 5-year period. They started off with $2.4 billion worth of 
revenues in 2004, and in 2009 it went to $3.8 billion. From $2.4 
billion to $3.8 billion, and the CEO got $9 million in salary, he got 
big kickers at the end of the year. A company called WellPoint, in 2004 
they did $960 million worth of sales revenues. Five years later they 
did $4.7 billion. The CEO got $13 million.
  I look at that as we ponder where the money has gone to pay for 
health care in this country. So I see one place that a lot of it goes, 
and that is to the insurance companies.
  Some of our colleagues want to recall this bill and remove the health 
care protection from 30 million Americans--30 million people across 
this country. Almost 10 percent of our population will lose health care 
if we repeal the bill that is now in place and is law. The fact is, 
repealing the health care reform law would be an enormous step backward 
for our country. It would hurt seniors, children, and small businesses, 
and our deficit would balloon, grow larger.
  Repealing this law would raise drug costs for seniors by removing 
from them a 50-percent discount on drugs they purchase when they are in 
the period of the doughnut hole. By the way, repeal of this law would 
serve to prevent us from totally closing that doughnut hole. Seniors 
across the country, listen to the truth about what is being said: The 
doughnut hole is going to be closed. It is roughly a $4,500 element in 
people's income--or cost, rather.
  This repeal would also give the biggest insurance companies more 
power over their patients to charge outrageous fees than ever before.
  This means the insurers could once again reduce benefits, stop 
coverage during a person's illness, and refuse to care for individuals 
and children stricken with preexisting conditions.
  Repealing health care reform would also hurt young adults, who would 
no longer be able to stay on their parents' health plans until age 26. 
For young adults--especially new college graduates facing a tough job 
market--staying on a parent's health insurance is the only reasonably 
priced insurance option available.
  If health reform is repealed, small businesses will lose tax credits 
for up to 35 percent of health insurance premium costs. It would 
jeopardize the recent growth in the number of small

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businesses offering health insurance coverage to their employees.
  This repeal effort is fiscally irresponsible because ending health 
reform would increase the deficit by at least $1 trillion when we are 
all looking at the deficit here and wondering what we can do to bring 
it under control. We cannot do it with the costs we have scheduled for 
health care.
  Mr. McCAIN. Mr. President, will the Senator yield for a question?
  Mr. LAUTENBERG. Yes.
  Mr. McCAIN. How much longer will he be?
  Mr. LAUTENBERG. About 3 minutes.
  Mr. McCAIN. I thank the Senator.
  Mr. LAUTENBERG. As a country, how could we repeal this law and then 
look our children and grandchildren in the eye? We should be focused on 
getting this critical jobs bill signed into law, not refighting last 
year's partisan battles.
  Make no mistake, Democrats are willing and eager to fix the parts of 
the health care reform law that might need adjustment. I, for one, 
would salute that kind of a review. But to repeal the entire law is an 
example of outrageous overreach. Instead of meeting us halfway, our 
colleagues on the Republican side are engaging in misguided political 
battles. It is wrong, and we can't allow repeal of this law which is 
improving the lives of millions of Americans.
  I thank my colleague from Arizona for permitting me a courteous 
extension of time.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. McCAIN. Mr. President, I ask unanimous consent to engage in a 
colloquy with the Senator from Wyoming, Mr. Barrasso.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCAIN. Mr. President, obviously we rise in support of the 
amendment put forward by the Republican leader for repeal of the health 
care bill. As we know, the House of Representatives has already acted 
in an overwhelming fashion. Neither the Senator from Wyoming nor I 
intend to go through all of the arguments we went through for nearly a 
year here on the floor of the Senate. In the years I have been here, I 
have never spent more time on any single issue, by far, than on the 
health care issue on the floor of the Senate.
  One of the most important parts of this debate has been the overall 
cost--either savings or loss--if this legislation is repealed. Of 
course, the highly regarded Congressional Budget Office has determined 
that there would be an overall increase in the cost of health care in 
America if the bill were repealed. I think it is very important for us 
to recognize the valuable work the Congressional Budget Office does. 
They are really one of the most important parts of the decisions we 
make on legislation. But I think it is also very important to point out 
that the Congressional Budget Office makes decisions directly related 
to the input and the parameters and the details of legislation they are 
sent. The Congressional Budget Office, most appropriately, does not 
decide on policy; they are simply there as a budget office. So what I 
am saying is, garbage in, garbage out. If you are given a certain 
database on which to make judgments of costs, then of course you are 
going to come out with basically predetermined results and analysis.
  One of the numerous aspects or parts of the legislation that was not 
taken into consideration by the CBO because of the way the legislation 
was written is the so-called doc fix. The doc fix, as we all know, is 
in compliance with a reduction in Medicare payments to doctors that was 
mandated several years ago. Then we found out that doctors would stop 
treating Medicare patients if they were deprived of the Medicare 
payments they needed in order to make up for the costs of the treatment 
they provided to Medicare enrollees. We know that every single year we 
have had to do the doc fix, which has not allowed the previously 
legislated reductions in Medicare payments to physicians. So that is an 
additional $208 billion over 10 years--that alone is $208 billion. 
Nowhere is that put into the equation.
  Then we have, of course, the so-called CLASS Act, which is a poorly 
designed Federal long-term care program. It was inserted at a point in 
the debate that was never in the original bill passed through the HELP 
Committee.
  I ask my colleague, it is a program for long-term care where people 
pay into the system in order to be eligible for long-term care 
benefits, but over time that money comes back out--not in the timeframe 
that was given to the CBO. There are a number of other provisions.
  I ask my colleague from Wyoming what his assessment of the costs were 
taking into consideration the doc fix, the CLASS Act, the envisioned 
Medicare cuts by $500 billion, and others, which are simply not going 
to happen. I would be interested in the Senator's total of the costs 
that actually would be saved by repeal of this legislation.
  Mr. BARRASSO. What we are trying to do is actually provide people 
with the care they need, the doctors they want, at a cost they can 
afford. Yet, when we look at this health care law that--remember, it 
was written behind closed doors in spite of the promises. That is why 
people were so offended and are still opposed to this. We had votes in 
the middle of the night, and there were all those special deals cut for 
Senators to get that 60th vote.
  What I hear most about as I travel my State are the proposed cuts to 
Medicare. As the Senator mentioned, it was $500 billion. You talked 
about the President having a commission to look at the debt. What that 
commission said is that if you are going to take money from Medicare, 
which this law does--$500 billion--it doesn't do it to help strengthen 
Medicare or lengthen the life or the vitality of Medicare; it does it 
to start a whole new government program. It takes $155 billion from 
hospitals, $202 billion from the 11 million seniors on Medicare 
Advantage, $15 billion from nursing homes, $40 billion from home health 
agencies, and $7 billion from hospices.
  As my colleague from Arizona said--he mentioned the CLASS Act, which 
has been called a Ponzi scheme that Bernie Madoff would be proud of. 
The President's own debt commission says repeal that because, with the 
way that is set up in terms of taking the money in first so they can 
count that as coming in, the obligations 10 years and beyond will 
bankrupt this country. Everyone on both sides of the aisle realizes 
that. The bipartisan President's debt commission realized it to the 
point that they put it in one of their recommendations. To hear our 
colleagues and the last speaker talk about the fact that this may 
actually help with the deficit and with the debt, anybody who looks at 
this over the long term and the nature of our country knows this will 
bankrupt the country.
  I worry about the jobs in this country. We are at 9.4 percent 
unemployment. I know both of us as Senators are working to try to find 
ways to make it easier and cheaper to create private sector jobs in 
America. This health care law makes it more expensive and harder to 
create private sector jobs.
  Mr. McCAIN. Nowhere during the debate, I ask my friend, did I 
understand that there would be a very large use of ``waivers'' for 
different companies, including unions, businesses, et cetera, and 
already we have had well over 700 waivers granted to unions and others 
who have sought relief from this legislation.
  I am told that only entails about 1 percent of America's economy, but 
isn't that quite a remarkable repudiation of this legislation? I would 
have liked to have heard during the debate: By the way, the Secretary 
of Health and Human Services is going to have to give well over 700 
waivers for people so they won't have to comply with this law. And the 
only reason you give a waiver, obviously, is because the implementation 
of the law would be harmful to them. I am very interested in hearing my 
colleague's comments about this so-called waiver business.
  Along with that, the Governor of my State has written to the 
Secretary of Health and Human Services to give the State of Arizona a 
waiver. I hope that, since the Secretary of Health and Human Services 
is in that business, she will grant that to my home State.

  Mr. BARRASSO. I would like to see every citizen in this country get a 
waiver. I would like every State to have an opportunity to get waivers 
because last week the Secretary of Health and Human Services gave 
another 500 new waivers. The total now is

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729 waivers. You can find them on the HHS Web site. It covers 2.2 
million people.
  It is interesting because before this bill was passed through in the 
middle of the night, labor unions publicly supported this health care 
law. Now there are 166 union benefit funds that are exempt and have 
gotten the waivers. They got the waivers. Unions now have 860,000 out 
of the 2.2 million waivers. Unions now have 40 percent of all the 
waivers even though they are only 7 percent of the private sector 
workforce in this country.
  My question to my colleague is, if this law is so good, why do so 
many people who supported it in the first place now say they don't want 
it to apply to them? Is it, as Nancy Pelosi said when she was Speaker 
of the House before the election--before the election that repudiated 
this health care law and the way it was crammed down the throats of the 
American public--didn't Speaker Pelosi say that first you have to pass 
it before you get to find out what is in it?
  It seems to me, and I ask my colleague from Arizona, that as people 
know more about what is in this law, it is less popular on a daily 
basis. Yesterday, 58 percent of Americans, in a Rasmussen poll, said 
they would like to have it repealed, and the numbers of people who 
thought all of us ought to be able to get waivers was even higher than 
that.
  Mr. McCAIN. I thank my colleague for his enormous contribution to 
this debate and his knowledge and background in the medical profession.
  There is one other issue I want to mention. Of course, I was pleased 
to hear the President, in the State of the Union Message, say that we 
ought to look at the issue of medical malpractice reform. I can't tell 
the number of times we have tried on this floor to have at least the 
beginning of some kind of meaningful medical malpractice reform. I said 
to the Secretary of Health and Human Services at a hearing the other 
day that I hoped she would be making some proposals to us, to the 
Congress, so that we could obtain some kind of medical malpractice 
reform.
  As we all know, sometimes as much as 20 to 30 percent of the cost of 
health care is accrued because of the physician's prescription for 
unneeded and unwanted and unnecessary tests for fear of the physician 
finding himself or herself in court trying to defend the treatment of a 
patient. That, of course, is a huge portion of the additional costs in 
health care in America today.
  I was pleased to hear the President of the United States say he 
wanted to examine and visit the issue of medical malpractice reform. I 
know my colleague stands ready to work with him on that issue.
  Mr. BARRASSO. The President said the same thing in June of 2009 when 
he visited and spoke to the American Medical Association. So when that 
issue didn't really come to the floor, as a number of us would have 
liked, in this health care law that was written, as I say, behind 
closed doors, they asked Howard Dean, then-chairman of the Democratic 
National Committee, why they don't include it, and he said: We can't 
stand up to the trial lawyers--who have such a remarkable influence on 
the party on the other side of the aisle.
  I am hoping that the President, in his statement in his State of the 
Union Address, was sincere because it clearly did not follow through 
what he said in June of 2009 when he met with doctors from all across 
the country.
  Mr. McCAIN. I thank my colleague. I thank the Senator from Maryland 
for her patience.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Udall of New Mexico). The Senator from 
Maryland is recognized.
  Ms. MIKULSKI. Mr. President, I rise today in very strong opposition 
to any attempt to repeal the health care reform bill. The Republican 
leadership has offered an amendment to repeal the Affordable Health 
Care Act. They are only keeping half of their promise. They went out 
there and campaigned--and the tea party had a teapot boiling over--and 
they said: We are going to offer a bill to repeal and to replace. Guess 
what they are doing today. One more hollow, symbolic, pander-to-the-
masses amendment. Their amendment offers a repeal, but it does not 
offer a plan or strategy to replace. Do you know why? They have no 
ideas. They just want to pander to the crowd.
  I want my colleagues to know that I am emphatically and unabashedly 
against the repeal of health care reform. But I want to say to my 
colleagues, as I listened to this colloquy, every Senator has the right 
to rewrite legislation, but they do not have the right to rewrite 
history or to rewrite the facts.
  I heard CBO criticized and being dismissed. But yet it was the 
Republican Party who said we could not move anything, bring up 
anything, even get a Kleenex without getting a CBO score. Now they do 
not want a CBO score. You cannot say I want a CBO score one day and 
then make fun of it the next. Garbage in, garbage out.
  Then second: Oh, they rewrote the bill in the middle of the night, 
sweetheart deals, whatever. I was on the HELP Committee. I chaired the 
task force on quality. I went to several hearings in an open, public 
forum to get the best ideas to produce the best bill. In many of those 
instances, very few of the other party even bothered to show up. So I 
am not real excited about their criticism.
  Then we went into a markup of the bill, 4 weeks in the HELP 
Committee, open, public markups in full view and on C-SPAN. Over 300 
amendments were dealt with--300 amendments. How is that secret? How is 
that behind closed doors? How is that in the middle of the night? We 
worked in the middle of the night because there were so many 
amendments. Fine, that is democracy. That is the way the legislative 
process works. But don't try to rewrite history. Don't try to rewrite 
facts. And if you want to rewrite the bill, keep your promise, 
Republican Party. If you want to repeal, then let's go to replace.
  I want to hear their ideas for replacement. I challenge them right 
here, right now, today on this amendment. Come in with other amendments 
on your ideas for replacement. I want to know what it is they want to 
do. I want to know which parts of the health care reform they want to 
repeal and replace. What is it they want to repeal and replace?
  How about this? No longer can big insurance deny coverage to a child 
with a preexisting condition. Do they want to repeal that? And with 
what are they going to replace it? Do they want to repeal the part 
where we allow young people to stay on their parents' plans until they 
are 26? Do they want to repeal that? And with what do they want to 
replace it?
  We eliminated the cap on what an insurance company could pay out. Do 
they want to repeal that cap--if you have cancer, if you need heart 
surgery? And with what are they going to replace it?
  I am proud of what we did in health care. It is an excellent bill. We 
accomplished four goals. First of all, we save and strengthen Medicare. 
We end those punitive practices of insurance companies. We expanded 
universal access. And, guess what. We came up with quality and 
prevention measures that save lives and save money. This is what people 
wanted in health care reform. I heard it all over Maryland and heard it 
at hearings. I had roundtables, hearings, I was in diners, I held 
online townhall meetings, phone calls, letters. Once they got the 
straight information about what we did, they liked it.
  Let's go to Medicare. We extended the solvency for a decade. We 
closed the doughnut hole that has been so hard to swallow. Last year, 
more than 32,000 Maryland seniors received a $250 rebate check to help 
pay for prescription drugs. That is in the health care reform bill. If 
we repeal it, do I have to call up 32,000 Marylanders and say give it 
back? Give it back; we repealed. Wow, I bet that is going to go over.
  These same seniors will now get 50 percent off their brand-name drugs 
when they hit the prescription drug coverage cap. Are we going to 
repeal that? And with what are we going to replace it?
  Also, one of my favorite parts of this bill is ending the punitive 
practices of insurance companies, such as seeing a child denied 
coverage because of chronic conditions because of asthma or juvenile 
diabetes.
  I also fought very long and hard, as everyone knows, for women. Did 
you know, Mr. President, when we began our hearings on the bill, we 
found out

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that in many instances insurance companies charged women 25 to 40 
percent more in their premiums simply because they were a woman, more 
than guys with the same age and same health status? Are we going to 
repeal that and bring back gender discrimination?
  Also, we ended the despicable practice of just being a woman being 
treated as a preexisting condition. Another point my hearing disclosed 
is that in seven States and the District of Columbia, women were denied 
coverage for simply being a victim of domestic violence. They were 
abused by their partner, and they were then abused by the insurance 
company. Are we going to abuse them once again by repealing that 
provision? Not if I can help it.
  Then there were other issues also related to the whole issue of 
prevention. We offered a prevention amendment. When they tried to take 
our mammograms away from us, the Democratic women took to the floor--
and good guys supported this bill and we passed it: preventive measures 
at no cost and no deductible in order to make sure we not only had our 
mammograms but that there were other preventive services.
  Provision after provision--are we going to go back to that? I hope 
not. If they are going to repeal, that is what they are repealing. They 
are really repealing the way we ended the punitive practices of 
insurance companies. They are really repealing our attempt to make sure 
Medicare is solvent and close the doughnut hole for prescription drugs 
for seniors and also get them better health evaluations. We also did 
other things.
  I am so proud of this. We said to the insurance companies, 80 percent 
of what you collect has to go into health care. It cannot go into 
administrative costs. It cannot buy you another Armani suit or a pair 
of Gucci shoes or a third or fourth home or $1,000 bottles of wine when 
you have those conferences where you think about price fixing; you have 
to put it back into health care. I do not want to repeal that 
provision. I want that 80 percent collected to go back into health 
care. I think that is a good idea.
  In our bill, one of the things I am proud of is that we stop big 
insurance from putting lifetime dollar caps on benefits. I heard from a 
woman in Columbia who told me her husband had reached his lifetime 
limit. So when he needed an EKG to deal with a long-time cardiac 
problem, they had to pay for it out of pocket. Even with health 
insurance, their health care costs still topped $17,000 a year with 
their annual income at $60,000. By lifting that cap, the man can get 
his EKG and prevent other kinds of problems.
  I could go case example after case example.
  Let's go to something called quality and prevention. I know that is 
often ridiculed. That is goosh; that is not like real medicine. I want 
to tell the story of a brilliant and talented physician at Johns 
Hopkins, Dr. Pronovost. He developed a checklist that, if followed, 
lowers infections that are caught in hospitals which takes lives, takes 
money, and extends stays.
  In health care reform, we improve patient safety and help prevent 
medical errors. The Pronovost checklist, which we allow to occur in the 
bill, has now, we found out, reduced in Michigan patient deaths by 10 
percent, and it has nearly had over an 85-percent effective rate at 
eliminating bloodstream infections.
  The cost savings to both public and private insurance in Michigan has 
been stunning. Do we really want to repeal these measures that are 
saving lives and saving money?
  I do not want to repeal this bill. We did a lot of good things in it. 
If the Republicans have ideas, then I do not think they should vote to 
repeal unless they have a better idea to replace what I outlined today. 
I challenge them: If you want to repeal, keep the other half of your 
campaign promise--replace. Let's put those replacement ideas out into 
the light of day. Let's put them out for debate and discussion and then 
vote. I am up to the task. I wonder if they are.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Georgia is recognized.
  Mr. CHAMBLISS. Mr. President, I rise today to urge my colleagues to 
repeal this highly unpopular health care law. Here is what repealing 
this health care bill will mean to Georgians.
  First of all, the Federal Government will not be required to spend 
$8,470 on health care for every single Georgian every year; 176,000 
Georgia seniors who are today enrolled in Medicare Advantage will not 
have their benefits reduced; and the $500 billion in Medicare cuts will 
not be used to pay for new programs under this law; around 2.1 million 
Georgia households making less than $200,000 will not have to pay 
higher taxes to fund this monstrous bill; 70 percent of small employer 
purchasers will not face higher premiums; small businesses employing 50 
or more people and 8,000 Georgia construction companies with five or 
more employees will not have to pay higher health care costs or be 
subjected to new penalties due to government mandates.
  Under this law, hundreds of thousands of additional low-income 
Georgians will become eligible for Medicaid in 2014. That is going to 
result in an estimated $1 billion in new expenses for my State to fund 
that program. How are we going to fund that $1 billion? We are a State 
that has to have a balanced budget every year, and we are struggling 
right now. Our Governor and the legislature are making tough and hard 
decisions cutting expenses to balance the budget this year.
  Under this bill, they are going to have to come up with another $1 
billion. They are going to have to raise taxes, raise tuition costs at 
our universities. Where are we going to get it? We do not know the 
answer to that, but that is what this bill would require.
  While States work to prepare balanced budgets in anticipation of 
Medicaid expansion, they will not be given the flexibility to make 
prudent market-based decisions to improve their fiscal outlook. The 
Governor of Georgia has put forward proposals such as ending Medicaid 
coverage of dental, vision, and podiatry treatment for adults. These 
are painful decisions that States are being forced to make, but the 
health care law requires States to maintain eligibility levels for 
beneficiaries in order to keep their Federal Medicaid dollars.

  Reimbursement from Medicaid is already so low that a majority of 
doctors will not see Medicaid patients. States are left with little 
options other than further reducing payments to providers or raising 
copayments for beneficiaries.
  The Federal Government should not be hindering States' flexibility in 
dealing with their individual budget issues. This is not an area where 
the Federal Government should be impeding on the sovereignty of our 
States.
  America's deficit is the single biggest issue facing our country 
today. Repealing the health care bill means that our deficit will not 
increase by an estimated $2.6 trillion when this bill is fully 
implemented over a 10-year period, and it would also prevent that same 
$500 million in cuts coming from Medicare to pay for entitlements that 
would do nothing but exacerbate our budgetary woes.
  My constituents in Georgia, and citizens all across this country, 
have made it clear that they want Congress to repeal this legislation 
and work to lower health care costs and insure Americans through 
commonsense solutions that are not negotiated behind closed doors. We 
need a law that replaces this law and that actually reduces health care 
costs and enacts insurance reforms immediately.
  Americans should be allowed to buy insurance policies across State 
lines; small businesses should be allowed to pool resources and offer 
more affordable insurance to workers; we need to limit baseless 
lawsuits against doctors; and we should expand health savings accounts.
  Furthermore, in light of recent judicial decisions in Virginia and 
Florida, it appears the law may not be upheld in the courts. I applaud 
the decisions reached by Judge Hudson and Judge Vinson that Congress 
does not have the authority to force Americans to either purchase 
health insurance or pay a penalty for not doing so. That provision of 
law, obviously, is ultimately going to be decided by the Supreme Court.
  I plan to vote on repealing this law and working with my colleagues 
on both sides of the aisle to start the process over, to make sure the 
next time we do it in the open and not behind closed doors and that we 
get it right.

