[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[Senate]
[Pages 27913-27918]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Mr. President, an unusual thing is about to happen 
here: an actual debate is about to break out on the floor of the Senate 
about health care. Sometimes we are talking past each other. My friends 
on the other side talk about jobs and small business, so let me start 
there.
  The difference between the Democratic proposals for health care and 
the Republicans is the Democrats start with a 2,000-page bill, more or 
less, with a government takeover, with more than $1 trillion in 
spending, with new taxes, higher premiums, and Medicare cuts, and we 
don't believe they can spend that much more money without increasing 
the debt--in other words, all going in the wrong direction.
  We believe we ought to be reducing costs step by step, and the 
Republican proposals say that step No. 1 should be small business 
health plans. They are saying they have an idea about small businesses, 
and we are saying the same thing.
  In my few minutes today, I would like to show why our proposals are 
better than theirs. For example, Senator Enzi of Wyoming, who was 
chairman and is now the ranking Republican member of the Health, 
Education, Labor, and Pensions Committee, has a small business health 
plan he has been trying to get this Senate to vote on for years. In 
fact, this plan came up before the Senate, and our Democratic friends 
blocked it. They like to say Republicans are the party of no; they are 
the party of no because on May 11, 2006, they voted no to small 
business health plans which would lower health care costs for thousands 
of employees in this country.
  Let me be specific about that and why it is superior to the 
suggestion that has been made in the Finance Committee bill, the 2,000-
page bill which has come out of the Senate Finance Committee. In the 
Enzi plan, the Republican plan, we would allow small businesses to come 
together and pool their resources. What that means is, if I have a 
small business with 50 people and you have one with 100 people and you 
have someone with open heart surgery, you cannot afford to keep paying 
for health insurance anymore because that one employee's health care 
costs make it impossible for you to do that or you have to lay people 
off or you have to reduce wages. That is what happens in the real 
world. What we are saying is, let's let small businesses come together, 
pool the resources, and offer insurance that way--spread the risk, in 
other words.
  What does the nonpartisan Congressional Budget Office say the effect 
of that proposal would be on small businesses and their health care 
costs?
  This is what the CBO said: No. 1, enacting the Republican proposal--
which we would hope would gain Democratic support--would extend more 
insurance to at least 750,000 Americans who are employees of small 
businesses. That is No. 1, more people insured.
  No. 2, it would lower the cost of insurance premiums, not raise them 
as this 2,000-page bill would--lower the cost of insurance premiums for 
three out of four employees.
  No. 3, it would reduce the cost of Medicaid, the government program 
for low-income Americans, by $1.4 billion.
  More people covered, lower premiums, and a lower cost--that is what 
they mean by bending the curve. So if that is the proposal, why do the 
Democrats not allow us to vote on it? You see, we believe these 2,000-
page bills with higher premiums and higher taxes, with Medicare cuts--
we have these bills all over the place. Senator Reid, the distinguished 
majority leader, has one in his office. He has been meeting secretly 
for weeks with people--we don't even know who--writing a bill which may 
emerge as early as today. Then when we get it, we will all have to read 
it. I am sure we will find more premiums, more taxes, more Medicare 
cuts, probably additions to the debt, probably more transfers of cost 
to State governments.
  We have Governors who are Democrats and Republicans saying: Please 
don't do that to us. We are in the worst condition we have been in 
since the Great Depression, and you are going to dump a lot of costs on 
us that we didn't volunteer to pay. We can't afford it. We have to 
balance our budgets.
  That is probably what is coming. What should we do instead? We said 
day after day on this floor that we should set a goal--reducing costs, 
the cost of premiums, the cost of health care to the government--and we 
should move step by step toward that goal.
  We said step No. 1 should be small business health insurance plans. 
Step No. 2 should be to allow competition for insurance across State 
lines. That would reduce costs. Step No. 3 would be to reduce junk 
lawsuits against doctors, which some States have done, and which 
everyone agrees drives up costs, encourages defensive medicine, and 
causes doctors to move out of rural areas so that pregnant women have 
to drive 60 or 80 miles to Memphis or halfway across Alaska to get 
their prenatal health care or check into hospitals for 3 weeks in a big 
city so when they have their baby they will have a doctor available. 
That is the effect of that.
  Then health insurance exchanges so you can shop for cheaper health 
care, then reducing waste, fraud, and abuse. The General Accounting 
Office has said $1 out of $10 in the Medicaid Program, which the 
Democratic proposals will expand, is wasted. It goes down the drain 
every year--$32 billion.
  If we really want to reform health care, why do we keep coming up 
with these 2,000-page bills and trillion-dollar costs and higher 
premiums and higher taxes and Medicare cuts and additions to the debt 
at a time when we have 10 percent unemployment? What is that going to 
do to small businesses? New taxes are going to create more jobs?
  We have the Finance Committee bill with $900 billion of new taxes 
over 10 years when fully implemented. That is not going to create new 
jobs. New taxes are passed on.
  If you run a business with 40 people or 100 people or 150 people, and 
you get a big new tax, what do you do? You layoff an employee, you 
reduce wages, you stop offering health care. You have to do that or you 
go out of business. That is what happens.
  We would like to see a debate. We think the way to reform health care 
is, instead of these 2,000-page bills, let's set a goal--reducing 
costs. Let's go step by step in that direction to re-earn the trust of 
the American people. Instead of talking in grand rhetoric about small 
businesses--they do have a plan embedded in the Finance Committee bill, 
but it is typically different from the plan we have proposed. Instead 
of allowing small businesses to pool their resources in the way I 
suggested so they, the small businesses, could be in control of their 
own health insurance, make decisions about it--no; the Democratic small 
business plan would not allow small businesses to pool their resources. 
It puts the government in charge of making decisions about what kind of 
insurance the small businesses could purchase. That is really a debate 
we ought to have.
  As President Obama, correctly said earlier this year, the health care 
debate is not just about health care. The health care debate, said the 
President--correctly, I would respectfully say--the health care debate 
is a proxy for the role of the Federal Government in American lives. So 
would this debate about how to help small businesses be the same.
  The PRESIDING OFFICER. The Senator has consumed 8 minutes.
  The Senator from Idaho is recognized.
  Mr. CRAPO. Mr. President, I would like to focus my remarks today on 
health care as many others have done. Actually, I am very glad to see 
the debate today was focused on small businesses and the impact of what 
we do on them.
  I am surprised, however, to see those who are discussing the current 
legislation that is before us are discussing it as something that will 
benefit small businesses and will help to drive down the cost curve 
because, as remarkable as it may seem, this legislation that both the 
House and the Senate have had under consideration--hopefully what we 
will now see in the near future as the final product that we will be 
able to review--will drive up the cost curve and increase the cost of 
health

