[Congressional Record (Bound Edition), Volume 155 (2009), Part 22]
[Senate]
[Pages 29761-29798]
[From the U.S. Government Publishing Office, www.gpo.gov]




        SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009--Resumed

  The PRESIDING OFFICER. The Senator from California is recognized.
  Mrs. BOXER. Mr. President, I ask unanimous consent that the time 
between 2:15 p.m. and 4:15 p.m. be equally divided between the two 
leaders, or their designees, in alternating 30-minute blocks of time, 
with the majority controlling the first 30 minutes and the Republicans 
controlling the second 30 minutes; further, that no amendments be in 
order during this time.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mrs. BOXER. Mr. President, since this is the 30 minutes of time for 
our side, I ask that I be recognized for 10 minutes, Senator Murray for 
5 minutes, Senator Lautenberg for 5 minutes, Senator Harkin for 5 
minutes, and Senator Cardin for 5 minutes.
  We have many Members who wish to come and speak, and I would urge 
them to contact us. I will just take a minute to get my notes in order, 
so I suggest the absence of a quorum, and the time should be taken off 
our time.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mrs. BOXER. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. BOXER. Mr. President, we are in the middle of a very important 
debate about whether we are going to move forward and make sure our 
people in America have health care. That is what it is about. I am 
going to throw out a few numbers that are always on my mind as I talk 
about this issue. One of them is 14,000. Every day, 14,000 Americans 
lose their health insurance. It is not because they did anything wrong. 
A lot of times it is just because they get sick and their insurance 
company walks away from them or they may reach the limit of their 
coverage, which they didn't realize they had, and they are done for. 
They could lose their job and suddenly they can't afford to pay the 
full brunt of their premium. They could get sick and then all of a 
sudden are now branded with a PC--and that is not a personal computer, 
it is a preexisting condition--and they can't get health care.
  So we are in trouble in this country, with 14,000 Americans a day 
losing their health care, and a lot of them are working Americans. As a 
matter of fact, most of them are working Americans. Sometimes a child, 
for example, will reach the age where they can no longer be covered 
through their parents' plan, and the child might have had asthma. When 
they go to the doctor, they beg the doctor not to say they have asthma. 
I have doctors writing to me saying that parents are begging them: 
Please, don't write down that my child has asthma; say she has 
bronchitis because when she goes off my medical plan, she is going to 
be branded with a preexisting condition. So 14,000 Americans a day, 
remember that number.
  Then, Mr. President, 66 percent, that is the percentage--66 percent--
of all bankruptcies that are due to a health care crisis. People are 
going bankrupt not because they didn't manage their money well or they 
didn't work hard and save but because they are hit with a health care 
crisis and either they had no insurance or the insurance refused them. 
The stories that come across my desk, as I am sure yours, are very

[[Page 29762]]

heartbreaking. So people are going bankrupt. They lose their dignity, 
they lose everything because of a health care crisis.
  Yesterday, I brought up a couple of numbers--29 out of 30 
industrialized nations. That is where we stand on infant mortality. We 
are not doing very well. It is no wonder; more than 50 percent of the 
women in this Nation are not seeking health care when they should. They 
are putting it off or they are never getting it. No wonder we don't do 
well with infant mortality.
  Now, why don't women do this? Because they either don't have 
insurance or they do not have good enough insurance or they can't 
afford the copay or they are fearful. They are fearful that maybe if 
they go this time, the insurance company will say: No more.
  We rank 24 out of 30 industrialized nations for life expectancy. My 
constituents are shocked to hear that. They are shocked at the infant 
mortality ranking, and they are shocked at the life expectancy ranking. 
I have heard my Republican friends try to rationalize this: Well, it is 
because our population is diverse--and all the rest. This is the most 
powerful, richest Nation on Earth. There is no reason we have to be 24 
out of 30 in terms of our life expectancy, especially when we know so 
much of our problem deals with about five diseases--diseases such as 
diabetes, which can be prevented and certainly treated.
  The last number I will talk about is 45 percent. The average family 
in America, by 2016, if we do nothing, will be paying 45 percent of 
their income on premiums. Now, this is disastrous, and 2016 is around 
the corner by my calculations. So that means more and more of us will 
not be able to afford insurance, and we are going to show up at 
hospital emergency rooms. That costs a lot and the outcomes are bad and 
America will continue on this downward spiral in relation to our health 
care system.
  Why do I take time to talk about this issue? It is because we need to 
keep our eye on the big picture, and the big picture is not a pretty 
picture for our people right now. The status quo is not benign, it is 
not neutral, it is cruel. Every one of us could wake up in the morning 
having lost a job and having no health care. So what we are doing is 
going to help every American, and I think one of the best things we do 
in the underlying bill is to make sure that health care premiums are 
affordable for everyone. That is the key, and we do it in a number of 
ways.
  But, Mr. President, in the middle of all this, we have an amendment 
that would roll back the clock on women's rights. I am here to say, as 
I said last night--and I am happy to see other colleagues joining me--
it is unacceptable to single out one group of people--namely the women 
of this country--and tell them they can't use their own private money 
to buy an insurance policy that covers the range of reproductive health 
care. Why are women being singled out? It is so unfair.
  We have had a firewall in place for 30 years. It said this: No 
Federal funds can be used for abortion, but private funds can be used 
as long as abortion is legal, and it is. Roe v. Wade made it legal in 
the early stages of a pregnancy. Women have had that right.
  Well, this amendment says there is one group of people we are going 
to treat differently. We are going to take one procedure, that only 
applies to them, and say they can't buy health insurance for that 
procedure--only if it is a separate rider, which everyone knows is 
unaffordable, impractical, and will not work.
  I don't see any amendment saying to men that if they want to have a 
procedure that relates to their reproductive health they can't use 
their own private money to buy coverage for it. No, it is not in there. 
We don't tell men, if they want to make sure they can buy insurance 
coverage through their pharmaceutical plan for Viagra, that they can't 
do it. No, we don't do that, and I wouldn't support that. It would be 
wrong. Well, it is wrong to single out women and to say to the women of 
this country that they can't use their own private funds to purchase 
insurance that covers the whole range of reproductive health care.
  You have to look behind this amendment to understand how pernicious 
it really is. I have five male colleagues on the other side of the 
aisle who were on the Senate floor for at least an hour or so talking 
about this amendment, and one thing about each and every one of them, 
they want to make abortion illegal. There is no question about it. They 
want to take away a woman's right to choose, even in the earliest 
stages of the pregnancy, even if it impacts her health, her ability to 
remain fertile, or her ability to avoid a very serious health issue 
such as a heart problem, a stroke. They do not want to have an 
exception for a woman's health. No question, that is what they want.
  The PRESIDING OFFICER. The Senator's 10 minutes has expired.
  Mrs. BOXER. I ask unanimous consent for an additional 30 seconds, and 
then I will turn to Senator Lautenberg.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. BOXER. So to sum up my part, the amendment that has been offered 
by Senators Nelson, Hatch, Vitter, Brownback, et al., hurts women. It 
singles out one legal procedure and says: You know what. You can't use 
your own private funds to buy insurance so that in case you need to use 
it for that legal procedure, you can. So I hope we will vote it down.
  I yield the floor, Mr. President, and note that Senator Lautenberg is 
here for 5 minutes. Oh, I am sorry. May I say that the order was 
Senator Murray for 5 minutes to be followed by Senator Lautenberg for 
5.
  The PRESIDING OFFICER. The Senator from Washington is recognized.
  Mrs. MURRAY. Mr. President, I thank the Senator from California for 
her debate, for outlining the serious concerns we have, and I rise 
today not only in strong opposition to the Nelson amendment but in 
strong support of women's health care choices, which this amendment 
would eliminate.
  Mr. President, we can't allow a bill that does so much for women and 
for families and for our businesses and for the future strength of this 
Nation to get bogged down in ideological politics because in every 
single sense of the word, health insurance reform is about choices--
giving options to those who don't have them: options for better care or 
better quality, and insurance that is within reach. This bill was never 
supposed to be about taking away choices, and we cannot allow it to 
become that.
  Mr. President, this bill already does so much for millions of women 
across America. Already so far, the Senate has passed Senator 
Mikulski's amendment to be sure that all women have access to quality 
preventive health care services, and that screenings, which are so 
critical to keeping women healthy, are available. This underlying bill 
will also help women by ending discrimination based on gender-rating or 
gender-biased preexisting conditions, on covering maternity care, 
preventive care and screenings, including mammograms and well-baby 
care, expanding access to coverage even if an employer doesn't cover 
it, and giving freedom to those who are forced to stay in abusive 
relationships because if they leave, they or their children could lose 
their coverage.
  Mr. President, the amendment before us today would undermine those 
efforts and goes against the spirit and the goal of this underlying 
bill. All Americans should be allowed to choose a plan that allows for 
coverage of any legal health care service, no matter their income, and 
that, by the way, includes women. But if this amendment were to pass, 
it would be the first time that Federal law would restrict what 
individual private dollars can pay for in the private health insurance 
marketplace.
  Let me repeat that: If this amendment were to pass, it would be the 
first time that Federal law would restrict what individual private 
dollars can pay for in the private health insurance marketplace.
  Now, the opponents of this bill have taken to the floor day in and 
day out for months arguing that this bill takes away choice. This bill 
doesn't take away choice, Mr. President, but this amendment sure does. 
This amendment stipulates that any health plan receiving any funds 
under this legislation

[[Page 29763]]

cannot cover abortion care, even if such coverage is paid for using the 
private premiums that health plans receive directly from individuals.
  Simply put, the amendment says if a health plan wants to offer 
coverage to individuals who receive affordability credits--no matter 
how small--that coverage cannot include abortion.
  In this way, the amendment doesn't only restrict Federal funds, it 
restricts private funds. It doesn't just affect those receiving some 
amount of affordability credits, it also impacts people who are paying 
the entire cost of coverage but who just happen to purchase the same 
health plan as those with affordability credits.
  The bottom line: This amendment would be taking away options and 
choices for American women.
  There is no question this amendment goes much further than current 
law, no matter what our colleagues on the other side contend. Current 
law restricts public funds from paying for abortion except in cases of 
rape or incest or where the woman's life is in danger. The existing 
bill before us represents a genuine compromise. It prohibits Federal 
funding of abortion, other than the exceptions I just mentioned, but it 
also allows women to pay for coverage with their own private funds. It 
maintains current law; it doesn't roll it back.
  This amendment now before us would be an unprecedented restriction on 
women's health choices and coverage. Health insurance reform should be 
a giant step forward for the health and economic stability of all 
Americans. This amendment would be a giant step backward for women's 
health and women's rights. Women already pay higher costs for health 
care. We should not be forced into limited choices as well.
  We are standing on the floor today having a debate about a broken 
health insurance system. It is broken for women who are denied coverage 
or charged more for preexisting conditions such as pregnancy or C-
sections or domestic violence. It is broken when insurance companies 
charge women of childbearing age more than men but don't cover 
maternity care or only offer it for hefty additional premiums.
  The status quo is not working. Women and their families need health 
insurance reform that gives them options, doesn't take them away.
  I urge my colleagues to stand up for real reform. Reject this 
shortsighted amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Mr. President, I ask unanimous consent to amend the 
previous order to give Senator Lautenberg 8 minutes, myself 2 minutes, 
and Senator Cardin 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from New Jersey.
  Mr. LAUTENBERG. Mr. President, throughout my service in the Senate, I 
have been a strong supporter for health care reform. But we can't allow 
reform to be used as an excuse to roll back women's rights that they 
have had for almost half a century. That is why I strongly oppose the 
amendment offered by my friend, the Senator from Nebraska. I think he 
is wrong.
  What this amendment does is remove a woman's right to make her own 
decision, as a practical matter. It is to prohibit any of the health 
plans on the exchange from covering abortion. It will ban coverage even 
for women who don't get a dime in Federal subsidy.
  Women's reproductive rights are always being challenged here in 
Congress. What about men's reproductive rights? Let's turn the tables 
for a moment. What if we were to vote on a Viagra amendment restricting 
coverage for male reproductive services? The same rules would apply for 
Viagra as being proposed for abortion. Of course, that means no health 
plan on the exchange would cover Viagra availability. How popular would 
that demand be around here? I understand that abortion and drugs such 
as Viagra present different issues, but there is a fundamental 
principle that is the same: restricting access to reproductive health 
services for one gender. This amendment is exclusively directed at a 
woman's right to decide for herself. It doesn't dare to challenge men's 
personal decisions.
  I have the good fortune of being a father of three daughters and 
grandfather of six granddaughters. I am deeply concerned by the 
precedent this amendment would set. I don't want politicians making 
decisions for my daughters or my granddaughters when it comes to their 
health and well-being, but that is exactly what this amendment does.
  Nothing made me happier than when any of my daughters announced a 
pregnancy. I watched them grow and prosper in their health and well-
being, as they were carrying that child. I was fully prepared to 
support a decision she might make for the best health of that new baby 
and protecting her health to be able to offer her love and care for a 
new child, as I saw in my years.
  I don't want to stand here and think that somebody is going to make a 
decision in this room that affects what my granddaughters or my 
daughters have to think about. If they want to restrict themselves, let 
them do it. But how can we stand here and permit this to take place 
when we are trying to make people healthier and better informed? This 
amendment wants to take away that right.
  Right now, the majority of private health insurance plans do offer 
abortion coverage. This amendment would force private health insurance 
companies to abandon those policies, eliminate services, and limit a 
woman's options. The amendment does not, contrary to statements being 
made here on the floor, simply preserve the Hyde language that has been 
in place for more than three decades. Make no mistake, this amendment 
goes well beyond the concept of limiting Federal funds from paying for 
abortion. This amendment would make it impossible for a woman who pays 
for her premiums out of her own pocket to purchase a private health 
plan that offers her the right to choose what is best for her, for her 
health, and her family's well-being.
  We have been working hard for a long time to eliminate discrimination 
against women in our current health care system. Right now, our health 
care bill takes a balanced approach to abortion coverage. It preserves 
existing Federal law. Women have fought since this Nation's founding to 
have full rights under the law, including suffrage, including many 
other things. Unfortunately, this amendment would force them to take a 
step backward. I don't want to see it happen.
  I urge my colleagues, please, use your judgment, make your own 
choices about your own family. Make your decisions as to what you would 
recommend to a daughter or a wife. But for God's sake, let the woman 
choose what is best for her.
  I urge my colleagues to vote against the amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, I rise in strong opposition to the Nelson-
Hatch amendment. Let me start by saying that I support a woman's right 
of choice as a constitutionally affirmed right. I understand how 
difficult and divisive this issue is. That is why the underlying bill 
we have before us carries out the compromise that has already been 
reached between pro-choice and pro-life supporters. It represents 
maintaining the prohibition on Federal funds for abortion but allows a 
woman to pay for abortion coverage through use of her own funds. That 
is current law, and that is what the underlying bill makes sure we 
continue.
  Many of us believe the health care debate is critically important. It 
is also controversial. Let's not bring the abortion issue into the 
bill. The Nelson-Hatch amendment would go beyond that. It would 
restrict a woman's ability to use her own funds for coverage to pay for 
abortions. It blocks a woman from using her personal funds to purchase 
insurance plans with abortion coverage. If enacted, for the first time 
in Federal law, this amendment would restrict what individual private 
dollars can pay for in the private insurance marketplace.
  When you look at those who are supporting this amendment, you can't