[[Page S450]]

  Mr. President, I yield the floor, and 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. PRYOR. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. PRYOR. Mr. President, I thank my colleague from Oklahoma. I know 
he has been gracious enough to allow me to speak in front of him. My 
speech today, hopefully, will be fairly short, but I do want to raise 
something that I think is of critical importance to the country.
  (The remarks of Mr. Pryor pertaining to the introduction of S. 256 
are printed in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  Mr. PRYOR. I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma is recognized.
  Mr. INHOFE. Mr. President, there has been some confusion, moving 
around the time. While I was supposed to be here earlier, let me ask 
unanimous consent that I be allowed to speak in morning business for 
such time as I will consume.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. INHOFE. I say to my friend from Arkansas who just spoke, I know a 
little bit about the program you have. In fact, the Senator is fully 
aware my daughter Molly is a marketing professor at the University of 
Arkansas, who has talked about this very concept. I do not know why all 
the successes have gravitated to northwest Arkansas, but it seems that 
they have. Maybe this has something to do with it. I look forward to 
following through with the Senator on this program.
  I wish to mention a couple things I have been wanting to talk about, 
but I am here actually to describe two amendments I have to the FAA 
bill.
  First, I would like to say publicly how proud I am of the new 
attorney general, Scott Pruitt, that we have in the State of Oklahoma. 
He is taking the leadership in suing to determine the constitutionality 
of the government-run health care. We are doing that currently in the 
State of Oklahoma. I am looking for some great results from that.
  As I look at this, sometimes you have to ask the very basic 
questions. If you are talking about a government-run system, something 
that doesn't work in Sweden or Denmark or the UK or Canada, why would 
it work here, when we have all these members of Parliament coming over 
saying: Why are you insisting on going to something that is a dismal 
failure at the same time we are moving toward a much more successful 
health delivery system, the model for the whole world, and that is what 
we have in the United States.
  I have to say also, when I look and listen to people talking about 
the debt and the deficit and the problems we have, I think it is 
ludicrous that we can go back and try to act like Bush had these great 
deficits. If you take the deficits during the 8 Bush years, add them 
all up and divide by 8, it came out to $247 billion each year. Now we 
have a President who has in just 2 years accumulated almost $3 
trillion--six times the deficit that was there under the Bush 
administration. When people keep saying something over and over that is 
not true, they assume people will eventually believe it. In this case, 
I believe the American people are so concerned about the spending, the 
unprecedented spending, the unsustainable spending of this 
administration, this President and his majority in both Houses, they 
are up on this issue.
  Before I get to my two amendments, I wish to mention one other aspect 
I was going to have as an amendment to the FAA bill. Unfortunately, 
there was not time to put it together, so I will be doing some sometime 
this summer, but I wish to serve notice. I have the distinction, I 
guess you would say, since the retirement of Senator John Glenn, I am 
now, I believe, the last remaining active commercial pilot in the 
Senate. When I look at the FAA bill, I have a lot of interest in it.
  I had an incident that occurred to me on October 20 of this year when 
I was flying my twin-engine airplane into a field in south Texas. It 
was called Cameron County Airport, a noncontrolled field. I experienced 
something that is going to make me go back and revisit to see if 
perhaps what happened to me, if it happens to someone else, people in 
the FAA would be just as generous as they were with me.
  Before I tell you what happened, I have to say the FAA could not have 
been better. They could not have been more cooperative. I sat down and 
talked with them about the incident. I will tell you what happened. I 
was flying some passengers in one of my planes, a twin-engine airplane, 
into Cameron County Airport. This happened to be a nice day. It was a 
VFR--visual flight rules is what that means--so I didn't have to have 
control with the controllers on the way down. However, as a 
precautionary measure, what I always do, I talk to them anyway. So when 
you go down straight south from Tulsa, OK, to Cameron County Airport, 
you fly right over Corpus Christi. That is about 120 miles north of the 
Cameron County Airport.
  Because they have a lot of training down there--they have the Navy 
guys, the training that takes place--it is always safer, when you are 
flying around down there with a lot of kids who may only have 30 or 40 
hours, to get on control so they are watching you. When you get on a 
control, in this case it is an approach control, they give you a squawk 
so you know--they know who you are, where you are, how fast you are 
going, how you relate to the other traffic in the area. So I got on 
Corpus Christi approach and I said: This is Twin Cessna 115 echo alpha. 
I will be coming south on VFR, descending through 15,500 to go to the 
Cameron County Airport.
  Halfway down they handed me off--this is the terminology that is 
used--to the FAA controller down there in the valley. This is way down 
South. A lot of the people back East here do not understand that Texas, 
when you get down to the southern tip, that is farther south than 
Miami, FL. It is way down there.
  We went down and they handed me off to what they call valley 
approach. Valley approach took me all the way down to Cameron County 
Airport, turned me loose--and I am trying to get the recording so I 
know exactly when it was--to land at the Cameron County Airport. This 
is the FAA.
  The problem is, when I went ahead and landed--by the time I got 
everything in landing configuration, it was too late to go around. We 
are going below the blue line, as the saying is, so I had to land when 
there were workers on the runway.
  I say to my friend from Iowa, the way they normally preclude 
something from happening, as he well knows, is they have you on their 
radar. They know you are there. But they publish NOTAMs, that is Notice 
to Airmen. Before you fly into any place, you check the NOTAMs to see 
if there is construction on the runway, if there is any kind of 
problem. Of course, we checked and there were no NOTAMs that day for 
Cameron County Airport, but there were people working on the runway.
  I wish to offer legislation, and I will include in the legislation a 
requirement that NOTAMs are published where they can be found by the 
pilot. In this case, the NOTAM that came out that there is someone 
working on the airport did not come out until November 2 and this was 
October 20, so I had no control over it. I am not blaming anyone. I am 
saying they need to be in a conspicuous place where that will happen.
  The second problem I see that affects general aviation is everything 
we do when we talk to a controller is recorded, and the public should 
have access to these recordings. I know it is a difficult thing. I have 
requested this, now, since way back in October and have not yet 
received it. I am going to try to set up a system where that is 
available to everyone.
  Then, last, because even though no action was taken--I didn't violate 
anything and everything turned out fine; I did study procedures and all 
that--but the bottom line is, all during that process, someone, a 
bureaucrat, could have taken away my license. Here I have more hours 
than most American airline pilots. I fly, on average, probably 4 hours 
a week still to this day. That would be taking away a major part of my 
life and that is how serious it is.

[[Page S451]]

  Many years ago, about 10 years ago, the greatest pilot in America, 
named Bob Hoover--he is a tremendous pilot, up in years, actually 
considerably older than I am--and they actually took away his license. 
This is called an emergency revocation. I authored a law to require a 
type of an appeal, appellate process. We passed it. I think a similar 
thing should be afforded to all members.
  Again, I wish to say the FAA could not have been more cooperative and 
more thorough, but I think we need to change the rules. We will 
probably have to do it legislatively. I plan to do that during the 
summer.
  My two amendments. The first is one I think most people, when they 
understand it, will appreciate; that is, they are attempting, it is my 
understanding--right now there is a rule that is pending. It is not 
part of this legislation directly but in a way it is because, with my 
amendment, we would be able to preclude this from happening. The air 
carriers are scheduled airlines and unscheduled. The unscheduleds--they 
are called charter airlines and other types of airlines--they are under 
a different FAR, the Federal Aviation Regulation, part 21, but it is a 
subpart S. Subpart S says, if you are an unscheduled airline, you are 
not restricted to the same crew restrictions they have for a scheduled 
airline. There is a reason for this.

  The reason is this. A scheduled airline, they are out there every 
day, and they adjust their schedules for crew rest time. A charter does 
not have that opportunity. So they may go maybe three or four times 
what the crew's rest would be and then have to take a longer flight. 
This does affect the military. Right now, if you are flying blood into 
Afghanistan, it is flown in by charter airlines. These airlines will 
take it down to Qatar and then go in probably on a C-17.
  To go from Ramstein down to Qatar and back is longer than they can 
take without crew rest or, if they take it into Afghanistan, that 
charter flight would have to do crew rest actually in Afghanistan--
maybe in Kabul. Obviously, they cannot leave a civilian plane there 
under some of those conditions. So the only choice, then, is we would 
have to use some of our lift capacity of the C-17s to do that.
  The problem we are having right now, our C-17s are so overworked, our 
crews are overworked, so I believe that exemption should continue to be 
in place and we will be trying to pass this amendment. I am going to 
try to get in the queue. This is actually our amendment No. 7.
  The other amendment I have I am very sensitive to because I have 
participated in these programs. There are a lot of voluntary 
organizations, volunteer pilots--I have done it at my own expense, 
helping heart patients get around different places, flying in to help 
people out. A lot of pilots are very generous with their equipment and 
time and money and they do this. What I want to do is get them a 
release from some of the liability to which they would otherwise be 
exposed. In other words, these people are doing this at their own 
expense, on their own time, but they are also exposing themselves to 
major lawsuits.
  These are the two amendments. That happens to be amendment No. 6. I 
will be trying to get that in the queue after tonight's vote, so 
perhaps we will be voting on it sometime between now and Tuesday.
  With that, I appreciate the patience of my friend from Iowa and I 
yield the floor.
  Mr. HARKIN. Mr. President, 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. HARKIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Cardin.) Without objection, it is so 
ordered.
  Mr. HARKIN. Mr. President, if there is one clear message that voters 
sent in the last election, it is that they want Democrats and 
Republicans in Congress to cut out the bickering and the partisanship 
and to focus like a laser beam on boosting the economy, creating jobs, 
and reducing the deficit. So I find it absolutely astonishing that the 
Republicans' No. 1 priority, indeed their obsession in these opening 
weeks of the new Congress, is to launch bitter new partisan attacks on 
the new health reform law, in an attempt to repeal it in its entirety, 
something that would cost hundreds of thousands of jobs, and add $240 
billion to the deficit in the next 10 years.
  It would be sufficient to oppose this reckless amendment strictly on 
budgetary grounds. As I said, it would add $240 billion to the deficit 
in the first decade. Nearly $1 trillion would be added to the deficit 
in the second decade, if we repeal the Affordable Care Act.
  The sponsors of the repeal amendment have proposed no offsets 
whatsoever. So for all of the Republicans' crocodile tears over big 
budget deficits, their first action in the new Congress is to propose 
adding nearly $\1/4\ trillion to the deficit over the next 10 years, 
and over $1 trillion in the second 10 years.
  The Congressional Budget Office is our only objective nonpartisan 
referee when it comes to budget projections. CBO has told us in no 
uncertain terms that the McConnell amendment, the repeal amendment, 
will add $240 billion to the deficit this decade. The Republicans' 
response is to attack the credibility of CBO, the Congressional Budget 
Office, and to claim that the hundreds of billions in budget savings, 
thanks to new health reform law, are based on ``gimmicks.'' That is 
complete nonsense. The budget savings in this new law are real. If 
anything, CBO has underestimated the savings that will come about, 
especially as a result of the robust wellness and prevention provisions 
in the new law, provisions that will keep Americans healthy and out of 
the hospital in the first place.
  I would simply add that if the savings in the new law were based on 
gimmicks, then those gimmicks would surely show up by the second decade 
of the law's implementation. That is the nature of gimmicks; they 
eventually get exposed. But the savings in the new law actually 
skyrocket in the second decade to nearly $1 trillion. So to wildly 
assert that the savings in the new health reform law are based on 
gimmicks is flat wrong. It is irresponsible.
  Let's be clear. The Republicans' obsession with repealing the new 
health reform law is not based on budgetary considerations, it is based 
strictly on ideology. They oppose the law's crackdown on abuse by 
health insurance companies, and they oppose any serious effort by the 
Federal Government to secure health insurance coverage for tens of 
millions of Americans who currently have none.
  We all remember William Buckley's conservative motto, sort of the 
father of the, I would say, modern American conservative movement. 
William Buckley said once that: The role of conservatives is ``to 
thwart history, yelling `stop.' ''
  In 1935 Franklin Roosevelt and the Congress passed Social Security, 
providing a basic retirement security for every American. Republicans 
fought it bitterly, and 75 years later they are still trying to undo it 
and privatize it. In 1965, President Johnson and the Congress passed 
Medicare, ensuring seniors access to decent health care. Republicans 
fought it bitterly, and 45 years later they are still trying to undo it 
and privatize it. To quote another famous Republican President: Here 
they go again.
  By the way, notice that the Republicans are no longer even pretending 
to offer a realistic comprehensive alternative. They used to talk about 
``repeal and replace.'' Now they are just talking about ``repeal.'' As 
always, the Republican approach to health reform can be summed up in 
five words: Pray you don't get sick.
  So make no mistake, the fight to provide access to quality affordable 
health care for all Americans has only just begun, it looks like. The 
same ideologue who came up with the big lies about the death panels and 
pulling the plug on grandma are rolling out their latest campaign of 
misinformation.
  The good news is that this time around the dynamics of the debate 
have shifted. Just as I long predicted, as people learn more about the 
great things in the Affordable Care Act, the benefits and protections 
that are now guaranteed by law, support for health care reform is 
growing steadily as time goes by and people learn more about what is in 
it.

[[Page S452]]

  A year ago, we were bogged down in the messy, frustrating politics of 
passing a bill. This time around the law is the law, and what is at 
stake is crystal clear: Are we going to put the health insurance 
companies back in the driver's seat, once again free to discriminate 
based on preexisting conditions, free to cancel your policy if you get 
sick, free to cut off payments? Are we going to revoke access to health 
insurance for more than 30 million Americans? Are we going to add 
hundreds of billions of dollars to the deficit by wiping out all of the 
savings of the Affordable Care Act? Are we going to impose higher taxes 
on up to 4 million small businesses that are eligible for health care 
tax credits thanks to this new health reform law?
  I also want to rebut the extreme ideological attacks on the 
individual mandate in the new law. Republicans claim that this is 
somehow an assault on freedom. Let's look at it another way. It is 
certainly an assault on an individual American's freedoms when someone 
goes without insurance and they show up in the emergency room and they 
stick other Americans with their emergency room bill. How about that 
freedom? Shouldn't I be free, shouldn't you be free, from having to pay 
for someone because they did not have insurance and they show up at the 
emergency room, which is the most expensive form of health care, and 
now we have got to pay the bill? What about that freedom?
  The individual mandate is just common sense, and that is why so many 
Republicans supported it in the past. Senator John Chafee's reform bill 
in the early 1990s included an individual mandate. It was supported by 
a number of Republicans, some of whom are still here. Republican 
Senator Grassley, my colleague from Iowa, Senator Hatch, Senator Lugar, 
all supported that individual mandate. More recently, the original 
Wyden-Bennett bill--that is Senator Bennett, a Republican from Utah--
included an individual mandate. It was supported by Senators Alexander, 
Crapo, Corker, and Grassley.
  As we all know, the individual mandate was a critical piece of 
Republican Governor Mitch Romney's health reform in Massachusetts. As I 
said, it is just common sense. By eliminating free riders and putting 
everyone in the risk pool, we keep rates down for everyone, and it is 
the only way that people with preexisting conditions are not left out 
in the cold.
  So it comes down to this, as we learned--I was watching in the last 
few weeks the HBO series, now on DVD--about John Adams. What the early 
colonists finally realized is that they could enhance their freedom, 
they would have more freedom, if they stuck together, if they worked 
together, if they joined together.
  The same is true here in health reform. When everyone is covered and 
no one is left out, we enhance an individual's liberty. So health 
reform is all about freedom, freedom from the fear that if you get 
sick, you will not be able to afford a doctor; freedom from the fear 
that a major illness will lead to financial ruin. These are the 
practical freedoms that matter to Americans.
  I cannot tell you how many people have come up to thank me and other 
sponsors for passing the Affordable Care Act. They tell me how it has 
personally affected their families in profoundly positive ways. Let me 
first tell you about Sarah Posekany of Cedar Falls, IA.
  She was diagnosed with Crohn's disease when she was 15 years old. 
During her first year of college, she ran into complications from 
Crohn's, which forced her to drop classes in order to heal from 
multiple surgeries. Because she was no longer a full-time student, her 
parents' private insurance company terminated her coverage, and 4 years 
later, she found herself--are you ready for this--$180,000 in debt, and 
was forced to declare bankruptcy. Sarah was able to complete one 
semester at Hawkeye Community College but could not afford to continue. 
Because of her earlier bankruptcy, every bank she applied to for 
student loans turned her down.
  With the new health law, people like Sarah will be able to stay on 
their parents' health insurance until they are age 26. This is a real 
person. This is a real story. These are real people. So they want to 
repeal this? They want to tell Sarah: Sorry, we cannot help you any, 
and we cannot help other young people like you stay on their parent's 
policies until they are age 26.
  We can consider the case of Eleanor Pierce, also of Cedar Falls, IA. 
When her job with a local company was eliminated, she lost her health 
insurance. She had the option of purchasing COBRA insurance, but it was 
completely unaffordable. So she searched for coverage on the private 
individual market and was almost universally denied access because of a 
preexisting condition of high blood pressure. The plans that would 
cover her came with premiums that she could not hope to afford without 
an income. So Eleanor, at age 26, suffering from high blood pressure, 
had no choice but to go without insurance and hope for the best. ``Hope 
for the best'' is no substitute for regular medical care. One year 
later, Eleanor suffered a massive heart attack. When all was said and 
done, she had racked up $60,000 in medical debts. So real people, real 
problems, and real solutions.
  We need to get beyond the ideological obsession and listen to 
ordinary Americans, victims of the old broken sick care system. 
Americans have a clear message: The new law has important new benefits 
and protections; do not take those protections away. Nearly half of 
nonelderly Americans have some type of preexisting condition such as 
high blood pressure, arthritis, heart disease. The new law outlaws the 
denial of coverage based on preexisting conditions. The McConnell 
amendment on repeal takes that away. The largest health insurer in 
California used technicalities to cancel the policies of women who got 
breast cancer. The new law outlaws the practice of cancelling policies 
when people get sick. The McConnell amendment takes away that 
protection and restores the right of health insurers to return to that 
despicable practice. The new law prohibits insurers from imposing 
lifetime limits on benefits. The McConnell amendment sweeps that away. 
The law allows parents to keep adult children on their policies until 
age 26, as I spoke about with Sarah. The McConnell amendment takes that 
away.
  I want to briefly mention the destructive impacts the McConnell 
amendment would have on my State of Iowa. One, it would raise taxes on 
more than 260,000 Iowans by taking away tax credits to help them 
purchase health care coverage. More than 8,300 young adults would lose 
their insurance coverage on their parents' health plans. Tens of 
thousands of Iowa seniors would face higher prescription drug prices 
and once again have to pay a copay for preventive services, such as 
colonoscopies and mammograms, which now they can get without a copay. 
And, of course, the 1.9 million Iowans with private coverage would once 
again be vulnerable to a whole range of abuses and discriminatory 
practices by the health insurance industry, like cutting you off if you 
get breast cancer or putting a lifetime cap on it or an annual cap.

  In addition, I want to mention that the new health care reform law 
dramatically remedies the discrimination against Iowa, my State, and a 
number of other States in terms of Medicare reimbursement.
  A little background. Under a very complicated Medicare formula, 
doctors in Iowa and a number of States were paid less for their 
services than their colleagues elsewhere for the same service. Under 
the formula, for example, Iowa physicians are reimbursed less than 
doctors in Louisiana for the same procedure.
  As part of the new health care reform bill, I joined with Congressman 
Bruce Braley, Congressman Leonard Boswell, and Congressman Dave 
Loebsack on the House side to negotiate a compromise that provides an 
immediate $800 million to address geographic disparities for both 
doctors and hospitals, as well as written guarantees from Health and 
Human Services Secretary Sebelius for further action to reform Medicare 
reimbursement rates. This great achievement is wiped out if the 
McConnell amendment passes.
  In addition, thanks to the new law, midsized hospitals in Iowa--we 
call them the so-called tweeners. They are not big enough to have 
economies of scale. They are not small enough to be put into the small-
hospital category.

[[Page S453]]

They are sort of in between, but they are important providers of health 
care to so many communities in Iowa and other States around the Nation. 
Well, thanks to the new law, we will see greater Medicare reimbursement 
to these midsized hospitals in Iowa and other States. The 2-year fix 
will cover fiscal years 2011 and 2012. It will aid these low-volume 
hospitals, some of which have struggled to keep their doors open. The 
fix was included in the new health care reform law, the Affordable Care 
Act.
  At the heart of the reform mission was an effort to decrease the 
number of uninsured and increase access--access--to affordable care. 
The law does just that and will ensure every Iowan access to quality 
health care, which these midsized community hospitals provide. Again, 
that goes away if the McConnell amendment prevails. We fought very hard 
to get that compromise to protect these tweener hospitals--wiped out by 
the McConnell amendment.
  Finally, I want to mention the many millions of Americans who will be 
denied health coverage if the McConnell amendment passes. The 
Republicans apparently reckon that middle-class Americans who already 
have health insurance do not care about those who are not so fortunate. 
I could not disagree more strongly. I believe Americans do care about 
the uninsured, and they are well aware of the devastating human costs 
of repeal. Nearly 45,000 Americans die each year in part because they 
do not have health insurance.
  With the landmark law, we are ensuring at long last that every member 
of our American family has access to quality, affordable health care as 
a right and not a privilege--as a right and not a privilege. I believe 
the American people, even those who have good private coverage 
understand--understand deep down--that it is not right in our society 
for 30 million Americans to go without health insurance coverage and 
the devastating effects it has on those individuals and their families 
when they do not have that health insurance coverage. So the American 
people are not going to allow the Republicans to take away this great 
humanitarian achievement.
  I urge my colleagues to oppose the McConnell amendment. It blows a 
huge hole in the budget deficit. It destroys hundreds of thousands of 
jobs. It repeals the Patients' Bill of Rights, allowing health insurers 
to return to the same old abusive and discriminatory practices. It 
revokes health insurance coverage for tens of millions of Americans. 
Instead, let's listen to those voices of the American people who have 
cried out for so long--for so long--for health reform. Let's get rid of 
the ideological obsessions.
  If there are things that need to be fixed, we can fix them. I have 
said many times that the health reform law is not the Ten Commandments, 
written in stone for all eternity. It is a law. We pass laws. No laws 
are perfect, and sometimes you have to make changes. We make changes in 
laws all the time. We are about to make a change in part of the health 
care reform law now dealing with small businesses. Fine. These things 
need to be adjusted and worked on as we go ahead. They should be done 
in a nonideological and hopefully bipartisan fashion. But to propose 
that we repeal everything--everything; repeal it--makes no sense.
  Let's move forward to build a reformed health care system that works 
not only for the healthy and the wealthy but for all Americans.
  Mr. President, I mentioned in my remarks about how we had changed the 
law for Medicare reimbursement to benefit certain Iowa hospitals, and 
because of that, many of the hospitals in Iowa were going to get a bump 
up in their payments this year. I have a chart here. I did not have 
time to get it put on a poster. For example, St. Luke's Hospital in 
Cedar Rapids will get an additional payment this year of $794,841--this 
year. That will be taken away by the McConnell amendment, by the way. 
Trinity Regional Medical Center, in Webster County, will get $434,913 
additional this year, taken away by the McConnell amendment. Mercy 
Medical Center will get $584,883, in Iowa City, taken away by the 
McConnell amendment. We worked hard to get these payments to help these 
hospitals that are under duress and not able to serve people who are in 
their communities. We are able to get this additional money to help 
them survive. Yet the McConnell amendment would take it all away.
  Mr. President, I ask unanimous consent to have an article by James Q. 
Lynch that was in the Cedar Rapids Gazette and also a chart showing the 
reimbursement to Iowa hospitals under our new Medicare rules for 2011 
printed in the Record at the end of my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. HARKIN. Finally, I just say, for those of us in Iowa, in a small, 
rural State, with a lot of midsized hospitals, with a lot of people 
uninsured--and quite frankly, we are not in the upper echelons of 
income in the United States--for us this health care law provides 
immediate protections, immediate benefits, and promises even more 
benefits as we get to 2014 and beyond. It would be a devastating blow 
to my constituents in Iowa to have this health care reform bill 
repealed. That is why I so strenuously urge all my colleagues to oppose 
the McConnell amendment.
  Mr. President, I yield the floor.

                               Exhibit 1

  Medicare Reimbursement Changes Will Benefit Iowa Hospitals, Doctors

                   (By James Q. Lynch, July 1, 2010)

       A proposed change in Medicare reimbursement could increase 
     payments to Corridor hospitals by more than $4 million next 
     year.
       Under changes expected to be finalized later this month, 
     reimbursement for Medicare services would increase payments 
     to St. Luke's Hospital by $794,841 and to Mercy Medical 
     Center by $584,883. In Iowa City, the University of Iowa 
     Hospitals and Clinics could see an increase of $2.3 million 
     in 2011 and Mercy Hospital could get a $509,898 boost.
       At the same time, a rule change on reimbursement to doctors 
     could boost their Medicare payments by 5 percent beginning 
     next year.
       ``This will mean a great deal to Iowa hospitals that have 
     been struggling for many years,'' according to 1st District 
     Rep. Bruce Braley, a Waterloo Democrat. He is part of a group 
     of U.S. House members who have sought to move Medicare away 
     from payment plans that resulted in geographic disparities 
     that ``punished health care providers in Iowa that provide 
     high-quality care and get low reimbursement rates.''

      REIMBURSEMENT TO IOWA HOSPITALS UNDER PROPOSED MEDICARE RULES
------------------------------------------------------------------------
            Hospital                     County           2011 Payment
------------------------------------------------------------------------
Marshalltown Medical & Surgical   Marshall...........            164,967
 Center.
St. Anthony Regional Hospital...  Carroll............            104,979
Unity Hospital..................  Muscatine..........             74,985
Trinity Regional Medical Center.  Webster............            434,913
Iowa Lutheran Hospital..........  Polk...............            479,904
Mercy Hospital..................  Johnson............            509,898
Mary Greeley Medical Center.....  Story..............            479,904
Skiff Medical Center............  Jasper.............            104,979
St. Lukes Hospital..............  Linn...............            794,841
University of Iowa Hospital &     Johnson............          2,399,520
 Clinics.
Mercy Medical Center--North Iowa  Cerrogordo.........          1,004,799
Mercy Medical Center--Cedar       Linn...............            584,883
 Rapids.
Iowa Methodist Medical Center...  Polk...............          1,709,658
Mercy Medical Center--Des Moines  Polk...............          2,129,574
Broadlawns Medical Center.......  Polk...............             44,991
Spencer Municipal Hospital......  Clay...............            164,967
Lakes Regional Healthcare.......  Dickinson..........             74,985
St. Lukes Regional Medical        Woodbury...........            374,925
 Center.
Grinnell Regional Medical Center  Poweshiek..........             89,982
Mercy Medical Center-Sioux City.  Woodbury...........            779,844
Continuing Care Hospital at St.   Iowa...............   Less than .0001%
 Luke's.
                                 ---------------------------------------
    Total.......................    .................         12,507,499
------------------------------------------------------------------------

  The PRESIDING OFFICER. The Senator from Kentucky.
  Mr. PAUL. Mr. President, I ask unanimous consent that Senator Isakson 
be recognized to speak following my remarks.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. PAUL. Mr. President, today we will vote on repealing President 
Obama's Federal takeover of health care. This vote will be not only to 
repeal the specifics of this legislation but to reassert that we 
operate under constitutional restraint.
  When this bill first came up, many on the other side sniffed and were 
incredulous that we would mention the Constitution. Many on the other 
side said the Constitution--they really had not even comprehended that 
the question would be asked, ``Where do you get the authority under the 
Constitution to do this?'' Well, interestingly, we do still operate in 
a society with constitutional restraint, and the courts have now 
decided that the commerce clause does not mean you can do anything.