[[Page 27914]]

care, not only for small businesses but for everybody in America.
  If we ask most Americans what they want in health care reform, they 
will tell us they want to stop the spiraling cost of health care 
insurance. Yet the legislation we see does exactly the opposite. Over 
the last few weeks I have come to this floor to discuss tax increases 
that were contained in the health care legislation passed by the Senate 
Finance Committee, both in terms of the big picture and, more 
specifically, in terms of what it means to middle-income Americans and 
to small businesses and to any American who wants to answer the 
question: How would this bill affect me and my family?
  We have already heard the answer to that question in a number of 
different contexts, but I think it bears repeating. Under the Senate 
Finance bill, if you have insurance, you get taxed. If you do not have 
insurance, you get taxed. If you don't want to purchase insurance, you 
get taxed. If you have a job, you get taxed. If you need medical 
devices, you get taxed. If you take prescription drugs, you get taxed. 
If you have high out-of-pocket medical expenses, you get taxed.
  The list goes on. The reason is this legislation will create new, 
brandnew massive entitlement programs to the tune of what we do not 
clearly know yet but which will almost certainly be in the neighborhood 
of $2 trillion. It pays for them--or offsets the cost of those on the 
Treasury--by increasing taxes on the American people by hundreds of 
billions of dollars and by cutting Medicare by hundreds of billions of 
dollars.
  We still do not have the ``merged'' Senate bill before us to review 
and debate, but we do have the House-passed bill to review. There have 
been a number of rumors and discussions in the media about what kind of 
new tax increases the Senate bill will have when it is finally 
disclosed. In fact, we hear we may find out, as a country--the people 
of America may find out tonight what this bill that has been negotiated 
and created behind closed doors actually contains. I would like to take 
a few minutes to review some of the provisions that we expect to be 
there.
  The House version of the health bill contains more than $752 billion 
of tax increases. Some of these tax increases are the same ones we have 
already seen in the Finance Committee bill, such as the medical device 
tax, the $2,500 cap on flexible spending accounts, the prohibition on 
prepurchase health care accounts--FSAs and HRAs--and the doubling of 
tax penalties for those in emergency situations who must use a portion 
of their health savings account to pay for nonmedical bills.
  There are many other new tax increases in the House bill which we 
have not seen in the Senate finance bill that we also need to review. 
From the beginning of this process the chairman of the Finance 
Committee has stated his intention to use only health-related offsets 
to pay for health-related spending. If there is to be new health-
related spending, that is definitely the right approach. We all know 
what a difficult circumstance our country faces today when it comes to 
jobs. The current unemployment rate is 10.2 percent. The last thing we 
need to do is to enact policies that would make it even tougher for 
U.S. companies, particularly small businesses, to create new jobs. But, 
amazingly, the House bill contains more than $80 billion in tax 
increases on domestic U.S. job-creating companies that have no 
involvement in the health care industry.
  Not only do these provisions violate the idea that we should be 
staying within the health care arena to find offsets on the health care 
bill, but these antijob tax increases are the last thing we need in 
this fragile economy. The largest tax increase in the House bill would 
also have a devastating effect on the job creators in our country, 
particularly small businesses, that are the top job creators. This $460 
billion so-called ``millionaire surtax'' is bad policy for many 
reasons.
  First, like the $80 billion tax increase on domestic companies that I 
just mentioned, this tax increase grabs hundreds of billions of dollars 
from outside the health care arena to pay for a massive expansion of a 
new health care entitlement.
  Second, although this provision is being billed as a tax increase on 
millionaires, the Joint Tax Committee reports that one-third of the 
revenue it will generate is not from individual income of millionaires 
but from small businesses. As we know, many small businesses file their 
taxes as individuals, and it would be these small businesses, the job 
creators of our economy, that would be facing this new punitive surtax.
  Third, although you would think we would have learned our lesson from 
the alternative minimum tax, like the AMT, this new surtax would also 
not be indexed for inflation. That means, over time, this would creep 
further and further down the income scale, and more and more small 
businesses and middle-income families would be suddenly hit by this 
surtax.
  Fourth, this surtax would not only apply to ordinary income, it also 
applies to capital gains and dividend income which are currently taxed 
at lower rates. The capital gains and dividend rates are currently 15 
percent. If Congress doesn't act before next year, the rates will go 
back up to the pre-2003 levels of 20 percent for capital gains and up 
to a maximum of 39.6 percent for dividends.
  The President has said he doesn't intend to extend the current lower 
rates for individuals making less than $200,000 a year or for families 
making less than $250,000 a year. But if we add in this new surtax in 
the House bill, Americans above those thresholds who are currently 
paying a 15-percent capital gains tax rate would see their tax rate 
jump to 25.4 percent in 2011, and those currently paying the 15 percent 
dividends rate would see their rates jump to 45 percent by 2011.
  Such a tax increase would violate yet another one of President 
Obama's tax pledges to the American people. Most of us are very 
familiar with his promise.
  Most of us are familiar with his promise that no individual making 
less than $200,000 a year or a family making less than $250,000 a year 
would see any increase in their taxes. In fact, in his words, ``not by 
one dime''--not an increase of their income tax, their payroll tax, 
their capital gains tax. In his words, not any of their taxes. Yet we 
see hundreds of billions of dollars of these taxes falling squarely on 
the middle class. In a speech in Dover, NH, on September 12, 2008, 
President Obama said:

       Everyone in America--everyone--will pay lower taxes than 
     they would under the rates Bill Clinton had in the 1990s.

  This surtax clearly breaks that promise to millions of additional 
Americans.
  Recent press reports have suggested that, in a need for even more tax 
revenue to pay for all of the new spending in the Senate, the Senate 
leader may include an increase and an expansion of the Medicare payroll 
tax. The Medicare payroll tax is funded by a 2.9-percent payroll tax 
levied on every dollar earned by employees. Half of this tax is paid by 
the employee and the other half by the employer, although in reality, 
the entire burden falls on the employee because the tax is taken from 
the employee's available wages. Revenue from this tax goes into the 
Medicare trust fund and is intended to be used for Medicare expenses 
when that individual enters retirement. Under this new plan, Senate 
Democrats are considering applying this Medicare tax to capital gains, 
dividends, interest, royalties, and partnerships for American families 
earning more than $250,000. None of this income is currently subject to 
the Medicare payroll tax.
  In addition, Democrats are said to be contemplating raising the 
employee's share of this tax, currently 1.45 percent of wages, to 1.95 
percent. Press reports indicate this would raise up to 40 or 50 billion 
new dollars in revenue. This proposal would make a bad bill even worse. 
It would fundamentally change the way Medicare financing occurs. By 
applying what has traditionally been a payroll tax to nonpayroll income 
and by using this money for a new non-Medicare entitlement, it breaks 
the

[[Page 27915]]