[[Page 29764]]

help but have some concern that this amendment is being offered as a 
way to derail and defeat the health care reform bill. Most of the 
people who are going to be supporting the amendment will vote in 
opposition to the bill. It is quite clear that the Senate health reform 
bill already includes language banning Federal funds for abortion 
services. So supporters of this bill are not satisfied with the current 
funding ban; they are trying to use this to move the equation further 
in an effort to defeat the bill. This is really wrong as it relates to 
women in America.
  I am outraged at the suggestion that women who want an abortion 
should be able to purchase a separate rider to cover them. Why would we 
expect this overwhelmingly male Senate to expect women to shop for a 
supplemental plan in anticipation of an unintended pregnancy or a 
pregnancy with health complications? Who plans for that? The whole 
point of health insurance is to protect against unexpected incidents.
  Currently, there are five States--Idaho, Kentucky, Oklahoma, 
Missouri, and North Dakota--that only allow abortion coverage through 
riders. Guess what. The individual market does not accept this type of 
policy. It doesn't exist.
  Abortion riders severely undermine patient privacy, as a woman would 
be placed in a position of having to tell her employer or insurer and, 
in many cases, their husband's employer that they anticipate 
terminating a pregnancy.
  Also, requiring women to spend additional money to have comprehensive 
health care coverage is discriminatory. We don't do that for services 
that affect men's reproductive rights.
  I hear frequently from my friends on the other side of the aisle that 
the statements we make; that is, those who support the underlying 
bill--that this allows individuals who currently have insurance to be 
able to maintain their insurance builds on what is good in our health 
care system. This amendment takes away rights people already have. So 
if you have insurance today as an individual that covers abortion 
services, if this amendment were adopted, you will not be able to get 
that. So we are denying people the ability to maintain their own 
current insurance, if this amendment were adopted.
  It is the wrong amendment. The policy is wrong. But clearly, on this 
bill it is wrong.
  I urge my colleagues to accept the compromise reached on this bill. 
Many of us who would like to see us be more progressive in dealing with 
this issue and remove some of the discriminatory provisions in existing 
law understand we will have to wait for another day to do that. Let's 
not confuse the issue of health care reform. Let's defeat this 
amendment that would be discriminatory against women. That is wrong.
  I urge my colleagues to reject the Nelson-Hatch amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Mr. President, I thank Senators Murray, Lautenberg, and 
Cardin for participating in our half hour of debate. Our block of time 
has almost expired. I would like to close the half hour by saying one 
word that I think is a beautiful word, and that word is ``fairness.'' 
``Fairness'' is a beautiful word. It should always be the centerpiece 
of our work here. We should never single out one group of people as 
targets. We should treat people the same.
  It has been very clearly stated that the Nelson-Hatch amendment, like 
the Stupak amendment in the House, singles out an area of reproductive 
health care that only impacts one group, and that is women. It says to 
women that they can't use their own private funds to buy coverage for 
the full range of reproductive health procedures. It doesn't say that 
to a man. It doesn't say to men: You can't use your own funds to cover 
the cost of a pharmaceutical product that you may want for your 
reproductive health. It doesn't say that they can't use their own 
private funds for a surgical procedure they may choose that is in the 
arsenal that they may choose for their own reproductive rights.
  So we say to the men of this country: Look, we are not going to 
single out any procedure or any pharmaceutical product you may want to 
use for your reproductive health care. We are saying, if a private 
insurer offers it, you have the right to buy it. We are singling out 
women.
  Again, let me say this as clearly as I can. We have had a firewall 
between the use of Federal funds and private funds. Senator Reid has 
kept that firewall in place in the underlying bill. He keeps the status 
quo of the Hyde amendment. The group here who is coming on the floor 
continually--mostly men; I think so far all men; there may be some 
women who have spoken on their behalf, but I have not heard it--are 
basically saying: Forget the firewall. Forget it. Women, you cannot use 
your private funds, and government will tell you what you can or cannot 
do. I will tell you something. That is not what Uncle Sam should do. 
Uncle Sam should respect women, should respect men. I hope we defeat 
this amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator's time has expired.
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, I yield up to 10 minutes to the Senator from 
Arizona.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. KYL. Mr. President, America's seniors have made clear they value 
the Medicare Advantage Program. They like their access to private 
plans, plan choices, lower cost sharing, and all the extra benefits not 
included in traditional Medicare, such as vision, dental, hearing, and 
the wellness programs that help them stay fit.
  Before the Medicare Modernization Act of 2003, seniors had been 
decrying their lack of choices. We made sure, under the Medicare 
Modernization Act, that seniors would be assured health care choices, 
just as all of us here in the Congress enjoy.
  Now that they have access to private coverage and enjoy more benefits 
and choices, seniors want us to make sure Medicare Advantage stays 
viable, and they are not happy about the proposed cuts in the majority 
leader's bill.
  I have received more than 500 phone calls since November 1 from 
constituents who oppose the $120 billion Medicare Advantage cuts 
proposed by the majority's bill. They know you cannot cut $120 billion 
from a program without cutting its benefits. A lot of seniors in 
Arizona are asking, What happened to the President's repeated promise 
that if you like your insurance, you get to keep what you have? They do 
not like the idea that under this bill their benefits would be slashed 
by 64 percent, from $135 of value per month to $49 of value per month, 
which is exactly what the Congressional Budget Office projects would 
happen. They do not want the money they paid into Medicare going to 
fund a new government entitlement program for nonseniors. They are not 
satisfied with the majority's promise to protect ``guaranteed'' 
benefits. They want Members of Congress to be straight about our 
intentions and not engage in semantics. They want an unequivocal 
promise they will be able to keep exactly what they have now, just as 
the President promised.
  Here is the problem. There is an earmark buried on page 894 of the 
legislation before us that suggests that senior citizens in Florida 
must have insisted on this exact kind of protection for their Medicare 
Advantage as well.
  This provision, in section 3201(g), was specifically drafted at the 
request of the senior Senator from Florida to protect the benefits for 
at least 363,000 Medicare Advantage beneficiaries in Florida but very 
few anywhere else. Nothing in the bill grants the same protection that 
is granted to these senior citizens to those in my State or in the 
other States in which there are a lot of seniors who have the Medicare 
Advantage Program.
  That is why I support the motion of my colleague, Senator McCain, to 
commit this bill to the committee and return it without these--
actually, what his bill does is to ensure that all seniors, whatever 
State they are in, enjoy the same grandfathering status as the senior 
citizens in Florida would have under the Nelson proposal.

[[Page 29765]]

  The McCain motion to commit is straightforward. First of all, it 
would help the President keep his commitment that seniors get to keep 
their insurance if they like it. And it applies to all of America's 
seniors the same protection granted to Floridians, as I said. Isn't 
that what all seniors deserve, the security of knowing their current 
benefits are safe? If our Democratic colleagues are not willing to 
extend this protection to every Medicare Advantage beneficiary, then I 
cannot imagine how they can claim to be in favor of protecting 
Medicare.
  I have been sharing letters that I have received from Arizona 
constituents describing what the Medicare Advantage Program means to 
them. I thought today I would share some excerpts from a few more of 
these letters.
  A constituent in Surprise, AZ--I hope the Presiding Officer likes the 
name of that town: Surprise, AZ--just west of Phoenix, says:

       I truly hope you will consider keeping the Medicare 
     Advantage plans for seniors. I find the savings a must on my 
     fixed income.
       I appreciate the [high quality] doctor care on my MediSun 
     Advantage plan. Prescriptions are included in the cost of my 
     plan, providing further savings for me. Medicare Advantage 
     has made a real difference in my life. Please don't let 
     anything happen to this important program.

  A constituent from Fountain Hills, AZ, writes:

       I suffer from a specific type of amyotrophic lateral 
     sclerosis, and rely on Medicare Advantage for all of my 
     medical needs. I am asking that you do all that is in your 
     power to protect and provide for the continued funding of 
     this program. In Arizona, we have over 329,000 people who 
     count on Medicare Advantage. Our lives would be devastated 
     without it.

  A constituent from Wickenburg, AZ, says:

       Please don't let anything happen to my Medicare Advantage. 
     I like my Medicare Advantage plan because I can choose my own 
     doctor in my own town and also choose a specialist if I need 
     one.
       I can also get regular check-ups and don't have trouble 
     getting to see the doctor. So, I ask that you don't let the 
     government cut my Medicare Advantage.

  A constituent from Mesa, AZ, says:

       I am a senior citizen. I am becoming more and more 
     concerned about President Obama's healthcare plans, and I am 
     writing to tell you that I am happy with my Medicare 
     Advantage plan. I request that you do all you can not to cut 
     my benefits.
       I have a fairly wide choice of doctors and specialists, who 
     have always treated me with respect, given me the time I feel 
     I need, and have given me excellent care.
       I have a fitness benefit, which entitles me to the Silver 
     Sneakers program at our local YMCA; two choices of a dental 
     plan; a vision plan; plus many other options to maintain my 
     level of health or to try to improve it.
       Please, I beg you, do whatever you can to maintain our 
     Medicare Advantage plan. Do NOT cut any of our benefits.

  We know there are millions of seniors out there who absolutely depend 
on Medicare Advantage. Many have stories to tell about how this program 
has improved the quality of their life and their health. I urge my 
colleagues to support the McCain motion to commit to ensure that all of 
America's seniors, not just those in certain preferred counties, 
primarily located in the State of Florida, are grandfathered in these 
benefits.
  Again, to make it very clear, Medicare Advantage benefits are cut by 
the $120 billion reduction in Medicare under the bill. The Senator from 
Florida found a way to grandfather the Medicare Advantage benefits for 
many of his constituents. What the McCain motion to commit does is to 
apply that same grandfathering to all seniors in all States so that 
none of the seniors who have Medicare Advantage today would lose any of 
the benefits they enjoy today.
  It seems to me what is good for our senior citizens in Florida ought 
to be good for our senior citizens in Arizona or any other State in 
which they reside. I urge my colleagues to consider and to support the 
McCain motion to commit.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I yield up to 10 minutes to the Senator from 
Ohio, Mr. Voinovich.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. VOINOVICH. Mr. President, I want to spend a minute discussing the 
very emotional and divisive issue of abortion. I personally believe 
that all children, born or unborn, are a precious gift from God, and we 
have a moral responsibility to protect them. It grieves me to think 
that there have been more than 40 million abortions performed in this 
country since 1973.
  I am pleased to support the Nelson amendment that would apply the 
long-standing Hyde amendment, which currently prohibits Federal funding 
to pay for abortion services except in cases of rape, incest, or to 
save the life of the mother, to the health care reform bill.
  The issue of abortion is one that results in very strong emotions on 
both sides of this issue. Because of the concerns that millions of 
Americans have with using Federal taxpayer dollars for abortion, 
Congress enacted the Hyde amendment. As my colleagues know, the Hyde 
amendment has restricted Federal Medicaid dollars from paying for 
abortion services since 1977, and has been applied to all other 
federally funded health care programs, including the Federal Employees 
Health Benefits Program.
  Think about that, this language has been in place since the Ford 
administration, and has survived through the administrations of 
Presidents Carter, Reagan, George H.W. Bush, Clinton, and George W. 
Bush. That is 33 years, and all of a sudden, my colleagues want to 
change our policy on Federal funding of abortion.
  We shouldn't be making this type of sweeping policy change in the 
health care legislation, and the Nelson amendment is a necessary 
addition to the bill in order to protect our current policy and the 
unborn.
  I understand that not everyone in this country agrees with my 
position on abortion, but I am deeply concerned about the possible 
implications of spending taxpayer dollars on abortions when the issue 
so deeply divides Americans on ethical grounds.
  While as I have said, I don't agree with abortion and believe Roe v. 
Wade should be overturned, the Nelson amendment does not prohibit 
anyone from seeking an abortion, it does not overturn Roe v. Wade, and 
it does not place any new restrictions on access to abortions.
  It simply ensures that the taxpayer dollars will not pay for services 
that cause such deep moral divisions in our Nation. I think it is 
notable that this amendment is one of the few bipartisan amendments 
that the Senate will consider as part of this debate.
  I am pleased that a similar amendment in the House of Representatives 
passed with a convincing margin, and I urge my colleagues to support 
the Nelson-Hatch amendment before the Senate.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Udall of Colorado). The Senator from 
Wyoming.
  Mr. ENZI. Mr. President, I yield up to 10 minutes to the Senator from 
Idaho, Mr. Crapo.
  Mr. CRAPO. Mr. President, I rise today to discuss the Medicare 
Advantage Program again. It is one that is facing nearly $120 billion 
in cuts under the Democratic health care bill.
  Currently, there are nearly 11 million seniors enrolled in Medicare 
Advantage, which is about one out of every four seniors in the United 
States. In my home State of Idaho, that is about 60,000 people or 27 
percent of all Medicare beneficiaries in the State.
  Medicare Advantage is an extremely popular program. In fact, it is 
probably the most popular and fastest growing part of Medicare. A 2007 
study reported high overall satisfaction with the Medicare Advantage 
Program. Eighty-four percent of the respondents said they were happy 
with their coverage, and 75 percent would recommend Medicare Advantage 
to their friends or family members.
  But despite the popularity of the program, the massive cuts in the 
Reid bill will result in most seniors losing benefits or coverage or 
both under Medicare Advantage.
  I have a chart in the Chamber which I have shown before. You cannot 
see the individual States too well on it from this distance at this 
size, but you

[[Page 29766]]

can see the coloring on the United States in this chart.
  If you live in a State that is red, deep red, or the pinkish color--
which is almost every State in the Union--then you are going to see 
your benefits cut under Medicare Advantage under this bill.
  Why am I bringing it up again? We have already had a vote on it. In 
fact, we have had two votes on it. The majority has insisted on keeping 
these cuts in the bill. The reason I am bringing it up again is 
because, as we have combed through this 2,074-page bill, we have found 
out there is a provision in the Reid bill that would protect Medicare 
Advantage benefits for some people in the United States, for just a few 
in this country.
  During the Finance Committee markup, Senator Bill Nelson of Florida 
advocated on behalf of Medicare Advantage and the beneficiaries in his 
home State of Florida. Subsequently, during closed-door negotiations, 
the legislative language was added to protect those beneficiaries.
  This is interesting because one of the responses to us, as we have 
tried to stop the imposition of these cuts to Medicare, has been this 
bill will not cut any Medicare benefits. Well, if not, then why does 
Florida need a special exemption for its citizens? If not, why not 
support the McCain amendment that would give the same protection to all 
Medicare Advantage beneficiaries that the bill gives to primarily just 
a few in Florida?
  Specifically, section 3201(g) of the Reid bill, very deep in the bill 
on page 894, has a $5 billion provision drafted to prevent the drastic 
cuts in the Medicare Advantage Program from impacting those enrollees 
who reside primarily in three counties in Florida: Broward, Miami-Dade, 
and Palm Beach. It seems unfair that taxpayers would foot a $5 billion 
provision that provides protection for only some of the Medicare 
Advantage beneficiaries. It certainly proves there are cuts to Medicare 
Advantage benefits in this bill; again, benefits that one out of four 
beneficiaries in America receives--one of the fastest, if not the 
fastest, growing parts of Medicare. Instead of preferential treatment 
for some, why not extend these same protections for Medicare Advantage 
to all beneficiaries under Medicare? I know the 60,000 Medicare 
beneficiaries on Medicare Advantage in Idaho, my home State, want and 
deserve that same level of protection.
  That is why I am here to support the McCain motion to commit, and 
that is what his motion to commit would accomplish, very plain and very 
simple.
  The McCain motion would extend this grandfathering provision to all 
beneficiaries in the Medicare Advantage Program so all seniors in this 
popular and successful program could maintain that same level of 
benefits that today they enjoy under the current law. Every senior in 
the Medicare Advantage Program deserves to keep these critical extra 
benefits, which include things such as dental protection, vision 
coverage, preventive and wellness services, flu shots, and much more.
  In fact, most people who are not on Medicare Advantage in the 
Medicare Program have to buy supplemental insurance to get access to 
this coverage. Those in Medicare Advantage, which is one of the reasons 
it is such a popular program, have the opportunity to get it through 
their Medicaid services. Why is Medicare Advantage so opposed? Well, 
some say it is because of the extra costs, except that the extra costs 
in Medicare Advantage are returned to the government or shared with the 
beneficiaries. I think the reason might be because Medicare Advantage 
is one part of the Medicare Program that we have successfully been able 
to turn over to the private markets for operation. Interestingly, when 
the private sector gets involved in administering this part of the 
Medicare Program, the Medicare beneficiaries get more benefits, and it 
becomes the most popular program in Medicare.
  I know my colleague from Pennsylvania, Senator Casey, has filed an 
amendment to protect the 864,000 Medicare Advantage beneficiaries in 
his home State, and I would expect strong bipartisan support for the 
McCain motion to commit, since I think every Senator representing their 
constituents in their State wants to see this kind of protection. At 
the end, the McCain motion to commit is simply an amendment that will 
protect nearly 11 million seniors today enrolled in the Medicare 
Advantage Program and help to keep the President's promise when he said 
if you like what you have, you can keep it. If this bill is not amended 
in the way it is being proposed to be amended by Senator McCain's 
amendment, 11 million Americans are not going to be able to keep what 
they have in the Medicare Program, and that is just a start on the 
impact of what people in America are going to see under this 
legislation in terms of a reduction of their benefits and the quality 
of services they have access to.
  I urge my colleagues to support this amendment, and I yield the 
floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. I yield myself the balance of the time.


                Amendment No. 2962 to Amendment No. 2786

  Mr. President, I rise to speak in support of the Nelson amendment. We 
have been talking about the McCain amendment, which provides fairness 
for seniors who have Medicare Advantage so everybody across the country 
can have the same thing Florida is getting. But the critical amendment 
I wish to talk about is the Nelson amendment.
  This amendment needs to be adopted if we truly want to prevent 
Federal dollars from being used to pay for abortions. I am asking my 
colleagues to support a Democratic amendment. This isn't a partisan 
issue; it is a human issue. Even if you are on the other side, I hope 
you can agree it is not right to force people to pay for a procedure 
they may find offensive to the core of their morality. This issue is 
very personal for many of us. It is for me.
  When my wife Diana gave birth to our first child, Amy was 3 months 
premature. She weighed just 2 pounds and the doctor's advice was: Wait 
until morning and see if she lives. The doctors couldn't do anything to 
help this newborn baby. She survived the night.
  The next day I took Amy to a hospital in Casper. An ambulance wasn't 
available so we went in a Thunderbird. It was in a huge blizzard, the 
same blizzard that prevented us to fly Amy to a hospital in Denver that 
specialized in that. But we took this car and went to the center of the 
State to the biggest hospital to get the best care we could find. We 
ran out of oxygen on the way because the snow slowed us. The highway 
patrol was looking for us, and they were looking for an ambulance. All 
along the way, we were watching every breath of that child.
  We arrived at the hospital in Casper and put her in the care of 
doctors. There were several times when Diana and I went to the hospital 
and found her isolette with a shroud around it. We would knock on the 
window and the nurses would come and say: It is not looking good. We 
had to help her to breathe again or: Have you had your baby baptized? 
We did have Amy baptized a few minutes after birth, as she worked and 
struggled to live. Watching an infant fight with every fiber of her 
being, unquestionably showing the desire to live, even though they are 
only 6 months developed, is something that will show you the value of 
life. Amy survived and is now a teacher so gifted she teaches other 
teachers.
  Amy's birth changed my whole outlook on life. It reminded me of the 
miracle of life and the respect we owe that miracle. The Reid bill, as 
it is currently, does not respect life. But the amendment before us 
will allow that respect to be given to every American who benefits from 
that bill.
  On September 9, President Obama told a joint session of Congress: 
``No Federal dollars will be used to fund abortions.'' I agree. No 
Federal dollars should ever be used to pay for abortions. To do 
otherwise would compel millions of taxpayers to pay for abortion 
procedures they oppose on moral or ethical grounds. Unfortunately, the 
Reid bill fails to meet that standard set by the President. Section 
1303 of the bill provides the Secretary the authority to mandate and 
fund abortions.