[[Page S454]]

  The commerce clause, though, for the last 70 years has gotten larger 
and larger. I used to joke that you can drive a truck through it now, 
it is so big. I also used to joke that if my shoes were made in 
Tennessee, they could regulate my walking in Kentucky.
  The commerce clause--the expansive definition and understanding of 
it--has been supplying no restraint to this body. But I think this 
court case and I think this bill is about so much more than health 
care. It is about whether we live and operate with constitutional 
restraint of government.
  This has been going on for a long time. It started with Wickard v. 
Filburn back in the 1940s, where they told a farmer he could not grow 
as much wheat as he wanted to.
  He wanted to grow 20 acres of wheat, and the government said: You can 
only grow 10 acres of wheat.
  He said: Why?
  They said: Well, because of the interstate commerce clause, we can 
tell you how much you are going to grow.
  He said: Well, I am not going to sell it to anybody. How am I engaged 
in commerce? I am just going to feed it to my livestock.
  They told him that by not selling it, he could indirectly affect the 
price of wheat between the States. It was a ludicrous argument then, 
and it is a ludicrous argument now.
  My hope is that out of this case, as it moves forward to the Supreme 
Court, maybe we will see a Court that takes a step toward overturning 
Wickard v. Filburn. I think that would be the most important case in 
the last 70 years in the Supreme Court, if we do it. Will we get there? 
I do not know. But listen to what the Founding Fathers said about this. 
Many people say: Oh, the general welfare clause says we can do this or 
the commerce clause says we can do this. Madison wrote that we would 
not have enumerated these specific powers and given them to the Federal 
Government if we intended for there to be no restraint.
  Recently, in the two Federal court decisions, the judges made a point 
of saying that if you can regulate inactivity--basically, the nonact of 
not buying insurance--then there is no aspect to our lives that would 
be left free from government regulation and intrusion.
  So I think this court case is incredibly important, more important 
even than the specifics of the health care bill. There are many reasons 
we should have opposed the health care bill and still should, but 
really No. 1 among them is that we need to have a government that 
operates under the Constitution and operates under a commerce clause 
that was intended to promote free trade between the States and was 
never intended to allow a government to grow so large and so invasive 
that it could intrude into every nook and cranny of our economic lives.
  With regard to the specifics of the health care bill, there were some 
problems in health care. As a physician, I have seen some of the 
problems. But do you know what the No. 1 complaint I got was? It was 
the expense of health insurance, the rising expenses. The Federal 
takeover of health care did nothing to that. In fact, it has already 
increased the expenses to those. You see premiums rising.
  But when you see problems, there are two directions to go. We had 
problems in health care, but you could say: Do we need more government 
or less government? From my perspective as a physician, I saw we 
already had too much government involvement in health care. I saw that 
what we had going on limited competition. You need more competition in 
health care if you want to drive prices down. So you need to allow 
insurance to be sold across State lines. You need to allow competition 
in prices.
  One of the surgeries I did was LASIK surgery, where you correct 
someone's eyes so they do not have to wear glasses anymore. No 
insurance covers it, and you would think: Well, gosh, maybe this body 
will get together and force people to buy insurance for LASIK surgery. 
It is good. It is a great thing. Well, do you know what. Without 
government getting involved, competition drove the prices down on 
LASIK. So the prices were driven down because the consumer was 
involved. The same way with contact lenses; you can buy a contact lens 
for 4 bucks, maybe 3 bucks. It used to be $20 or $30 a contact. 
Competition works.

  So what we should have asked ourselves when we looked at this health 
care debate is--yes, there are problems. Yes, we can agree portability 
was a problem. Yes, we can agree preexisting conditions were a problem. 
But we should have said: Do these problems exist because there is too 
much capitalism or too little capitalism? I would argue there is very 
little capitalism at all.
  I do cataract surgery also. Do you know what. I charge the exact same 
price as every other doctor in my town, every other doctor in the 
State, and every other doctor in the country because the prices are set 
in Washington by a central committee. That is not capitalism, and that 
is why health care is broken.
  We need to get back to the fundamentals, and we need to say: Why does 
capitalism work in nine-tenths of the economy but doesn't work in 
health care? Well, maybe it is because we are not allowing capitalism 
to operate in health care.
  Today's vote on repeal is very important. There is great symbolism to 
this because we have to say: Yes, we operate as a body under the 
restraint of the Constitution, but there is also a message about 
economic systems. The American economic system is capitalism, and we 
should be proud of it. We should try to inject capitalism into more 
enterprises and not less capitalism. We should not have such great 
faith in government that government has all the answers because 
government is notoriously inept and inefficient at most of the things 
it does.
  I rise today to support the repeal of the President's takeover of 
health care. I hope the Democrats will reconsider. I understand some of 
them are reconsidering.
  I yield back the remainder of my time.
  The PRESIDING OFFICER. The Senator from Georgia.
  Mr. ISAKSON. Mr. President, first of all, I commend the Senator from 
Kentucky, Mr. Paul, for his remarks and particularly his reference to 
the Constitution. When I read the decision of Judge Vinson in Florida, 
it read a lot like the Congressional Record of December 23 of last year 
when we were on the floor right before Christmas Eve debating whether 
to pass the Affordable Care Act. Judge Vinson was clear and precise 
both on his ruling on the commerce clause as well as recognizing the 
necessary and proper clause nor the general welfare clause can 
substantiate requiring people to make the decisions that the health 
care bill requires.
  I am going to vote for the amendment by Senator McConnell to repeal 
the Affordable Care Act. I wish to repeat the reasons I stated a year 
and a half ago on the floor of the Senate as to why I believe that. 
First of all, it has little or nothing to do with affordable care, in 
my judgment, and we have seen in the 13 months since its passage and 
the 9 months since its signing increase after increase in costs, both 
in terms of insurance premiums as well as the application of the law to 
the practice of medicine. So it is not about affordable care; it is 
about care going up in its costs.
  Secondly, if you look at the way in which the bill ostensibly claimed 
it paid for itself, it shot big holes in America's health care future, 
taking $500 billion out of Medicare to begin with, reducing the 
reimbursement almost in its entirety for home health care which, in a 
State such as Georgia with many rural people, is the primary way in 
which health care is delivered to them, and the assessment of taxes, 
whether it be on hearing aids and medical devices or the 3.8-percent 
surtax placed on earned income for those people making more than 
$200,000 or families making $250,000.
  It is appropriate to start over, but by starting over it doesn't mean 
we delay dealing with the problems Americans face with their health 
care. It may mean we, in fact, accelerate it beyond what this bill 
would have done if it is carried out to its entirety.
  When we had the meeting at the Blair House a year and a half ago in 
the middle of the health care debate, when the President and the 
Democratic leadership sat down across the table from the Republican 
leadership and for 4 hours engaged in a discourse over the differences 
in the two ideas, it became quite clear what the majority wanted

[[Page S455]]

to do. They wanted to change the paradigm and put the government in 
charge of health care in America.
  That is why every provision in the bill, from the fines for not 
buying insurance to the provisions of reimbursement, drives government 
to be the decisionmaker and the controller, just as the distinguished 
Senator from Kentucky talked about the price of health care today. The 
price of health care begins and ends with the assessment of 
reimbursement made in Washington, DC.
  So, No. 1, we do need to change the paradigm and get back to a 
capitalistic-type system and a competitive system. For example, 
repealing the barrier on interstate sales of health insurance and 
having a national marketplace. Allow affiliated groups or similar 
groups to join together and compete across State lines as a larger risk 
pool like independent contractors, like the profession I came from, 
real estate agents, who are not employees, who don't have the benefits 
of ERISA coverage but bound together could compete with IBM or any 
other company in buying insurance as a group with a large enough risk 
pool to reduce the cost of their premiums and raise their coverage.
  It is very important to realize that the real solution to health 
care, both in terms of its costs as well as a healthy America in the 
future, is the way we practice wellness and disease management. Those 
are the types of programs we can then begin to incentivize now to raise 
them in their practice and lowering in the outyears the cost of health 
care and begin to get our arms around what is right now a spiraling 
contributor to the deficit and to the debt.
  But most importantly of all, the fact that over 70 waivers have been 
issued by Health and Human Services already is proof the bill is 
flawed, and it is proof its continuation up until its beginning in 2014 
is going to be nothing more than making other exceptions for other 
groups for trying to make a bill that is designed to fail work. It 
won't happen. It should be repealed.
  I commend the leader on his amendment, and I will vote for it this 
afternoon.
  I yield the remainder of my time.
  The PRESIDING OFFICER. The Senator from Indiana.
  Mr. COATS. Mr. President, it was my understanding that another member 
of the Democratic Party was going to speak at this time, but not seeing 
him, I think I will just go ahead and deliver my presentation.
  As a candidate for the Senate during this past year, I met with many 
Hoosier families and small business owners, as well as health care 
providers, patients, doctors, and all those involved with concerns 
about where this health care process was going to go. Everywhere I 
went, from Lake County to Fort Wayne to Indianapolis, Muncie, and down 
to Evansville--all across the State I heard a resounding plea to 
overturn the costly and intrusive health care law that was passed by 
this last Congress and signed into law by the President.
  The issue for these people was not whether we needed to address 
issues of health care, whether it was quality, cost-effectiveness, or 
access; the issues for them were two things: One, they resented the 
process where a massive bill, which many did not fully understand or 
grasp the implications of, was forced through these Chambers and passed 
hours before Christmas. The rules were bent to try to move the bill 
through the process, and it became a policy which was not supported on 
a bipartisan basis but yet a policy that affected virtually every 
American.
  If experience tells us anything, it is that massive changes in policy 
need bipartisan support to be acceptable if they are going to be 
effective. The majority of people I spoke to about the health care plan 
that is now in place believe it is fatally flawed and needs to be 
repealed so we can start over with a much more cost-effective, 
efficient, affordable health care plan.
  Those who have listened to the people express their views on this 
particular issue have come to the conclusion that their voices were not 
heard, as they expressed throughout the deliberation of this; that 
Congress wasn't hearing what they were saying. The results of 
November--I think with this issue being central to the election--
ratified that. So I urge my colleagues in the Senate to listen to the 
American people and repeal the law that is before us, a health care law 
that raises taxes, penalizes businesses, straps States with costly 
mandates, and increases premiums for American families.
  Recent polls show a significant majority of Americans want the 
President's health care law to be repealed, and they want Congress to 
start over and put together a plan which does not cost the taxpayers a 
lot of money and will not provide the access and the care and the 
quality Americans are looking for.
  We know more than half the States, including my State of Indiana, 
have joined in lawsuits challenging provisions of the constitutionality 
of the law that will be settled by the Supreme Court in due time. But I 
believe we must take this opportunity now to overturn the law and start 
over.
  Let me address some of the consequences to my State of Indiana and to 
Hoosiers if we do not repeal the current health care law. Hoosier 
families will clearly face higher premiums. Nonpartisan budget experts 
from the Congressional Budget Office reported that individual health 
insurance premiums will increase by $2,100 per family as a result of 
this new law. If we do not repeal the health care law, 50,000 low-
income Hoosiers will be dropped from the Healthy Indiana Plan. This was 
the plan implemented by our Governor and our State representatives and 
senators, an innovative plan that addressed the real problem of low-
income Hoosiers not qualifying for other support. This plan put in 
place a proposal for health savings accounts. The program has been so 
popular that it now includes more than 50,000 participants.
  Unfortunately, as a result of the health care law, the State may need 
to terminate the Healthy Indiana Plan and place its participants into 
Medicaid. This is just one example of a provision of law enacted at a 
Federal level that denies units of government--States, localities, and 
others--from innovating and bringing about sensible, market-based 
solutions to problems they face.
  The one-size-fits-all Federal health care law basically says to those 
States and those innovators: No, we know better. We will tell you what 
to do regardless of what the cost is or regardless of how effective 
your program is. Our Governor had negotiated savings for prescription 
drugs for low-income recipients, but this law prevents that type of 
innovation and progress made on the state level.
  If we do not repeal the health care law, Hoosier taxpayers will bear 
a heavy burden. The law will force Indiana to expand Medicaid, 
enrolling approximately one of every four citizens in the program. 
According to an actuarial analysis by the Indianapolis-based Milliman, 
Inc., Indiana will have to absorb an estimated $3.6 billion in new 
costs over the next decade if the 1.5 million eligible Hoosiers enroll 
in Medicaid, which they may under this plan. That burden is passed on 
to Hoosier taxpayers, and our State, frankly, cannot afford to do that.
  The report also predicts that Indiana would have to spend more than 
$300 million on new administrative costs alone. So with States already 
facing budget cuts, there is no doubt these costs will either be passed 
on to taxpayers or the State will opt out of the plan and turn people 
over to the exchanges and to the control of the Federal Government.
  If we don't repeal the health care law, Hoosiers will see a decrease 
in the quality of service of care. I met with physicians, health care 
providers, and hospital administrators at sites all across the State. I 
heard a very common concern: The new law will jeopardize the quality of 
care for patients.
  The health care plan cuts reimbursement dollars for hospitals and 
providers at a time when they can least afford it. These cuts simply 
exacerbate the dire shortage of doctors and nurses and will result in 
less advanced care for people in need, less personal attention from 
providers, and fewer choices for patients.
  If we do not repeal the health care law, Hoosier businesses will 
suffer. The President's health care overhaul hits our job creators with 
harmful mandates and regulations, mountains of paperwork, and countless 
taxes. The new

[[Page S456]]

law requires businesses with 50 or more people on staff to pay a $2,000 
tax per worker if the employer does not offer an acceptable health 
insurance plan for its employees.
  If I heard one thing more than any other thing from business owners, 
it was that this law will drive them to make employment decisions that 
are adverse to the benefit of those seeking employment. Companies that 
were in the 45-to-50 range of employees, or even less, have basically 
said if the choice comes down to whether to hire new employees or 
whether to outsource or whether to use technology to replace those 
employees, they will do so to prevent going over 50 employees and being 
forced to offer insurance or pay a penalty.
  An arbitrary line drawn at 50 basically puts the job creators of this 
country--the small- and medium-sized businesses--in the position of 
having to decide whether to take on the mandated tax burden of the 
Federal Government or simply not go forward and hire over that 
particular limit, forcing them to find other ways to produce their 
product without added employment.
  At a time when we are facing 9-plus--nearly 10 percent in many 
areas--unemployment, putting a law into place on a nationwide basis 
that discourages businesses from hiring is simply the wrong thing to 
do.
  Other businesses may find it more cost effective--and many have told 
me they would drop workers from their health insurance plan and pay the 
fine instead. Turtle Top, a shuttle bus maker located in New Paris, IN, 
found that dropping health care coverage for employees and paying the 
Federal penalty would generate a savings in the six-figure range for 
the company. That is a story repeated over and over. The law dictates 
that it financially benefits some companies to drop their insurance 
plans and shift coverage for employees over to the Federal taxpayer.
  In fact, the administration's own estimates revealed that more than 
6,000 pages of regulations mandated by the law could force half of all 
employers--as many as 80 percent of small businesses--to give up their 
current health care coverage within the next 2 years.
  One burdensome regulation is the 1099 provision. I believe we are 
going to vote on that amendment, and I hope it passes. This is one of 
the many egregious, unexpected consequences of pushing a law through 
without fully understanding the law or the implications of the law. 
Rather than beginning a piecemeal approach to de-construct this 
approximately 2,100-page bill, I believe it is expeditious for us to 
repeal and start over.
  The medical device tax particularly impacts my State. It adds a 2.3-
percent sales tax on medical devices. This is an industry in the State 
of Indiana that probably is one of our top manufacturers, is making a 
profit, and is hiring people. Yet it will be arbitrarily taxed as a way 
of helping to pay for the cost of the health care bill. Cook Medical, a 
medical device company in Bloomington, IN, expects that the new health 
care law will cost the company $15 million to $20 million per year. 
This is a company, along with Biomet, Zimmer, and other medical device 
companies, that had the deep pockets because they were producing 
products that the world wanted to buy. They were one of our export 
leaders, and because they were making profits at a time when the 
Federal Government was looking for money to pay for other aspects of 
the health care plan, they simply added a 2.3-percent sales tax on the 
devices, to a total of about $20 billion.
  The health care law devastates Indiana businesses. At a time when 
nearly 1 out of every 10 individuals today in Indiana is looking for a 
job, Congress should be focused on a way to encourage private sector 
growth and job creation, not stifle it.
  Our health care system in America has problems, but restructuring it 
with a one-size-fits-all, government-run plan that increases taxes, 
raises premiums, and hits businesses with penalties is not the right 
thing to do.
  Congress needs to repeal the current law and start over with a step-
by-step approach that reduces the skyrocketing costs of care.
  Listening to Hoosiers over this past year, I created a list of 10 
priorities that Congress, I believe, should focus on when we start over 
on health care:
  One, allow competition to cross State lines. We need to improve 
access and the quality of care by increasing competition and allowing 
consumers to purchase health insurance across State lines.
  Encourage innovation. I talked about the innovation taken away from 
our State through this law.
  Eliminate frivolous lawsuits and include liability reform. Passing a 
health care bill without liability reform part of it--when all of us 
know defensive medicine is forced upon doctors and providers at 
hospitals through frivolous lawsuits and without a sensible process of 
providing for those who clearly are victims of malpractice--undermined 
the credibility of what Congress was trying to do and what the American 
people and the health care providers were looking for.
  Improving Medicaid and the SCHIP program.
  Allowing for the immediate creation of association health plans for 
small businesses.
  Incentivizing and rewarding healthy lifestyles.
  Expanding health savings accounts, not reducing them.
  Advancing the use of electronic medical records, while retaining 
privacy.
  Increasing cost transparency.
  Retaining our promises to our military personnel veterans and their 
eligible family members.
  Those are all components of the more detailed plan I outlined this 
past year in Indiana.
  Most important, I believe the underlying principles to ensure that 
our health care system is one that preserves personal freedoms and puts 
individuals in control of their own health care decisions is critical 
to addressing the next bill we take up.
  Let's take this opportunity now and listen to the patients, listen to 
the health care providers, the physicians and listen to the job 
creators and small business owners and then let's listen to the 
American people who sent us here to represent them. Let's repeal this 
law and let's start over.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. NELSON of Florida. Mr. President, it seems to me that what we 
ought to be doing with regard to this law is fixing it instead of 
repealing it. We ought to be focusing on fixing it instead of focusing 
on repeal. Already, unanimously, it seems, people have embraced 
different parts of this law as certainly necessary. You could go down 
the list. Twenty-six-year-olds can now stay on their parents' health 
insurance policies. Health insurance companies can't go off spending 
all kinds of money on all kinds of jet airplanes and vacations. They 
have to deliver, on large group insurance policies, 85 cents of health 
care out of the $1 of premium paid--85 percent.
  Then, of course, you can't have a health insurance company cancel you 
in the middle of your coverage. Who in the world would not embrace this 
in the law; that is, you can't have some silly kind of reason that you 
are not going to give health insurance to a patient because they had a 
preexisting condition when, in fact, they had a skin rash, and that is 
an excuse.
  There is a lot in this law that is good, not the least of which is 
that there are 35 million people out of the 45 million who are 
uninsured in this country who, come 2014, will have private insurance, 
private exchanges, called health insurance exchanges, in each State, to 
which they can go and shop for health insurance. If they can't afford 
it because they are somewhere between that and the rate at which they 
are eligible for Medicaid or they are up to 400 percent of the poverty 
level for a family of four, they will have some assistance from the 
Federal Government so they can purchase that private enterprise 
exchange insurance. If you can bring 35 million people into the health 
insurance system, what happens to it? If they have health insurance, 
they start getting preventive care. That means you avoid what happens 
now, which is they don't have health insurance, they avoid going to the 
doctor because they can't afford it, and they wait until the health 
problem turns into an emergency. Where do they end up? They end up in 
the emergency room, which is the most expensive place now, with a full-
blown emergency, and the laws of the 50 States require the emergency 
rooms to treat

[[Page S457]]

those people. Guess what. Who pays? All the rest of us pay.
  So if you can bring 35 million people out of the 40-some million 
uninsured Americans into the health insurance system, you bring down 
the per-unit cost that all the rest of us pay, which is tacked onto the 
health insurance premiums we pay. Because when the hospital picks up 
the tab, who do you think pays? It is distributed right out to the 
health insurance system, and the rest of us end up paying. So there is 
a lot of good in here. What we ought to do is fix it. We should not 
repeal it.
  There is another issue that has arisen in this great debate we are 
having, which is of historic proportions, on what is going to happen to 
this law that was passed in this body by a 60-vote margin. What has 
happened is there have been a lot of lawsuits filed. In two cases, 
Federal district judges have ruled the law is constitutional. In two 
other cases, Federal district judges--this is the lower court of the 
Federal court system--have ruled it is not constitutional. Of course, 
we have had action by the legislative branch, the other House, the 
House of Representatives, which has voted to repeal the law. Now here 
we are with the issue in front of us on which we will vote later today.
  Well, doesn't anybody conclude that this matter is going to the 
Supreme Court to decide if this law is constitutional? When the Supreme 
Court decides, regardless of what we have done or what we haven't done, 
the Supreme Court decision is going to discard political and partisan 
interests. So isn't it in our commonsense interest if we would come 
here and join together in a resolution to petition the Supreme Court to 
have an expedited review of this case?
  Typically, what happens with these two for and two against, that will 
work its way up through the court of appeals, and that will take 
another year, year and a half, and then it will get to the Supreme 
Court. That will take another year, year and a half. Why don't we 
expedite the matter? Why don't we express our intent to have an 
expedited review by the Supreme Court?
  I have filed such a sense of the Congress--a resolution--and its 
passage might prevent people from arguing back and forth over this law 
for the next several years. Everybody in this country that will be 
affected would have an answer, and they deserve an answer. Therefore, I 
urge the Senate to consider adopting the resolution asking the Supreme 
Court to step in and decide quickly whether the current law meets the 
constitutional test.
  My preference is that we fix the law, that we not throw it out. I 
don't want to go back to the days of the insurance companies dropping 
people because they get sick or depriving seniors of help getting their 
prescription drugs. But because the matter ultimately is going to be 
resolved by the Nation's highest Court, I think we ought to take a 
commonsense approach on this resolution. I urge my colleagues to adopt 
it.
  Mr. President, I see no one else is on the floor seeking recognition. 
I will just add that another commonsense component in this law that 
certainly means don't repeal it is the assistance that is given to 
senior citizens.
  That assistance is in the form of help with the cost of their 
prescription drugs. The Congress passed, and it was signed into law 
years ago, a prescription drug benefit, but that benefit was only 
partially assisted by the Federal Government, and senior citizens had 
to pick up a big part of the tab. This law closes a lot of that gap, 
what is commonly referred to as the doughnut hole. We do not want to 
take that away from senior citizens. I certainly think that is going to 
stand the constitutional muster.
  There is another part of this law that is so beneficial as well, and 
that is, are we not concerned about the deficit, are we not concerned 
about how we are going to get our country back on a road toward balance 
of our deficit so that we have a balanced budget? What this law does, 
which seems to me common sense that you do not want to repeal it, it 
saves the Federal Government, according to the Congressional Budget 
Office, a nonpartisan, highly technical economic team, $250 billion 
over the next 10 years and in the second 10-year period would save up 
to $1.2 trillion to the Federal Government.
  There are plenty of reasons that we ought to fix it instead of 
repealing it. I urge my colleagues--and I see my dear friend from the 
State of Nevada came in. Before he came in, I had urged us to consider 
a sense-of-the-Congress resolution to have an expedited appeal to the 
U.S. Supreme Court.
  Mr. President, I yield the floor.
  Mr. ENSIGN. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ENSIGN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator is recognized.
  Mr. ENSIGN. Mr. President, I rise today in support of the amendment 
offered by the Republican leader to repeal what I believe is an 
unconstitutional government takeover of our health care system. Make no 
mistake, we all want to improve access to affordable health insurance 
for all Americans, including those individuals with preexisting 
conditions. Unfortunately, this health reform law is not the right 
prescription.
  Over the past year, I have spoken with tens of thousands of Nevadans 
about this bill. They were very clear when they said that this law is 
not the cure for our broken health care system.
  This law imposes new burdens on most Nevadans and most Americans. It 
requires that every American citizen purchase health insurance 
coverage. Those who fail to buy health insurance that meets the minimum 
requirements are subject to financial penalties.
  Two weeks ago, I received an e-mail message from Tommy Felt, a Boy 
Scout in Las Vegas. This is a picture of Tommy. He is 12 years old. He 
attends Molasky Junior High School, and he is working to earn his 
Citizenship in the Nation Merit Badge.
  Tommy's e-mail stated:

       I'm really concerned that the bill will damage our country. 
     I think it is unconstitutional for the government to force 
     citizens to buy health coverage. Also, I believe that the 
     hidden costs in this bill will drive our country much deeper 
     into debt. My dad says that this bill will lead to the 
     elimination of Senior Dimensions and Medicare Advantage plans 
     for our seniors.