link between the Medicare tax base and Medicare benefits. As the Wall 
Street Journal pointed out, this new tax would ``sever the link between 
the tax paid over a lifetime and the medical benefits received, 
officially making Medicare an income redistribution program.''
  It would additionally hurt growth. These additional taxes on savings 
and investment act as disincentives for these activities which are the 
primary drivers of wealth creation. It would kill jobs. Imposing these 
new taxes would hurt small businesses. Because many small businesses 
pay their taxes at the individual level, imposing higher individual 
income taxes hurts these engines of job creation.
  Finally, it doesn't fully finance health care shortfalls. According 
to Bloomberg, House Democrats rejected this proposal, now being 
considered by the Senate, ``because lawmakers concluded they may need 
to increase the payroll tax in the future to pay Medicare benefits that 
are projected to outpace revenue.'' The New York Times pointed out that 
``the higher payroll tax would not be sufficient in the long run [to 
even protect Medicare].''
  In closing, for all the talk about this need to rush the bill through 
so we can achieve the objective the American people seek in health care 
reform, the bill does not reduce the cost of medical care. It increases 
it. The bill does not reduce the cost curve for health care insurance. 
It increases it. And in accomplishing this, it also increases taxes 
across the board on Americans and cuts Medicare by deep rates that will 
cause Medicare to face insolvency even earlier than it otherwise would 
have.
  For all these reasons, we need to slow down and start working 
together, step by step, to remember the original objective; that is, to 
bend the cost curve down and stop these spiraling increases in health 
care insurance that Americans are facing and that are driving American 
families to the edge.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from Arizona.
  Mr. McCAIN. Mr. President, from media reports, certainly not because 
Members on this side of the aisle have been told about it, I understand 
the majority leader is now corralling the final three Democrats, which 
I am sure he will succeed in doing, in order to secure 60 votes to move 
forward with the greatest takeover of the private sector in health care 
by legislation perhaps in the history of this country. Of course, I 
would not know that myself, nor would any Member on this side of the 
aisle, because of the fact that there is no communication between the 
majority leader and Republicans. I understand they have 60 votes. I 
understand they will get 60 votes. I understand that they may likely be 
able to railroad this through the Senate. Then, again, they will gather 
in a small room, and they will come out with significant changes and 
revisions in the form of a conference report.
  I have been having townhall meetings around my State of Arizona, the 
second hardest-hit State in America because of the economic downturn. I 
assure my colleagues on the other side of the aisle, there is a 
revolution going on out there. It is a peaceful revolution. They do not 
want increased costs of a reform commitment that would be up to $3 
trillion, that would cut Medicare by $500 billion and tax Americans 
across the entire income spectrum by an additional $500 billion. My 
friends across the aisle may not have gotten the message from the 
elections in New Jersey and Virginia not that long ago. Americans want 
cost control, and they want affordable and available health care. They 
don't want increases in taxes. They don't want the government taking 
over the health care system. Yet that is what is going to be delivered.
  A lot of people, may I say, may not trust the word of some of us on 
this side of the aisle and may think we are uninformed or we are just 
politicians. Maybe we ought to listen to Dr. Jeffrey Flier, dean of the 
Harvard Medical School. I have never been that great of an admirer of 
Harvard, but the dean of the Harvard Medical School states in today's 
Wall Street Journal, entitled ``Health Debate Deserves a Failing 
Grade''--and he has some criticism for this side of the aisle that 
perhaps is deserved--

       As the dean of the Harvard Medical School, I am frequently 
     asked to comment on the health-reform debate. I'd give it a 
     failing grade.
       Instead of forthrightly dealing with the fundamental 
     problems, discussion is dominated by rival factions 
     struggling to enact or defeat President Barack Obama's 
     agenda. The rhetoric on both sides is exaggerated and often 
     deceptive. Those of us for whom the central issue is health--
     not politics--have been left in the lurch. And as the 
     controversy heads towards a conclusion in Washington, it 
     appears that the people who favor the legislation are engaged 
     in collective denial.
       Our health-care system suffers from problems of cost, 
     access and quality, and needs major reform. Tax policy drives 
     employment-based insurance; this begets overinsurance and 
     drives costs upward while creating inequities for the 
     unemployed and self-employed. A regulatory morass limits 
     innovation. And deep flaws in Medicare and Medicaid drive 
     spending without optimizing care.

  During the last campaign, I proposed addressing the issue of 
employer-provided health benefits, doing away with it in return for a 
$5,000 refundable tax credit. Tens of millions of dollars in attack ads 
were leveled against it. I proposed it not because it was easy, not 
because I didn't think the American people didn't need straight talk. I 
did it because it is one of the fundamental problems with the cost of 
health care in America. If someone gets something for free, they are 
not going to be careful about the money that is spent.
  Ronald Reagan once said: Nobody ever washed a rental car. He is 
right. So when people receive free medical care that they don't have to 
pay for and that they don't have to have accountability for, it is 
obvious that that is misused.
  Again, there is the story this morning about some $49 billion in 
wasteful spending in Medicare. The numbers go on and on.
  Why is it that the dean of the Harvard Medical School says ``the 
rhetoric on both sides is exaggerated and often deceptive''? Maybe it 
is. But the rhetoric on both sides becomes more intense because of a 
failure to sit down and try to work something out together. At no time 
during this entire, long, drawn-out process have there been serious 
negotiations between Republicans and Democrats. Not once. Of course, 
the rhetoric gets exaggerated on both sides and even deceptive. We are 
not doing what the American people expect us to do, and that is sit 
down together and work these things out on one of the greatest 
financial crises this Nation faces.
  Dr. Flier goes on to say:

       Speeches and news reports can lead you to believe that 
     proposed congressional legislation would tackle the problems 
     of cost, access and quality. But that's not true. The various 
     bills do deal with access by expanding Medicaid and mandating 
     subsidized insurance at substantial cost--and thus addresses 
     an important social goal. However, there are no provisions to 
     substantively control the growth of costs or raise the 
     quality of care. So the overall effort will fail to qualify 
     as reform.