[[Page 29767]]

  Some have questioned exactly how this bill funds abortions. It is 
quite simple. The bill funds abortions through the government-run 
insurance option and through subsidies to individuals to help pay for 
the cost of private insurance. Both of these options are funded with 
Federal dollars. Under the community health insurance option, also 
known as the government-run plan, the Secretary of Health and Human 
Services could allow the plan to cover abortions. In addition, the new 
tax subsidies in the bill could also go to private plans that cover 
abortions. In both these cases, Federal subsidies would be paid to 
plans that cover abortion.
  The Reid bill attempts to use budget gimmicks so its sponsors can 
argue that Federal funds will not pay for abortions. As the accountant 
in the Senate, I am not fooled by these gimmicks and neither should 
anyone else be. If the Reid bill is passed, Federal dollars will be 
used to pay for abortions.
  Money is fungible. That is an interesting word. It means Federal 
dollars paid into a health plan could be shifted across accounts. We 
don't have a good accounting system for that. It can replace other 
spending and those dollars could then go to pay for abortions. There is 
no way to absolutely prevent Federal dollars from paying for abortions 
once they are paid to plans that cover abortions.
  That is why Federal laws for the last 30 years have explicitly 
prohibited Federal funding going to such plans. That is right. It is 
already Federal law, although it comes in, in the appropriations bill, 
on an annual basis. Federal law currently prohibits funds going to pay 
for abortions under the Medicaid Program, under FEHBP--that is the 
program where we get our health insurance; it is the one that provides 
all the health insurance for all Federal employees, the same choices of 
plans--and the TRICARE Program, which is for all our Active military 
and their families.
  Current law recognizes the only way to actually prevent Federal funds 
from being used to pay for abortion is to offer the coverage of 
abortion in separate insurance plans and collect separate premiums to 
pay for that plan. This is what States who want to cover abortion for 
their Medicaid populations already do. As I said earlier, Medicaid is 
prohibited from using Federal dollars to pay for abortions. As a 
result, States set up separate plans and collect non-Federal dollars in 
separate accounts to pay for those services.
  If anyone has any doubts about the impact of the Reid bill, I would 
point them to the comments made by the senior staff at the U.S. 
Conference of Catholic Bishops. The associate director, Richard 
Doerflinger, recently described the Reid bill as ``completely 
unacceptable'' and said it was the worst health reform bill they had 
seen so far on life issues.
  It is probably worth it to note that the bishops have been longtime 
supporters of health care reform and covering the uninsured. Similarly, 
National Right to Life said the Reid bill ``seeks to cover elective 
abortions in two big new Federal health programs, but tries to conceal 
that unpopular reality with layers of contrived definitions and hollow 
bookkeeping requirements.''
  There has also been some misinformation out there regarding this 
amendment, and I wish to take a minute to clear up a couple arguments 
used against the Nelson amendment. First, it does not prohibit 
individuals from purchasing abortion coverage with their own private 
dollars. When similar arguments were made during the House debate on 
the Stupak language, PolitiFact, a Pulitzer Prize-winning, fact-
checking organization, concluded that such statements were false. The 
Nelson amendment only prohibits Federal funds from subsidizing those 
plans.
  Some have argued the Nelson amendment could cause individuals to lose 
the abortion coverage they currently receive from their current health 
insurance plans. That also isn't accurate. I would urge everyone to 
read section 1251 of the bill. Section 1251 says, clearly and 
unequivocally, that:

       Nothing in this act or an amendment made to this act shall 
     be construed to require that an individual terminate coverage 
     under a group health plan or health insurance coverage in 
     which such individual was enrolled at the date of the 
     enactment of this act.

  According to the sponsors of this bill, this section protects the 
ability of persons with existing insurance coverage to keep that same 
coverage. If section 1251 works as its authors describe it, this bill 
should make no changes to existing insurance plans that cover abortion 
and should allow individuals to keep the plans they have.
  Some have also said this amendment would ban abortion procedures. 
That, too, is false. The amendment does not ban abortions; it simply 
prohibits Federal dollars from paying for abortions, which is 
consistent with the current law.
  Many of my Democratic colleagues have argued during the debate that 
the health care we provide under this bill should be as good as the 
coverage given to Senators. If they believe that, they should all 
support applying the same rules regarding abortion coverage that apply 
to our own health plans. Federal employees' plans are prohibited from 
covering abortion--all Federal employees, not just Senators.
  I will work hard to see that taxpayers are not compelled to fund 
abortion services. I believe those of us in elected office have a duty 
to work to safeguard the sanctity of human life, since the right to 
life was specifically named in the Declaration of Independence. By 
safeguarding our right to life, our government fulfills the most 
fundamental duty to the American people. When that right is violated, 
we violate our sacred trust with our Nation's citizens and the legacy 
we leave to future generations.
  Regardless of what some people think, God doesn't make junk. He makes 
people in a variety of sizes, shapes, and abilities, and disabilities. 
There is a purpose even if we cannot understand it. I like the sign 
just outside Gillette. It says: ``If it's not a baby, you're not 
pregnant.''
  I don't believe Federal funding should be used to pay for abortions, 
and I will work to ensure that it doesn't happen under this bill. I 
will vote in support of the Nelson amendment and encourage my 
colleagues to do the same to protect life and respect the miracle of 
life that I witnessed with the birth of my daughter Amy.
  I thank the Chair and yield the floor.
  The PRESIDING OFFICER. The Senator from California is recognized.
  Mrs. BOXER. Mr. President, I ask unanimous consent for the following 
order: Boxer, 1 minute; Durbin, 5 minutes; Stabenow, 5 minutes; 
Shaheen, 5 minutes; Dodd, 5 minutes; Menendez, 5 minutes; and Baucus, 4 
minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mrs. BOXER. Mr. President, I gave birth to two beautiful children, 
and I am proud to say that I have now four grandchildren--the light of 
my life. I am just here to say as a mother, as a grandmother, and as a 
Senator from California that I trust the women of this country. I don't 
want to tell the women of this country--or tell anybody else anything 
like this--that they can't buy insurance with their own private money 
to cover their whole range of legal reproductive health care. We don't 
do that to the men. We don't say they can't get any surgery if they 
might need it for their reproductive health care. We don't tell them 
they can't get certain drugs, under a pharmaceutical benefit, they may 
need for their reproductive health care. Imagine if the men in this 
Chamber had to fill out a form and get a rider for Viagra or Cialis and 
it was public. Forget about it. There would be a rage in this Chamber.
  We are just saying treat women fairly. Treat women the same way you 
treat men. Let them have access to the full range of legal reproductive 
health care. That is all we are saying. Vote no on this amendment, the 
Nelson-Hatch amendment, because Harry Reid takes care of the firewall 
between private funds and Federal funds. We keep that firewall.
  Is it OK if Senator Durbin goes after Senator Stabenow?

[[Page 29768]]


  Mr. DURBIN. Yes.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Ms. STABENOW. Mr. President, first, I thank the Senator from 
California for her passionate advocacy and standing up for all of us, 
the women of this country. She is a mom, as she said. I, too, am a mom. 
As hard as it is for me to believe, I am also a grandmother with 
wonderful 2-year-old Lily and a little grandson Walter, who was born on 
his daddy's--my son's--birthday in August. Obviously, they are the 
light of my life, as well.
  One of the reasons I feel so passionate about the broader bill on 
health care reform is that this is about extending coverage to babies 
so they can be born healthy, and about prenatal care; it is about 
making sure that in the new insurance exchange we have basic coverage 
for maternity care. I was shocked to learn that 60 percent of the 
insurance policies offered right now in the individual market don't 
offer maternity care as basic care. We happen to think that is 
incredibly important. We are 29th in the world in the number of 
babies--below Third World countries--that survive the first year of 
life. This health care reform bill is about making sure we have healthy 
babies, healthy moms, and it is about saving lives and moving forward 
in a way that is positive, expanding coverage, not taking away 
important coverage for women who, frankly, find themselves in a crisis 
situation.
  That is what we are doing, unfortunately, through the Nelson-Hatch 
amendment. I have great respect for both of my colleagues who have 
offered this amendment, and for others who feel deeply about this 
issue. In the bill that has come before us, I think we respect all 
sides and keep in place the longstanding ban on Federal funding for 
abortion services, and no one is objecting to that. No one is trying to 
change that.
  As my friends have said, this is about whether we cross that line 
into private insurance coverage--whether we say to a woman, to a 
family: You are going to have to decide whether, when you have a child 
and you are having a crisis in the third trimester and might need some 
kind of crisis abortion services--whether you are going to find 
yourself in a situation where you are going to need abortion services, 
and you are going to have to publicly indicate that and buy a rider on 
insurance because you can't use your own money to buy an insurance 
policy.
  Here is what we know now. We know five States have riders right now--
Idaho, Kentucky, Oklahoma, Missouri, and North Dakota. There is no 
evidence there are any riders available in the individual market. So 
even though, technically, they say you can buy additional coverage, it 
is not offered or available. We are told by the insurance carriers 
that, in fact, it probably will not be available.
  We all know what this is about. This is about effectively banning 
abortion services coverage in the new insurance exchange we are setting 
up, which could, in fact, have a broader implication of eliminating the 
coverage for health plans outside the exchanges. So that is what this 
is about, which is why it is so important.
  Again, we are agreeing on the elimination or banning of Federal 
funding for abortions, other than extreme crises circumstances. We have 
done that in Federal law. This is about whether we go on to essentially 
create a situation where effectively people cannot get that coverage 
with their own money.
  The Center for American Progress noted that because approximately 86 
percent of the people who are going to be offered new opportunities for 
insurance--small businesses, individuals, in the private market--that 
because 86 percent of them will, in fact, receive some kind of tax 
credit or tax cut, in fact, again, we are talking about eliminating 
this option altogether because the majority of people will get some 
kind of a tax cut during this process.
  I think there are also some broader implications around the tax 
policy. If we are saying that someone can't purchase an insurance 
policy of their liking if they are getting a tax credit to help with 
health insurance, the fact is, what about other tax credits? What about 
other kinds of ways in which people get tax credits or tax cuts today? 
The implications of this are extremely broad.
  I urge a ``no'' vote. Let's keep Federal policy in place that doesn't 
allow Federal funding for abortion but respects the women of this 
country.
  The PRESIDING OFFICER. The Senator from Illinois is recognized.
  Mr. DURBIN. Mr. President, I rise in opposition to the Hatch-Nelson 
amendment. For 27 years, it has been my honor to serve in both the 
House and Senate. During that 27 years, the issue of abortion has been 
front and center as one of the most controversial and contentious 
issues we have faced. When I returned home to my congressional 
district, and now to the State, there have been many strong, heartfelt 
positions on this issue that are in conflict. Members of the Senate and 
House meet with people who have varying degrees of intensity on this 
issue all the time. We are not going to resolve this issue today with 
this amendment or this bill. We are going to do several things that I 
think are important.
  What we set out to do in health care reform was honor the time-
honored principles that we have now accepted. They are these: Abortion 
is a legal procedure since the Supreme Court case of Roe v. Wade. For 
over 30 years now, we have said no public funds can be used for an 
abortion but to save the life of a mother or in cases of rape or 
incest. We have said that no doctor or hospital will be compelled to 
perform an abortion procedure if it violates their conscience. Those 
are the three basic pillars of our abortion policy in this country.
  Now comes this debate about health care reform and a question about 
whether, if we offer health insurance policies through an exchange that 
offers abortion services, and the people are paying for the premiums 
for those policies with a tax credit, whether we are indirectly somehow 
or another financing and supporting abortion. I argue that we are not. 
We find, on a daily basis, many instances where Federal funds go to a 
private entity, even a religious entity with clear guidelines that none 
of the Federal funds can be spent for religious or private purposes.
  Organizations far and wide across America live within those bounds. 
They keep their books clean, and they account for the money received, 
and no questions are asked. The audits show that they followed the 
guidelines. This bill before us strictly follows these guidelines, as 
well. No Federal funds shall be used for any abortion procedure in an 
insurance policy. It has to be privately funded.
  I want to step back and make a slightly different argument too. There 
are those who have said in the House and in the Senate that unless the 
Stupak language in the House is adopted, they would seriously consider 
voting against health care reform. I argue to them that is a wrong 
position to take if they are opposed to abortion because the health 
care reform bill before us dramatically expands health care coverage.
  Today, there are 17 million women of reproductive age in America who 
are uninsured. This bill will expand health insurance coverage to the 
vast majority of them, which means millions more women will have access 
to affordable birth control and other contraceptive services. This 
expanded access will reduce unintended pregnancies and reduce 
abortions. So the family planning aspect of our health care reform will 
actually net fewer abortions in America--we know this because of the 
history of the issue--as more women have access to family planning. So 
those who argue that they either have this amendment or they will vote 
against health care reform should reflect on the fact that there will 
be fewer abortions in America with these health care services.
  Senator Mikulski, in the first amendment we adopted, provided for 
more preventive services for women across the board. Those services, I 
believe, would result in more counseling, more contraception, and fewer 
unintended pregnancies. That is a reality. Every Federal dollar that we 
spend on

[[Page 29769]]

family planning saves $3 in Medicaid costs. In 1972, we established a 
special matching rate of 90 percent for family planning services in 
Medicaid. Across the board, we know this money, well spent to allow 
women to decide their own reproductive fate, means there are fewer 
unintended pregnancies.
  I argue that whether your position is for or against abortion, if you 
believe there should be fewer abortions, you want this health care 
reform bill to pass--with or without the Stupak amendment. I think that 
the Stupak amendment goes too far, and I think we have come up with a 
reasonable alternative that adheres to the three pillars I mentioned 
earlier on abortion policy in America, and it sets up reasonable 
accounting on these insurance policies. I think this language in the 
bill is the right way to move to lessen the number of abortions in 
America and stay consistent with the basic principles that guide us.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut is recognized.
  Mr. DODD. Mr. President, I commend my colleague from Illinois, the 
Democratic whip of the Senate, for his arguments. He speaks for me when 
he identifies the pillars of our views on this issue.
  I was elected to the House of Representatives in 1974, 2 years after 
Roe v. Wade, and I have been in Congress now for 35 years. We have 
lived with those guidelines since then. I know it has not resolved the 
matter for many people. But it has served us well.
  What we have in this bill is a reflection of a continuation of those 
pillars. Having been the acting chair of the Health, Education, Labor, 
and Pensions Committee during the markup of the bill--in fact, Senator 
Kennedy voted by proxy, as they call it in that process--we insisted 
upon the adoption of a Kennedy amendment that maintained the notion of 
conscience in these matters. So we would not be forcing individuals to 
engage in abortion practices if they felt otherwise.
  We have long held the view in this Congress, under Democratic and 
Republican leadership, despite the differences--others have different 
views on this matter--that clearly public money should not be used. 
Despite the arguments to the contrary, we have done that again with 
this bill.
  The Senator from Illinois made a point about the measures in the bill 
that deal with wellness and reproductive rights. We minimize the 
likelihood of there being a demand for abortion on the part of many.
  I appreciate the fact that our leadership has made this matter, the 
Nelson-Hatch amendment, a matter of conscience. There is no caucus 
position on this amendment. There never has been and nor should there 
be, in my view, given the nature of this debate.
  I want to mention another argument we fail to understand here, in 
addition to the eloquent ones made by the Senator from Illinois. We 
rank 29th in infant mortality in the United States. It is an incredible 
statistic when you consider the wealth of our Nation. I worked on 
legislation with our colleague, Lamar Alexander, on infant births, 
prescreening, trying to provide resources and help for families with 
infants who suffer these debilitative and fatal problems.
  This legislation takes a major step forward in taking the United 
States out of the basement when it comes to infant mortality and gets 
us back to where we ought to be in reducing the tragedy that occurs in 
infant mortality.
  There is a distinction, clearly, between abortion and infant 
mortality. But this legislation takes a major step in improving quality 
of life, assisting children who arrive prematurely, as many do in our 
country today, and many do not survive that prematurity. Today many 
women are not getting the kind of support they need during their 
pregnancy, thus increasing the likelihood of premature births 
occurring, or not getting the screenings that need to occur immediately 
so you can avoid the terrible problems that can ensue thereafter. This 
legislation takes a major step in that direction.
  While we have done what is necessary for us to do, that is, protect 
the longstanding distinction between public and private dollars when it 
comes to abortion, we also have gone so much further. This bill 
provides support for families when it comes to minimizing the 
likelihood a child will be lost because they are not getting support 
services, as well as providing the reproductive services that will 
assist women during their pregnancies.
  My colleagues know I am a late bloomer. I am a parent of a 4-year-old 
and an 8-year-old. My colleagues talk about being grandparents. I 
always said I was the only candidate in the country who used to get 
mail from AARP and diaper services at the same time, having qualified 
for Medicare and also being a parent of infant children, two little 
girls, Grace and Christina. I want them to grow up having all the 
rights of young women in this country. I am hopeful that one day I may 
even be around to be a grandparent. We fought very hard to make sure 
those children were going to get the protections they could during my 
wife's pregnancies, to see to it they would be born healthy and sound. 
I have a great health care plan, as a Federal employee, to make sure 
that will happen. I want every American to have that same sense of 
security when that blessing occurs with the arrival of a child or 
grandchild. This bill does that.
  For all of those reasons, this amendment ought to be defeated. This 
bill ought to be supported and achieve a great success for our fellow 
citizens.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire is recognized.
  Mrs. SHAHEEN. Mr. President, I rise today to speak in opposition to 
the Nelson-Hatch amendment.
  The Patient Protection and Affordable Care Act we have before us does 
so many good things. It gives women access to preventive care. It makes 
health care more accessible to families across the country. It changes 
the way patients receive the care they need. We must not let the issue 
of reproductive choice overshadow all of the things this bill gets 
right.
  For over three decades, the Hyde amendment, which prohibits the use 
of Federal funds to pay for abortions except in cases of rape, incest, 
or if the life of the mother is at risk, has been the law of this land. 
Abortion should play no role in this health care debate. The Finance 
and HELP Committees spent countless hours drafting legislation that is 
part of the language in our health care bill to make sure it remains 
neutral on the issue of choice.
  The Patient Protection and Affordable Care Act that is currently 
before us maintains the Hyde amendment prohibiting Federal funding of 
abortions. As a result, neither the pro-choice nor the pro-life agendas 
are advanced.
  This is clearly explained in an analysis done by the nonpartisan 
Congressional Research Service. I ask unanimous consent to have printed 
in the Record this analysis.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:
                                                November 30, 2009.