  I wish that more than half of my colleagues would heed the words of 
this young 12-year-old.
  I could not agree with Tommy more. I, too, am also concerned that 
this health reform law will destroy our health system in our country. I 
am also concerned about the unprecedented overreach of the government's 
demand that every American purchase health insurance just because they 
live in America.
  A judge in Florida, as we have all heard, ruled that the entire 
health care law is unconstitutional. Let's ask the question, Is it 
really Constitutional for the government to tell all Americans they 
must buy health insurance coverage? What is next? What personal liberty 
or property will the Congress seek to take away from Americans next? 
Will the government mandate what cars we are allowed to drive or what 
food we feed our children? Where do we draw the line? Or will we even 
draw one at all?
  After all, the Constitution is about enumerated powers, the specific 
powers given to the Congress. This bill blows the lid off those 
enumerated powers.
  I have spoken at length about the unconstitutional provision and even 
raised a Constitutional Point of Order before the Senate voted to pass 
this reform bill.
  As I previously mentioned, earlier this week, a Florida judge ruled 
the individual mandate unconstitutional and even went so far as to say 
that the whole bill is unconstitutional because the mandate cannot be 
separated out. In December 2010, a Federal judge in Virginia also 
struck down the individual mandate as unconstitutional.
  We know it could take several years for this case to reach the 
Supreme Court of the United States. My good friend from Florida, 
Senator Nelson, talked about expediting that procedure--which makes a 
lot of sense--so that we do not have to wait several years for the 
Supreme Court to reach its decision. The administration should ask for 
that. The administration has the right to bypass the Court of Appeals 
and go directly to the Supreme Court. In the meantime, because it

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may take several years, we should act to repeal this law before we 
begin to suffer under its tyranny.
  Now, going back to Tommy. His e-mail addresses the significant costs 
associated with this health reform bill. Tommy has every right to be 
concerned. In fact, every American should be concerned. Spending in 
this country has continued to spiral out-of-control. The health reform 
law is only adding to our financial demise. Unless we repeal it, the 
law will further exacerbate the cost of health care, explode our 
deficit and debt, and forever alter the relationship between the 
government and the American people.
  We hear from the other side that this bill is going to reduce the 
deficit because there are $500 billion in cuts to Medicare as well as 
tax increases. By the way, the Congress could repeal those cuts in 
Medicare and often does. The other side also used fuzzy math when this 
bill was being debated. A lot of the savings in Medicare were counted 
twice. That is why a study by the Republican side of the Senate Budget 
Committee said that this bill would actually increase the deficit in 
the first 10 years by $700 billion.
  Let's have some common sense. Do you think you can increase the 
Medicaid rolls by 16 million people in America and actually cut costs? 
Does that make sense to anyone? Increase the Medicaid rolls, which are 
paid by the Federal Government and the States, and then say we are 
actually going to decrease the deficit? That defies common sense.
  Many small business owners in my State have already seen a dramatic 
increase in their health insurance premiums. This bill was supposed to 
bring down costs. It is doing exactly the opposite.
  I have met with many companies across our State. At least three large 
companies I've met with tell me they are considering, because of the 
costs, dropping their health insurance and paying the $2,000 fine per 
employee. It makes sense to them. They can pay their employees a little 
stipend, they can put their employees on the government system, and 
they are money ahead.
  With businesses struggling just to make it today, this decision could 
be the difference between staying in business or not. They are looking 
at huge increases in their premiums, or paying the fine and putting 
people on the government system. That is one of the reasons I think 
this bill is going to massively increase the Federal debt.
  This law does not help the typical Nevada family who purchases 
insurance in the individual market either. In fact, in traveling the 
State, I met with Nevadans who are already seeing increases in their 
premiums. Those who purchase insurance plans in the individual market 
could see a 10- to 13-percent increase in their premiums because of 
this bill. But some of the small businesses that I have talked with are 
already seeing increases this year around 15 to 30 percent. A few of 
the small businesses are seeing increases around 8 or 9 percent, but 
most of them are in the 15- to 30-percent range.
  In my State, unfortunately, about 70 percent of all the health plans 
provided by businesses will not meet the minimum requirements that will 
be mandated by the government starting in 2014.
  In Tommy's e-mail to me, he also mentioned Medicare Advantage. There 
are more than 100,000 Nevada seniors who choose a Medicare Advantage 
plan. These Nevadans are not better off because of this reform. Their 
extra benefits actually will be reduced by more than half.
  This bill does not help middle-income workers in Nevada either. Our 
hard-working hotel housekeepers, casino restaurant workers, airline 
workers, teachers, and police officers now look forward to collectively 
sharing the burden of the $200 billion tax on health insurance holders.
  Many American workers will pay for new taxes and penalties with 
reduced wages and lost jobs. Oh, and by the way, there are also new 
taxes on prescription drugs, clinical lab work, and medical devices 
that will also get passed on to the American people.
  Simply put, I believe this health care bill is a job killer. My State 
cannot afford to lose more jobs. We have 14.5 percent unemployment in 
my State, and 9.4 or 9.6 percent across the Nation. We cannot afford to 
lose more jobs.
  I am sure many of us have heard the phrase that the devil is in the 
details. Truer words could not be spoken when talking about this health 
care reform bill.
  We know when Democrats passed this legislation that they gave 
enormous discretion to the Secretary of Health and Human Services. But 
I do not think any of us could have fathomed that the 2,000-page bill 
would generate potentially up to 20,000 new pages and regulations.
  I have printed off many of the rules and regulations as well as the 
bill itself. Look at the size of this stack, and they are not even 
close to being done writing all the regulations. I challenge any 
company or any American to try to understand this bill and its 
regulations. It is virtually impossible. It takes a team of lawyers and 
health care experts to even come close to understanding all the 
implications of this bill.
  According to my staff's calculations, so far there are about 6,200 
pages of regulations. As I mentioned before, this could go to at least 
20,000 pages. It is safe to say that the devil is in the details with 
this health bill.
  The American people are going to learn more about the unintended 
consequences of this legislation as more and more of these regulations 
roll out. Remember last year when Nancy Pelosi said, We have to pass 
the bill so we can find out what is in it. We may be able to find out 
what is in the bill if you are able to understand it when you get 
through reading it all. I wonder how many people in this body have read 
not only the legislation but the rules regulations. It is absolutely 
daunting.
  This health care reform bill is an over 2,700-page bill full of new 
taxes on Americans, funding cuts for programs they rely on, and raised 
premiums, which is why we should be repealing this bill. Instead of 
doing so, however, this administration is granting special waivers to 
various provisions in this law. These waivers are basically exceptions 
to the rules, and they allow organizations to circumvent the standards 
required in this health reform law. If waivers are needed, isn't that 
proof the health care reform bill is problematic? Isn't it proof this 
health care reform bill isn't working, or are special interest waivers 
a greater priority than the plight of the American people? It is 
interesting to me that some of the biggest supporters of this law have 
been working behind the scenes so they can obtain special waivers to 
get out of complying with this law so that they will not be held to the 
same standards as businesses in Nevada.

  Nevadans are not behind this bill. The American people are not behind 
this bill. But there is no doubt that we need to improve health care in 
the United States. What is the primary problem with health care in the 
United States? The new Senator from Kentucky said it best: It is too 
expensive to buy health insurance in the United States. This bill does 
nothing but make that problem worse.
  The people of this country did not sign up for the kind of change 
that brings with it billions of dollars in new taxes and a potential 
loss of their current insurance coverage or the choice to decide which 
coverage they have. The American people don't want a bureaucrat coming 
between them and their doctor.
  Now, turning my attention back to taxes just for a moment, this bill 
alone ensures that hard-working Americans hand over even more of their 
paychecks each month to the government. It is funny how reforming 
health care means more money for Uncle Sam.
  There is a new surtax on investment income--which, yes, does include 
a gain on home sales--which has many Nevadans infuriated.
  There are new limits on the use of flexible spending accounts, which 
concerns many Nevadans who use these accounts to fund exceptional 
medical costs, even though President Obama promised that people could 
keep their current health care plans.
  There is also a new tax on certain employer-provided health care--the 
so-called Cadillac plans. There are taxes on drug companies, medical 
devices, indoor tanning services, and the onerous 1099 reporting 
requirements for small businesses that, apparently, even President 
Obama opposes now.

[[Page S459]]

  President Obama said in his State of the Union Address that we need 
to fix parts of the bill that need fixing and move forward. Well, I 
believe this whole bill needs fixing. So let's repeal it and replace it 
with real health care reform that actually attacks cost, the No. 1 
problem in health care in the United States. We can go back to the 
drawing board, take the best ideas from both sides of the aisle, and 
put together a health reform bill that will take us into the future.
  Republicans have come up with many ideas on ways to fix the Nation's 
broken health care system. The answer is not unbearable taxes, 
unsustainable growth of the government, or paying for a brandnew 
entitlement program.
  Those aren't the qualities of comprehensive health reform. They are 
the qualities of a terrible policy that will lead to devastating 
results for Americans and our health care system, which is the best in 
the world. There is a better way. It will take time, but if we can 
change the way Americans think about health care, then we can create a 
better system.
  Imagine a system where Americans get to keep their choices in health 
care and where they are allowed to buy insurance across State lines. 
Imagine a system where there is transparency, where you know how much 
your doctor's visit will cost and how much your surgery will be. Ask 
yourself: When was the last time you went to a doctor's office and got 
a written estimate? In this third-party payer system we have, where 
someone else is paying the bill and you are receiving the service, the 
doctors don't care what you think of the cost. So there is no 
transparency in today's system. We need to have a system that is 
transparent, where you can shop around for the best value for your 
money.
  Imagine a system that rewards individuals for engaging in healthy 
behaviors. Imagine a system where you are not punished for having a 
preexisting condition. Imagine a system that allows small businesses to 
pool their purchasing power together to provide health insurance to 
their employees through small business health plans.
  Imagine a system where doctors can practice medicine to heal patients 
instead of practicing medicine with the goal of not being sued. And 
imagine a patient-centered health care system instead of an insurance-
centered system or a government-centered system, which is what we have 
today.
  These are all standards we should work toward. We cannot afford to 
settle for this bill.
  I believe this bill will bankrupt our country, our families, and our 
neighbors.
  We simply cannot survive with this agenda of taxing and spending away 
our future. We can't survive it; we can't afford it.
  Mr. President, I believe we should repeal this bill: all of its 
pages, all of its regulations, all of the regulations to come. I 
believe we should work together--not as Republicans, not as Democrats--
as Americans to address the primary problem in health care in this 
country: the cost. It is critical for the future competitiveness of 
American business, and it is incredibly important for the quality of 
health care and for the future of our citizens as well.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Begich). The Senator from New York.
  Mr. SCHUMER. Mr. President, I rise in strong, vehement opposition to 
the amendment offered by the minority leader, Senator McConnell, to 
repeal the health care reform law.
  First, I would say to my good friend from Nevada, yes, we would like 
to work together to further reduce costs, but this bill does reduce 
costs significantly. The CBO has said in no uncertain terms that repeal 
would balloon the deficit by $230 billion in the first decade and more 
than $1 trillion in the second decade. That is because the law smokes 
out a good deal of the waste, the inefficiency, and the duplication 
that we all know is part of our system.
  That is the place where we have to continue to work together. Our 
country delivers the best health care in the world, but it is also the 
most inefficient. We spend 17 percent of our GDP on health care. The 
next highest spending country is only 10 percent. Under the reformed 
law, we will begin the first large step in keeping quality care but 
getting costs under control.
  If my colleagues on the other side of the aisle said: You know, you 
are right; we have to reduce costs, we have a better way and they 
offered a bill on the floor, well, then, maybe we would take a look at 
it. But they are silent. It is very easy to sit there and say repeal, 
but what would they put in its place?
  The reason this amendment will be so easily defeated today is because 
a budget point of order says if you are going to raise the deficit $230 
billion in the first decade and $1 trillion in the second, you better 
find out where that money is coming from. The other side is silent, not 
a peep about where that money would come from. So that makes one feel 
this is sort of for show. Let's wave the flag for some of our hard-core 
supporters who definitely want repeal, but there is nothing in its 
place.
  The old mantra the other side seemed to have--some of them--of repeal 
and replace is gone. It is now repeal and we have nothing to replace it 
with. That does not meet with the favor of the American people. In 
fact, the number who are against repeal is growing. Only about one-
fifth of those who say they want to see the law changed want full 
repeal. Only 20 percent of the public wants full repeal. If those 
numbers are correct, and I believe they are, that means almost 
certainly that a majority of Republican voters don't want full repeal.
  The bottom line, Mr. President, and particularly in this area of 
health care, is that talking about deficit reduction is a lot easier 
than doing it. That fact is evidenced by the amendment my friend, the 
leader from Kentucky, will offer. That is why a budget point of order 
is the appropriate response, and that is why this will be defeated 
rather handily.
  In later days maybe my colleagues will come up with parts of the bill 
they wish to change. We will be open to it. Today Senator Stabenow is 
offering an amendment to change the 1099 section of the law. She has 
worked with people on both sides of the aisle. I know Senator Johanns 
has been a leader, the Republican from Nebraska. We are going to pass 
that today. So the idea that we are unwilling to change any part of 
this law is belied by what we are doing on the Senate floor.
  We want to work together. But somehow, when we get a repeal 
amendment--repeal the whole thing, no substitute, no answer to how to 
deal with the debt--one wonders what this repeal is all about.
  Furthermore, why is the American public becoming more favorable to 
this law as we go through this debate? That is what the polling data 
has shown. Well, I would give two reasons. First, many of the horrors 
that were bandied about as the law was being put together are proving 
not to be true.
  I will never forget that last summer someone came to me, a gentleman 
from Long Island, and he said: Senator Schumer, I am a Democrat. I have 
voted for you in every election, but I am not going to vote for you 
again.
  I said: Why?
  He said: I hate the health care law.
  I said: What do you hate about it?
  He said: I am going to lose my health care benefits on Labor Day.
  I said: What is your profession?
  He said: I am a New York City firefighter. He lived on Long Island, 
but he was a New York City firefighter.
  Well, anyone who knows even a little about the health care bill knows 
that a New York City firefighter will not lose their benefits on Labor 
Day or any other time under this provision. But this poor man had 
listened to some talk radio and they had convinced him he was going to 
lose his benefits.
  But that is all fading. I haven't spoken to the gentleman since. I 
don't know his name. I just met him at a summer street fair. But he has 
found his benefits are just as good today as they were on the day 
before Labor Day, so it is pretty logical to suppose he would have said 
repeal the law a year ago but wouldn't say so today.
  But there is another reason, and probably an even more important 
reason, this law is gaining support as people learn about it, and we 
owe some thanks to our Republican colleagues because they have given us 
a second chance to make a first impression. Most who looked last year 
said the messaging--rightly or wrongly, falsely or truly--was done 
better by the opponents than by the proponents of the

[[Page S460]]

law. But now, as people look at the law, they are learning about the 
many good things in the bill.
  I daresay that most of my colleagues on the other side of the aisle 
want to keep those good things. I would be quite certain that the vast 
majority of Americans would want to keep those things, and the polling 
data backs that up.
  So when you say repeal, when you just use a hatchet and not a 
scalpel, you lose all the good things, many of which are in effect 
today. So I would ask my colleagues on the other side of the aisle who 
support repeal: Do you support increasing prescription drug costs for 
our Nation's seniors? Thanks to this law, the so-called doughnut hole--
which was created in the prescription drug plan of 2003 under George 
Bush--will be fixed. Seniors who fall into this doughnut hole--which 
says when they pay about $2,500 for drugs, the government will help 
them no longer--will now get a 50-percent discount on their 
medications. This first year that will amount to a savings of $550 for 
the average senior.
  When you are a senior on a fixed income, $550 is a nice amount of 
change, and that will help a whole lot of people. The discount keeps 
increasing every year until the last crumb of the doughnut hole is 
gone.
  I will admit that is a mixed metaphor because a doughnut hole, by 
definition, has no crumbs. But good try, staff. Excellent work, in any 
case. It sounded very good to me too.
  But in these times, these savings aren't exactly chicken feed. They 
will make a huge difference for seniors. The average senior, when the 
doughnut hole is fully eliminated--crumbs and all--will save more than 
$2,000 a year.
  How about the provision that helps young people? Every one of us 
knows of instances where young men and women get out of college or get 
out of high school and they go into the job market. Oftentimes those 
new jobs they are seeking do not provide health care. That happens 
quite often. It is a new job, it is a low-paying job, they are just 
starting out. I know--I have spoken to many young people like this, and 
their parents--there is a lot of anguish. Does that young person who 
maybe has a job that pays $25,000 or $30,000 a year pay $1,000 a month 
for health care for himself or herself? They cannot afford that.
  On the other hand, to go without health care insurance--yes, they are 
young and healthy but God forbid they have an accident, go to the 
hospital, come up with some unusual and rare and expensive disease. 
What are they going to do? This keeps lots of young people and their 
parents up at night. This new bill solves that problem because you can 
stay on your parents' health care insurance, should they have it, until 
you are 26. By then you are in the labor force a little bit longer and 
the likelihood of your employer giving you health care is somewhat 
greater. Do my colleagues on the other side of the aisle want to take 
that away? If so, what are you going to put in its place? What are you 
going to tell the young people, 22 and 23 and 24 and 25 and 26, to do?
  Then there is another provision that I think is worth keeping--
preventive medicine. We all know one of the big problems with our 
health care system as opposed to some of the others in some of the 
other western countries is we do not do enough prevention. So instead 
of a disease being nipped in the bud, making the patient healthier and 
costing the system a whole lot less, it waits and waits. Those of us 
who put this health care bill together realized that and said early 
detection saves not only lives but billions of dollars. In this health 
care bill Medicare will provide a free wellness checkup once a year for 
every senior citizen. If there is a little bit of illness, they can nip 
it in the bud.
  We all know the earlier you detect cancer or heart disease or 
diabetes or emphysema, the better chance of curing it and the less 
expensive to cure it. This is going to save billions of dollars. Just 
giving certain tests at these wellness checkups will save people 
themselves money but, more importantly, save the Medicare system money, 
a lot of money. It is important for the people to save their money too, 
of course. This makes a great deal of sense.
  A mammography can find breast cancer before it metastasizes. A simple 
blood test can find prostate cancer before it spreads. What are my 
colleagues on the other side of the aisle going to say to seniors? What 
are they going to say to the Medicare system, which is trying to get 
more effective by getting involved in early detection and prevention? 
Forget it? That is what you are doing when you vote for repeal. You 
have nothing in its place.
  How about the small business tax credit? My dad was a small 
businessman. He had a little exterminating business. I know how small 
businessmen struggle. My father truly never became happy until he left 
the business. Now, praise God, he is 87 and he is a much happier guy 
than he was, even at 60, struggling in that business. One of the 
dilemmas that small business people face is the high cost of medical 
care for their employees. They want to provide it, A, because they want 
their employees to be healthy, B, because they like most of their 
employees, and C, because they want to keep the employees from going 
somewhere else if they are good--but it costs so darned much. Here is 
what is in the bill. If you are a small business that makes less than 
$1.2 million and you have 25 or fewer employees, you get a 35-percent 
credit, going up to 50 percent in 2014. That is a huge help to small 
businesses that are already providing health care for their workers, 
and a great incentive for small businesses that are not already to do 
so. Hundreds of thousands of small businesses in my State alone will 
benefit from this. What, my friends on the other side of the aisle, are 
you saying to those small businesses? What are you saying to their 
workers? Go at it alone? Because you want to repeal it but you have 
nothing--nothing--to replace it.
  There is one more provision I want to speak of. There are so many 
good things in this bill. No matter how much you don't like some of the 
bad provisions--and I know that is genuinely held by some of my 
colleagues--to just repeal it and get rid of the good stuff makes no 
sense, in my judgment. We have all heard the horror stories of 
insurance companies--when you go to them after you, your spouse, your 
kid has an illness and you say: Thank God, I have insurance--the 
insurance company deliberately, or maybe not but anyway they say: Mr. 
Smith, you did not check off that little box on page 17. You did not 
dot that I or cross that t. You are not covered.
  We all know the intent was to cover it. We all know the insurance 
company was happy to take the premiums even without that dotted I or 
crossed t or checked box when the family was healthy and money was 
coming in. But now all of a sudden they say bye-bye. This bill does not 
allow that to happen.
  The kinds of rescission I talked about are banned. What are we 
saying, not just to the families who have experienced this but to every 
American family with insurance who worries about this? What are we 
saying to them? Again, you have nothing in its place because you are 
repealing, not replacing, even though people said early on that is not 
what they are doing.
  I have one more point before I conclude. We are willing to work with 
you. The Stabenow amendment on the floor of the Senate shows that. I 
would have drafted it a different way and there will be a Levin 
amendment that I would prefer. But either way we are going to address 
the 1099 issue. Many people on your side of the aisle, many people on 
our side recognize that was a mistake. Not every bill is perfect. We 
are not digging in and saying we have to have the bill exactly as 
written and exactly as drafted. But you are doing the inverse--you are 
saying we have to have no part of this bill because if you wanted to 
retain parts of it you would have had an amendment on the floor saying 
take these parts out and keep these parts in. But you are not. Why? 
Your guess is as good as mine. But it is a lot easier to tear down than 
create, as we learned when we did the health care bill. But you have an 
obligation, unless you believe there should not be a health care system 
or we ought to go back to the system without any changes in the law 
that we have, which nobody liked. It is not fair.
  In conclusion, No. 1, this bill reduces the deficit. The repeal 
increases the deficit and there is no money there to make up for those 
funds that the bill would bring in by cost cutting and by