  Dr. Flier is alleging that there is no control of the growth of costs 
or rise in the quality of care. We all know that the cost of health 
care is unsustainable. The Medicare trustees have said in 7 years it 
will go broke. I believe forcing more Americans into Medicaid, a public 
program that gets failing grades for access to care and the quality of 
care, is not the right approach to covering millions more Americans.
  Dean Flier goes on:

       In discussions with dozens of health-care leaders and 
     economists, I find near unanimity of opinion that, whatever 
     its shape, the final legislation that will emerge from 
     Congress will markedly accelerate national health-care 
     spending rather than restrain it.

  The whole problem with health care in America is not the quality of 
health care, it is the accessibility and affordability. Dr. Flier says 
``the final legislation that will emerge will markedly accelerate 
national health care spending rather than restrain it.''
  Dr. Flier continues:

       Likewise, nearly all agree that the legislation would do 
     little or nothing to improve quality or change health-care's 
     dysfunctional delivery system.


[[Page 27916]]


  This isn't just Dr. Flier's opinion. Look at Samuelson's article the 
other day about the effects of what has been passed by the House and 
will apparently be before us. Democrats are proposing a $3 trillion 
expansion of government health care, including $1 trillion in Medicare 
cuts and tax increases. But experts tell us the legislation would do 
little or nothing to improve quality or change health care's 
dysfunctional delivery system. Senate committees have spent months 
writing bills and spinning the benefits of legislation, and experts 
tell us the efforts fail the basic test.
  On March 5 of this year, the President is quoted as saying:

       If people think we can simply take everybody who's not 
     insured and load them up in a system where costs are out of 
     control, it is not going to happen. We will run out of money. 
     The federal government will be bankrupt; state governments 
     will be bankrupt.

  The President is right. But the Democratic leadership writing these 
bills is not listening. Partisan reform designed behind closed doors 
will bankrupt this country, in effect committing generational theft. 
The majority leader continues to put his bill together in a secret 
committee of one with a deaf ear to what experts tell us is needed. And 
we wait. We wait with great anticipation to see how high taxes and fees 
will be increased. We wait with great anticipation to finally 
understand how Senate Democrats will force a government health 
insurance entitlement into our health care market. We will wait to see 
how much they will cut Medicare. And these are Medicare cuts, my 
friends, have no doubt about it. We will wait to see the new mandates 
on individuals and employers to buy government-designed insurance.
  We already know that the Senate Finance Committee bill includes 
roughly $508 billion in new taxes on individuals and businesses.
  Beginning in January of 2010, health insurers would also be required 
to pay annual nondeductible fees totaling $60.4 billion over 10 years.
  Beginning in January of 2010, medical device manufacturers are 
required to pay $40 billion in new nondeductible fees.
  Beginning in January 2010, prescription drug manufacturers are 
required to pay $22 billion in new nondeductible fees.
  By the way, in case my colleagues missed it, surprise, surprise, the 
pharmaceutical industry has now dramatically increased their prices, 
while the cost of living has gone down. What a shocker. Those great 
people from the pharmaceutical lobby who have been willing to make such 
``sacrifices'' for the American people are raising their prices in an 
unprecedented fashion, totally disconnected to the absolutely 
nonexistent increase in the cost of living. And the administration 
continues to oppose drug reimportation from Canada, where seniors could 
get prescription drugs for about half of what it is now costing them.
  Beginning in 2013, Democrats raise taxes by $201 billion by 
increasing taxes by 40 percent on certain family health care plans with 
higher coverage values, payable by insurance companies or employers.
  Beginning in 2013, taxpayers who deduct medical expenses on their tax 
returns will pay $15 billion more in taxes.
  Taxes on individuals who fail to maintain government-approved health 
insurance coverage will pay $4 billion in new penalties, breaking 
President Obama's promise that no one with income under $250,000 would 
pay higher taxes.
  Businesses that are struggling to keep the doors open and keep 
workers employed in this recession will see higher taxes of $23 billion 
in the form of mandates and penalties for failing to offer government-
approved health insurance.
  Again, I urge my colleagues to read the article in the New York Post 
entitled ``Obamacare: Buy now, pay later'' by the well-respected 
economist Robert Samuelson. He writes:

       There is an air of absurdity to what is mistakenly called 
     ``health-care reform.'' Everyone knows that the United States 
     faces massive governmental budget deficits as far as 
     calculators can project, driven heavily by an aging 
     population and uncontrolled health costs. As we recover 
     slowly from a devastating recession, it's widely agreed that, 
     though deficits should not be cut abruptly (lest the economy 
     resume its slump), a prudent society would embark on long-
     term policies to control health costs, reduce government 
     spending and curb massive future deficits. The administration 
     estimates these (deficits) at $9 trillion from 2010 to 2019. 
     The president and all his top economic advisers proclaim the 
     same cautionary message.
       So what do they do? Just the opposite. Their far-reaching 
     overhaul of the health-care system--which Congress is halfway 
     toward enacting--would almost certainly make matters worse. 
     It would create new, open-ended medical entitlements that 
     threaten higher deficits and would do little to suppress 
     surging health costs. The disconnect between what President 
     Obama says and what he's doing is so glaring that most people 
     could not abide it. The president, his advisers and allies 
     have no trouble. But reconciling blatantly contradictory 
     objectives requires them to engage in willful self-deception, 
     public dishonesty, or both.

  Those are not my comments, Mr. President. Those are the comments of 
Robert Samuelson, one of the most respected economists in America.
  I want to take another minute to talk about how the influence of 
special interests--I mentioned the pharmaceutical companies and the 
deal they cut so the administration would oppose drug importation from 
Canada, that there would not be competition for Medicare patients. But 
let me talk about probably the most powerful force in this whole 
discussion of legislation, and that is the trial lawyers of America.
  There is no provision for medical liability or medical malpractice 
reform in this legislation. In fact, it was passed by the House that if 
States have enacted reforms, they will not be eligible for any 
additional funding to try and fund demonstration projects to reduce the 
cost of medical malpractice.
  Everybody knows, ask any physician, they will tell you, they practice 
defensive medicine. They do so because of their fear of finding 
themselves in court and being wiped out. Sometimes these additional 
procedures and tests are not so comfortable for the patient, but, most 
importantly, they dramatically increase costs. Time after time after 
time, any effort we have made to put in medical malpractice reform--and 
we will do it again when the majority leader gives birth to whatever 
you want to call this--then, the fact is, they are not seriously 
interested in reducing costs, but they are seriously dependent on the 
largesse and generosity of the trial lawyers of America, and it is an 
outrage. It is an absolute outrage.
  I would point out, when the President talks about, ``demonstration 
projects,'' there is a demonstration; it is called Texas. The State of 
Texas was hemorrhaging doctors and physicians and medical care 
practitioners. They reformed the medical malpractice. There have now 
been reductions in premiums. There have been reductions in lawsuits. 
There have been doctors and physicians and medical care providers 
flowing back into the State of Texas. It is proven. It is not 
everything we want. But it shows that medical malpractice reform can 
reduce health care costs.
  And what have my friends on the other side and a couple on this side 
done? They have refused to consider in any significant way what 
everyone agrees could reduce health care costs in America. Outrageous. 
So do not be surprised when our approval rating is 18 percent. The 
approval rating of Congress: 18 percent. And in the townhall meetings I 
have been having, I have not met anybody in that 18 percent.
  We need truth and honesty in our national discussion on health care 
reform, not spin, not budget gimmicks, not cuts to Medicare, not higher 
taxes, not government takeover, and not trillions in new health care 
spending.
  We have $12 trillion in debt, 10 percent unemployment--17 percent 
real unemployment in my State--and an economy that is still struggling. 
Meanwhile, Wall Street makes obscene profits and bonuses that are 
unbelievable. We cannot afford another $3 trillion open-ended health 
entitlement. Americans deserve an honest discussion of ideas without 
artificial deadlines, and real solutions that will bring our 
skyrocketing health care costs under control.

[[Page 27917]]