                               Memorandum

     To: Hon. Jeanne Shaheen.
     From: Jon O. Shimabukuro, Legislative Attorney, American Law 
         Division, Congressional Research Service.
     Subject: Abortion and the Patient Protection and Affordable 
         Care Act.

       This memorandum responds to your request concerning 
     abortion and the Patient Protection and Affordable Care Act. 
     The measure was proposed by Senator Harry Reid on November 
     21, 2009 as an amendment in the nature of a substitute for 
     H.R. 3590, the Service Members Home Ownership Tax Act of 
     2009. You asked several questions about the Patient 
     Protection and Affordable Care Act and the use of federal 
     funds to pay for abortion services. This memorandum addresses 
     those questions.
       1. ``Does the Senate's Patient Protection and Affordable 
     Care Act prohibit affordability and cost-sharing credits from 
     paying for abortions beyond those permitted by the most 
     recent appropriation for the Department of Health and Human 
     Services?''
       Division F of the Omnibus Appropriations Act, 2009, 
     provides appropriations for the Departments of Labor, Health 
     and Human Services, Education, and Related Agencies for 
     FY2009. Section 507, included within Division F, prohibits 
     generally the use of appropriated funds to pay for abortions:

[[Page 29770]]

       (a) None of the funds appropriated in this Act, and none of 
     the funds in any trust fund to which funds are appropriated 
     in this Act, shall be expended for any abortion.
       (b) None of the funds appropriated in this Act, and none of 
     the funds in any trust fund to which funds are appropriated 
     in this Act, shall be expended for health benefits coverage 
     that includes coverage of abortion.
       (c) The term ``health benefits coverage'' means the package 
     of services covered by a managed care provider or 
     organization pursuant to a contract or other arrangement.
       This restriction on the use of appropriated funds to pay 
     for abortions is commonly referred to as the ``Hyde 
     Amendment.'' In 1976, Rep. Henry J. Hyde offered an amendment 
     to the Departments of Labor and Health, Education, and 
     Welfare, Appropriation Act, 1977, that restricted the use of 
     appropriated funds to pay for abortions provided through the 
     Medicaid program.
       An exception to the general prohibition on using 
     appropriated funds for abortions is provided in section 
     508(a) of the omnibus measure:
       The limitations established in the preceding section shall 
     not apply to an abortion--
       (1) if the pregnancy is the result of an act of rape or 
     incest; or
       (2) in the case where a woman suffers from a physical 
     disorder, physical injury, or physical illness, including a 
     life-endangering physical condition caused by or arising from 
     the pregnancy itself, that would, as certified by a 
     physician, place the woman in danger of death unless an 
     abortion is performed.
       In other words, funds appropriated to the Department of 
     Health and Human Services (``HHS'') for FY2009 could be used 
     to pay for an abortion if a pregnancy is the result of an act 
     of rape or incest, or if a woman's life would be endangered 
     if an abortion were not performed. Appropriated funds remain 
     unavailable, however, for elective abortions.
       Under the Senate measure, the issuer of a qualified health 
     plan would determine whether or not the plan provides 
     coverage for either elective abortions or abortions for which 
     the expenditure of federal funds appropriated for HHS is 
     permitted. If a qualified health plan decides to provide 
     coverage for elective abortions, it could not use any amount 
     attributable to a premium assistance credit or any cost-
     sharing reduction to pay for such services. The community 
     health insurance option established by the Senate measure 
     would be similarly restricted. H.R. 3590 would allow coverage 
     for elective abortions by the community health insurance 
     option, but amounts attributable to a premium assistance 
     credit or cost-sharing reduction could not be used to pay for 
     such abortions.
       2. ``Does the Senate's Patient Protection and Affordable 
     Care Act ensure that the community health insurance option 
     does not use federal funds to pay for abortions beyond those 
     permitted by the most recent appropriation for the Department 
     of Health and Human Services?''
       The Senate measure would allow coverage for elective 
     abortions by the community health insurance option, but 
     amounts attributable to a premium assistance credit or cost-
     sharing reduction could not be used to pay for such 
     abortions.
       3. ``Under current law, the Weldon Amendment prohibits 
     Federal agencies or programs and State or local governments 
     who [sic] receive certain federal funds from discriminating 
     against certain health care entities, including individuals 
     and facilities, that are unwilling to provide, pay for, 
     provide coverage of, or refer for abortions. Does the 
     Senate's Patient Protection and Affordable Care Act offer an 
     additional, new conscience protection for individual health 
     care providers and facilities that are unwilling to provide, 
     pay for, provide coverage of, or refer for abortions?''
       Under the Senate measure, individual health care providers 
     and health care facilities could not be discriminated against 
     because of a willingness or unwillingness to provide, pay 
     for, provide coverage of, or refer for abortions, if their 
     decisions are based on their religious or moral beliefs. 
     Section 1303(a)(3) of the Senate measure states: ``No 
     individual health care provider or health care facility may 
     be discriminated against because of a willingness or an 
     unwillingness, if doing so is contrary to the religious or 
     moral beliefs of the provider or facility, to provide, pay 
     for, provide coverage of, or refer for abortions.''
       4. ``Does the Senate's Patient Protection and Affordable 
     Care Act ensure that there is a health plan available in 
     every exchange that does not cover abortion beyond those 
     permitted by the most recent appropriation for the Department 
     of Health and Human Services?''
       The Senate measure would require the Secretary of HHS to 
     ensure that in any health insurance exchange (``Exchange''), 
     at least one qualified health plan does not provide coverage 
     for abortions for which the expenditure of federal funds 
     appropriated for HHS is not permitted. If a state has one 
     Exchange that covers more than one insurance market, the 
     Secretary would be required to provide the aforementioned 
     assurance with respect to each market.

  Mrs. SHAHEEN. Mr. President, the health reform legislation before us 
preserves the Hyde language and maintains the status quo in this 
country. We should keep it so. This should be a debate about health 
care. It should be about patients and about ensuring they have access 
to quality care at all stages of their lives, regardless of what may 
happen in their lives. It is a mistake to make this debate one about 
abortion.
  The amendment that is before us, the Nelson-Hatch amendment, would 
restrict any health plan operating in the exchange that accepts 
affordability credits from offering abortion services. In essence, the 
amendment before us would amount to a ban on abortion coverage in the 
health insurance exchange regardless of where the money comes from. Put 
another way, a woman who pays for insurance with money out of her own 
pocket would most likely not be able to get insurance that covers 
abortion.
  Make no mistake about it, this amendment is much more than a debate 
on whether Federal funds should be used for abortion, which is already 
established law. It is established law that is maintained in the 
Patient Protection and Affordable Care Act before us.
  The Nelson-Hatch amendment is a very far-reaching intrusion into the 
lives of women in how we would get private insurance. It is 
unprecedented, and it would mean millions of women would lose coverage 
they currently have.
  It is true, as we have heard from those people who support this 
amendment, that a woman would be able to buy an abortion rider. What we 
heard from Senator Stabenow and what we have seen from the National 
Women's Law Center shows us that in the five States that do require 
such a rider, there is no evidence that such plans exist. And even if 
they did exist, who would purchase that kind of a rider? No woman 
expects to need an abortion. This is not something you go into planning 
ahead of time.
  Finally, this amendment would have effects that reach well into the 
private insurance market. An independent analysis by the School of 
Public Health and Health Services at George Washington University 
concluded that a similar amendment adopted in the House--what is 
commonly known as the Stupak amendment--will have an ``industry-wide 
effect,'' eliminating coverage of medically indicated abortions over 
time for all women.'' That means any type of abortion for which there 
is a medical indication of need would go uncovered.
  I ask unanimous consent that ``Introduction and Results in Brief'' of 
the George Washington University analysis be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

   An Analysis of the Implications of the Stupak/Pitts Amendment for 
               Coverage of Medically Indicated Abortions

(By Sara Rosenbaum, Lara Cartwright-Smith, Ross Margulies, Susan Wood, 
                           D. Richard Mauery)


                   Introduction and Results in Brief

       This analysis examines the implications for coverage of 
     medically indicated abortions under the Stupak/Pitts 
     Amendment (Stupak/Pitts) to H.R. 3962, the Affordable Health 
     Care for America Act. In this analysis we focus on the 
     Amendment's implications for the health benefit services 
     industry as a whole. We also consider the Amendment's 
     implications for the growth of a market for public or private 
     supplemental coverage of medically indicated abortions. 
     Finally, we examine the issues that may arise as insurers 
     attempt to implement coverage determinations in which 
     abortion may be a consequence of a condition, rather than the 
     primary basis of treatment.
       Industry-wide impact that will shift the standard of 
     coverage for medically indicated abortions for all women: In 
     view of how the health benefit services industry operates and 
     how insurance product design responds to broad regulatory 
     intervention aimed at reshaping product content, we conclude 
     that the treatment exclusions required under the Stupak/Pitts 
     Amendment will have an industry-wide effect, eliminating 
     coverage of medically indicated abortions over time for all 
     women, not only those whose coverage is derived through a 
     health insurance exchange. As a result, Stupak/Pitts can be 
     expected to move the industry away from current norms of 
     coverage for medically indicated abortions. In combination 
     with the Hyde Amendment, Stupak/Pitts will impose

[[Page 29771]]

     a coverage exclusion for medically indicated abortions on 
     such a widespread basis that the health benefit services 
     industry can be expected to recalibrate product design 
     downward across the board in order to accommodate the 
     exclusion in selected markets.
       Supplemental insurance coverage for medically indicated 
     abortions: In our view, the terms and impact of the Amendment 
     will work to defeat the development of a supplemental 
     coverage market for medically indicated abortions. In any 
     supplemental coverage arrangement, it is essential that the 
     supplemental coverage be administered in conjunction with 
     basic coverage. This intertwined administration approach is 
     barred under Stupak/Pitts because of the prohibition against 
     financial commingling. This bar is in addition to the 
     challenges inherent in administering any supplemental policy. 
     These challenges would be magnified in the case of medically 
     indicated abortions because, given the relatively low number 
     of medically indicated abortions, the coverage supplement 
     would apply to only a handful of procedures for a handful of 
     conditions. Furthermore, the House legislation contains no 
     direct economic incentive to create such a market. Indeed, it 
     is not clear how such a market even would be regulated or 
     whether it would be subject to the requirements that apply to 
     all products offered inside the exchange. Finally, because 
     supplemental coverage must of necessity commingle funds with 
     basic coverage, the impact of Stupak/Pitts on states' ability 
     to offer supplemental Medicaid coverage to women insured 
     through a subsidized exchange plan is in doubt.
       Spillover effects as a result of administration of Stupak/
     Pitts. The administration of any coverage exclusion raises a 
     risk that, in applying the exclusion, a plan administrator 
     will deny coverage not only for the excluded treatment but 
     also for related treatments that are intertwined with the 
     exclusion. The risk of such improper denials in high risk and 
     costly cases is great in the case of the Stupak/Pitts 
     Amendment, which, like the Hyde Amendment, distinguishes 
     between life-threatening physical conditions and conditions 
     in which health is threatened. Unlike Medicaid agencies, 
     however, the private health benefit services industry has no 
     experience with this distinction. The danger is around 
     coverage denials in cases in which an abortion is the result 
     of a serious health condition rather than the direct 
     presenting treatment.
       The remainder of this analysis examines these issues in 
     greater detail.


                    Overview of Current Federal Law

       1. The Hyde Amendment and Medicaid
       The Hyde Amendment has been part of each HHS-related 
     appropriation since FY 1977. As set forth in the most recent 
     annual Labor/HHS federal appropriations legislation, the Hyde 
     Amendment provides in pertinent part as follows:
       Sec. 507. (a) None of the funds appropriated in this Act, 
     and none of the funds in any trust fund to which funds are 
     appropriated under this Act, shall be expended for any 
     abortion.
       (b) None of the funds appropriated in this Act, and none of 
     the funds in any trust fund to which funds are appropriated 
     in this Act, shall be expended for health benefits coverage 
     that includes coverage of abortion.
       (c) The term ``health benefits coverage'' means the package 
     of services covered by a managed care provider or 
     organization pursuant to a contract or other arrangement.
       Sec. 508. (a) The limitation established in the preceding 
     section shall not apply to an abortion--
       (1) if the pregnancy is the result of an act of rape or 
     incest; or
       (2) in the case where a woman suffers from a physical 
     disorder, physical injury, or physical illness, including a 
     life-endangering physical condition caused by or arising from 
     the pregnancy itself, that would, as certified by a 
     physician, place the woman in danger of death unless an 
     abortion is performed.