[[Page S461]]

fees. No. 2, there are lots of good things in the bill that probably my 
colleagues would support but they get rid of them with no replacement--
nothing. Nothing for the seniors, nothing for the 21- to 26-year-olds, 
nothing for the people who are treated poorly by their insurance 
companies. And, No. 3, we want to work with you. There are some changes 
we could work together on in the bill, not only 1099 but walking 
farther down the road of reducing the inefficiencies in the system, the 
high cost, the waste, by still preserving good care for the people who 
get it. That is something that would lend itself, particularly in these 
times of high deficits, to bipartisan support and working together.
  Today, simple repeal, again, it may feed some red meat to the 
minority in this country. It is a small minority, if you believe the 
polling, who say repeal it. But the responsible job of a legislator, 
whether you agree with this bill or disagree with this bill, is not to 
repeal but to improve. That is not happening today.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Alabama.
  Mr. SESSIONS. Mr. President, I rise in strong and vehement support of 
the amendment of Senator McConnell to repeal the health care reform law 
as now constituted, and I will support replacing it with reforms that 
truly provide Americans with access to quality, affordable health care, 
reduce skyrocketing health care costs, and put our Nation on a more 
sustainable fiscal path. These good goals can be achieved. But this 
current bill does not do it.
  I am pleased to see my colleague say he would accept some amendments, 
but the Johanns amendment he referenced was voted on twice last year. 
When the Democrats held a significant majority in this body they voted 
it down. After seven new Members have been added, many of them elected 
on a promise to repeal this bill--virtually everyone on the promise to 
repeal this bill--we now have agreement to change the 1099 reporting 
requirements, which is about one-thousandth of 1 percent of what is 
significant about this legislation. Indeed, if Senator Scott Brown had 
been elected a month or so sooner, the bill would not have been passed 
on December 24, the day before Christmas.
  The truth is, the American people have never supported this bill. 
Polling numbers show they still do not support this bill. The 
Democratic health care legislation was sold as a package that would 
reduce insurance premiums by $2,500 dollars per family. We were told 
that repeatedly. It was also supposed to reduce the Federal deficit, 
and immediately create 400,000 new jobs.
  Sadly, none of these promises were met. They were all false. The 
claims were attacked on this floor by sophisticated people who pointed 
out how these matters were not going to be achieved, and they have not 
been. They were false then, and they are false now.
  Instead, the new health care law will cause health care spending to 
rise over the next decade. Americans will see dramatic increases in 
their premiums. That is a fact. The Federal deficit will increase by an 
additional $700 billion. This bill does not reduce the deficit, and the 
law's expensive mandates, penalties, and tax hikes will lead to job 
losses and layoffs that will damage our economy. The last thing we need 
to do now is to have employers lay off people because of surging health 
care costs, as is happening. Talk to small businesses in your community 
to confirm this.
  As our Nation's reckless fiscal policy and surging debt bring us ever 
closer to a tipping point--a debt crisis that could substantially 
damage our country, as it has others around the world--respected 
economists have stressed the need for Congress to reduce Federal 
spending and contain mounting health care cost. But rather than tackle 
these problems that threaten the long-term stability of our Nation, the 
new health care law exacerbates our fiscal crisis by creating a new, 
open-ended entitlement, a monumental new entitlement program and by 
introducing $2.6 trillion in new spending. Tell me how we can spend 
$2.6 trillion and not increase our country's debt.
  Entitlements today are hammering our budget. They are surging our 
deficit. Entitlements are dangerous things. The last thing we need to 
do is create a new entitlement program that is not going to have 
restrained spending. According to the Congressional Budget Office, our 
official analysts appointed by the Democratic majority, says that the 
health care law will cause insurance premiums in the individual market 
to soar by 10 percent to 13 percent; for American families, translating 
into a $2,100 increase in their costs for purchasing health care 
coverage by 2016. That is huge.
  Another $2,100? That is a stunning development, and it is the exact 
opposite of the promises for the bill. CBO determined that. Total 
health care spending in the United States consumes already 17.3 percent 
of GDP, and we have felt that was too high. It is the largest of any 
industrialized nation in the world. But under this new law, the 
national health care spending will approach 20 percent of GDP by the 
end of this decade.
  Sadly, many supporters of the health care law continue to perpetuate 
the myth that repealing this law would increase the deficit. My friend, 
Senator Schumer, said: Repeal the law, and the deficit will go up. A 
thorough examination of the law pulls back the curtains and exposes the 
deceptive budget gimmicks to reveal its true cost.
  First, our Democratic colleagues double counted $398 billion in 
Medicare costs and taxes, $29 billion in Social Security taxes, $70 
billion in new long-term health care premiums to pay for the new health 
care spending--all double counted money. It is the largest false 
accounting scheme, I suppose, in the history of the world.
  Think I am exaggerating? December 23--the night before this health 
care bill was finally passed 60 to 40, 60 Democrats, 40 Republicans--I 
called the Congressional Budget Office and Dr. Elmendorf, selected by 
our Democratic colleagues to be the Budget Director. This is what he 
said: The key point is, savings to the HI trust fund--that is the 
hospital insurance trust fund of Medicare--under the health care bill 
would be received by the government only once, so they cannot be set 
aside to pay for future Medicare spending and, at the same time, pay 
for current spending on the other parts of the legislation or on other 
programs.
  This bill was cutting Medicare benefits and raising Medicare taxes. 
They did not use the money to strengthen Medicare, which is heading to 
insolvency. They took the money and spent it on a new program. 
Actually, they borrowed the money from Medicare. But it was not the 
Treasury's money to spend on new programs.
  The way it was written, the CBO score double counted the money. It is 
this money that they are counting to say this bill actually creates a 
surplus. Without this money, there is no surplus.
  Since Medicare is going into deficit, they are going to call their 
debt instruments, their bonds from the Treasury as they go into 
deficit. By the way, the U.S. Treasury pays Medicare interest on the 
money they borrowed from them to start this new program. Soon that 
money is going to be gone. We are going to have to borrow money on the 
open market to fund this new entitlement, and the new entitlement is 
going to cost far more than is currently estimated.
  Over the 10-year budget window, the Congressional Budget Office 
reports point out how the law was doctored to start certain revenue 
enhancements, taxes, and so forth now, but only starting the 
expenditure programs in 2014. Why is that important? Well, they got a 
score from CBO of what it would cost over 10 years. So you get income 
for 10 years and you get expenditures for 6. This plus the double 
counting of the money and several other gimmicks might look pretty 
good, which is how they say this is creating a surplus. But it is not a 
surplus.
  As the ranking member on the Budget Committee, I am stunned by how 
difficult and how challenging our current financial situation is. We 
have to do something about it. We need the President to help us and 
lead, but he is not, so it looks like Congress may have to tackle it.
  The former Director of the CBO, Douglas Holtz-Eakin, an economist who 
understands budget gimmicks and has seen them for many years, cowrote 
an article in the Wall Street Journal in January that eliminates any 
confusion about the law's impact. I am disappointed that Members of our 
Senate are still coming down here to suggest that repeal of this law is 
going to adversely impact our deficit. I am stunned to see this 
continue to be repeated.

[[Page S462]]

  This is what Dr. Holtz-Eakin, a highly respected individual, said in 
the Wall Street Journal in January. The article is entitled, ``Health 
Care Repeal Won't Add to the Deficit.''
  He said this:

       Repeal is a logical first step towards restoring fiscal 
     sanity.

  Fiscal sanity. He goes on:

       How then does the Affordable Care Act magically convert $1 
     trillion in new spending into painless deficit reduction? It 
     is all about budget gimmicks, deceptive accounting, and 
     implausible assumptions used to create the false impression 
     of fiscal discipline. Repeal is not a budget buster, keeping 
     the Affordable Care Act is.

  This Dr. Douglas Holtz-Eakin, former Director of the Congressional 
Budget Office. There is no question about it. That is a stunning thing. 
A poll by the Kaiser Foundation and Harvard University released last 
week revealed that the American people are seeing through these ploys. 
They have heard these talks before, and they are not buying it. Sixty 
percent of the country believes the health care law will increase the 
deficit over the next 10 years, while only 11 percent think it will 
lower the deficit.
  So, colleagues, give us a break, would you? The American people are 
not going to buy this argument. I wish it would not be repeated. But 
the President continues to say it himself. Clearly, the American 
people, once again, show they are wiser than their government leaders 
in many instances.
  The final point I would like to make about the health care law is its 
debilitating impact on jobs. The expensive mandates and penalties 
included in the health care law, coupled with rising costs of insurance 
facing families and businesses, are costing us jobs right now, and it 
will continue to do so in the future.
  I will just add, I had meetings with small business groups in Phenix 
City, AL, and Jasper, AL, with 10 or 15 individuals. Every one of them 
told me, without question, this health care law would cause them to 
reduce their employment. We do not need to be reducing employment; we 
need to be increasing employment.
  This bill is a job killer. It is indisputable. Over 6,000 pages of 
regulations have been written. Economic estimates indicate that 
repealing the law that threatens our economic recovery would save 
700,000 jobs. It is imperative that Congress repeals this law. Yes, we 
need to start and continue to work on things we already agreed on, such 
as preexisting conditions, interstate competition, and other things 
that we all agreed on and could agree on to make health care better. 
That is not the massive Federal entitlement program that funded by 
dubious gimmicks imposed on the American people against their will and 
damaging to the American economy.
  We cannot allow this. It will be repealed, in my view. I know my time 
is up. I will just conclude by saying, we had a new election. A lot of 
people took that issue to the American people. I think their voice was 
clear. The American people are not happy with Congress, which did not 
listen to them and passed the bill against the public's wishes. They 
expect Congress to reconsider it, eliminate it and start over with new 
legislation.
  Their message is clear, and that is what we need to do. I urge my 
colleagues to support Senator McConnell's amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, it is very hard for me to understand how 
anyone could be voting to repeal the entire health care bill. Because 
when you do that, among other things, what you are saying is that we 
will continue the odious practice by insurance companies of denying 
health care to people who have preexisting conditions.
  For 8 years under President Bush, more and more people lost their 
health insurance, the cost of health care soared, and our Republican 
friends had virtually nothing to say on health care.
  Now that a bill has been passed, which I am the first to agree is not 
the best bill we could have passed--and I will tell you why. It has its 
share of problems which should be remedied. But to say right now, when 
50 million Americans have no health insurance, when States all over 
this country are wrestling with huge budget deficits, which no doubt 
will result in millions more being thrown off health insurance, to say 
we should retreat to where we were is beyond comprehension.
  Second of all, for my Republican friends to say let's repeal health 
care, there are millions of families who now are beginning to be able 
to include within their own health care plans their sons and daughters, 
up to the age of 26. Goodbye to that. Furthermore, in a nation which 
ends up spending more on health care, almost double per person, 
compared to any other nation on Earth, we have put in the health care 
reform bill billions of dollars for disease prevention.
  We are, as a nation, very weak in terms of trying to keep people 
healthy, trying to keep them out of the hospital. We spend a fortune on 
people after they are sick. In this bill, we have made some significant 
steps forward in terms of disease prevention, wellness, which is very 
cost effective in terms of health care dollars, not to mention human 
pain and suffering.
  In that regard, I am proud to have worked with a number of other 
Senators in doubling, in that bill, the number of community health 
centers in America, which are providing the most cost-effective primary 
health care that is provided in this country, keeping people out of 
emergency rooms, keeping people out of hospitals, giving them access to 
primary health care, dental care, low-cost prescription drugs, and 
mental health counseling.
  In the midst of an extraordinary crisis in terms of primary health 
care, where everybody recognizes we do not have enough primary health 
care doctors or nurses or technicians, we tripled funding for the 
National Health Service Corps, and it is already working effectively in 
getting doctors and dentists and nurses and other practitioners into 
underserved areas. All that would be undone. I think that makes no 
sense whatsoever.
  Now, to my mind, what we have to do is not to repeal this bill but to 
make it a better bill. I will give you one very specific suggestion 
that I have worked on now for over 1 year. Senator Wyden has worked on 
this, others have worked on it. That is to say, that if a State in this 
country, the State of Vermont, the State of Alaska, any other State, 
can maintain the high standards for quality health care and coverage 
that the national health care bill did, then that State should be given 
significant flexibility to perhaps do it in their own way and do it 
more cost effectively.
  I should tell you that in the State of Vermont, our new Governor is a 
supporter of a Medicare-for-all single-payer program. There are other 
States that want to move in a different direction, maintaining high 
standards but doing it perhaps in a different way than has been 
proposed by the national legislation.

  In my view, they should have that right. And if Vermont is effective 
in doing what I believe we could--providing quality health care to all 
of our people in a cost-effective way--I suspect other States around 
the country can learn from Vermont's experience. I think that is a 
positive step forward.
  The beauty of our Federalist system: 50 States--every State has a 
good idea. I think if we maintain standards that are high and give 
States flexibility, this can improve the health care reform bill we 
passed last year. But killing this whole bill makes no sense to me at 
all.


                            Social Security

  Mr. President, I also want to say a word on an issue which is getting 
more and more attention; that is, Social Security.
  In my view, Social Security has proven itself to be the most 
successful social program in American history. Over a 75-year period--
and this is really extraordinary; we take it for granted, but it is an 
extraordinary success story--in good times and in bad times, Social 
Security has paid out every nickel owed to every eligible American. And 
it does that with a minimal administrative cost.
  Despite its strong record of success over the last 75 years, Social 
Security now faces unprecedented attacks from Wall Street, from many of 
my Republican friends, and from some Democrats. I have to be very 
clear: If the American people are not prepared to stand up and fight 
back, we could begin to see the dismantling of Social Security this 
very year.

[[Page S463]]

  Let me cite the facts with regard to Social Security. I know when we 
watch TV tonight there will be some guy up there saying: Social 
Security has gone bankrupt. Social Security is collapsing. That is 
absolutely untrue. There has been a significant number of misstatements 
regarding Social Security. Here are the facts that nobody denies.
  No. 1, according to the latest report of the Social Security 
Administration, Social Security will be able to pay out 100 percent of 
all benefits owed to every eligible American for the next 26 years. 
Now, you tell me how a system is going bankrupt--we have a lot of 
problems in this government, and our country faces enormous problems, 
but when you can pay out every benefit owed to every eligible American 
for the next 26 years, do not tell me this is a program in crisis or 
going bankrupt. After 2037, Social Security will be able to pay out 78 
percent of promised benefits. Do we have to deal with that over the 
next 26 years? Yes, we do. But it is not a crisis, and this Senator 
will do everything he can to oppose any effort toward privatization, 
any effort to raise the retirement age, any effort to lower benefits.
  Second point. Everybody is concerned about the deficit crisis we 
face--a $14 trillion national debt. How much has Social Security 
contributed to the deficit and the national debt? How much? Well, not 
one penny. Not one-half a penny. Social Security is funded by the 
payroll tax. Social Security has a $2.6 trillion surplus. That surplus 
will go up. To attack Social Security because of the deficit crisis is 
grossly unfair.
  Do you want to know why the deficit went up? We are in the middle of 
a recession. We fought two wars in Afghanistan and Iraq and forgot to 
pay for those wars. We gave hundreds of billions of dollars in tax 
breaks to the wealthy; bailed out Wall Street; Medicare Part D 
prescription drug program, written by the insurance companies--all 
unfunded. Those are the reasons you have a deficit. Social Security has 
nothing to do with it.
  So I would suggest that in the midst of all of this financial 
instability that is out there, with the middle class shrinking and 
poverty increasing and people really worried about their retirement 
years, one of the most significant things we as a Congress can do is 
stand up and say: We are there. We are going to protect Social 
Security. We are not going to cut it. And we are going to make it 
stronger so that, while it has done a great job for the last 75 years, 
it will continue to do a good job for the next 75 years.
  With that, Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. VITTER. Mr. President, I rise today in strong support of the 
McConnell amendment No. 13 that would completely repeal President 
Obama's, in my view, unconstitutional health care bill. Of course, I 
was an active participant in the debate last Congress about ObamaCare 
and fought that tooth and nail. The day after it passed into law, I 
introduced a freestanding measure to repeal it completely. The first 
day of this new Congress that I could file bills, I reintroduced that 
measure. Of course, for all those reasons, I certainly support this 
amendment that accomplishes that important goal.
  Let me begin by responding to the suggestions of my distinguished 
colleague from Vermont. Everybody who wants to repeal this law, 
including me--we do not want to do away with the idea that you should 
not be shoved off insurance because of preexisting conditions, that you 
should not have portability, you should not be able to meet those 
obligations. We do not think that at all. We are, however, for complete 
repeal for a very simple reason.
  What is wrong with this bill, what is wrong with ObamaCare is not one 
detail here and one comma there, it is not at the periphery of the 
plan; it is at the heart of the plan, it is the essentials, it is the 
core of the plan. We can and should and must pass significant reforms 
such as protection for individuals with preexisting conditions. That is 
why we have introduced those measures. We have advocated those measures 
in a targeted way. That does not mean we can or should or must preserve 
the whole of ObamaCare, which has significant problems at the core of 
that gargantuan bill.
  Let me mention four of those core problems from my point of view.
  The first is--maybe most fundamental, most basic--there are important 
elements at the core of ObamaCare that are flatout unconstitutional. 
Even if they were not unconstitutional, they would be unwise because 
they are a dramatic expansion of the power and role and authority of 
the Federal Government.
  The most obvious is an absolute mandate in the bill, a mandate from 
your Federal Government that every man, woman, and child in the United 
States must buy health insurance.
  This is unprecedented. There has never been a mandate like that from 
the Federal Government or any level of government. There has never been 
this forced purchasing of a product in the private marketplace.
  Some people bring up the comparison with car insurance, but that is 
not a close comparison at all because at the State level that is not a 
forced mandate; that is simply saying: If you want the right, the 
privilege of driving a car, which is not some constitutionally 
guaranteed right, then part of the deal is you have to cover the 
damages from any accident. So that is not a good comparison.
  So this absolute mandate that every man, woman, and child in the 
United States go out and purchase health insurance, purchase a product 
in the private marketplace, is unprecedented, and for that reason it is 
unconstitutional. It is an unprecedented expansion of the power and 
role and authority of the Federal Government.
  In the last few days, there have been hearings--quite late to the 
hour, but there have been hearings in the Senate in the committees 
about the constitutionality or unconstitutionality of ObamaCare. Of 
course, this central question came up. I found the response of some of 
the witnesses at the hearings who favored ObamaCare or advocate for 
ObamaCare pretty startling on this point. One Senator in the committee 
asked them: Well, if we can mandate constitutionally that every 
American man, woman, and child buy health insurance, why can't we pass 
a law that says obesity is a real problem in this country--which it 
is--and therefore we are going to mandate that every man, woman, and 
child in America eat certain vegetables and certain healthy foods every 
day? Do you know what the response was from this advocate of ObamaCare? 
Well, I don't think you can mandate that they eat the food; you can 
only mandate that they buy the food. Great. Very reassuring. To me, 
that is not an argument for the constitutionality of ObamaCare; that is 
a clear argument for the unconstitutionality and danger of the 
ObamaCare Federal power overreach.

  There are many other aspects of ObamaCare which also pose serious 
constitutional problems. My point is, these are big problems, and they 
are not minor details which we can tweak with amendments. They go to 
the heart of this gargantuan bill.
  Similarly is the dramatic expansion of government and the cost of 
that expansion. Instead of controlling and lowering health care costs, 
ObamaCare is expanding government and expanding health care costs. In 
fact, the Senate Budget Committee estimates that the bill will cost 
$2.6 trillion for the first 10 years of full implementation. All of 
that new spending does not lower health care costs, and there are 
multiple sources affirming that. Yet President Obama continues to claim 
that the act will ``slow these rising costs.'' Maybe he did not see 
that CMS's Chief Actuary, Richard Foster, said that overall national 
health expenditures will increase by a total of $311 billion over the 
next 10 years under the law. Now, when the CMS Actuary was asked 
directly if President Obama's health care bill would hold down 
unsustainable medical costs just last week, that Actuary replied: ``I 
would say false.''
  Last year, CBO also confirmed our concerns about the bill's inability 
to contain costs, stating, ``In CBO's judgment, the health legislation 
enacted earlier this year does not substantially diminish that 
pressure.''
  In addition to increased costs for the government and present and 
future taxpayers, health insurance premiums will increase for Americans 
and their

[[Page S464]]

families. In fact, the CBO estimated that premiums will increase by 
$2,100 even though at least candidate Obama promised to lower premiums 
by $2,500 per family.
  So that big expansion of government and cost and health care costs, 
including taxes and health care premiums, is another big problem. 
Again, this is not a minor detail which we can fix with a perfecting 
amendment, with a few tweaks to the bill. This goes to the core of the 
entire plan.
  Another fundamental issue which goes to the core of the entire plan 
is the fact--and I think it is a well-established fact--that the 
ObamaCare plan will cost us not just money, not just increased taxes, 
not just increased health insurance premiums, it will cost us jobs. 
That should always be worrisome, but it should be particularly 
worrisome as we stand here today and debate this in a horrible economy, 
as we are trying to come out of the worst recession since the Great 
Depression of the 1930s. Again, this is not just any period of time; 
this is a time of prolonged historic unemployment.
  This bill costs us jobs, and this bill absolutely decimates job 
creation. The bill taxes jobs and places more burdens on job creators. 
For instance, the National Federation of Independent Business, 
representing thousands of American small businesses, including many in 
Louisiana, my home State, said:

       If new taxes, new mandates and new government programs in 
     PPACA--

  That is the ObamaCare bill--

     remain intact the law will stifle the ability to hire, grow 
     and invest. . . .

  In addition to the often-discussed 1099 paperwork nightmare for small 
businesses, the bill also includes a pay-or-play mandate on job 
creators. This complicated new tax penalty imposes a tax on businesses 
with more than 50 workers if they do not offer coverage or do offer 
coverage but workers elect to decline that benefit. Yet again, this is 
a fundamental problem with the bill that goes to the heart of the bill, 
not the periphery. This aspect of the bill will have many dire 
consequences. First, because the $2,000 penalty for not offering 
insurance is less than the $6,100 average employer benefit 
contribution, businesses are actually given an incentive to drop 
coverage. So there is a concrete money incentive, a major money 
incentive for businesses to drop coverage and actually push workers off 
good coverage many have right now.
  Second, businesses that are able to grow and hire more workers may 
choose not to create jobs and to stay under the 50-employee threshold 
to avoid all of these disincentives and difficulties.
  Because of all this, the nonpartisan Congressional Budget Office 
concluded that the bill ``will encourage some people to work fewer 
hours or to withdraw from the labor market.'' It also said: On net, it 
will reduce the amount of labor used in the economy. Is that what we 
want to encourage in any economy but particularly in a horribly down 
economy? We are trying to come out of the worst recession since the 
Great Depression. Do we want to reduce labor opportunity in our 
economy?
  These are stunning conclusions that so many of us warned against 
during the debate--conclusions the majority of Americans feared. Taxing 
American job creators and sticking businesses with more government 
compliance requirements and costs is absolutely the wrong approach, 
particularly in a down economy.
  Finally, there is another core concern which I share with so many 
others in this body that again goes to the heart of the bill. It is not 
a minor debate. It is not something we can solve with a perfecting 
amendment. It is not at the periphery. It is not changing a comma, 
changing a sentence. It is at the heart of the bill; that is, the bill 
contains at its heart over $500 billion in Medicare cuts--yes, over 
$\1/2\ trillion in cuts to Medicare. These cuts aren't invested back 
into Medicare. They don't help Medicare stay solvent. They don't help 
Medicare survive or stay solvent longer. They don't help fix the 
looming Medicare challenge. They are stolen from Medicare to pay for 
brandnew stuff for other people in ObamaCare.
  These Medicare cuts directly impact seniors, and one study shows that 
the massive cuts to Medicare Advantage will hit Louisiana seniors 
particularly hard. A study by the Heritage Foundation shows that 
Louisiana seniors enrolled in Medicare Advantage plans lose more than 
any other State in the Nation because of the Obama health bill. The 
report says that projected enrollment in Medicare Advantage will drop 
by over 125,000 Louisianians--62 percent--and benefits will be cut by 
$5,000 per beneficiary.
  So this bill takes away benefits and choices for seniors not to fix 
Medicare, not to preserve Medicare, not to preserve its solvency for 
longer, but steals it from Medicare, steals it from seniors for 
brandnew purposes for other folks. This directly contradicts the 
President's promise that ``if you like what you have, you can keep 
it.'' No, you can't, Mr. President. Thousands of Louisiana seniors 
can't. In fact, CMS's Chief Actuary also verified that the promise will 
be broken, confirming that Americans may lose their current health care 
coverage regardless of whether or not they want to keep it.
  So I respond directly to my friend and colleague from Vermont by 
saying that we want full repeal of ObamaCare for a very simple reason: 
The big problems with the bill, the big problems with the plan aren't 
at the margin, they are at the core, and the big problems can't be 
fixed with a perfecting amendment, with changing a comma, changing 
punctuation, revising 1 or 2 or 5 or 10 sentences. The big problems are 
at the core of the plan, starting with a mandate from the Federal 
Government--unprecedented--that every man, woman, and child in America 
needs to go into the market and buy a particular product.
  That is why we demand repeal, that is why we will continue to pursue 
repeal until it happens, and that is why we will replace this huge 
burdensome bill with targeted reforms such as protecting folks with 
preexisting conditions, such as reimportation, such as generics reform 
and other measures to reduce prescription drug prices, such as allowing 
American citizens to shop for health insurance across State lines and 
to pool together through their small businesses, through other means, 
through association health plans.
  Thank you, Madam President. With that, I urge all of my colleagues to 
come together. Let's repeal this very problematic plan, and let's start 
anew with focused, targeted reforms that the American people have been 
asking for.
  Madam President, I yield the floor, and I note the absence of a 
quorum.
  The PRESIDING OFFICER (Mrs. Hagan). The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  The PRESIDING OFFICER. The Senator from Mississippi.
  Mr. WICKER. 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. WICKER. Madam President, I rise today in support of the McConnell 
amendment to the FAA reauthorization bill.
  What we have this afternoon actually is an opportunity to show the 
American people that we are listening to them. The American people want 
the ObamaCare law--the affordable health care law, as it is known--to 
be repealed and replaced with something less expensive, with something 
workable. Polls show this, the individuals with whom we speak when we 
go home tell us this, and this vote will be an opportunity for us to 
show them we are listening.
  I have heard some of my colleagues come to the floor this week and 
suggest that this massive, 2,000-page, tax-increasing, job-killing bill 
is, in fact, just what we need. I would suggest there are a number of 
facts that indicate otherwise. The other side would have us believe 
that without this health care law, this country is going to fall off 
the tracks and the world will virtually come to an end. They try to 
cite one or two popular proposals that are in this law, which, of 
course, could be enacted after repeal practically by unanimous consent, 
and ignore the fatal flaws in the law.
  The former Speaker of the House, Nancy Pelosi, during the 
consideration of this act in the House and Senate, famously told a 
grassroots group that had come to Washington, DC: We need to hurry up 
and pass the bill so you can find out what is in it. Well, indeed, 
since the passage and signing of

[[Page S465]]

the law of ObamaCare, every day the American people are finding out 
something new that is in the bill that they don't like. As a matter of 
fact, it turns out that Members of the House and Senate who voted for 
ObamaCare also did not know precisely what was in the bill and 
certainly did not anticipate the ramifications of this massive, ill-
advised law.
  Under the new law, it is absolutely a fact, and we know this, that 
Medicare will face over $500 billion in cuts, and senior citizens have 
a right to be concerned. Future senior citizens have a right to be 
concerned about these cuts. They include $155 billion from hospitals, 
$202 billion from Medicare Advantage, $15 billion from nursing homes, 
$40 billion from home health agencies, and $7 billion from hospice.
  Cuts from these Federal expenditures in Medicare are to pay for the 
new ObamaCare legislation.
  Everyone agrees that Medicare needs to be made more solvent, and we 
need to work on Medicare. But these reckless cuts will only make 
Medicare's problems worse.
  Another thing Americans have found out about this affordable health 
care law which is being implemented even as we speak is that the law 
falls short of the President's goal of controlling runaway costs. In 
fact, it raises projected spending.
  Last week, in his State of the Union Address, President Obama said 
the health insurance law we passed last year will slow these rising 
costs. This is simply not true. To support my assertion it is not true, 
I cite the President's own Actuary. CMS reports that, in fact, spending 
will be increased by about 1 percent over what it would have been over 
10 years. That increase could get bigger, of course, the report points 
out, since the Medicare cuts I have pointed out may be unrealistic and 
politically unsustainable, according to the report. CMS said, overall, 
national health expenditures under the health reform act would increase 
by a total of $311 billion and that health expenditures will be 21 
percent of the gross domestic product by 2019.
  But it is not just the government bean counters who are worried. Here 
is what the National Federation of Independent Business said:

       Small businessowners everywhere are rightfully concerned 
     that the unconstitutional new mandates, countless rules and 
     new taxes in the health care law will devastate their 
     business and their ability to create jobs.