  Finally, I guess we are told that maybe this evening there may be 
something that will emerge with white smoke from the majority leader's 
office and we will be given the manifesto that he will call health care 
reform, and that will begin a great debate. I believe the question will 
be: Will the special interests and the big spenders and those who are 
in favor of government control of health care in America win or will 
the American people win?
  That is why the American people are aroused. If they stay aroused, 
and if we continue to see the tea parties and the townhall meetings and 
the expressions of anger and frustration the American people feel, we 
will beat this back and we will go back to the bargaining table--for 
the first time we will go to the bargaining table and sit down, 
Republicans and Democrats, together.
  History shows there has been no successful reform in America without 
bipartisanship, and I do not believe this will be the first one. I 
hope--I hope and pray--it will not be.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. ENSIGN. Mr. President, one of the hallmarks of the Democrats' 
health care bill is that it spends a tremendous amount of money--more 
than $1 trillion. When the true 10 year costs are reflected, it is 
actually well over $2 trillion. That is a hefty price tag, and most 
Americans want to know who is going to pay for this.
  Contrary to what Democrats want you to believe, this bill will be 
paid for by all Americans, including low- and middle-income families 
and small business owners. So for the next week, I want taxpayers as 
they go about their daily activities to take a moment to understand why 
they will be paying a new tax for each day of their hardworking week.
  Monday is not usually a favored day for most folks during the week--
and if this health care reform passes, it will be absolutely a 
miserable day for families making less than $200,000 a year. That is 
because 91 percent of you will start the week off by paying a $200 
billion tax on health insurance.
  I have talked about this before at length, this so-called tax on 
``Cadillac'' plans. It is actually a 40-percent tax on high-cost 
premium ``Cadillac'' plans. But the people who are going to pay for 
these plans and for this tax are more likely driving minivans, used 
cars, and cars that are paid off. That is because it disproportionately 
impacts middle-income families.
  That is new tax No. 1. But there are more.
  The 40-percent insurance plan tax is what I just talked about. But 
all told, there are seven new taxes in this health care bill, and maybe 
more to come. These new taxes, as shown on this chart, fall on some 
people directly and on others indirectly. The nonpartisan Joint Tax 
Committee testified that these new taxes--however they are named--will 
act as excise taxes and will be passed on to consumers to some extent.
  So, on Tuesday, as your kids are getting ready to get off for school, 
do not forget that you will be paying higher taxes on insurance 
premiums because of a new tax on insurance companies. It is the 
insurance tax. I want to quote a letter the Joint Tax Committee wrote. 
Remember, this is the nonpartisan Joint Tax Committee. They wrote to me 
in response to my concern over this debilitating tax. I quote:

       An insurer offering a family health plan that exceeds the 
     excise tax threshold and is subject to the excise tax faces 
     an increase in the cost of offering that health coverage. 
     Generally, we expect the insurer to pass along the cost of 
     the excise tax to consumers by increasing the price of health 
     coverage.

  So Tuesday is not a great day either in this new week of taxes.
  On Wednesday, our small businesses--the engine of our economy--will 
be taxed if they do not offer health insurance. That is the employer 
tax, tax No. 3. The employer tax will hit small businesses and make it 
more expensive to hire workers. I do not think that is a good idea when 
the Nation is facing an over 10-percent unemployment rate. Those who 
are hired will see their wages reduced because of the required employer 
``responsibility'' payments. That is what they are called.
  The Congressional Budget Office--which again is a nonpartisan 
entity--has explicitly stated:

       Although the surcharges would be imposed on the firms, 
     workers in those firms would ultimately bear the burden of 
     those fees. . . .

  The tax credit to small businesses does little to help because it 
only helps firms with 25 employees or less, and it is temporary. Also, 
this tax credit drops off so suddenly for firms with more than 10 
employees that some firms will be penalized--actually penalized--for 
adding jobs or raising workers' pay--clearly, a perverse incentive.
  So Wednesday is clearly not a good day for small businesses or their 
employees, especially those making minimum wage. So I hope you didn't 
have to call in sick on Thursday, because if you go to a doctor and get 
a prescription, there is a new tax on the pharmaceutical companies that 
you will pay. This is tax No. 4, the drug tax. Don't think about using 
your health savings account or flexible spending account for the over-
the-counter medication you need as well. Under the House plan, 
nonprescription medications can no longer be purchased with moneys from 
these accounts, and under the Senate plan, there is a $2,500 cap for 
pretax dollars that can be used in these accounts. The weekend is so 
near on Friday; but wait, if you need some lab work done, you will have 
to pay a new tax on clinical laboratories. This is the lab tax.
  You think your work is over on Saturday, but you will still be paying 
more taxes under this bill. If you need surgery, there is a new tax on 
medical devices, such as pacemakers, prosthetics, and hearing aids. 
This is No. 6. This raises the cost of health care. This is passed on 
to the consumers. All these taxes have one thing in common: They do 
raise the cost of health care for middle-income Americans.
  My Democratic colleagues may claim they are raising taxes on health 
care companies, not people, and people will be better off once all this 
tax money is collected in Washington and then used as subsidies. The 
truth is, the people are paying and many are in the middle class who 
Democrats claim would be spared. It is true some people may, on a net 
basis, get more subsidy than they pay in higher taxes, but over 46 
million middle-income families will pay more than they receive. In 
other words, their health care costs in the net are going to go up. 
They lose under this health care bill and these are middle-income 
Americans.
  According to the analysis from the nonpartisan Congressional Budget 
Office, from which I wish to quote now, these taxes:

       Would increase costs for the affected firms, which would be 
     passed on to purchasers and would ultimately raise insurance 
     premiums by a corresponding amount.