  Mrs. SHAHEEN. When we pass this legislation that will reform our 
health care system, it should not be done in a way that would lose 
benefits for women. All women should have access to comprehensive 
health care, including reproductive health care, from the provider of 
their choice.
  I urge my colleagues to oppose any amendment that threatens 
reproductive care that women have counted on for over 30 years.
  The PRESIDING OFFICER. The Senator from New Jersey is recognized.
  Mr. MENENDEZ. Mr. President, health care reform legislation we are 
considering is good for America, it is good for women and for families. 
It is a health care reform bill; it is not an abortion bill. In fact, 
not a dime of taxpayers' money goes to subsidize abortion coverage in 
this bill. It is, in fact, abortion neutral.
  This amendment, however, would change that. It would roll back the 
clock on a woman's right to choose. It unfairly singles women out and 
takes away benefits they already have. It singles out our daughters and 
legislates limits on their reproductive health, their reproductive 
rights. If we were to do the same to men, if we were to single out 
men's reproductive health in this legislation, imagine the outcry. 
Imagine if men were denied access to certain procedures. Imagine if 
they were denied access to certain prescription drugs. Imagine if the 
majority had to suffer the decision of the minority. But that is 
exactly what we are being asked to do to our daughters with this 
amendment--rolling back the hands of time. I personally find that 
offensive, as do women across this country.
  The language of this bill has been carefully negotiated to ensure 
that we are preserving a woman's right to choose but doing so without 
Federal funding. To claim otherwise is hypocritical and misleading.
  We need not fight all battles that have nothing to do with the real 
issue at hand--that millions of Americans do not have health insurance 
and many are being forced into debt to buy coverage that insurers later 
deny. But now, instead, we are not only reopening long-settled debates 
over this issue, we are actually faced with a proposal that would turn 
back the clock and deny women access to reproductive health care. It is 
the wrong debate at the wrong time.
  Over the years, we have made extraordinary progress in addressing 
women's reproductive rights. We have debated this issue in the Senate. 
We have debated it in our churches, in our homes, in our communities, 
and in the U.S. Supreme Court that has said a woman's right to choose 
is the law of the land. Let's not turn back the clock.
  I respect the deeply held views of my friend from Nebraska and the 
deeply held views of my friend from Utah. I know we will debate the 
issue many times in many forums. They will raise their voices in 
protest of a woman's right to choose, as I will raise mine to protect 
it. But this is neither the time nor the legislative vehicle for hot-
button politics to get in the way of badly needed health care reform.
  The language in this bill is clear: It preserves a woman's 
reproductive rights without any taxpayer funding. Yet we are engaged in 
a debate in which we are basically being told that neutrality is not 
good enough; that there needs to be an antichoice bill, not a health 
care reform bill; that neutrality on the issue is not acceptable; that 
only effectively banning abortion is acceptable. We are not going to be 
dragged down that road, and the women of this country will not stand 
for it. Certainly, this Senator will not either.
  The sponsors claim the amendment simply reinforces existing law 
restricting Federal funding of abortion coverage. Let's be very clear: 
There is no taxpayer money going to a woman's reproductive choices--
none--and to say otherwise is simply wrong.
  The fact is, this amendment that clearly takes us back in time would 
leave our daughters with the same hopeless lack of options their 
grandmothers faced, and that is not where we ought to be.
  This amendment would make it virtually impossible for insurance plans 
in the exchange to offer abortion coverage even if a woman were to pay 
premiums entirely out of her own pocket. It would do so by forbidding 
any plan that includes abortion coverage from accepting even one 
subsidized customer.
  This amendment is nothing more than a backdoor effort to restrict 
rights women already have. Would I like to see it clearly stated in 
this legislation that a woman should have a right to choose and all 
aspects of her reproductive health should be available under every 
plan? Yes, I would. But am I willing to accept neutrality as a 
reasonable compromise for the sake of passage of a bill that will 
provide affordable, accessible health care to every American and not 
spend a dime of taxpayers' money on women's reproductive choices? I 
will.
  Under this bill, if a plan chooses to provide abortion coverage, only 
private funds can go toward that care. That is further than I would 
like to go, but it is neutrality. In this bill, in each State exchange, 
there would be at least one plan that covers abortion and one plan

[[Page 29772]]

that does not. That is neutrality. It is fair. Let's accept it and move 
on.
  Under this legislation, women will keep their fundamental right to 
reproductive health benefits and gain other benefits.
  The PRESIDING OFFICER. The Senator has spoken for 5 minutes.
  Mr. MENENDEZ. That is what we should do in terms of the underlying 
bill. Let's vote down this amendment. Let's not turn back the clock.
  Mrs. BOXER. Mr. President, I ask unanimous consent that in lieu of 
Senator Baucus's 4 minutes, Senator Casey take that time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Pennsylvania is recognized.
  Mr. CASEY. Mr. President, I rise in support of the Nelson amendment 
for two reasons, and I speak for myself, not for other Members of the 
Senate. Obviously, I know there is a good bit of disagreement on both 
sides and even within both sides of the aisle.
  But I support this amendment for two reasons. One, I wish to make 
sure we ensure, through this health care legislation, the consensus we 
have had as part of our public policy for many years now--that taxpayer 
dollars don't pay for abortions. I believe we can and should and will 
get this right by the end of this debate.
  The second reason I support this is, I believe it is important to 
respect the conscience of taxpayers, both women and men across the 
country, who don't want taxpayer dollars going to support abortions. If 
there is one or maybe two areas where both sides can agree--people who 
are pro-life and pro-choice--it is on these basic principles: No. 1, we 
don't want to take actions to increase the number of abortions in 
America. I think that is the prevailing view across the divide of this 
issue. No. 2, we also have to do more to help those women who are 
pregnant, and I don't believe we are doing enough. We will talk more 
about that later. Even as we debate this amendment, the third thing I 
think we can agree on is, no matter what happens on this vote--and this 
debate will continue, even in the context of this bill--I believe we 
have to pass health care legislation this year.
  There are all kinds of consumer protections in this bill that will 
help men and women--prevention services that have never been part of 
our health care system before, insurance reforms to protect families 
and, finally, the kind of security we are going to get by passing 
health care legislation for the American people. I believe we can get 
this decisive issue correct in this bill. We are not there yet, but I 
believe we can. I believe we must pass health care legislation this 
month through the Senate and then, from there, get it enacted into law.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Mr. President, before we turn this over to the Republican 
side, I ask unanimous consent to have printed in the Record a letter 
from religious leaders who support maintaining the underlying bill and 
who oppose this amendment, and they are: Catholics for Choice, 
Disciples Justice Action Center, The Episcopal Church, Jewish Women 
International, Presbyterian Church Washington Office, Religious 
Coalition for Reproductive Choice, Union of Reform Judaism, United 
Church of Christ, Justice and Witness Ministries, United Methodist 
Church-General Board of Church and Society, Unitarian Universalist 
Association of Congregations.
  We are proud to have their support for our position.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  Religious Leaders Support Maintaining the Status Quo on Abortion in 
                           Health Care Reform

       The undersigned religious and religiously affiliated 
     organizations urge the Senate to support comprehensive, 
     quality health care reform that maintains the current Senate 
     language on abortion services.
       We believe that it is our social and moral obligation to 
     ensure access to high quality comprehensive health care 
     services at every stage in an individual's life. Reforming 
     the health care system in a way that guarantees affordable 
     and accessible care for all is not simply a good idea--it is 
     necessary for the well-being of all people in our nation.
       The passage of meaningful health reform legislation will 
     make significant strides toward accomplishing the important 
     goal of access to health care for all. Unfortunately, the 
     House-passed version of health reform includes language that 
     imposes significant new restrictions on access to abortion 
     services. This provision would result in women losing health 
     coverage they currently have, an unfortunate contradiction to 
     the basic guiding principle of health care reform. Providing 
     affordable, accessible health care to all Americans is a 
     moral imperative that unites Americans of many faith 
     traditions. The selective withdrawal of critical health 
     coverage from women is both a violation of this imperative 
     and a betrayal of the public good.
       The use of this legislation to advance new restrictions on 
     abortion services that surpass those in current law will 
     serve only to derail this important bill. The Senate bill is 
     already abortion neutral, an appropriate reflection of the 
     fact that it is intended to serve Americans of many diverse 
     religious and moral views. The bill includes compromise 
     language that maintains current law, prohibiting federal 
     funds from being used to pay for abortion services, while 
     still allowing women the option to use their own private 
     funds to pay for abortion care. American families should have 
     the opportunity to choose health coverage that reflects their 
     own values and medical needs, a principle that should not be 
     sacrificed in service of any political agenda.
       We urge the Senate to support meaningful health reform that 
     maintains the compromise language on abortion services 
     currently in the bill.
           Respectfully,
         Catholics for Choice, Disciples Justice Action Center, 
           The Episcopal Church, Jewish Women International, 
           NA'AMAT USA, National Council of Jewish Women, 
           Presbyterian Church (U.S.A.) Washington Office, 
           Religious Coalition for Reproductive Choice, The 
           Religious Institute, Union of Reform Judaism, United 
           Church of Christ, Justice and Witness Ministries, 
           United Methodist Church--General Board of Church and 
           Society, Unitarian Universalist Association of 
           Congregations.

  Mrs. BOXER. I thank the Chair.
  Mr. ENZI. Mr. President, I assume that added a few additional minutes 
to our time as well.
  I yield 10 minutes to the Senator from Nebraska.
  The PRESIDING OFFICER. The Senator from Nebraska is recognized.
  Mr. JOHANNS. Mr. President, let me start my remarks today, if I 
could, by offering my words of support and commendation to Senators 
Nelson and Hatch for offering this amendment. They have long been 
champions of the pro-life cause, and I applaud them for putting the 
time and effort into this amendment to get it right, bringing it to the 
floor, and offering it. I am very proud to stand here today as a 
cosponsor of this legislation.
  Fundamentally, this legislation is simply about doing the right 
thing. It ensures that current Federal law is upheld. In its most basic 
form, it says taxpayer dollars are not going to be used, directly or 
indirectly, to finance elective abortions. In fact, this has been the 
law of our country now dating back three decades.
  Basically, this amendment applies the Hyde amendment to the health 
care reform bill. It bars Federal funding for abortion, except in the 
case of rape, incest, or to protect the life of the mother. The Hyde 
amendment--as we have heard so many times during this debate--finds its 
genesis in 1977. The language in the Nelson-Hatch amendment is 
virtually identical to the Stupak language that was included in the 
House bill, where 240 Representatives in the House supported it and it 
passed on a vote of 240 to 194.
  The Stupak language very clearly prohibits Federal funding of 
abortions. It says this: No. 1, the government-run plan cannot cover 
abortions. That seems very straightforward. No. 2, Americans who 
receive a subsidy cannot use it to buy health insurance that covers 
abortion. No. 3, the Federal Government cannot mandate abortion 
coverage by private providers or plans. Then, finally, No. 4, as has 
been the case for 30 years, private insurance plans may cover abortion, 
and individuals may purchase a plan that covers it, but taxpayer 
dollars cannot be in the mix to purchase that.
  Compare that to what is in the current Senate bill. The government-
run plan can cover abortion. Americans who receive a subsidy can use it 
to buy a health insurance policy that covers abortion. The Federal 
Government can

[[Page 29773]]

and does mandate abortion coverage by at least one provider or plan. 
There is a stipulation in the current bill that requires the Health and 
Human Services Secretary to assure the segregation of funds, the tax 
credit/Federal dollars can't be used.
  But the reality is, it is akin to saying: Here, put those Federal 
dollars in your left pocket. When you are purchasing the abortion 
coverage, make sure it is your right hand that is reaching into your 
right pocket. How do you segregate those funds? It is impossible. What 
it does is to simply erase the line between taxpayer dollars and 
funding of abortions.
  Quoting the National Right to Life:

       Senator Reid included in his substitute bill language that 
     some have claimed would preserve the principles of the Hyde 
     Amendment. Such claims are highly misleading. In reality, the 
     Reid language explicitly authorizes direct funding of 
     elective abortion by a Federal Government program.

  Well, I feel very strongly we must ensure that Federal dollars are 
not used to fund abortions directly or indirectly. Health care reform, 
under the Reid language, has become a vehicle for changing the current 
law of the land regarding abortion coverage. Here is what some of my 
constituents have said to me, and I am quoting from a gentleman in 
Kearney:

       It is time to make sure that abortion is explicitly 
     prohibited by any language that may be put forward.

  Another Nebraskan said to me:

       I know that the pro-life issue is not the only component of 
     the Healthcare bill to consider, but it is probably the most 
     important issue of concern that I have in this bill. Abortion 
     is not health care.

  From central Nebraska I heard this:

       I'm taking a minute to send a note to say ``thank you'' for 
     standing up for life. Life is precious, whether you are just 
     conceived or over 100 years of age.

  Pro-life groups across the board support this amendment--the National 
Right to Life, Catholic Bishops, Family Research Council, and others. 
They represent millions of Americans. But the reality is, Americans 
support this.
  In a recent CNN survey, we confirm that 6 in 10 Americans favor a ban 
on the use of Federal funds for abortion. A recent Washington Post-ABC 
News poll indicates 65 percent of adults believe private insurance 
plans paid for with government assistance should not include coverage 
of abortion.
  I was in McCook, NE, a while back, doing a townhall meeting in 
August. After everybody had left, a gentleman came up to me. He told me 
something about that I will remember all the years I am in the Senate. 
First, he spoke about his faith, and then he said: I hope you 
understand, Senator, I cannot, under any circumstances, agree to 
anything that would allow my taxpayer dollars, either directly or 
indirectly, to fund abortions. He said: I cannot go there. He said: 
Please, do everything you can to stop this from happening.
  Today, I stand with that gentleman from McCook, NE, to say we have to 
stop this.
  I applaud my colleague from Nebraska, and I wish to end my comments 
with this. Senator Nelson stood on this issue and in a recent interview 
he said this:

       I have said at the end of the day, if it doesn't have the 
     Stupak language on abortion in it, I won't vote to move it 
     off the floor.

  I think that is a courageous statement. I do not mind standing here 
and saying I am very pleased to associate myself with Senator Nelson 
and Senator Hatch on this important amendment.
  Mr. President, how much time do I have remaining?
  The PRESIDING OFFICER. The Senator has 2 minutes 45 seconds.
  Mr. JOHANNS. I yield my 2 minutes 45 seconds to Senator Hatch when he 
speaks. I yield the floor.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GRASSLEY. Mr. President, I yield 10 minutes to the Senator from 
Kansas.
  The PRESIDING OFFICER. The Senator from Kansas is recognized.
  Mr. BROWNBACK. Mr. President, I appreciate this very much. It has 
been a healthy debate, a big debate, and it is an unusual debate 
because we haven't debated Hyde around here for 20 years. So this is an 
unusual debate we are having. Normally, we debate about abortion but 
not about abortion funding because there has been an agreement in this 
body for 33 years about that. So this is an unusual debate, but I think 
it is an important one.
  I think it is extraneous, in many respects, to the health care bill 
itself. Abortion is not health care, and so why we are debating the 
funding of abortion in a health care bill seems odd to me. But it is in 
the base bill, and we need to deal with that.
  A lot of people are coming forward and saying: Well, OK, which way is 
this; is it in the bill or not on funding for abortion? I am going to 
go to an independent fact checker and cite this. This is an independent 
research and prize-winning fact checker, PolitiFact.com, and they say 
our opponents' characterization of this amendment was ``misleading'' 
and that ``the people who would truly pay all their premium with their 
own money, and who would not use Federal subsidies at all, not barred 
in any way from obtaining abortion coverage, even if they obtain their 
insurance from the federally administered health exchange.''
  That is an independent group, PolitiFact.com, saying this doesn't 
limit the ability for somebody on their own to be able to purchase 
abortion coverage, if they want to do that, but in the base bill, what 
we are saying is we don't want to put Federal funds in it as the 
longstanding policy has been here.
  As the President himself has said when he spoke to a joint session of 
Congress, launching the health care debate:

       One more misunderstanding I want to clear up--under our 
     plan, no Federal dollars will be used to fund abortions, and 
     Federal conscience laws will remain in place.

  Unfortunately, in the Reid bill, this is not true. This is not true 
in the Reid bill. What is in the Reid bill is the so-called Capps 
amendment language, which allows for the Federal funding of abortion.
  I wish to describe--and I think a great deal of what is in here has 
been described, but what is taking place is the Federal subsidization 
of an insurance program that will have abortion funding in it. 
According to most groups, that is what is taking place in the Capps 
language, which is in the base Reid bill.
  I say this is an unusual debate that is taking place because we 
haven't debated Hyde for years around here. I wish to read to you what 
is our normal status on funding of abortions; that is, that we don't do 
Federal funding of abortions. I will read to you what the normal status 
is. The U.S. Conference of Catholic Bishops, which supports this base 
bill but does not support funding of abortions, describes it this way:

       In every major federal program where federal funds combined 
     with nonfederal funds to support or purchase health coverage, 
     Congress has consistently sought to ensure that the entire 
     package of benefits excludes elective abortions. For example, 
     the Hyde amendment governing Medicaid prevents the funding of 
     such abortions not only using federal funds themselves, but 
     also using the state matching funds that combine with the 
     federal funds to subsidize the coverage. A similar amendment 
     excludes elective abortions from all plans offered under the 
     Federal Employees Health Benefits Program, where private 
     premiums are supplemented by a federal subsidy.

  So there it is prohibited as well.

       Where relevant, such provisions also specify that federal 
     funds may not be used to help pay the administrative expenses 
     of a benefits package that includes abortions. Under this 
     policy, those wishing to use state or private funds to 
     purchase abortion coverage must do so completely separately 
     from the plan that is purchased in whole or in part with 
     federal financial assistance.
  Here I take a quick aside. That is what we are saying should be done 
in this bill, but it is not what is done in this bill.
  Going on:

       This is the policy that health care reform legislation must 
     follow if it is to comply with the legal status quo on 
     federal funding of abortion coverage. All of the five health 
     care reform bills approved in the 111th Congress violate this 
     policy.