  That is the National Federation of Independent Business. The National 
Association of Manufacturers says that manufacturers remain adamantly 
opposed to the employer mandates and to the Medicare hospital insurance 
tax increases. These employers who are faced with incorporating the 
first round of health care changes are grappling and having difficulty 
with how to comply with the long list of new rules.
  These are not scare tactics. These are not unwarranted fears by a 
confused public. These are people who work with health care every day 
and are telling us that this Congress has made a mistake. In fact, 
there are already real consequences of this health care reform law.
  Abbott Laboratories said it is cutting about 1,900 jobs. It is just a 
fact. The job cuts come ``in response to changes in the health care 
industry, including U.S. health care reform and the challenging 
regulatory environment.'' That is simply a fact. It is not conjecture.
  Blue Shield California Health Insurer recently stunned individual 
policyholders with a huge rate increase, effective March 1, seeking 
cumulative hikes of as much as 59 percent in premiums for tens of 
thousands of their customers. That San Francisco-based Blue Shield said 
the increases were the result of fast-rising health care costs and 
other expenses relating to the new health care law.
  Again, just a fact, Madam President. It is also an absolute certainty 
that State taxes are going to go up, and they are going to go up big 
time unless we repeal this health reform law.
  In my State of Mississippi, the legislation will cost the State $1.7 
billion over 10 years, including $443 million in year 10 alone. From 
fiscal year 2014 to fiscal year 2020, the massive expansion of Medicaid 
will cost Mississippi taxpayers $225 million to $250 million extra each 
year. Our Governor--one of the staunchest opponents of tax hikes I have 
ever heard of--has stated that this law will certainly force the State 
of Mississippi to increase its taxes unless it is repealed. Again, 
these costs are simply facts. They result from the mandate.
  Madam President, there is also bipartisan opposition to this law. We 
didn't see much bipartisan support for its repeal in the other body, 
and I was disappointed by that. But when you get off of Capitol Hill 
and out to individuals, it is not a Republican or Democratic issue. 
There is a bipartisan American opposition to this law.
  I have repeatedly quoted former Governor Phil Bredesen, a Democrat of 
Tennessee, someone who ran as a Democrat in his State successfully 
twice and ran as the standard bearer for his party three times--a loyal 
Democrat who, of course, called this law the ``mother of all unfunded 
mandates.''
  After the law was enacted, he wrote an op-ed in the Wall Street 
Journal on October 21, 2010. I ask unanimous consent that it be printed 
in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

             [From the Wall Street Journal, Oct. 21, 2010]

                ObamaCare's Incentive To Drop Insurance

                          (By Philip Bredesen)

       One of the principles of game theory is that you should 
     view the game through your opponent's eyes, not just your 
     own.
       This past spring, the Patient Protection and Affordable 
     Care Act (President Obama's health reform) created a system 
     of extensive federal subsidies for the purchase of health 
     insurance through new organizations called ``exchanges.'' The 
     details of these subsidies were painstakingly worked out by 
     members of my own political party to reflect their values: 
     They decided who was to benefit from the subsidies and what 
     was to be purchased with them. They paid a lot of attention 
     to their own strategies, but what I believe they failed to 
     consider properly were the possible strategies of others.
       Our federal deficit is already at unsustainable levels, and 
     most Americans understand that we can ill afford another 
     entitlement program that adds substantially to it. But our 
     recent health reform has created a situation where there are 
     strong economic incentives for employers to drop health 
     coverage altogether. The consequence will be to drive many 
     more people than projected--and with them, much greater 
     cost--into the reform's federally subsidized system. This 
     will happen because the subsidies that become available to 
     people purchasing insurance through exchanges are 
     extraordinarily attractive.
       In 2014, when these exchanges come into operation, a 
     typical family of four with an annual income of $90,000 and a 
     45-year-old policy holder qualifies for a federal subsidy of 
     40% of their health-insurance cost. For that same family with 
     an income of $50,000 (close to the median family income in 
     America), the subsidy is 76% of the cost.
       One implication of the magnitude of these subsidies seems 
     clear: For a person starting a business in 2014, it will be 
     logical and responsible simply to plan from the outset never 
     to offer health benefits. Employees, thanks to the exchanges, 
     can easily purchase excellent, fairly priced insurance, 
     without pre-existing condition limitations, through the 
     exchanges. As it grows, the business can avoid a great deal 
     of cost because the federal government will now pay much of 
     what the business would have incurred for its share of health 
     insurance. The small business tax credits included in health 
     reform are limited and short-term, and the eventual penalty 
     for not providing coverage, of $2,000 per employee, is still 
     far less than the cost of insurance it replaces.
       For an entrepreneur wanting a lean, employee-oriented 
     company, it's a natural position to take: ``We don't provide 
     company housing, we don't provide company cars, we don't 
     provide company insurance. Our approach is to put your 
     compensation in your paycheck and let you decide how to 
     spend it.''
       But while health reform may alter the landscape for small 
     business in unexpected ways, it also opens the door to what 
     is a potentially far larger effect on the Treasury.
       The authors of health reform primarily targeted the 
     uninsured and those now buying expensive individual policies. 
     But there's a very large third group that can also enter and 
     that may have been grossly underestimated: the 170 million 
     Americans who currently have employer-sponsored group 
     insurance. Because of the magnitude of the new subsidies 
     created by Congress, the economics become compelling for many 
     employers to simply drop coverage and help their employees 
     obtain replacement coverage through an exchange.
       Let's do a thought experiment. We'll use my own state of 
     Tennessee and our state employees for our data. The year is 
     2014 and the Affordable Care Act is now in full operation. 
     We're a large employer, with about 40,000 direct employees 
     who participate in our health plan. In our thought 
     experiment, let's exit the health-benefits business this year 
     and help our employees use an exchange to purchase their own.
       First of all, we need to keep our employees financially 
     whole. With our current plan,

[[Page S466]]

     they contribute 20% of the total cost of their health 
     insurance, and that contribution in 2014 will total about $86 
     million. If all these employees now buy their insurance 
     through an exchange, that personal share will increase by 
     another $38 million. We'll adjust our employees' compensation 
     in some rough fashion so that no employee is paying more for 
     insurance as a result of our action. Taking into account the 
     new taxes that would be incurred, the change in employee 
     eligibility for subsidies, and allowing for inefficiency in 
     how we distribute this new compensation, we'll triple our 
     budget for this to $114 million.
       Now that we've protected our employees, we'll also have to 
     pay a federal penalty of $2,000 for each employee because we 
     no longer offer health insurance; that's another $86 million. 
     The total state cost is now about $200 million.
       But if we keep our existing insurance plan, our cost will 
     be $346 million. We can reduce our annual costs by over $146 
     million using the legislated mechanics of health reform to 
     transfer them to the federal government.
       That's just for our core employees. We also have 30,000 
     retirees under the age of 65, 128,000 employees in our local 
     school systems, and 110,000 employees in local government, 
     all of which presents strategies even more economically 
     attractive than the thought experiment we just performed. 
     Local governments will find eliminating all coverage 
     particularly attractive, as many of them are small and will 
     thus incur minor or no penalties; many have health plans that 
     will not meet the minimum benefit threshold, and so they'll 
     see a substantial and unavoidable increase in cost if they 
     continue providing benefits under the new federal rules.
       Our thought experiment shows how the economics of dropping 
     existing coverage is about to become very attractive to many 
     employers, both public and private. By 2014, there will be a 
     mini-industry of consultants knocking on employers' doors to 
     explain the new opportunity. And in the years after 2014, the 
     economics just keep getting better.
       The consequence of these generous subsidies will be that 
     America's health reform may well drive many more people than 
     projected out of employer-sponsored insurance and into the 
     heavily subsidized federal system. Perhaps this is a 
     miscalculation by the Congress, perhaps not. One principle of 
     game theory is to think like your opponent; another is that 
     there's always a larger game.

  Mr. WICKER. Madam President, among other things, Governor Bredesen, 
who was still Governor at the time, said:

       Our Federal deficit is already at an unsustainable level, 
     and most Americans understand that we can ill afford another 
     entitlement program that adds substantially to it. But our 
     recent health reform has created a situation where there are 
     strong economic incentives for employers to drop health 
     coverage altogether. The consequence will be to drive many 
     more people than projected--and with them, much greater 
     cost--into the reform's federally subsidized system.

  The Democratic-elected Governor of Tennessee criticized this act. He 
pointed out other facts that are wrong. In his subsequent book on the 
subject, Phil Bredesen also criticizes the health care law, saying it 
will cause deficits to go up, costs to continue increasing, employers 
to drop coverage, State costs to increase, governments to grow, and 
will make our current problems worse.
  ``Obamacare is not what the doctor ordered,'' according to Governor 
Bredesen.
  My time is limited. I could go on and on, and Members of the Senate 
and House could and will go on and on as we face this issue, if we 
don't win it today.
  The facts are there. This is a terribly flawed piece of legislation. 
Facts are stubborn. The consequences have already started to mount up. 
Opposition is strong. Support for repeal is strong and bipartisan, and 
for those reasons I will vote in favor of the McConnell amendment when 
we consider it later today.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. Madam President, I can't say with any certainty anything 
about the critics of the government's affordable health care plan, 
except one thing: Each of the critics on the Republican side of the 
aisle of what they call government-administered health insurance--every 
single Senate Republican critic is currently protecting his or her 
family with government-administered health care. In other words, what 
is good enough for their families should not be good enough for the 
rest of America.
  As a show of good faith, I think the Republican Senators should come 
to the floor today and say: Not only are we going to vote for repeal of 
health care reform, we are going to show our personal commitment by 
walking away from the Federal Employees Health Benefits Program, a 
government-administered health insurance program. I would admire them 
so much if their actions as Senators reflected their speeches on the 
floor. But they don't. They are denying to the rest of America what 
every single Member of Congress has available today to protect their 
families. That, to me, is indefensible.
  A judge in Florida this week decided that this Affordable Health Care 
Act was unconstitutional. Before we get carried away with that 
decision, step back. This law has been challenged 16 times in Federal 
courts. Twelve courts have dismissed the challenges on procedural 
grounds, saying the person who filed the suit didn't have standing in 
court. Four of the Federal courts decided it on the merits. Two of the 
Federal courts decided it was a constitutional law, and two said it was 
unconstitutional.
  You say to yourself: Wow, two Federal district courts said this law 
was unconstitutional. Aren't you worried? Well, I don't take anything 
for granted, but I do understand a little bit of history. What other 
laws in America were found unconstitutional by lower courts and then 
constitutional by the Supreme Court? Anything significant? Social 
Security was found unconstitutional; then the Supreme Court said, no, 
it is constitutional. The Federal minimum wage law was found 
unconstitutional by a lower court, and the Supreme Court said it was 
constitutional. The Civil Rights Act of 1964 was found unconstitutional 
by a lower court, and the Supreme Court said it was constitutional.
  Let's not get carried away with lower court decisions that are 
clearly split on this issue. We had a hearing in the Judiciary 
Committee today that I chaired where we had constitutional experts from 
across the United States. There was a lot of difference of opinion 
between Democrats and Republicans. I think the case is clear and strong 
that we have the power, under article I, section 8 of the 
Constitution--the enumerated powers of Congress--to regulate commerce.
  Is there anybody on the Republican side who will stand here and argue 
that the health care industry, which represents 18 percent of the 
economy of America, is not commerce? Of course it is. Then, of course, 
we have the authority in that same section to pass laws necessary and 
proper, to carry out the responsibilities and authority given us.
  Here is what we are trying to do. We are trying to make sure 
everybody in America has health insurance. We say to the 83 percent of 
Americans who currently are insured: You don't have to worry about this 
argument. You already have health insurance. For the 17 percent who are 
uninsured, many of them are people who have preexisting conditions and 
have been denied coverage or they can't afford it. Some are people who, 
frankly, cannot afford coverage even if they don't have a preexisting 
condition.
  This law moves us to a point where more Americans will be covered 
with health insurance. We say those who can afford health insurance, 
and don't buy it, will pay a tax because of that decision. Is that 
heartless? Is that a Federal mandate on people who want to be left 
alone? If they were just being left alone, that is one thing, but human 
experience teaches us that these people who want to go it alone--don't 
bother me, I am on my own--will get sick someday. When they go to the 
hospital, they will be treated. When they can't pay for their 
treatment, do you know who will pay? All of the rest of us. Everybody 
else paying health insurance premiums has to absorb the cost of those 
who are freeloading on the system. It is not fair.
  It used to be that conservative Republicans preached personal 
responsibility. When we put personal responsibility in this law, all of 
a sudden they don't like it. I think personal responsibility still 
counts. I believe it is clearly constitutional to include it. I have 
listened to some of the arguments about repealing this law. I heard the 
Senator from Mississippi say how bipartisan the support is for it. I 
would have liked to have asked him how he explains the fact that four 
out of five people in America--80 percent of Americans--oppose repeal. 
They don't think the law is perfect. Many say improve it if you can, 
but 80 percent oppose repeal.

[[Page S467]]

  The signature issue for the House Republicans, and now the Senate 
Republicans, is the repeal of affordable health care. It would be 
devastating if we did. The first thing you will notice, if you read the 
amendment--three pages--filed by Senator McConnell, the Republican 
leader, is that on the second page he manages to include the Statutory 
Pay-As-You-Go Act of 2010, as passed and printed by the House of 
Representatives. Unless you are a person who follows closely what is 
going on around here, you may not know what that says.

  What it says is that Senator McConnell wants us to ignore the fact 
that repeal of the Health Care Act will add $230 billion to our 
national deficit over the next 10 years and more than $1 trillion in 
the decade after that. A party that comes to the floor every single day 
telling us of their passionate determination to end our deficits and 
address our debt with the McConnell amendment will add $230 billion to 
our national deficit over 10 years and $1 trillion more in the next 10 
years.
  This is a budget buster amendment. This will add more to the deficit 
in one fell swoop than any single thing we have done in Congress in the 
time I have served. And it is being offered by the party of so-called 
fiscal responsibility.
  When we talk about premium increases currently taking place under 
health insurance policies across America, I understand it. We have all 
lived through it. We have seen it. Businesses see it all the time. 
There is a provision in our Affordable Health Care Act which addresses 
that issue that would be repealed by the McConnell amendment. The 
provision is called medical loss ratio. It says a health insurance 
company has to spend 80 to 85 percent of premium dollars on actual 
health care. They cannot take it away in advertising, in administrative 
costs, in salaries and bonuses for their CEOs.
  One of the things that will happen if the Republicans have their way 
and repeal health care is that health insurance companies will be 
allowed to raise premiums at any level as quickly or as much as they 
want without being held to this medical loss ratio.
  That may not be the worst thing, though. Any person in America who 
has been raised in a family where someone in the family suffers from 
what is known as a preexisting condition knows that you always live in 
fear that you will not have health insurance and fear that if you have 
to go out and buy it on the open, public market, you will never be able 
to afford it.
  This law that Senator McConnell and the Republicans want to repeal 
today says no health insurance company in America can discriminate 
against anyone under the age of 18 who has a preexisting condition. 
That is something any parent would appreciate. You never know if that 
beautiful son or daughter of yours is going to have problems with 
asthma, diabetes, cancer, or mental illness. And you certainly want 
that child, that love of your life, to have health insurance coverage.
  Senator McConnell and the Republicans want to repeal the protection 
for families who have children with a preexisting condition. That is 
fact. It is not as though they are offering exclusions and saying: No, 
no, we will keep that. They eliminate the entire law with this 3-page 
amendment. They eliminate the protections.
  How about protections for those who get diagnosed with a serious 
illness and health insurance companies cutting them off completely, 
putting a cap on the amount of money they will spend to provide for 
medical services and treatment, saying at some point they are going to 
eliminate their policies altogether because they failed to make a 
disclosure on the application form? It happens too often.
  In my State, we sadly lead the Nation in what is called rescissions--
health care insurance companies that cancel coverage when people get 
seriously ill. How would you like to be in that predicament? How would 
you like to face a serious illness that keeps you awake at night 
tossing and turning about whether you are going to live or die and then 
fight the insurance company in daylight hours in the hopes they will 
cover the prescriptions and treatment you need to stay alive?
  That is a reality addressed by the Health Care Act, a reality that 
will be repealed by Senator McConnell and the Republicans' efforts 
today. Those are the real results of what they want to do. It is not 
about who wins the political debate and has the largest cheering 
section when it is over. It is about real life changes.
  How about senior citizens under Medicare? Many of them struggle to 
pay for prescription drugs. Even with the Medicare prescription drug 
plan there is a gap in coverage called the doughnut hole. We start to 
close that gap and say to seniors: If you have expensive prescription 
drugs, we are going to make sure ultimately they are covered completely 
from the first of the year to the end of the year. Now there is a gap 
in the coverage.
  The Republicans and Senator McConnell want to repeal that provision 
of the Health Care Act which provides for seniors not only more 
coverage for their prescription drugs, but also an opportunity for an 
annual physical and the kind of preventive care they need to stay 
healthy, strong, and independent in their homes for a longer period of 
time. That is what Senator McConnell and the Republican Senators want 
to do with the repeal of this law.
  What about job creation? The Senator from Mississippi talked about 
one company cutting some employees. I am not sure of the particulars in 
that company, but one of the things we did in this law was to take a 
look at tax subsidies to medical device and pharmaceutical companies, 
if they were duplicative or overly generous, to make sure they got 
closer to a reality of what a company needs in incentives to grow. It 
is true some of those tax subsidies were eliminated and some of the 
companies were not happy about it. The bottom line is we were trying to 
make sure that health care is affordable. We cannot afford to provide 
massive subsidies to profitable companies on an unlimited basis.
  This bill the Republicans want to repeal will crack down on fraud in 
Medicare and Medicaid. It will simplify paperwork for private insurers, 
it invests in prevention, it creates a pathway for generic biologic 
drugs, and tests new ways to pay health care providers to reward value 
rather than volume.
  If the law is repealed, we will have fewer jobs and higher costs for 
families and businesses. The No. 1 complaint of Illinois small 
businesses across our State is the cost of health insurance. If the 
Republicans have their way and repeal this law we passed, the cost of 
health insurance will grow, the cost to businesses will grow, the 
number of employees will shrink.
  A 1-percent or 1.5-percent growth in health care costs above the 
rates under the new law will prevent employers from creating 2.5 to 4 
million jobs over the next 10 years. Talk about a job destroyer.
  The Republican repeal amendment does just that. Repeal means going 
back to the same broken system we have had for so long with insurance 
companies once again free to overcharge families and businesses to 
protect their corporate profits and CEO bonuses; the same broken system 
with workers seeing their paychecks shrink as more and more of their 
hard-earned wages are deducted to cover skyrocketing premiums; the same 
broken system with seniors being forced to shoulder the full cost of 
prescription drugs in the doughnut hole; and the same broken system 
with small businesses closing their doors and laying off workers 
because they cannot afford the crushing cost of health insurance.
  The Republican claim that this health care bill is a job killer is 
just plain false. The economy has been gaining private sector jobs 
since President Obama signed the bill a year ago after losing jobs for 
a long period of time before. Since the President signed the bill, we 
have created more than 1.1 million private sector jobs. By contrast, in 
the 10 years before health reform was enacted, we lost 3.3 million 
private sector jobs.
  Average real incomes for Americans are back on the rise after years 
of being stalled under the old health care system. Just this week, the 
Commerce Department reported that average real disposable income has 
risen 1.3 percent over the past year, after falling one-tenth of 1 
percent in each of the previous 2 years.
  I will close by saying that our hearing today before the Senate 
Judiciary

[[Page S468]]

Committee on the constitutionality question makes it clear to me that 
the Supreme Court, if it follows the clear precedents that have been 
handed down for decades, if Supreme Court Justices who have spoken 
eloquently and directly on the commerce clause will view this Health 
Care Act in the same context, they will find it constitutional. Then 
perhaps we can move on. Perhaps at that point the Republicans will stop 
beating this drum on repealing health care, will join us in making it 
an even stronger bill, and will focus on creating jobs instead of 
killing jobs as this McConnell amendment would do.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. KIRK. Madam President, I wish to talk about two topics today, 
first on this health care bill and then on the situation in Egypt.
  I rise today in support of the amendment to repeal the health care 
law. We made a mistake last year in passing this law, and a large 
majority of American people know it. In the face of the largest debt in 
our history, it was the height of folly to create a new spending 
program, offering subsidized health care to 30 million Americans. It is 
a promise we cannot afford to keep and one that our lenders may force 
us to retract.
  Before losing our credit rating or suffering the humiliation of 
foreign lenders denying us new loans, we should take the decisive 
action now to end this entitlement. Congress should replace this 
mistaken law with bipartisan reforms that prohibit the government from 
overriding the decisions you make with your doctor, that defend your 
right to buy insurance from any State in the Union, and to make lawsuit 
reforms to lower the costs of defensive medicine.
  The failed health care law now ruled as unconstitutional by two 
Federal courts uses the commerce clause of the Constitution to create 
an unlimited government that could require Americans to buy what they 
do not want. The very heart of the Constitution was the creation of a 
limited government that could only accomplish its defined missions, 
leaving all else to the people and to the States.
  These courts are right, the law is unconstitutional. It spends over 
$2.6 trillion, it hurts small businesses, it cuts senior health care 
under Medicare, and levies billions in new taxes against our economy in 
the teeth of the great recession.
  Recently, I visited Decatur Memorial Hospital in Decatur, IL. Their 
president, Ken Smithmier, warned me that the Medicare cuts required by 
the new health care law would cut $10 million annually from their 
hospital, resulting in the loss of over 200 jobs. Decatur is not alone 
in its troubles. In nearly half of my State's counties, hospitals are 
among the top three employers. They are the backbone of our local 
economies, and their employment would be greatly harmed by this health 
care law.
  We made a promise to seniors who depend on Medicare that we would 
take care of them. This law cuts Medicare and hurts them. We should 
honor, instead, our promises to defend the Nation, to support seniors 
on Social Security and who depend on Medicare before making an 
extravagant promise that is irresponsible and cannot be kept under the 
health care law.