  So now it is Sunday, historically a day of rest but not for these new 
taxes. There is one more tax that again falls squarely on lower and 
middle-income families, a penalty excise tax for failure to obtain 
insurance. That is tax No. 7. We are faced with a bill where, according 
to the Congressional Budget Office, at least seventy-one percent of the 
individual mandate penalties would fall on the backs of American 
families making less than $120,000 a year. Remember what the President 
said: No new taxes on anybody making $250,000 a year or less. Actually, 
probably over 90 percent of this tax will be paid by those on whom the 
President said not one dime in new taxes will be raised. Yet under this 
bill that is coming before the Senate, their taxes are raised and they 
are raised significantly.
  Well, we have run out of days of the week, but the Democrats are not 
finished yet. If you have been using pretax dollars in a flexible 
spending account, which most Federal employees have and a lot of other 
people who are employed by other companies have as well, and you pay 
for services not covered by your plan, such as speech therapy for a 
child with autism, you are out of luck under this bill. As I said 
earlier, the Federal spending accounts are capped at $2,500 in this 
bill, so your income tax will rise as well as your medical expenses. If 
you have been dealing with extraordinarily high medical expenses and 
have been counting

[[Page 27918]]

on qualified medical expenses tax deductions to pay for care or tuition 
for a special needs school, again, you are out of luck. The itemized 
deduction bar will be raised from 7.5 percent to 10 percent of your 
income in this bill. In other words, this bill hurts those who are 
being hit hardest by medical catastrophes.
  In committee, my colleagues and I on the Republican side tried to 
inject some limits to this tax mania. We offered an amendment to carve 
out lower and middle-income families from paying taxes. I offered an 
amendment to protect the middle class, specifically, from the onerous 
penalty excise tax for those who fail to obtain insurance. 
Unfortunately, on party-line votes, the Democrats voted down those 
amendments.
  I offered an amendment to eliminate the growing threat that the 40-
percent insurance tax posed to every American with insurance, but, once 
again, the majority voted it down. We offered amendments to strike some 
of these specific, heavy-handed new taxes, but, once again, the 
majority, on party lines, voted them down. We tried to apply 
limitations so these taxes would not go into effect if they caused 
consumer costs to rise. The majority, again, voted them down. We tried 
to prevent these new taxes from hurting veterans, but as Democrats 
first accepted it, they then passed a second amendment to eliminate the 
protections. We tried to ensure that vulnerable Americans would not be 
hit with a tax increase on catastrophic medical costs. Again, the 
Democrat majority in committee voted it down. After losing every 
attempt to remove these new, onerous taxes, we tried to preserve the 
ability of Americans to continue to use their flexible spending 
accounts. Once again, that was voted down by the majority.
  There are at least seven brand new taxes in this bill--one, two, 
three, four, five, six, seven new taxes--with more taxes being 
discussed. Before the final bill is completed, I am sure there will be 
more taxes in this bill. The House bill has a surcharge on small 
businesses. They are also talking about adding a value-added tax, which 
would be a regressive national sales tax on everyone, and a new 
windfall profits tax on insurance companies. There is even talk of a 
tax on soda pop. All these taxes do is cost Americans more money 
without giving them much in return. Even if the spending in this bill 
was worthwhile, these sweeping and unreasonable taxes would more than 
outweigh the benefits.
  It is very clear America's lower and middle classes will bear the 
brunt of these new taxes. On top of that, they will not be allowed to 
keep the insurance plans they have. Instead, they will be forced into a 
new experimental system that will succeed only in exploding our deficit 
spending for generations to come.
  So where is the break for hard-working families, we have to ask. 
Under this plan, they pay for government-run insurance to cover more 
Americans. They lose their own insurance--many of them--along the way, 
and they watch as deficits continue to eclipse their children's 
futures. That is not even close to the American way.
  On behalf of millions of American workers, families, and small 
businesses that sent us to Washington to be their voice, I cannot stand 
by and watch the majority destroy our chance for meaningful health care 
reform that does not bankrupt our Nation. I am going to do everything 
in my power to stop these new taxes from becoming reality. I am 
confident, with the American people behind us, we can stop these new 
taxes. We can start over, in a bipartisan way, and go step by step and 
come up with health insurance reform that controls costs, preserves and 
even improves quality, and doesn't end up with a government-run health 
care system that cuts over $500 billion in Medicare and raises $500 
billion in new taxes.
  I urge our colleagues to work together--not as Republicans and 
Democrats but as Americans--so we can preserve the quality of health 
care we have enjoyed in this country for so long but do it in a way 
that is more affordable and provides more access to more Americans.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. BINGAMAN. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER (Mrs. Hagan). Without objection, it is so 
ordered.
  Mr. BINGAMAN. Madam President, I ask unanimous consent to speak as in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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