  This is from a group, the United States Conference of Catholic 
Bishops,

[[Page 29774]]

that supports health care reform but not the abortion funding in it. 
They say as well that this fails in the Reid bill, that there is 
explicit funding for abortion in this bill.
  I thank my colleagues, particularly on the other side of the aisle, 
Senators Nelson and Casey, for being major cosponsors of this 
amendment. They are the ones who look at this and say: I don't want 
this in the base bill. This should not be in the base bill. It doesn't 
belong in the base bill. The language should be different.
  I also wish to note that most people across the country don't want 
this in the base bill. A majority of the country is opposed to the bill 
overall. They don't think this is the way we should go. They think it 
is the wrong way. But even people who support the bill itself by and 
large don't want Federal funding for abortion to be in this bill.
  A Pew poll even showed that 46 percent of people who support health 
care reform want to see the radical abortion language removed, the 
Capps language in the Reid bill, and all pro-choice Republicans and 
several pro-choice Democrats supported the measure in the House that 
put Stupak language in that removed the Federal funding for abortion. 
The American people feel this way because they know that forcing 
Federal funding of abortion is fiscally irresponsible and morally 
indefensible. Those are the two central pieces we are discussing, the 
fiscal responsibility or irresponsibility of this and the moral 
indefensibility. At a time of hemorrhaging debt, the Federal Government 
being supportive and funding elective abortions flies in the face of 
trying to restrain or bend the cost curve down in this legislation. 
That is not us being fiscally responsible.
  I have shown this chart before, but I think it is so striking. Back 
when we did do funding for abortions, we funded about 300,000 a year. 
How is that extra funding going to help us be more fiscally 
responsible? That is why a majority of the people, pro-life and pro-
choice, are saying the Federal Government should not be funding this. I 
don't believe that is fiscally responsible. And it is morally 
indefensible.
  Whether you are pro-choice or pro-life, we are having 300,000 
children who are not going to be here that we are funding the 
elimination of. Under anybody's definition of looking at that, they 
would say that is morally indefensible for the Federal Government that 
has long debated abortion policy, has not debated abortion funding, 
that that is morally indefensible for us to do something along that 
line.
  There are many issues to debate but thankfully Hyde has not been one 
of them we have been debating until now. I say to my colleagues the 
admonition we have had many times, whether you choose this day life or 
death, blessing or curse, why wouldn't we choose the life route on this 
one? Even if you have a close call or you are questioning this, why 
wouldn't we choose the route that says: I am not going to fund 300,000 
abortions. I want abortion to be safe, legal and rare, as some people 
in this body, but that is not rare, 300,000. Why wouldn't we choose the 
life route that says this is a controversial issue sometime way in the 
past, not recently. We don't fund these things. So many people in 
America don't want their money used to pay for abortions. Yet in this 
base Reid bill, it is there. I urge my colleagues to vote in favor of 
the Nelson-Hatch-Casey amendment that puts into Hyde language that is 
the status quo that there is not taxpayer funding going toward abortion 
and to reject those who would put the Reid language forward that would 
take us back decades to an era when we did fund abortion procedures.
  I yield the floor.
  Ms. SNOWE. Mr. President, I rise today to voice my opposition to the 
Nelson-Hatch amendment. In deliberating how to construct a fair 
equitable solution to such a divisive question, the one thing that our 
Group of 6 agreed on during our meetings prior to the markup of 
legislation in the Finance Committee was that we wanted to remain 
neutral and preserve the status quo.
  I am pleased that Majority Leader Reid chose to reflect the Finance 
Committee's work because I believe that we achieved that careful 
balance. Federal funds continue to be prohibited being used to pay for 
abortions unless the pregnancy is due to rape, incest or if the life of 
the mother is in danger. Health plans that choose to cover abortion 
care must demonstrate that no tax credits or cost-sharing credits are 
used to pay for abortion care.
  The Finance Committee adopted this solution primarily because the 
policy of separating Federal dollars from private dollars has been 
achieved in other instances and there is a precedent for that approach. 
Today, 17 States cover abortion beyond the Hyde limitations with State-
only dollars in their Medicaid Programs. States and hospitals, which in 
no way want to risk their eligibility for Medicaid funding, use 
separate billing codes for abortions that are allowable under the Hyde 
amendment, and those that are not. And let me emphasize, there have 
never been any violations among the States in this regard. Moreover, a 
similar approach has also been taken with Title X family planning funds 
and the United Nations Population Fund. We ought to hew to current law 
and what we know already works.
  Yet some want to prohibit women from using their own money--beyond 
taxpayer dollars--towards purchasing a plan in the exchange that covers 
abortion or limit coverage only through a supplemental policy. I have 
strong reservations about taking such an approach.
  Under the Nelson-Hatch amendment, a woman must try to predict whether 
or not she will require that coverage. This is an unfair proposition. 
Half of all pregnancies in this country are unplanned and most women do 
not anticipate the necessity for abortion coverage. Furthermore, in 
most cases, women already have that coverage. Today, between 47 and 80 
percent of private plans cover abortion services. So for a middle 
income woman who already purchases coverage in the individual market 
and could now receive a subsidy, let me be clear about the effect this 
change would have. This would take away coverage she currently has 
essentially creating a two tiered system for women who don't have 
coverage through their employer and instead receive it through the 
exchange. That is fundamentally wrong, and it is patently unfair.
  And the fact is, over time, more and more individuals will receive 
coverage through the exchange, which means that the number of women who 
will confront these restrictions will grow. Not only that but this 
amendment threatens to reach even further than the exchange. According 
to a study by the George Washington University School of Public Health 
that reviewed the Stupak/Pitts provisions from the House ``the size of 
the new market is large enough so that Stupak/Pitts can be expected to 
alter the `default' customs and practices that guide the health 
benefits industry as a whole, leading it to drop coverage in all 
markets in order to meet the lowest common denominator in both the 
exchange and expanded Medicaid markets.''
  As opposed to the demonstrated evidence from States that separating 
Federal funds can and does work, we cannot say the same about the 
availability of supplemental, abortion-only coverage.
  In the five States that have similar prohibitions on abortion 
coverage to the Nelson-Hatch amendment, supplemental coverage is 
generally not offered--as a result of a lack of market demand for 
riders. And even if supplemental coverage were available, there are 
significant privacy concerns. If a woman opted to purchase supplemental 
abortion coverage, it could be inferred that she plans to obtain an 
abortion. Confidentiality is vital to women who are making this choice 
and the possibility that this information could be disclosed is both 
serious and disturbing. Women may face harassment and intimidation on 
what should be a private matter between her family and her physician.
  The fact of the matter is, whether to undergo an abortion is one of 
the most wrenching decisions a woman can ever make--and we shouldn't 
ignore the real life circumstances that lead them to

[[Page 29775]]

this choice. For some expecting mothers, tragedy strikes when a lethal 
fetal anomaly is discovered. Other times there may be adverse health 
consequences to continuing a pregnancy. In these heartbreaking cases, a 
woman without coverage can face severe financial hardship in paying for 
these health costs--not to mention emotional anguish from ending a 
planned pregnancy.
  Rather than focusing on abortion, we should concentrate on the 
significant obstacles women of child-bearing age face under our current 
health care system. And we have achieved some clear victories for women 
in this bill. For example, maternity and newborn care is specifically 
included as an essential health benefit. Pregnancy is typically the 
most expensive health event for families during their childbearing 
years and there are significant consequences in a lack of coverage or 
even minimal coverage. Maternity coverage in the individual insurance 
market is difficult to find and exceedingly expensive if it is 
available. Maternity coverage riders alone ranged from $106 to $1,100 
per month, required waiting periods of one to 2 years with either no or 
limited coverage during that period and capped total maximum benefits 
as low as $2,000 to $6,000. Yet expenditures for maternity care average 
$8,802.
  I am also pleased that we passed the Mikulski amendment, which I was 
proud to cosponsor, that will enhance preventive services for women. 
This could include preconception care, where doctors counsel women on 
nutrition and other health interventions before they become pregnant, 
as well as proper prenatal care.
  This is critical as mothers who receive no prenatal care have an 
infant mortality rate more than six times that of mothers receiving 
early prenatal care. Yet 20 percent of women of childbearing age are 
uninsured and approximately 13 percent of all pregnant women are 
uninsured.
  This bill also at long last ends the discriminatory practice of 
gender rating. For years, women in this age group seeking insurance 
coverage have faced clear inequities compared to men. A study conducted 
by the National Women's Law Center found that insurers who practice 
gender rating charged 25-year-old women anywhere from 6 percent to 45 
percent more than 25-year-old men, and charged 40-year-old women from 4 
percent to 48 percent more than 40-year-old men. These critical 
improvements will enhance both access and health care outcomes for 
women. This is precisely the direction we should be heading in . . . 
rather than placing additional obstacles in front of women.
  Throughout my tenure in Congress I have opposed Federal funding for 
abortion. At the same time, as a champion of women's health, I have 
profound reservations about limiting coverage options for women when 
they are contributing private dollars. Women who are subject to an 
individual mandate and are contributing private dollars to the cost of 
their insurance should not have coverage choices dictated for them by 
the Federal Government. We are making decisions that will affect women 
on an intensely personal level and if we fail to craft the right 
solution, it could have serious implications for women's health and 
privacy.
  I appreciate the Finance Committee's effort to navigate this 
difficult issue and hope we can concentrate on the task at hand--
providing coverage to the 30 million uninsured Americans. In that 
light, I urge my colleagues to vote against the Nelson-Hatch amendment.
  The PRESIDING OFFICER (Mr. Casey). Who yields time?
  Mr. GRASSLEY. I yield such time as is remaining to the Senator from 
Utah.
  Mr. HATCH. Mr. President, I had a longer statement I was going to 
deliver this afternoon, but after listening to my colleagues speak 
about the Nelson-Casey-Hatch amendment, I want to take my time to 
refute some of the arguments they are making about our amendment.
  It does not even sound as though they are talking about the same 
amendment I filed with Senators Nelson and Casey. Our amendment does 
nothing to roll back women's rights. When my colleagues on the other 
side say that, they are simply mischaracterizing our amendment. Our 
amendment ensures that the Hyde language, a provision that has been in 
the HHS appropriations legislation for the last 33 years, will apply to 
the new health care programs created through this bill. We are applying 
current law to these programs. That is it. The current Hyde language 
ensures that no Federal Government funds are used to pay for elective 
abortion or health plans that provide elective abortion. Today States 
may only offer Medicaid abortion coverage if the coverage is paid for 
using entirely separate State funds, not State Medicaid matching funds. 
They cannot do that under current law. This is a longstanding policy 
based on a principle that the Federal Government does not want to 
encourage abortion.
  For example, Guttmacher studies show that when abortion is not 
covered in Medicaid, roughly 25 percent of women in the covered 
population who would have otherwise had an abortion choose to carry to 
term. I wanted to explain why the Reid-Capps language in the Reid bill 
is not the Hyde language. First, the Hyde amendment prohibits funding 
for abortions through Medicaid and other programs funded through the 
HHS appropriations bill. However, the public option is not subject to 
further appropriation and therefore is not subject to Hyde. Directly 
opposite of the Hyde amendment, the Reid-Capps language explicitly 
authorizes the newly created public option to pay for elective 
abortions. The public option will operate under the authority of the 
Secretary of HHS and draw funds from the Federal Treasury account. 
Regardless of how these funds are collected, these funds from the 
Treasury are Federal funds. Funding of abortion through this program 
will represent a clear departure from longstanding policy by 
authorizing the Federal Government to pay for elective abortion for the 
first time in decades.
  The Nelson-Hatch-Casey amendment would prohibit funding for abortion 
under H.R. 3590 except in the cases of rape, incest, or to save the 
life of the mother. As is the case with the CHIP program and Department 
of Defense health care, the Nelson-Hatch-Casey amendment would be 
permanent law rather than an appropriations rider, subject to annual 
debate and approval. Any funding ban subject to annual approval will be 
in jeopardy in the future. Even if there are the votes to maintain the 
Hyde language, procedural tactics and veto threats could be employed 
and make it impossible to retain an annual ban.
  Secondly, the Hyde amendment prohibits funding for health benefits 
coverage that includes coverage of abortion. This requirement ensures 
that the Federal Government does not encourage abortion by providing 
access to it. When the government subsidizes a plan, it is helping to 
make all of the covered services available. Federal premium subsidies 
authorized and appropriated in H.R. 3590 are not subject to annual 
appropriations and they are, therefore, not subject to the Hyde 
language. Directly opposite of the Hyde language, the Reid-Capps 
explicitly allows federal subsidies to pay for plans that cover 
abortion by applying an accounting scheme. Under the accounting scheme, 
the government is permitted to subsidize abortion coverage provided 
that funds used to reimburse for abortions are labeled ``private'' 
funds. This is an end run around the Hyde restriction on funding for 
plans that cover abortion.
  Furthermore, under the accounting scheme, premium holders will be 
forced to pay at least $12 per year as an abortion surcharge to be used 
to pay for abortions. The Nelson-Casey-Hatch amendment would ensure 
that no funds under H.R. 3590 will subsidize plans that cover abortion. 
However, it does nothing to prohibit individuals from purchasing 
separate abortion coverage or from purchasing plans that cover abortion 
without a Federal subsidy.
  Another issue I want to raise is the impact the Nelson-Hatch-Casey 
amendment would have on coverage of elective abortions by private 
health plans. I heard some of my colleagues say that

[[Page 29776]]

our amendment would prohibit women from purchasing health plans with 
abortion coverage, even if they spend their own money. I understand 
there is a Politifact story with the headline ``Lowey Says Stupak 
Amendment Restricts Abortion Coverage, Even for Those Who Pay for Their 
Own Plan.''
  That is simply not true. Our amendment would not prohibit the ability 
of women to obtain elective abortions as long as they use their own 
money to purchase these policies and not the money of the taxpayers of 
America, directly or indirectly. Again, our opponents will argue that 
it does, but if they take the time to read our amendment, they will 
note on page 3, line 6, that it ensures there is an option to purchase 
separate supplemental coverage or a plan with coverage for elective 
abortions. In fact, let me read it to my colleagues so we are all clear 
on what the language actually says. I am going to read it because I am 
tired of hearing some of the misrepresentations made on the floor by, I 
am sure, well-meaning people who are very poorly informed on this 
amendment. It is easy for me to see why they are poorly informed when I 
look at this itty-bitty bill.
  My gosh, no matter how bright you are, who could know everything in 
this itty-bitty bill that will break the desk, if I drop it on it.
  I am sorry. I scared the distinguished Senator from Iowa with this 
itty-bitty bill. I should have dropped it a little bit softly. I 
apologize.
  Let me tell you what it actually says.

       (2) Option to purchase separate supplemental coverage or 
     plan.--Nothing in this subsection shall be construed as 
     prohibiting any non-Federal entity (including an individual 
     or a State or local government) from purchasing separate 
     supplemental coverage for abortions for which funding is 
     prohibited under this subsection, or a plan that includes 
     such abortions, so long as--
       (A) such coverage or plan is paid for entirely using only 
     funds not authorized or appropriated by this Act; and
       (B) such coverage or plan is not purchased using--
       (i) individual premium payments required for a qualified 
     health plan offered through the Exchange towards which a 
     credit is applied under section 36B of the Internal Revenue 
     Code of 1986; or
       (ii) other non-Federal funds required to receive a Federal 
     payment, including a State's or locality's contribution of 
     Medicaid matching funds.

  Under the Nelson-Hatch-Casey amendment, women are allowed to purchase 
separate elective abortion coverage with their own money. I wish they 
would not, but we allow it. Anybody who says otherwise is 
misrepresenting what this amendment does. I am sure they are not 
intentionally misrepresenting but nevertheless misrepresenting. So have 
fair warning.
  It is also true that our amendment allows women to purchase a health 
plan that includes coverage of elective abortions in addition to the 
supplemental abortion policy as long as they pay for it with their own 
money. So when those who oppose our amendment say a woman would never 
want to purchase abortion coverage as a separate rider, they are truly 
misunderstanding that our language also permits women to purchase an 
identical exchange plan that includes coverage of elective abortions, 
in addition to other health benefits. To be clear, under our amendment, 
a woman may purchase with her own funds either a supplemental policy 
that covers elective abortions or an entire health plan that includes 
the coverage of elective abortions.
  Today, Federal funds may not pay for elective abortions or plans that 
cover elective abortions. This is the fundamental component of the Hyde 
language. And to be clear, the Nelson-Hatch-Casey language does not 
prevent people purchasing their own private plans that include elective 
abortion coverage with private dollars.
  In addition, our amendment explicitly states that these types of 
policies may be offered. In other words, our amendment does not 
restrict these policies from being offered. The only caveat is that 
they may not be purchased with Federal subsidies. We want to make that 
clear, and the Reid-Capps language does not.
  Let me read that section of the Nelson-Hatch-Casey amendment for my 
colleagues. It may be found on page 4, line 3, of the Nelson-Hatch-
Casey amendment.

       (3) Option To Offer Supplemental Coverage Or Plan.--

  Now get this:

       Nothing in this subsection shall restrict any non-Federal 
     health insurance issuer offering a qualified health plan from 
     offering separate supplemental coverage for abortions for 
     which funding is prohibited under this subsection, or a plan 
     that includes such abortions, so long as--
       (A) premiums for such separate supplemental coverage or 
     plan are paid for entirely with funds not authorized or 
     appropriated by this Act;
       (B) administrative costs and all services offered through 
     such supplemental coverage or plan are paid for using only 
     premiums collected for such coverage or plan; and
       (C) any such non-Federal health insurance issuer that 
     offers a qualified health plan through the Exchange that 
     includes coverage for abortions for which funding is 
     prohibited under this subsection also offers a qualified 
     health plan through the Exchange that is identical in every 
     respect except that it does not cover abortions for which 
     funding is prohibited under this subsection.