                                 Egypt

  Madam President, I also wish to take this time to speak on an 
entirely different subject, which is what is going on in Egypt.
  I entitle this discussion ``The Muslim Brotherhood: Its Leaders in 
Their Own Words.''
  Will Egypt follow Poland or Georgia to foster a new democratic 
government or will it follow Iran's revolution, converting Egypt into a 
state sponsor of terror?
  While U.S. policy should support human rights and democracy, we face 
the risk that the Muslim Brotherhood, the al-Ikhwan al-Muslimun, could 
seize power. Who is part of the brotherhood and what are its political 
objectives?
  A detailed study shows why these questions should command the 
attention of the Congress and the President. With so much at stake in 
the Middle East, Americans must be clear-eyed about the Muslim 
Brotherhood and its radical Islamic agenda with a pledge of jihad 
against the West and the State of Israel.
  The Muslim Brotherhood is the largest Islamist movement in the Middle 
East and is widely described as the most organized political force in 
Egypt. Its membership is estimated at over 600,000.
  Although it claims to be nonviolent, this conservative organization, 
the Muslim Brotherhood, has profoundly influenced Islamic terrorist 
organizations such as al-Qaida, Islamic Jihad, and Hamas. One of its 
disciples was the prominent Islamist theologian Sayyid Qutb who 
provided the intellectual underpinnings of al-Qaida. Ayman al-Zawahiri, 
al-Qaida's second in command, was once a member of Egypt's Muslim 
Brotherhood.
  As recently as 2004, the organization's motto was as follows:

     Allah is our objective.
     The Prophet is our leader.
     Qur'an is our law.
     Jihad is our way.
     Dying in the way of Allah is our highest hope.

  The Muslim Brotherhood was founded in 1928 by Hassan al-Banna. Banna 
is famously quoted as saying that ``it is the nature of Islam to 
dominate, not to be dominated, to impose its law in all nations and to 
extend its power to the entire planet.''
  The Muslim Brotherhood has a violent history. Back in 1946, the U.S. 
Army issued an intelligence report stating that the Muslim Brotherhood 
``maintains commando units and secret caches of arms.''
  Throughout the 1940s, the paramilitary branch of the movement carried 
out targeted bombings and assassinations. In 1948, the Muslim 
Brotherhood was implicated in the murder of Egyptian Prime Minister 
Mahmoud Naqrashi. In 1954, the group allegedly tried to assassinate 
then-Prime Minister Gamal Abdel Nasser. The government banned the 
brotherhood as a political party that very same year.

  The Muslim Brotherhood went underground only to resurface during the 
1980s. It claimed to disavow violence and attempted to win political 
power as a religious and social organization. It was increasingly 
successful with allied candidates, winning 17 seats in the Parliament 
in 2000 and then a stunning 88 seats, or 20 percent of Egypt's 
Parliament, in 2005.
  The Muslim Brotherhood is not a monolithic organization, but it does 
maintain a leadership structure and a core set of beliefs. Its leader 
is called the general guide. He has several deputy guides. Below them 
is a guidance council, comprised of 15 to 16 senior leaders as well as 
a broader body, the Shura, comprised of roughly 100 members.
  Mohammed Badi was elected as the eighth general guide of the Muslim 
Brotherhood in January of 2010. As noted by the U.S. Government's Open 
Source Center, Badi is ``influenced by the writings of famous Muslim 
Brotherhood idealogue Sayyid Qutb, and is known for his conservative 
views.''
  In an April interview in 2010, Mr. Badi said:

       We will continue to raise the banner of Jihad and the Koran 
     in our confrontation with the enemy of Islam. The Muslim 
     Brotherhood still considers the Zionists to be its main and 
     only enemy. The Jews who occupy Palestine have their eyes set 
     on Egypt.

  Two days ago, a leading member of the Muslim Brotherhood, Muhammed 
Ghannem, reportedly told Al-Alam Iranian news network that he ``would 
like to see the Egyptian people prepare for a war against Israel,'' 
adding that the world should understand ``the Egyptian people are 
prepared for anything to get rid of this regime.'' He went on to say 
that the Suez Canal should be ``closed immediately'' and that the flow 
of gas from Egypt to Israel should cease ``in order to bring about the 
downfall of the Mubarak regime.''
  In 2007, the Muslim Brotherhood released a political platform which 
contained a number of indications on how this organization would govern 
Egypt if it came to power. According to the Congressional Research 
Service, the platform called for ``the establishment of a board of 
religious scholars with whom the President and the legislature would 
have to consult before passing laws.''
  As noted by Mohamed Elmenshawy--the editor-in-chief of Taqrir 
Washington and Arab Insight:

       Reminiscent of Iran's Guardian Council, this 
     undemocratically selected body could have the power vested by 
     the state to veto

[[Page S469]]

     any and all legislation passed by the Egyptian parliament and 
     approved by the president that is not compatible with Islamic 
     Shari'a law.

  The same document raises the important question of the Muslim 
Brotherhood's commitment to a pluralistic society. Despite pledges to 
treat minorities and women as equals, the platform allows neither to 
hold high public office. As stated in the platform: ``Nonmuslims are 
excused from holding this mission.'' For women, the post of President 
or Prime Minister would ``contradict her nature, social and other 
humanitarian roles.'' The draft also cautions against ``burdening women 
with the duties against their nature or role in the family.''
  The people of Egypt and apparently its army are mandating the fall of 
the Mubarak regime. While we support human rights and democracy, we 
must heed the growing warnings about the Muslim Brotherhood, their 
leaders, and plans for taking Egypt all the way back to the 13th 
century. We, as Americans, have seen this movie before--in Iran, in 
Lebanon, and in Gaza.
  To prevent a strategic reversal on the scale of what happened in 
Iran, the United States and her allies should do all they can to 
support Egypt's armies and secular leaders, ensuring no future for the 
Muslim Brotherhood. Egypt, locked under Shari'a law and oppressing 
women, Christians, and Jews, would be a catastrophic setback for 
progress in the Middle East. Such a state could renounce the Camp David 
peace accords or even start yet another war with Israel.
  Decisive action and influence now will benefit the national security 
and economy of the United States later. The defeat of the Muslim 
Brotherhood and victory for Egyptian secular nationalists would be the 
best way to avoid war and restore economic confidence in the Middle 
East and the wider world.
  Mr. ENZI. Madam President, I rise to urge my colleagues to vote to 
repeal the new health care law. Repeal is the only way we can prevent 
the job losses, insurance premiums increases and devastating Medicare 
cuts that are a direct consequence of the new health care law.
  We are just now beginning to see many of the consequences resulting 
from this poorly conceived, hurriedly drafted 2,700 page law. Rather 
than taking the time to get it right, the majority rushed to enact this 
new law, despite the many warning signs pointing out serious flaws in 
the new law.
  These consequences are a result of the majority willfully ignoring 
those who criticized their proposals and deciding that folks in 
Washington knew what was best for small businesses and families across 
the country.
  One example of this kind of unintended but easily predicted 
consequence is the impact on child only health plans. Last week, my 
staff conducted a survey, and found that the new law and the 
regulations implementing it have caused many health insurers to stop 
selling child only plans.
  As a direct result of the new law, insurance plans in 34 States have 
stopped offering child-only plans, and parents in at least 20 states 
are no longer able to purchase any child only plans. This is a 
devastating problem for parents who need to buy health insurance plans 
for their children.
  Many parents need to buy child only plans for their children, because 
their jobs provide insurance for them but not for family members. 
Before the new law took effect, these parents could buy child only 
policies for their kids. Unfortunately, because of the new law, parents 
in 20 States no longer have this option.
  For other parents the cost of getting a family plan is too expensive, 
and their family budget can only afford to buy health insurance for 
their kids. Again, because of the new law these parents in 20 States no 
longer have the ability to buy health insurance for their children.
  I recently got a letter from a disabled Veteran in Wyoming. He wrote 
to tell me that because of the new law, he can't get health insurance 
for his kids. He gets his health care from the VA so he doesn't need a 
family policy. He needs a policy for his two kids. Because of how the 
law was drafted and then implemented, this veteran now cannot get 
health insurance for his children.
  I discussed this issue with Secretary Sebelius at a hearing last week 
in the HELP Committee and her reply was that kids can enroll in SCHIP 
or the new high-risk pools. In fact, the veteran in Wyoming doesn't 
qualify for either. While some low income kids are eligible for public 
programs like SCHIP or Medicaid and some sick kids are eligible for 
high-risk pools, many children are ineligible for any of these plans, 
and will now go without insurance as a result of the new law.
  Another unintended but easily predicted consequence of the new law is 
how the new law is undermining the economy and the preventing the 
creation of new jobs. During that same HELP Committee hearing, we also 
heard the testimony of Mr. Joe Olivo, who owns a small printing company 
in Moorestown, NJ.
  Mr. Olivo told us how the new law will actually restrict his ability 
to expand his business and hire new workers. While he currently has 46 
employees, he will do everything he can to not hire 5 more people, in 
order to avoid the new law's mandate to offer health insurance to his 
employees or pay a new tax. Small businesses across the country are 
being forced to make similar decisions, in order to avoid the $52 
billion in new taxes that the new law attempts to place on employers.
  A study by the National Federation of Independent Business estimates 
that the employer mandate will eliminate 1.6 million jobs at a time 
when over 15 million Americans are searching for new jobs, most of 
which are small businesses.
  We need to be encouraging our businesses to grow, not discouraging 
them. Over the last 2 years our economy has lost almost 3 million jobs. 
Unfortunately, the health reform law makes a bad employment situation 
even worse.
  Another consequence of the new health care law will be to increase 
the health insurance premiums paid by millions of Americans. During the 
health care debate, GOP Senators highlighted how the new health care 
law will cause millions of Americans to pay higher health insurance 
premiums.
  In November of 2009, the Congressional Budget Office estimated that 
the new law will increase health insurance premiums by 10 to 13 
percent. This means families purchasing coverage on their own will have 
to pay $2,100 a year more because of the new law.
  The Joint Committee on Taxation estimates that many of the new taxes 
included in the health care reform law will be passed on directly to 
consumers. This means that each of these new taxes, including the $60 
billion tax on health plans, the $20 billion tax on medical devices, 
and the $27 billion tax on prescription drugs, will further increase 
premiums for Americans.
  In addition to CBO and JCT, six additional private actuarial analyses 
published by Oliver Wyman, PriceWaterhouseCoopers, the Hay Group, 
Milliman, Wellpoint and Lewin have all shown that the new law could 
increase premiums, with increases ranging as high as 60 percent.
  Additional studies by Milliman determined that because Medicaid pays 
doctors and hospitals below costs, these providers must increase their 
costs to everyone else, thereby costing the average American family an 
extra $1,700 per year. Forcing 16 million more people on to Medicaid 
will further increase insurance premiums for many Americans, as 
providers try to shift the costs resulting from inadequate Medicaid 
reimbursements
  The estimates of the law increasing insurance premiums are already 
being born out in the market. I heard from a small business owner in 
Saratoga, WY, whose health insurance premiums are going up by 30 
percent.
  A 30-percent increase in health insurance premiums could tip him over 
the edge of staying in business or closing his doors. He wrote to me to 
tell me that he is considering closing the doors of his construction 
company because he is having trouble making ends meet; he urged me to 
repeal the new health care law.
  Blue Shield of California--a nonprofit health insurer--recently filed 
a 59-percent premium increase for some of their individual market plans 
and said that at least a portion of its increase was a direct result of 
the new law. They estimate premiums will increase by 4 percent to 
comply with the new mandated benefit.

[[Page S470]]

  Another unintended yet easily predicted consequence is the impact of 
cutting $500 billion from the Medicare Program. You can't cut a program 
by a $\1/2\ trillion and not expect to see decreases in covered 
benefits or access to providers.
  Republicans understand how important Medicare is to nearly 46 million 
seniors and disabled Americans. We want to protect and strengthen it. 
We all know Medicare faces tremendous challenges in the near future.
  Yet the law cuts over $500 billion from Medicare, not to strengthen 
Medicare, but to fund new entitlement spending. More importantly, the 
new law fails to address even the most basic problems with the Medicare 
Program, such as the broken physician payment formula.
  I have already heard from seniors in Wyoming about how the new law is 
hurting them. A lady from Thermopolis, WY, wrote to tell me that she 
got a letter from her Medicare Advantage plan saying her premiums were 
drastically increasing because of the changes made in the new law.
  She wrote say ``unfortunately, my former policy was $0. The ones 
available now--even the most expensive one--have fewer benefits than 
what I was getting for free before ObamaCare took so much money from 
Part C. For instance, $45 for a specialist instead of $35; $10 for a 
generic drug instead of $6; and up to $350 for tests, when the old 
policy had a flat rate of $16 for tests. I can't afford the premiums on 
my Social Security and am considering dropping Part B, which would save 
me $97 per month.''
  These are real life examples of the impact this new law is having on 
everyday Americans. I get letters every day from my constituents asking 
me to repeal this new health care law that is limiting their freedoms 
and emptying their pocketbooks. The Senate will soon vote on whether or 
not to repeal the new health care law. I urge my colleagues to listen 
to their constituents and vote in favor of repeal.
  Madam President, we need to pursue a step by step, bipartisan, 
approach to health reform that will reduce costs, expand coverage and 
allow our economy to expand. Using that process will allow us to 
thereby avoid the unintended consequences of this deeply flawed new 
law.
  Mr. LEAHY. Madam President, the 112th Congress began just 1 month 
ago, with both sides of the political aisle voicing a renewed 
commitment to cooperation. It is not hard to understand why I am 
disappointed that at the first opportunity, Senate Republicans have 
chosen to manipulate the open amendment process. The Senate minority is 
demanding a vote on an amendment to repeal the health care reform law 
in its entirety--an issue totally unrelated to the bill we are 
considering, the FAA Transportation Modernization Safety Improvement 
Act, which creates jobs, makes airline travel safer and more efficient, 
and offers consumers a `passenger bill of rights.'
  The Senate's vote today follows the carefully staged show vote a few 
weeks ago by the new Republican majority in the House of 
Representatives. The American people have the right to know what a vote 
to repeal the Affordable Care Act really means. Repeal of this law 
would take away the rights of millions of patients and would eliminate 
insurance coverage for millions more, from the aging and elderly, to 
men and women with preexisting conditions, to the most vulnerable 
children.
  When you boil away the rhetoric, the only alternative offered to the 
American people by advocates of repeal is: Don't get sick.
  This amendment would turn back the clock to a time when, once again, 
women would have to pay more for health insurance than men, insurance 
companies could rescind a health insurance policy because someone gets 
sick, and coverage could forever be denied to someone born with a 
disease or ailment. In Vermont, repeal would mean nearly 2,000 young 
adults would no longer have coverage through their parents' insurance 
plans, more than 5,000 Vermont seniors would see an increase in the 
price of their prescriptions, and 350,000 Vermonters with private 
insurance could have lifetime limits slapped on how much insurance 
companies will spend on their health care.
  Some in Congress want to drain federal spending on domestic programs 
while looking the other way in supporting a repeal amendment that will 
accelerate the health cost spiral and add to our ballooning deficit. 
The nonpartisan Congressional Budget Office estimates that repeal of 
the Affordable Care Act would boost the federal debt and deficits by 
$230 billion. The economic turmoil would reach beyond the overall costs 
of repeal by removing vital antifraud provisions I have long advocated 
that have helped the Obama administration recover billions of taxpayer 
dollars. Repealing the Affordable Care Act would remove these fiscal 
safeguards and reopen the floodgates to insurance discrimination, by 
putting insurance companies back in charge.
  Opponents of the Affordable Care Act have gone to new lengths to 
repeat and prolong this political battle. Not only do they want to 
replay a 2-year long debate on a law that was enacted by a decisive 
majority, but some opponents are also replaying the debate in the 
courts. These political opponents seek to achieve in the courts what 
they could not in Congress. They want judges to override legislative 
decisions properly assigned by the Constitution to Congress, the 
elected representatives of the American people.
  Today, the Judiciary Committee held a hearing on the 
constitutionality of the historic Affordable Care Act. A dozen federal 
courts have dismissed challenges to the law. Another four courts have 
heard arguments about its constitutionality; two have upheld the law as 
constitutional, and two have not. Legal challenges to the law are 
expected to reach the U.S. Supreme Court.
  As I concluded during the debate on the Affordable Care Act, I have 
no doubt that Congress acted well within the bounds of its 
constitutional authority in working to secure affordable health care 
for all Americans through this plan that is based on the long 
established health insurance marketplace. The testimony we heard today 
from constitutional scholars makes clear that the language and spirit 
of the Constitution provides for such a response to a clearly 
established national need, as do judicial precedent and prior acts of 
Congress that also protect hardworking Americans in the national health 
care market and promote the general welfare.
  The Senate should not be spending its valuable time relitigating a 
law that has already helped millions of Americans and will help 
millions more as the law is fully implemented. The American people 
rightly expect us to work together and make progress on so many 
challenges that we face today.
  I will not support a return to less protection, less coverage, less 
fairness and higher costs. The Affordable Care Act extended health 
insurance to millions of families in Vermont and across the country. 
Those who represent the American people in Congress should stand ready 
to get to work for their constituents. This is not a time to cobble 
back together a broken system that has burdened most American 
households with health coverage uncertainty and crippling costs.
  Mr. LEVIN. Madam President, we are here today, holding this debate, 
preparing for this vote, because our Republican friends believe a 
collection of myths. Some of them say they want to repeal a law that 
amounts to a ``government takeover'' of health care. Some of them say 
they want to repeal a bill that violates the Constitution. They say 
they want to repeal a law that will cut the benefits on which Medicare 
recipients depend. Others say they want to repeal a bill that will 
explode the deficit, or that they want to repeal the law because it 
will kill jobs.
  If such a law existed, I would want to repeal it too. Thankfully, the 
law Republicans describe is a fiction.
  The Affordable Care Act, the law Republicans want us to repeal, does 
not take over the health care system; it strengthens and protects our 
existing private health insurance system. The independent fact checkers 
at Politifact.com found that the law ``is, at its heart, a system that 
relies on private companies and the free market,'' and called the claim 
that government would take over the system Politifact's ``Lie of the 
Year.''
  This bill does not violate the Constitution. Opponents claim that the 
individual mandate included in this bill

[[Page S471]]

violates the Constitution because it requires citizens to purchase 
insurance; under their arguments, many other programs, including 
Medicare, would violate the Constitution. Perhaps that is what these 
opponents believe, but it is emphatically not what most Americans 
believe, and it is contrary to decades of legal precedent.
  This law does not reduce care for Medicare beneficiaries. In fact, 
most Medicare recipients already enjoy expanded benefits under the 
Affordable Care Act. As a result of this law, Medicare beneficiaries 
now receive preventive care such as annual check-ups with no out-of-
pocket costs, and starting last year this law began to shrink the 
``donut hole'' that hits so many seniors with significant drug costs. 
The law strengthens Medicare by beginning to rein in the enormous costs 
that threaten to swamp the system in coming years, and it does so by 
encouraging efficiency and reducing waste and abuse, not by cutting 
benefits.
  The Affordable Care Act does not explode the deficit. The 
independent, nonpartisan Congressional Budget Office has found that 
repeal of the Affordable Care Act would increase the deficit by $143 
billion over the first decade, and by significantly more in the years 
to follow. It is ironic in the extreme that Senators who describe the 
2010 election as a mandate to reduce the deficit could now try to add 
$143 billion to that deficit as their first major action of the new 
Congress by repealing the Affordable Care Act.
  This law does not kill jobs. Again, independent observers have 
dismissed this claim as patently false. The independent FactCheck.org 
called the claim ``exaggerated and misleading'' and that Republicans 
have ``badly misrepresented'' findings by the Congressional Budget 
Office in making their arguments.
  We should leave the realm of myth and discuss what the Affordable 
Care Act does, in fact, do.
  This law protects Americans from abuses by insurance companies, such 
as denial of coverage for preexisting conditions or gender. It allows 
parents to keep children covered under their insurance plan until age 
26. It requires that coverage include preventive care at no out-of-
pocket cost. It limits the unilateral power of insurance companies to 
arbitrarily impose annual or lifetime coverage limits. Those arbitrary 
limits have forced families to choose between foregoing much-needed 
care and bankruptcy. Families will be protected from unexplained 
premium increases, and they will get clear, easy-to-read summaries of 
their options. Small businesses will receive tax credits to help them 
provide affordable insurance coverage to their workers. And insurance 
companies will be prevented from rescinding coverage when patients need 
it most, when they get sick.
  This law is not a government takeover of health care. It is sensible, 
moderate reform that in the coming years will make health insurance 
more affordable and secure for those who have it today, and make 
affordable coverage available for millions of Americans who are now 
without it. It will reduce the deficit, protect the Medicare benefits 
that seniors depend on now and in the future, and help ensure that 
families can afford the insurance coverage they need. It is unfortunate 
that so many of our colleagues subscribe to the mythical notions about 
this law. But here, in the real world, we need to preserve and protect 
the Affordable Care Act.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader.
  Mr. REID. Madam President, I ask unanimous consent that at 5:15 p.m. 
today, the Senate proceed to votes in relation to the following 
amendments to S. 223, the FAA authorization bill, in the order listed 
below:
  Levin amendment relative to repeal of 1099, the text of which is at 
the desk; the Stabenow amendment No. 9, repeal of 1099; and the 
McConnell amendment No. 13, which is the repeal of health care reform; 
that no other amendments, points of order or motions be in order to 
these amendments prior to the votes, except that a budget point of 
order, if applicable, remain in order to each of these amendments, and 
if one is raised, a motion to waive the budget point of order be in 
order; that if the motion to waive is agreed to, the amendment be 
considered agreed to; and the Senate then proceed to vote in relation 
to the next amendment in the sequence; further, that the Levin 
amendment be subject to a 60-vote threshold for its adoption and if it 
fails to achieve 60 affirmative votes, the amendment be withdrawn.
  Finally, that there be 2 minutes of debate, equally divided, prior to 
each vote; and that all votes after the first vote be limited to 10 
minutes each.
  The PRESIDING OFFICER. Is there objection? Without objection, it is 
so ordered.
  Mr. KIRK. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. LEVIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Amendment No. 28

  Mr. LEVIN. Madam President, there is, I believe, overwhelming 
bipartisan support for repeal of the recent changes to the 1099 
reporting requirement. Small businesses in my State and across the 
country have told us that the new reporting requirements they face 
under the Affordable Care Act will create an unnecessary burden that 
can make already tough times even tougher.
  I believe there may even be a consensus among our colleagues that we 
should act, but I strongly oppose one of the methods proposed to 
address this problem. That method would undermine Congress's role in 
the constitutional scheme of separation of powers among the branches of 
government and it would abdicate Congress's responsibility to decide on 
the spending of taxpayer dollars. We can and we should remove the 1099 
burden on small businesses. We can and we should do so without 
abandoning our role in determining Federal spending. The power of the 
purse should not be handed to the President, any President. The 
challenge we face is that repealing the section 1099 provision carries 
a cost of about $22 billion over 10 years. The mechanism that some 
support to meet that cost would empower the Director of the Office of 
Management and Budget to decide by himself which funds we have 
appropriated but that have not yet been obligated--which of those 
unobligated funds should be cut to pay the cost of repeal.

  To some this may be a convenient way to relieve Congress of its 
responsibility to make difficult choices. To others it may be a 
convenient way to shift the blame for the painful impact of any cuts 
from Congress onto the President. But what is convenient is not always 
right. The Constitution places in our hands and ours alone the 
authority to appropriate funds. We cannot statutorily pass that buck, 
and we should not.
  The Framers of the Constitution consciously and deliberately placed 
the power of the purse in the hands of the Congress. James Madison 
described this authority as, ``the most complete and effectual weapon 
with which any Constitution can arm the immediate representatives of 
the people.''
  We do not know what programs the Director of OMB will decide to 
reduce under the approach that some have proposed, but I do know that 
what they are proposing is that this would be his decision and his 
decision alone. What are some areas the OMB Director could unilaterally 
cut? What is the universe of the potential cuts? Do we care? We surely 
should, because the implications for our constituents will be 
significant.
  Disaster Relief Enhancement Funds were set aside to help States 
affected by natural disasters in 2008. According to the Appropriations 
Committee, 13 States received such funding and they all have 
unobligated balances. Would the Senators from those States turn over to 
the OMB Director the decision whether to eliminate the unobligated 
balances affecting their States? I would not. But that is what could 
happen under the proposal that is going to be considered here later.
  The Appropriations Committee tells us that the EPA has $624 million 
in unobligated balances in the Clean Water State Revolving Fund and 
$343 million in the Drinking Water State Revolving Fund. In addition, 
there is $388 million unobligated in specific State sewer programs 
approved by Congress. The two

[[Page S472]]

State revolving funds, $967 total, include projects in all 50 of our 
States. So there is a $1.3 billion target that could affect sewer and 
drinking water infrastructure in every one of our States. We 
appropriated those funds and if they are going to be cut, then we 
should do the cutting and not hand that power over to the executive 
branch, to the President's OMB Director.
  According to our Appropriations Committee, the Department of Justice 
had a total of $1.25 billion in unobligated funds as of November 30 
last year. It is probably lower now, but what is it? What programs are 
part of it? Do we know? Do we care? We surely should. Will the OMB 
Director decide to cut funding for U.S. Attorneys' investigations and 
prosecutions? What about U.S. Marshals, who provide security to our 
courthouses? Will the OMB Director decide to reduce funding for Project 
Gunrunner, which is focused on firearms enforcement along the Southwest 
border?
  NASA had a total unobligated balance of $155 million as of the end of 
January. About $10 million of that is for Constellation, the follow-on 
manned space vehicle to the shuttle.
  According to the Appropriations Committee, in recent years spending 
for the Women, Infants and Children Program, the WIC Program, has 
totaled more than $6 billion. Is the OMB Director going to decide to 
cut unobligated balances in the WIC Program? He could do so if we adopt 
the approach that is going to be before us after the vote on our 
amendment. I might agree to some of these cuts in a larger package but 
I would surely want to know what is in the whole package so we can 
adopt some priorities.
  I favor the repeal of the 1099 reporting requirement and I favor 
paying the cost of repeal, whether through spending reductions or 
closing tax loopholes. But I strongly oppose paying for the repeal by 
abdicating our power of the purse, the power we have under the 
Constitution. We cannot and we should not abdicate this to the 
executive branch to unilaterally make spending cuts to programs we have 
previously enacted.
  The provisions we are going to debate today but hopefully not adopt 
must also be understood in a larger context, one that foresees the 
difficult decisions ahead on how we will return to fiscal discipline. 
There are many, perhaps even some in this Chamber, who believe that we 
in the Senate and here in the Congress are incapable of making these 
decisions. They point out there are only two ways of lowering the 
deficit, reducing spending or increasing taxes, and that neither of 
these is popular with our constituents. They argue we will prove unable 
to muster the political courage to make decisions that we know will be 
unpopular, and there is some truth in those sentiments. Restoring 
fiscal balance will be painful and we are in the fiscal hole we are in 
because spending is popular and so are tax cuts, and we have provided 
plenty of both. It would certainly be easier for all of us if we could 
hand somebody else the authority to decide how to remedy the excesses 
of the past. But we cannot and should not run from this responsibility.
  Justice Kennedy once put it this way: ``Failure of political will 
does not justify unconstitutional remedies.'' He added: ``The 
Constitution is a compact, enduring for more than our time, and one 
Congress cannot yield up its own powers. . . . Abdication of 
responsibility,'' he said, ``is not part of the constitutional 
design.''
  We must not run from painful decisions. Difficult or not, only the 
Congress can decide how to pay for repeal of these reporting 
requirements. And difficult or not, only Congress can decide the larger 
issue of how to bring our spending in line with our revenues. If we 
cannot today exercise our responsibility on the finding of $22 billion 
to pay for the repeal of these reporting requirements, how can we 
expect to tackle the much larger budget deficit we face?
  There is an alternative amendment which we are offering today. I, 
along with Senator Inouye and others, am proposing today an amendment 
which will make specific decisions on spending cuts and revenue 
increases to account for the cost of repealing this provision. We would 
reform unjustified tax expenditures related to oil and gas production 
by large oil companies, companies that are enormously profitable with 
or without these tax expenditures. Our amendment will reform a loophole 
that provides tax credits to filers who pay taxes both in the United 
States and in foreign countries, and our amendment will eliminate some 
unintended loopholes used to avoid clearly intended rules on gift tax 
exemptions.
  If there are better alternatives than the ones we are proposing, 
fine. Let's consider them. But what we cannot support is the abdication 
of our responsibility to make these decisions. It was the will and the 
wisdom of the Framers of the Constitution to give us that 
responsibility and I urge our colleagues not to shrink from it but to 
exercise it.
  I will yield the floor but first I call up our amendment and ask for 
its consideration.
  The PRESIDING OFFICER (Mr. Whitehouse). The clerk will report.
  The legislative clerk read as follows:

       The Senator from Michigan [Mr. Levin], for himself, Mr. 
     Inouye, Mr. Leahy, Mr. Sanders, Mr. Rockefeller and Mrs. 
     Feinstein, proposes an amendment numbered 28.

  The amendment is as follows:

(Purpose: To repeal the expansion of information reporting requirements 
  under the Patient Protection and Affordable Care Act, and for other 
                               purposes)

       On page 335, after line 20, insert the following:

                    TITLE XI--ADDITIONAL PROVISIONS

     SEC. 1101. REPEAL OF EXPANSION OF INFORMATION REPORTING 
                   REQUIREMENTS.

       Section 9006 of the Patient Protection and Affordable Care 
     Act, and the amendments made thereby, are hereby repealed; 
     and the Internal Revenue Code of 1986 shall be applied as if 
     such section, and amendments, had never been enacted.

     SEC. 1102. DENIAL OF DEDUCTION FOR MAJOR INTEGRATED OIL 
                   COMPANIES FOR INCOME ATTRIBUTABLE TO DOMESTIC 
                   PRODUCTION OF OIL, GAS, OR PRIMARY PRODUCTS 
                   THEREOF.

       (a) In General.--Subparagraph (B) of section 199(c)(4) of 
     the Internal Revenue Code of 1986 is amended by striking 
     ``or'' at the end of clause (ii), by striking the period at 
     the end of clause (iii) and inserting ``, or'', and by 
     inserting after clause (iii) the following new clause:
       ``(iv) in the case of a taxpayer which is a major 
     integrated oil company (as defined in section 167(h)(5)(B)), 
     oil related qualified production activities (within the 
     meaning of subsection (d)(9)(B)).''.
       (b) Conforming Amendment.--Section 199(d)(9)(A) of the 
     Internal Revenue Code of 1986 is amended by inserting 
     ``(other than a major integrated oil company (as defined in 
     section 167(h)(5)(B))'' after ``taxpayer''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2010.

     SEC. 1103. MODIFICATIONS OF FOREIGN TAX CREDIT RULES 
                   APPLICABLE TO DUAL CAPACITY TAXPAYERS.

       (a) In General.--Section 901 of the Internal Revenue Code 
     of 1986 (relating to credit for taxes of foreign countries 
     and of possessions of the United States) is amended by 
     redesignating subsection (n) as subsection (o) and by 
     inserting after subsection (m) the following new subsection:
       ``(n) Special Rules Relating to Dual Capacity Taxpayers.--
       ``(1) General rule.--Notwithstanding any other provision of 
     this chapter, any amount paid or accrued by a dual capacity 
     taxpayer to a foreign country or possession of the United 
     States for any period with respect to combined foreign oil 
     and gas income (as defined in section 907(b)(1)) shall not be 
     considered a tax to the extent such amount exceeds the amount 
     (determined in accordance with regulations) which would have 
     been required to be paid if the taxpayer were not a dual 
     capacity taxpayer.
       ``(2) Dual capacity taxpayer.--For purposes of this 
     subsection, the term `dual capacity taxpayer' means, with 
     respect to any foreign country or possession of the United 
     States, a person who--
       ``(A) is subject to a levy of such country or possession, 
     and
       ``(B) receives (or will receive) directly or indirectly a 
     specific economic benefit (as determined in accordance with 
     regulations) from such country or possession.''.
       (b) Effective Date.--
       (1) In general.--The amendments made by this section shall 
     apply to taxes paid or accrued in taxable years beginning 
     after December 31, 2010.
       (2) Contrary treaty obligations upheld.--The amendments 
     made by this section shall not apply to the extent contrary 
     to any treaty obligation of the United States.

     SEC. 1104. RULES RELATING TO FOREIGN OIL AND GAS INCOME.

       (a) Separate Basket for Foreign Tax Credit.--Paragraph (1) 
     of section 904(d) of the Internal Revenue Code of 1986 is 
     amended by striking ``and'' at the end of subparagraph (A), 
     by striking the period at the end of subparagraph (B) and 
     inserting ``, and'', and by adding at the end the following:
       ``(C) combined foreign oil and gas income (as defined in 
     section 907(b)(1)).''
       (b) Coordination.--Section 904(d)(2) of the Internal 
     Revenue Code of 1986 is amended by redesignating 
     subparagraphs (J) and (K) as

[[Page S473]]

     subparagraphs (K) and (L) and by inserting after subparagraph 
     (I) the following:
       ``(J) Coordination with combined foreign oil and gas 
     income.--For purposes of this section, passive category 
     income and general category income shall not include combined 
     foreign oil and gas income (as defined in section 
     907(b)(1)).''
       (c) Conforming Amendments.--
       (1) Section 907(a) of the Internal Revenue Code of 1986 is 
     hereby repealed.
       (2) Section 907(c)(4) of such Code is hereby repealed.
       (3) Section 907(f) of such Code is hereby repealed.
       (d) Effective Dates.--
       (1) In general.--The amendments made by this section shall 
     apply to taxable years beginning after December 31, 2010.
       (2) Transitional rules.--
       (A) Carryovers.--Any unused foreign oil and gas taxes which 
     under section 907(f) of the Internal Revenue Code of 1986 (as 
     in effect before the amendment made by subsection (c)(3)) 
     would have been allowable as a carryover to the taxpayer's 
     first taxable year beginning after December 31, 2010 (without 
     regard to the limitation of paragraph (2) of such section 
     907(f) for first taxable year) shall be allowed as carryovers 
     under section 904(c) of such Code in the same manner as if 
     such taxes were unused taxes under such section 904(c) with 
     respect to foreign oil and gas extraction income.
       (B) Losses.--The amendment made by subsection (c)(2) shall 
     not apply to foreign oil and gas extraction losses arising in 
     taxable years beginning on or before the date of the 
     enactment of this Act.

     SEC. 1105. REQUIRED MINIMUM 10-YEAR TERM, ETC., FOR GRANTOR 
                   RETAINED ANNUITY TRUSTS.

       (a) In General.--Subsection (b) of section 2702 of the 
     Internal Revenue Code of 1986 is amended--
       (1) by redesignating paragraphs (1), (2), and (3) as 
     subparagraphs (A), (B), and (C), respectively, and by moving 
     such subparagraphs (as so redesignated) 2 ems to the right,
       (2) by striking ``For purposes of'' and inserting the 
     following:
       ``(1) In general.--For purposes of'',
       (3) by striking ``paragraph (1) or (2)'' in paragraph 
     (1)(C) (as so redesignated) and inserting ``subparagraph (A) 
     or (B)'', and
       (4) by adding at the end the following new paragraph:
       ``(2) Additional requirements with respect to grantor 
     retained annuities.--For purposes of subsection (a), in the 
     case of an interest described in paragraph (1)(A) (determined 
     without regard to this paragraph) which is retained by the 
     transferor, such interest shall be treated as described in 
     such paragraph only if--
       ``(A) the right to receive the fixed amounts referred to in 
     such paragraph is for a term of not less than 10 years,
       ``(B) such fixed amounts, when determined on an annual 
     basis, do not decrease relative to any prior year during the 
     first 10 years of the term referred to in subparagraph (A), 
     and
       ``(C) the remainder interest has a value greater than zero 
     determined as of the time of the transfer.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to transfers made after the date of the enactment 
     of this Act.

  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. INOUYE. Mr. President, I rise today in support of the Levin 
amendment, which I believe is a far superior alternate to the Stabenow 
amendment as it currently stands. The amendment offered today by 
Senator Stabenow proposes to rescind $44 billion from unobligated 
balances of appropriated funds that are designated for specific 
purposes in various appropriations bills previously enacted by 
Congress. The Senator offers these rescissions in order to offset the 
loss of revenues resulting from an amendment.
  This amendment is a perfect representation of what I expect to be a 
flood of similar amendments and stand-alone bills that seek to 
eviscerate the nondefense functions of the Federal Government. With the 
exception of the proposal from the junior Senator from Kentucky, which 
had the courage to list each and every cut he proposed, I expect many 
other bills and amendments will be blanket rescissions that leave it to 
the executive branch to decide how the taxpayers' moneys will be spent. 
These bills and amendments turn the constitutional separation of powers 
on its head and provide a terribly dangerous precedent.
  In the specific case of the Stabenow amendment, it simply provides 
for generic rescission of funds, with the authority and decisionmaking 
on the programs to be impacted delegated entirely to the executive 
branch. Rescinding funds in this manner, as pointed out by Senator 
Levin, may be politically convenient as it simply cites the top line 
number of $44 billion, but it is also thoughtless and rash. It will 
serve to shelter those who vote in its favor from the righteous anger 
of Americans whose lives are disrupted when important and, in some 
cases, vital projects and programs are shut down as they inevitably 
will be, should the amendment be agreed to.
  I can also promise that if this amendment is enacted into law, the 
force of these cuts will be felt in each of the 50 States, and the 
capricious nature of the cuts will only deepen the pain.
  I know that because we are in the middle of the second quarter of the 
fiscal year operating under a CR. Consequently, as I explained in 
November, the only unobligated balances remaining outside of those for 
operating under a CR in 2011 are those accounts that have slow spend 
rates, such as construction and infrastructure accounts. That is why it 
is taking $44 billion in rescissions to pay for a $19 billion problem. 
As a result, we will be cutting deeply into our nondefense 
discretionary programs without congressional guidance and without any 
analysis of the ultimate costs and impacts. This approach is simply 
irresponsible.
  While we cannot say with certainty what the cuts will be because the 
executive branch will have complete authority over what programs will 
be impacted, I believe the following cuts are likely: State and local 
law enforcement will face cuts of $200 million to $300 million in grant 
programs, including $82 million in Violence Against Women grants, $81 
million in Byrne and other Office of Justice grants, and $10 million in 
Juvenile Justice grants. Cutting these grant funds will take funding 
from programs already expected to be awarded, and will fall 
particularly hard on States with large problems with crime.
  A cut of $95 million from the DEA would mean halting efforts to go 
after and take down Mexican drug cartels, to enforce narcoterrorist 
investigations, and information sharing, and to address emerging 
technologies used by drug traffickers. The TSA stands to lose $674 
million of funds to procure and install over 200 explosive detecting 
systems at airports across the Nation.
  Finally, the U.S. Marshals would face a cut of $48.7 million, 
bringing an end to courthouse security equipment projects and also 
halting Marshals' operations in the Southwest border where they engage 
in activities such as tracking fugitives.
  Supporters of the Stabenow amendment would claim that I am using 
scare tactics, painting a dark picture when the real cuts are not as 
devastating.
  How can anyone stand here and claim we can cut $44 billion and not 
have it hurt our States and our constituents? This amount is equivalent 
to funding the entire Department of Homeland Security, which covers 
everything from the Coast Guard to FEMA, from the Secret Service to the 
Border Patrol.
  No one denies that waste, fraud, and abuse exist and that we need to 
continue to enact reforms that will lesson waste, convict those who 
would defraud the government, and eliminate abuses of programs that are 
designed to help those who need it most. But if this amendment is 
signed into law, then 60 days later we will all get a harsh reminder 
that campaigning against waste, fraud, and abuse is not the same thing 
as implementing a policy that cuts billions of dollars in useful 
spending. These rescissions will hurt individuals, they will hurt 
communities and jeopardize safety of life and our security.
  Let me also point out to my colleagues that if this amendment is 
enacted, we cannot stop rescissions of unobligated balances from a 
single account we may view as vital because the amendment gives sole 
decisionmaking power in identifying cuts to the executive branch.
  I will say this again. This amendment is not in the best interests of 
the Senate, it is not in the best interests of our democratic 
priorities, and it is certainly not in the best interests of the 
American people.
  If it is indeed the will of the Senate to eviscerate these critical 
programs, let's stop hiding behind generic rescissions. Let's instead 
support the Levin amendment, which offsets a revenue loss with a 
revenue gain, which eliminates unnecessary tax loopholes, and which 
will leave important national priorities intact.
  I yield the floor.
  The PRESIDING OFFICER. Under the previous order, there will be 2 
minutes of debate equally divided prior to

[[Page S474]]

a vote in relation to amendment No. 28, offered by the Senator from 
Michigan, Mr. Levin.
  Mr. LEVIN. Mr. President, I have just spoken on this. I ask unanimous 
consent that we be allowed to yield back the time on both sides.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LEVIN. Mr. President, 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 amendment.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Connecticut (Mr. 
Lieberman) and the Senator from Virginia (Mr. Warner) are necessarily 
absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 44, nays 54, as follows:

                       [Rollcall Vote No. 7 Leg.]

                                YEAS--44

     Akaka
     Baucus
     Bennet
     Blumenthal
     Boxer
     Brown (OH)
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Durbin
     Feinstein
     Franken
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson (SD)
     Kerry
     Klobuchar
     Kohl
     Lautenberg
     Leahy
     Levin
     Manchin
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (FL)
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Whitehouse
     Wyden

                                NAYS--54

     Alexander
     Ayotte
     Barrasso
     Begich
     Bingaman
     Blunt
     Boozman
     Brown (MA)
     Burr
     Chambliss
     Coats
     Coburn
     Cochran
     Collins
     Conrad
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Hatch
     Hoeven
     Hutchison
     Inhofe
     Isakson
     Johanns
     Johnson (WI)
     Kirk
     Kyl
     Landrieu
     Lee
     Lugar
     McCain
     McConnell
     Moran
     Murkowski
     Nelson (NE)
     Paul
     Portman
     Pryor
     Risch
     Roberts
     Rubio
     Sessions
     Shelby
     Snowe
     Thune
     Toomey
     Vitter
     Webb
     Wicker

                             NOT VOTING--2

     Lieberman
     Warner
  The PRESIDING OFFICER. On this vote, the yeas are 44, the nays are 
54. Under the previous order requiring 60 votes for the adoption of 
this amendment, the amendment is withdrawn.


                            Amendment No. 9

  The PRESIDING OFFICER. Under the previous order, there will now be 2 
minutes of debate, equally divided, prior to a vote in relation to 
amendment No. 9, offered by the Senator from Michigan, Ms. Stabenow.
  The Senator from Michigan.
  Ms. STABENOW. Mr. President, we all know that small business is the 
engine of the economy. This amendment will address a burdensome 
regulation we have all talked about. We need to repeal an unnecessary, 
burdensome provision in the law that would require 40 million 
businesses in America, most of them small businesses, to file 2,000 
percent more paperwork with the IRS. We have a chance to do something 
about that with this amendment.
  I wish to thank Senator Baucus and his staff for their work. I wish 
to thank Senator Johanns for his work and my colleagues who are 
cosponsoring this amendment. I also wish to thank the 11 business 
organizations supporting this, including the Chamber, the Farm Bureau, 
the Motor & Equipment Manufacturers Association, the National 
Association of Manufacturers, Realtors, NFIB, the Small Business & 
Entrepreneurship Council.
  This is an amendment that is fully paid for without raising taxes, 
while it protects our Nation's defense, our veterans, and our Social 
Security. So I would hope we would all join in supporting this effort 
to make a needed change that eliminates burdensome paperwork for our 
small businesses.
  The PRESIDING OFFICER. The Senator's time has expired.
  Who yields time in opposition?
  The Senator from Hawaii.
  Mr. INOUYE. Mr. President, I yield back my time. But I make a point 
of order that the pending amendment violates section 311 of S. Con. 
Res. 70, the concurrent resolution on the budget for fiscal year 2009.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974, the waiver provisions of applicable 
budget resolutions, 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 the purposes of the pending 
amendment, 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 bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Connecticut (Mr. 
Lieberman) and the Senator from Virginia (Mr. Warner) are necessarily 
absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 81, nays 17, as follows:

                       [Rollcall Vote No. 8 Leg.]

                                YEAS--81

     Alexander
     Ayotte
     Barrasso
     Baucus
     Begich
     Bennet
     Bingaman
     Blumenthal
     Blunt
     Boozman
     Boxer
     Brown (MA)
     Brown (OH)
     Burr
     Cantwell
     Cardin
     Casey
     Chambliss
     Coats
     Coburn
     Cochran
     Collins
     Conrad
     Coons
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Feinstein
     Graham
     Grassley
     Hagan
     Hatch
     Hoeven
     Hutchison
     Inhofe
     Isakson
     Johanns
     Johnson (SD)
     Johnson (WI)
     Kerry
     Kirk
     Klobuchar
     Kohl
     Kyl
     Landrieu
     Lee
     Lugar
     Manchin
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Moran
     Murkowski
     Nelson (NE)
     Nelson (FL)
     Paul
     Portman
     Pryor
     Risch
     Roberts
     Rockefeller
     Rubio
     Sessions
     Shaheen
     Shelby
     Snowe
     Stabenow
     Tester
     Thune
     Toomey
     Udall (CO)
     Udall (NM)
     Vitter
     Webb
     Wicker
     Wyden

                                NAYS--17

     Akaka
     Carper
     Durbin
     Franken
     Gillibrand
     Harkin
     Inouye
     Lautenberg
     Leahy
     Levin
     Mikulski
     Murray
     Reed
     Reid
     Sanders
     Schumer
     Whitehouse

                             NOT VOTING--2

     Lieberman
     Warner
  The PRESIDING OFFICER. On this vote, the yeas are 81, the nays are 
17. Three-fifths of the Senators duly chosen and sworn having voted in 
the affirmative, the motion is agreed to.
  The motion to waive having been agreed to, the amendment is agreed to 
under the previous order.


                            Amendment No. 13

  The PRESIDING OFFICER. Under the previous order, there will now be 2 
minutes of debate equally divided prior to a vote in relation to 
amendment No. 13 offered by the Republican leader.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. CONRAD. Mr. President, I rise to make a point of order that the 
pending amendment violates section 311 of S. Con. Res. 70, the 
concurrent resolution on the budget for fiscal year 2009.
  Mr. President, the amendment will significantly worsen the deficit--a 
fact confirmed by the CBO in a letter to Speaker Boehner on January 6. 
The CBO letter says clearly they estimate that enacting the health care 
law repeal would increase Federal deficits in the decade after 2019 by 
an amount that is in the broad range around one-half percent of GDP for 
that period. The GDP for that period is $293 trillion. Mr. President, 
one-half of 1 percent is an increase in the deficit and debt of this 
country of more than $1.4 trillion.
  We have heard colleagues on all sides say we have to get our deficits 
and debt under control. Yet one of the first measures is to explode the 
deficits and debt, add $1.4 trillion to the debt. That is not just 
irresponsible, it is reckless. I urge my colleagues to support the 
budget point of order.
  The PRESIDING OFFICER. The Republican leader is recognized.
  Mr. McCONNELL. Mr. President, only in Washington could you argue with 
a straight face that starting a new multitrillion-dollar entitlement 
program is going to save money. CBO could only look at the proposition 
that was presented to it, which frontloads tax increases in Medicare 
cuts and backloads benefits.

[[Page S475]]

  Therefore, 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.
  Mr. REID. Mr. President, we are going to have no more votes tonight. 
We have an amendment that Senator Whitehouse is waiting to offer, and 
there are a number of other FAA-related amendments. We hope to have a 
productive day tomorrow. In the near future, we hope to develop a 
finite list of amendments so we can conclude this bill.
  The PRESIDING OFFICER. Is there a sufficient second? There is a 
sufficient second.
  The question is on agreeing to the motion to waive. The yeas and nays 
have been ordered. The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Connecticut (Mr. 
Lieberman) and the Senator from Virginia (Mr. Warner) are necessarily 
absent.
  The PRESIDING OFFICER (Mr. Bennet). Are there any other Senators in 
the Chamber desiring to vote?
  The yeas and nays resulted--yeas 47, nays 51, as follows:

                       [Rollcall Vote No. 9 Leg.]

                                YEAS--47

     Alexander
     Ayotte
     Barrasso
     Blunt
     Boozman
     Brown (MA)
     Burr
     Chambliss
     Coats
     Coburn
     Cochran
     Collins
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Hatch
     Hoeven
     Hutchison
     Inhofe
     Isakson
     Johanns
     Johnson (WI)
     Kirk
     Kyl
     Lee
     Lugar
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Portman
     Risch
     Roberts
     Rubio
     Sessions
     Shelby
     Snowe
     Thune
     Toomey
     Vitter
     Wicker

                                NAYS--51

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

                             NOT VOTING--2

     Lieberman
     Warner
  The PRESIDING OFFICER. On this vote, the yeas are 47, the nays are 
51. Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  The motion to waive having been rejected, the point of order is 
sustained and the amendment falls.

                          ____________________