  Our amendment has the support of the U.S. Conference of Catholic 
Bishops, the National Right to Life Committee, the Family Research 
Council, the Ethics & Religious Liberty Commission of the Southern 
Baptist Convention, Concerned Women for America, the National 
Association of Evangelicals, and Americans United for Life Action.
  Polls across the country indicate a majority of Americans do not want 
their tax dollars paying for elective abortions. According to a CNN/
Opinion Research Corporation survey, 6 in 10 Americans favor a ban on 
the use of Federal funds for abortion. Anybody who understands that 
figure knows there are pro-choice people who also favor a ban on the 
use of Federal funds for abortion.
  It also indicates that the public may also favor legislation that 
would prevent many women from getting their health insurance plan to 
cover the cost of an abortion, even if no Federal funds are involved. 
This poll indicates that 61 percent of the public opposes the use of 
public money for abortions for women who cannot afford the procedure, 
with 37 percent in favor of allowing the use of Federal funds.
  So my question to my fellow Senators is the following: When is this 
Congress going to start listening to the American people, people on 
both sides of this issue, who do not feel that taxpayers ought to be 
saddled with paying for abortion through their tax dollars, or in any 
other way, for that matter?
  I urge my colleagues to support the Nelson-Hatch-Casey amendment. Do 
the right thing and support our amendment, which truly protects the 
sanctity of life and provides conscience protections to health care 
providers who do not want to perform abortions. That is an important 
aspect of this issue, and I have waited until the last minute to say 
something about that issue. Why should people of conscience be forced 
to participate in any aspect of elective abortions? They should not. 
People who have deep feelings of conscience should not be forced--that 
includes nurses, doctors, health care providers, hospitals--they should 
not be forced to do this, just because of the radicalness of some 
people who exist in our society today, and some think the radicalness 
of some in this body and in the other body. It is radical to expect the 
American taxpayers to pay for elective abortions, especially when such 
a high percentage--up to 68 percent, according to some polls, and I 
think even higher--do not want to have Federal dollars used for this 
purpose.
  I appreciate my colleagues. I appreciate what my colleagues stand 
for. But this is very important stuff.
  I ask unanimous consent that a number of constituent letters be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                          Constituent Letters

       Senator Hatch: I am absolutely and adamantly opposed to 
     having any of my tax dollars go to fund abortion directly or 
     indirectly. I urge you in the strongest possible terms to 
     vote against any motion to have the Senate consider any bill 
     that does not include specific language like the Stupak 
     Amendment.

[[Page 29777]]

       Please let me know how you vote on the upcoming motion to 
     proceed to consider any healthcare legislation.
       Thank you.
                                  ____

       Senator Hatch: I am extremely concerned that the majority 
     of members of all the congressional committees that have 
     considered healthcare legislation have refused to 
     specifically include language that would prohibit allowing 
     any of my tax dollars from directly or indirectly funding 
     abortions.
       I am absolutely opposed to being forced to fund abortions 
     in any way with my tax dollars, and I urge you not to support 
     any healthcare bill that does not specifically prevent this. 
     I consider abortion to be the taking of innocent life and a 
     fundamental moral issue. I do not want to be forced to 
     support it in any way. . . .
       Thank you.
                                  ____

       Senator Hatch: During floor debate on the health care 
     reform bill, please support an amendment to incorporate 
     longstanding policies against abortion funding and in favor 
     of conscience rights. If these serious concerns are not 
     addressed, the final bill should be opposed.
       Genuine health care reform should protect the life and 
     dignity of all people from the moment of conception until 
     natural death.

  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the Senator 
from Nebraska be allowed to speak for up to 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Nebraska.
  Mr. NELSON of Nebraska. Mr. President, I rise to discuss the 
bipartisan amendment which I have proposed with Senator Hatch, the 
Presiding Officer, and others. As my good friend and colleague from 
Utah has so eloquently explained, our amendment mirrors the language 
offered by Representative Stupak that was accepted into the House 
health care bill. Our view is that it should become part of the Senate 
health care bill we are debating as well.
  It is a fact that the issue of abortion stirs very strong emotions 
involving strongly held principles all across America, from those who 
support the procedure and those who do not. We are hearing that passion 
at times here on the Senate floor.
  But we are not here to debate for or against abortion. This is a 
debate about taxpayer money. It is a debate about whether it is 
appropriate for public funds to, for the first time in more than three 
decades, cover elective abortions. In my opinion, most Americans and 
most of the people in my State would say no.
  As it is currently written, though, the Senate health care bill 
enables taxpayer dollars, directly and indirectly, to pay for insurance 
plans that cover abortion. We should not open the door to do so. As I 
said yesterday, when we offered the amendment, some suggested the 
Stupak language imposes new restrictions on abortion. But that is not 
the case. We are seeking to apply the same standards to the Senate 
health care bill that already exist for many Federal health programs.
  But the bill does set a new standard. It is a standard in favor of 
public funding of abortion. Our amendment does not limit the procedure, 
nor prevent people from buying insurance that covers abortion with 
their own money. It only ensures that when taxpayer dollars are 
involved, people are not required to pay for other people's abortions.
  Some have claimed that the amendment restricts abortion coverage even 
for those who pay for their own plan. That is not true, according to 
politfact.com, a prize-winning, fact-checking Web site, which looked at 
similar claims by a House Member during House debate on the Stupak 
amendment. PolitFact found, and I quote:

       First, she suggests the amendment applies to everyone in 
     the private insurance market when it just applies to those in 
     the health care exchange. Second, her statement that the 
     restrictions would affect women ``even when they would pay 
     premiums with their own money'' is incorrect. In fact, women 
     on the exchange who pay the premiums with their own money 
     will be able to get abortion coverage. So we find her 
     statement false.

  The Nelson-Hatch-Casey amendment only incorporates the longstanding 
rules of the Hyde amendment, which Congress approved in 1976, to ensure 
that no Federal funds are used to pay for abortion in the legislation.
  This standard now applies to Federal health programs covering such 
wide and broad groups as veterans, Federal employees, Native Americans, 
active-duty servicemembers, and others--all of whom are covered under 
some form of a Federal health program.
  Thus, this standard applies to individuals participating in the 
Children's Health Insurance Program, Medicare, Medicaid, Indian Health 
Services, veterans health, and military health care programs.
  I wish to emphasize another point. All current Federal health 
programs disallow the use of Federal funds to help pay for health plans 
that include abortion. Our amendment only continues that established 
Federal policy. Some have said the Hyde amendment already is in effect 
in this bill. But that is not the case at all. The bill says the 
Secretary of Health and Human Services may allow elective abortion 
coverage in the Community Health Insurance Option--the public option--
if the Secretary believes there is sufficient segregation of funds to 
ensure Federal tax credits are not used to purchase that portion of the 
coverage.
  The bill would also require that at least one insurance plan that 
covers abortion and one that does not cover abortion be offered on 
every State insurance exchange.
  Federal legislation establishing a public option that provides 
abortion coverage and Federal legislation allowing States to opt out of 
the public option that provides abortion coverage eases--let me repeat 
the word ``eases''--the standards established by the Hyde amendment.
  The claim that the segregation of funds accomplishes the Hyde intent 
falls short. Segregation of funds is an accounting gimmick. The reality 
is, taxpayer-supported Federal dollars would help buy insurance 
coverage that includes covering abortion.
  I wish to offer some other points about the effect of the Nelson-
Hatch-Casey amendment.
  Under the amendment, no funds authorized or appropriated by the bill 
could be used for abortions or for benefits packages that include 
abortion. The amendment would prohibit the use of the affordability tax 
credits to purchase a health insurance policy that covers abortion. It 
would also prohibit Federal funding for abortion under the Community 
Health Insurance Option.
  In addition, the amendment makes exceptions in the cases of rape or 
incest or in cases of danger to the mother's life.
  In addition, the amendment allows an individual to use their own 
private funds to purchase separate supplemental insurance coverage for 
abortions, perhaps even what is called a rider to an existing plan.
  The amendment allows an individual whose private health care coverage 
is not subsidized by the Federal Government to purchase or be covered 
by a plan that includes elective abortions, paid for with that 
individual's own premium dollars.
  Under the amendment, a private insurer participating in the exchange 
can offer a plan that includes elective abortion coverage to 
nonsubsidized individuals on the exchange, as long as they also offer 
the same plan without elective abortion coverage to those who receive 
Federal subsidies.
  On another point, under Federal law, States are allowed to set their 
own policies concerning abortion. Many States oppose the use of public 
funds for abortion. Many States have also passed laws that regulate 
abortion by requiring informed consent and waiting periods, requiring 
parental involvement in cases where minors seek abortions, and 
protecting the rights of health care providers who refuse, as a matter 
of conscience, to assist in abortion.
  But perhaps most importantly, there is no Federal law, nor is there 
any State law, that requires a private health plan to include abortion 
coverage. But the bill before us, as written, does.
  As I have said, the current health care bill we are debating should 
not be used to open a new avenue for public

[[Page 29778]]

funding of abortion. We should preserve the current policies, which 
have stood the test of time, which are supported by most Nebraskans and 
most Americans. The Senate bill, as proposed, goes against that 
majority public opinion. I think most Americans would prefer that this 
health care bill remain neutral on abortion, not chart a new course 
providing public funds for the procedure. Public opinion suggests so. 
So does the fact that over the last 30-plus years Congress has passed 
new Federal laws that have not broken with precedent.
  Finally, as President Obama has said, this is a health care reform 
bill. It is not an abortion bill. So it is time to simply extend the 
longstanding standard disallowing public funding of abortion to new 
proposed Federal legislation.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I yield to the Senator from California. At 
least indirectly it is our understanding that Senator Reid will soon 
come to the floor to speak.
  Mrs. FEINSTEIN. As soon as he comes in, I would be happy to yield.
  Mr. BAUCUS. That would be my request.
  Mrs. FEINSTEIN. Thank you. I appreciate that.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. FEINSTEIN. Mr. President, simply put, I believe this amendment 
would be a harsh and unnecessary step back in health coverage for 
American women.
  What this amendment would do, as I read it, is to prohibit any health 
insurance plan that accepts a single government subsidy or dollar from 
providing coverage for any abortion, no matter how necessary that 
procedure might be for a woman's health, even if she pays for the 
coverage herself.
  The proponents of this amendment say their sole aim is to block 
government funds from being used to cover abortion, but the underlying 
bill already does that. In the bill before us, health plans that opt to 
cover abortion services--in cases other than rape, incest, or when the 
life of the mother is at stake--must segregate the premium dollars they 
receive to ensure that only private dollars and not government money is 
used. They argue that segregating funds means nothing--you heard that--
and that money is fungible. However, this method of separating funds 
for separate uses is used in many other areas, and there is ample 
precedent for the provision.
  For example, charitable choice programs allow agencies that promote 
religion to receive Federal funds as long as these funds are segregated 
from religious activities. We all know that. We see it in program after 
program. If these organizations can successfully segregate their 
sources of funding, surely health insurance plans can do the same. 
Additionally, the Secretary of Health and Human Services must certify 
that the plan does not use any Federal funding for abortion coverage 
based on accounting standards created by the GAO.
  This amendment would place an unprecedented restriction on a woman's 
right to use her own money to purchase health care coverage that would 
cover abortions. Let me give my colleagues one example. Recently, my 
staff met with a bright, young, married attorney who works for the 
Federal Government. She and her husband desperately wanted to start a 
family and were overjoyed to learn she was pregnant. Subsequently she 
learned the baby she was carrying had anencephaly, a birth defect 
whereby the majority of the brain does not develop. She was told the 
baby could not survive outside of the womb. She ended the pregnancy but 
received a bill of nearly $9,000. Because she is employed by the 
Federal Government, her insurance policy would not cover the procedure. 
Her physician argued that continuing the pregnancy could have resulted 
in ``dysfunctional labor and postpartum hemorrhage, which can increase 
the risk for the mother.'' The physician also warned that the 
complications could be ``life threatening.''
  However, OMB found that this circumstance did not meet the narrow 
exception in which a woman's life, not her health, is in danger. The 
patient was told: ``The fetal anomaly presented no medical danger to 
you,'' despite the admonitions of her physician. The best she could do 
was to negotiate down the cost to $5,000.
  Now, this story, without question, is tragic. A very much-wanted 
pregnancy could not be continued and, on top of this loss, the family 
was left with a substantial unpaid medical bill. Health insurance is 
designed to protect patients from incurring catastrophic bills 
following a catastrophic medical event. But if this amendment passes, 
insured women would lose any coverage included in the underlying bill, 
even if she pays for it herself. Why would this body want to do that? I 
can't support that.
  A woman's pregnancy may also exacerbate a health condition that was 
previously under control, or a woman may receive a new diagnosis in the 
middle of her pregnancy. It happens. If this amendment passes, women in 
these circumstances would also learn that their insurance does not 
cover an abortion. In some cases, it may be unclear whether the woman's 
health problem meets the strict definition of life endangerment.
  The National Abortion Federation has compiled calls they receive on 
their hotline which are available to women who need assistance 
obtaining abortion care. Let me give you a few examples.
  Molly was having kidney problems and was in a great deal of pain. She 
couldn't go to work. She couldn't provide for her two children. When 
she became pregnant, she made the decision to terminate the pregnancy 
in order to have her kidney removed to begin her recovery. She knew 
carrying the pregnancy would create additional health problems and 
would leave her unable to provide for her family.
  Jamie already had severe health problems when she learned she was 
pregnant. She was a severe diabetic and her low blood sugar levels 
caused her to suffer from seizures. She was unable to continue her 
pregnancy but had difficulty affording the procedure.
  Another was suffering from a serious liver illness when she became 
pregnant. Doctors were unsure of the cause, but she was in a great deal 
of pain. She already had two children. She could not care for them 
because of this pain. The tests and medications she needed to address 
her medical condition were incompatible with pregnancy.
  None of these women experienced immediate threats to their lives, so 
under this amendment their circumstances would not meet the narrow 
exceptions permitted for abortion coverage.
  This is a problem. How can one say we are going to provide insurance, 
but we don't like one aspect of it. We don't want the government to pay 
for it. OK, OK. But the woman herself can't pay for it. That is the 
extra step that this legislation takes.
  To this day, it is still legal to have an abortion. Women in this 
situation don't buy insurance for abortion, but they buy a policy that 
may cover them, married women, should something happen in a pregnancy 
in the third trimester. If they find a baby is without a brain, she can 
have an abortion, and it is covered.
  One of the problems with this whole debate is everybody sees 
something through their own lens. They don't see the grief and trouble 
and morbidity that is out there and the circumstances that drive a 
woman to decide--married--she has to terminate her pregnancy for very 
good medical reasons. Nobody considers that. This is all ideologic, and 
it really, deeply bothers me.
  So I can only tell my colleagues I very much hope this amendment goes 
down.
  Thank you very much, Mr. President. I yield the floor.
  The PRESIDING OFFICER. The Senator from Nebraska.
  Mr. NELSON of Nebraska. Mr. President, I would like to summarize the 
reasons for and the intent of the amendment that Senator Hatch and the 
Presiding Officer and I, together with others, have proposed to the 
health care bill.

[[Page 29779]]

  First of all, I should say the examples our very good friend from 
California has outlined would not have been covered under the Federal 
Employees Health Benefits Plan either because the Federal Employees 
Health Benefits Plan does not provide abortion coverage for such 
circumstances.
  Our amendment mirrors the language that has been offered by 
Representative Stupak that was adopted into the House health care bill, 
and we believe it should be applied to the Senate bill as well. As I 
said earlier, the issue of abortion certainly prompts strong opinions, 
fierce passions, and deep-seated principles for millions and millions 
of Americans, those who support the procedure and those who don't. But 
our amendment does not take sides on abortion. It is about the use of 
taxpayer money.
  The question before us is whether public funds, for the first time in 
more than three decades, should cover elective abortions. Numerous 
public opinion polls have shown that most Americans, including a number 
who support abortion, do not support public funds paying for abortion. 
But the Senate bill we are debating allows taxpayer dollars, directly 
and indirectly, to pay for insurance plans to cover abortion. That is 
out of step with the majority of Nebraskans and of all Americans.
  Our amendment does not impose new restrictions on women despite what 
some have claimed, and I respect but strongly disagree with them. We 
are seeking to just apply the same standards to the Senate health care 
bill that already exist for every Federal health program.
  Our amendment does not add a new restriction, but the bill does add a 
new relaxation of a Federal standard that has worked well for more than 
30 years. Under our amendment, abortion isn't limited, nor would people 
be prevented from buying insurance on the private market covering 
abortion with their own money.
  Our amendment only ensures that where taxpayer money enters the 
picture, people are not required to pay for people's abortions.
  The Nelson-Hatch-Casey amendment incorporates the longstanding 
standard established by the Hyde amendment which Congress approved in 
1976. Today it applies to every Federal health program. That includes 
plans that cover veterans, Federal employees, including Members of 
Congress, Native Americans, Active-Duty servicemembers, and a whole 
host of others.
  Some people have called our amendment radical. Nothing could be 
further from the truth. It is reasonable. It is rational because it 
follows established Federal law. It is right. Taxpayers shouldn't be 
required to pay for people's abortions. It is just that simple.
  Thank you, Mr. President. I yield the floor, and I note the absence 
of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Kaufman). Without objection, it is so 
ordered.
  Mr. REID. Mr. President, there were 45,000 funerals in America this 
year. These funerals, 45,000 in number, stood out from all the rest. 
Why? They were tearful, as all funerals are. They filled loved ones 
with sorrow and grief, as many of us know firsthand. But these 45,000 
funerals were avoidable. That is why they were more tragic than most, 
because 45,000 times this year--nearly 900 times a week, more than 120 
times each day, about every 10 minutes in America, every day, without 
end--someone dies as a direct result of not having health insurance.
  That is a sickening number. You would have to be heartless not to be 
horrified. It doesn't even include those who did have health insurance 
but died because it was not enough to meet their most basic needs. That 
is what this is all about.
  But it is not even just about death. How many citizens in each of our 
States are bankrupt and broke because of a broken health care system? 
How many have to choose between their mother's chemotherapy and their 
daughter's college tuition? How many have to work two or three jobs to 
provide for a family they never have time to see, all because of an 
accident they had or an illness they acquired that some insurance big 
shot calls a preexisting condition.
  So many of these tragedies could be prevented. If our Nation truly 
values the sanctity of life, as I believe it does, we will do 
everything we can to prevent them. That is why we are pushing so hard 
to make it possible for every American to afford good health. That is 
why we cannot take no for an answer, and that is why we will not let 
the American people down.
  That value is also evident in the amendment before us. As some know, 
for many years--nearly 28 years as a Member of the House of 
Representatives, of the Senate, and as majority leader--I have 
consistently cast my vote against abortion.
  To me, it is not about partisanship of any kind or political points 
or even polling data. To me, it is a matter of conscience.
  I might not be the loudest on this topic, but that doesn't make my 
beliefs any less strong. I might oppose abortion, but that does not 
mean I am opposed to finding common ground for the benefit of the 
greater good. We can find common ground.
  My belief in the sanctity of life is why I have repeatedly voted 
against using taxpayer money for abortion. It is why I have repeatedly 
voted against covering abortions in Federal employees health insurance 
plans and repeatedly voted against allowing Federal facilities to be 
used for abortions.
  But I recognize abortion is an emotional issue. Many Senators in this 
body disagree, as many citizens in the country disagree, on the issue. 
But divisive issues don't have to divide us. There is value in finding 
common ground.
  Among this institution's immortals is Senator Henry Clay, who worked 
under the premise that, as he said:

       All legislation is founded upon the principle of mutual 
     concession.

  It is in that spirit that I have been able to work with my colleagues 
to my left and to my right--Congressmen and Senators who are pro-life, 
such as I am, and those who are pro-choice. One of the ways I have done 
this is by trying to reduce the rate and number of unintended 
pregnancies.
  Our great country leads the world in many ways. But this area is not 
one in which we take much pride. The United States has one of the 
highest rates of unintended pregnancies among all industrialized 
nations, and that is an understatement. Half of all pregnancies in 
America--every other one--is unintended. Of those, more than half 
result in abortions.
  I have worked to stop this problem before it starts. In 1997, Senator 
Olympia Snowe and I started the first of many efforts to improve access 
to contraception. We said health plans should treat prescription 
contraception the same way it treats other prescription medications. We 
even passed a law that ensures that Federal employees have access to 
contraception. This proves what is possible when Senators have 
different backgrounds, both of good faith, work with each other rather 
than against each other.
  In this case, a pro-life Democrat and a pro-choice Republican 
followed common sense and found common ground. I have always been 
appreciative of Senator Snowe for her cooperation and her courage. I 
continue, to this day, to be grateful.
  Let's not forget that the historic bill before this body will 
continue those efforts. By making sure that all Americans can get good 
health care, we will reduce the number of unintended pregnancies at the 
root of this issue. That is a goal both Democrats and Republicans can 
agree is worthwhile.
  Let's talk about current law and this bill. In that and many other 
respects, this bill is a good, strong, and historic one. It is a bill 
that will affect the lives of every single American, and it will do so 
for the better. It will--as you have heard me say many times--save 
lives, save money, and save Medicare.
  But you have also heard me say this bill deserves to go through the 
legislative process. That process includes

[[Page 29780]]

amendments. It warrants additions, subtractions, and modifications, as 
the Senate sees fit. This is an appropriate process, one that has 
served this body well for more than two centuries.
  The amendment before us today, offered by Senator Nelson of Nebraska, 
would make dramatic changes in current law in America. It is worth 
examining what that law says, how this bill would treat it and what 
this amendment would require in addition and then evaluating whether it 
improves the overall effort.
  As current law dictates, not a single taxpayer dollar--not one--can 
be used to pay for an abortion. There are very few--but very serious--
exceptions to this rule: Those are explicitly limited to cases in which 
the life of the mother is in danger and when the pregnancy is the 
result of rape or incest.
  This law is called the Hyde amendment. It has been on the books since 
the late Republican Congressman Henry Hyde wrote it in 1976. I have 
great respect for Henry Hyde, and I recall with fondness how this 
Illinois Republican Congressman came to Nevada and campaigned for me. 
We worked together at a time when a Republican could campaign for a 
Democrat and vice versa and not fear retribution and condemnation from 
his own party.
  When we drafted the health reform bill now under consideration, we 
worked hard to come up with a compromise between pro-life and pro-
choice Senators. On one side, there are some Senators who don't believe 
abortion should be legal, let alone mentioned in any health plan. On 
the other side, there are Senators who don't want a woman's access to 
legal abortion to depend on which health plan she could afford, and 
they wanted that reflected in this bill.
  So legislating in pursuit of mutual concession, as Senator Clay 
advised, we struck a compromise. It is a compromise that recognizes 
people of good faith can have different beliefs, and instead of trying 
to settle the sensitive question of abortion rights in this bill, we 
found a fair middle ground.
  That compromise is, we maintain current law. We are faithful to the 
Hyde amendment, which has been in place now for 33 years. Let me be 
clear. As our bill currently reads, no insurance plans in the new 
marketplace we create--whether private or public--would be allowed to 
use taxpayer money for abortion, beyond the limits of existing law.
  But we don't stop there. The bill takes special care to keep public 
and private dollars separate to make sure that happens. This isn't a 
new concept. It is worth noting this practice of segregating money is 
consistent with other existing rules that make sure the public doesn't 
pay for things it shouldn't. It is consistent with the existing 
Medicaid practice that gives States the option of covering abortion 
also at their expense. It mirrors practices already in place to 
separate church and State by ensuring money the Federal Government 
gives religious organizations is not used for religious practices. So 
we are not reinventing the wheel.
  Just as current law demands, the bill respects the conscience of both 
individual health care providers and health care facilities. And once 
again, it goes further. Our bill not only safeguards a long list of 
Federal laws regarding conscience protections and refusal rights, it 
even outlaws discrimination against those health care providers and 
facilities with moral and religious objections to abortion. That means 
if a doctor does not believe it is right to perform an abortion, he or 
she can say no, no questions asked. Health care facilities such as 
Catholic hospitals, which are the largest nongovernment, nonprofit 
health care providers in the country, would continue to have the same 
right to refuse to perform abortions.
  Under our bill, at least one plan that does not cover abortion 
services will have to be offered in each exchange so no one will be 
forced to enroll in a plan that covers abortion services. This is an 
improvement since the current marketplace does not provide a similar 
guarantee.
  It is clear that the current bill does not expand or restrict 
anyone's access to abortion, period. It does not force any health plans 
to cover abortion or prohibit them from doing so, period. Why? Because 
this bill is about access to health care, not access to abortions.
  I have great respect for Senator Ben Nelson. His integrity and 
independence reflect on the Nebraskans he represents. His strong 
beliefs are rooted in his strong values. But he shows, better than 
most, that one can be steadfast without being stubborn. Senator Nelson 
has always been a gentleman whose consideration is the true portrait of 
how a Senator should conduct oneself.
  I mentioned that our underlying bill leaves current law where it is. 
This amendment, however, does not. It goes further than the standard 
that has guided this country for 33 years. It would place limits not 
only on taxpayer money, which I support, but also on private money. 
Again, current law already forbids Federal funds from paying for 
abortions, and our bill does not weaken that rule one bit. I believe 
current law is sufficient, and I do not believe we need to go further. 
Specifically, I do not believe the Senate needs to go as far as this 
amendment would take us. No one should use the health care bill to 
expand or restrict abortion, and no one should use the issue of 
abortion to rob millions of the opportunity to get good health care.
  This is not the right place for this debate. We have to get on with 
the larger issue at hand. We have to keep moving toward the finish line 
and cannot be distracted by detours or derailed by diversions.
  Our health reform bill now before this body respects life. I started 
by saying I believe in the sanctity of life. But my strong belief is 
that value does not end when a child is born; it continues throughout 
the lifetime of every person.
  With this bill, nearly every American will be able to afford the care 
they need to stay healthy or care for a loved one. It respects life.
  Those who today have nowhere to turn will soon have security against 
what President Harry Truman called ``the economic effects of 
sickness.'' It respects life.
  Those who suffer from disease, from injury, or from disability will 
no longer be told by claims adjustors they never met that they are on 
their own. It respects life.
  It will help seniors afford every prescription drug they need so they 
do not have to decide which pills to skip and which pills to split. It 
respects life.
  It will stop terrible illnesses before they start and stop Americans 
from dying of diseases we know how to treat. It respects life.
  We will stop terrible abuses, such as insurance companies looking at 
earnings reports instead of your doctor's report and charging rates 
that make the health we want a luxury. It respects life.
  We will ensure the most vulnerable and the least prosperous among us 
can afford to go to a doctor when they are sick or hurt, not to the 
emergency room where the rest of us pick up the bill. It respects life.
  This bill recognizes that health care is a human right. This bill 
respects life.
  The issue in this amendment is not the only so-called moral issue in 
this debate. The ability of all Americans to afford and get the access 
to care they need to stay healthy is also a question of morality.
  The reason I oppose abortion and the reason I support the historic 
bill is the same: I respect the sanctity of life.
  This is a health care bill. It is not an abortion bill. We cannot 
afford to miss the big picture. It is bigger than any one issue. 
Neither this amendment nor any other should be something that 
overshadows the entire bill or overwhelms the entire process.
  Throughout my entire public career, I voted my conscience on the 
subject of abortion. As I said, that decision is based on something 
personal with me. My vote today will also honor another principle I 
believe to my very core and that I will believe until my very last day 
on Earth: We must make it possible for every American to afford a 
healthy life.
  I believe the compromise in our current bill and the current bill 
itself fully

[[Page 29781]]

fulfill both of these moral imperatives. And I believe when we are 
given the trust of our neighbors, friends, relatives, the privilege to 
lead the opportunity to improve others' lives, we cannot turn our 
backs. We cannot turn our backs on the tens of millions of Americans 
who have no health insurance at all--none--not thousands, not hundreds, 
not millions but tens of millions. We cannot turn our backs on the many 
who do but live one accident, one illness, or one pink slip away from 
losing that insurance they have.
  One of the most cherished charters this Nation has, drafted by one of 
our most beloved leaders, declared life to be the first among several 
of our absolute rights. Jefferson put it even before liberty, even 
before the pursuit of happiness--life.
  If we still truly value life in America--and I believe we do--if we 
still truly value the life of every American, we cannot turn our backs 
on the 14,000 of us who lose health coverage every single day of every 
week of every month of every year in this country--no weekends off, no 
vacations. How many of the thousands of men, women, and children who 
today will be kicked out in the cold will next year become one of the 
tens of thousands who die because of it? If we value the sanctity of 
life, as I know we do, and fix what is broken, as I know we must, we 
will not have to find out.
  I believe in this bill and what it will do for our country for 
generations to come, what it will do for our constituents, my children, 
my grandchildren, and their children and their grandchildren. I will 
not support efforts to undermine this historic legislation.
  Mrs. BOXER. Mr. President, I ask unanimous consent that the Senate 
proceed to vote in relation to the Nelson-Hatch amendment No. 2962; 
that regardless of the outcome of the vote with respect to that 
amendment, there be 2 minutes of debate prior to a vote in relation to 
the McCain motion to commit, equally divided and controlled in the 
usual form; that upon the use or yielding back of that time, the Senate 
proceed to vote in relation to the McCain motion to commit; the McCain 
motion be subject to an affirmative 60-vote threshold; that if the 
motion achieves that threshold, then it be agreed to and the motion to 
reconsider be laid upon the table; that if it does not achieve that 
threshold, then it be withdrawn; and that no amendment be in order to 
the motion.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. BOXER. Mr. President, I move to table the Nelson 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 legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 54, nays 45, as follows:

                      [Rollcall Vote No. 369 Leg.]

                                YEAS--54

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

                                NAYS--45

     Alexander
     Barrasso
     Bayh
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Casey
     Chambliss
     Coburn
     Cochran
     Conrad
     Corker
     Cornyn
     Crapo
     DeMint
     Dorgan
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kaufman
     Kyl
     LeMieux
     Lugar
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Pryor
     Risch
     Roberts
     Sessions
     Shelby
     Thune
     Vitter
     Voinovich
     Wicker

                             NOT VOTING--1

       
     Byrd
       
  The motion was agreed to.
  Mrs. BOXER. I move to reconsider the vote.
  Mrs. FEINSTEIN. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. Under the previous order, there will be 2 
minutes of debate equally divided prior to a vote in relation to the 
motion to commit offered by the Senator from Arizona.
  Who yields time?
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, the McCain motion to commit on Medicare 
Advantage would keep overpayments in the Medicare Advantage program, 
even though the Medicare Payment Advisory Commission recommends that 
they be eliminated.
  The McCain motion to commit is a tax on all seniors. It would 
maintain the overpayments to private insurers and require beneficiaries 
to pay higher Part B premiums. The average couple pays $90 per year 
just so insurers can reap greater profits under Medicare.
  The McCain amendment is a raid on the Medicare trust fund. MA 
overpayments take 18 months off the life of the Part A trust fund. And 
according to MedPAC, there is no evidence of greater quality of care. 
In fact, MedPAC told Congress this year that ``only some'' MA plans are 
of high quality. MedPAC finds that ``only half of beneficiaries 
nationwide have access to a plan that Medicare rates above average on 
overall plan quality.''
  The more than 45 million seniors with Medicare deserve better. They 
do not deserve to subsidize high profits of private insurers. And the 
more than 11 million Medicare beneficiaries who choose to enroll in 
private plans also deserve better. They deserve plans that coordinate 
care. Most plans today do not. They deserve plans that are of high 
quality. Many plans today do not.
  If Senators want to help beneficiaries, they will vote to eliminate 
overpayments under Medicare Advantage. And they should vote against the 
McCain motion.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. McCAIN. Mr. President, this amendment is about an earmark. It is 
about a special deal cut for a special group of people who happen to 
reside in the State of Florida. I am never so presumptuous. I have lost 
too many votes trying to eliminate earmarks. But what I am trying to do 
is allow every American citizen who is enrolled in Medicare Advantage 
to have the same protection of their Medicare Advantage Program as the 
Senator from Florida has carved out in this bill. That is all it is 
about. It is about equality. It is about not letting one special group 
of people who reside in a particular State get a better deal than those 
who live in the rest of the country. That is all this amendment is 
about.
  It will probably be voted down on a party-line vote. But what you 
have done is you have allowed a carve-out for a few hundred thousand 
people in the State of Florida and have disallowed the other 11 million 
who have Medicare Advantage from having their health care cut. That is 
what this is all about.
  Mr. BOND. 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 assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 42, nays 57, as follows:

[[Page 29782]]



                      [Rollcall Vote No. 370 Leg.]

                                YEAS--42

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

                                NAYS--57

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

                             NOT VOTING--1

       
     Byrd
       
  The PRESIDING OFFICER. On this vote, the yeas are 42, the nays are 
57. Under the previous order requiring 60 votes for adoption of the 
motion, the motion is withdrawn.
  Mrs. HUTCHISON addressed the Chair.
  The PRESIDING OFFICER (Mrs. Shaheen). The Senator from Texas.
  Mr. DORGAN. Madam President, will the Senator from Texas yield for a 
unanimous consent request?
  Mrs. HUTCHISON. I will.
  Mr. DORGAN. Madam President, I ask unanimous consent that following 
the presentation by the Senator from Texas that I be recognized to 
offer an amendment, and following that Senator Crapo be recognized to 
offer an amendment, and Senator Crapo, I believe, wishes to speak 2 or 
3 minutes, and following that then I would be recognized as well for a 
presentation on the amendment I have offered, and following my 
presentation, the Senator from Minnesota, Ms. Klobuchar, would be 
recognized, and Senator Kaufman would be recognized as part of the 
colloquy with Senator Klobuchar.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Texas.
  Mrs. HUTCHISON. Madam President, we have spent the last few days 
highlighting how this health care reform bill is paid for by cutting 
benefits to seniors, jeopardizing their access to care. Almost $500 
billion will be cut from the Medicare Program.
  But this bill also imposes $\1/2\ trillion in new taxes. These are 
taxes that hit every American and virtually every health care business 
or related business in the country.
  During an economic downturn, this approach is counterintuitive. These 
taxes will discourage investment and hiring. We are in one of the worst 
economic downturns in the history of our country. We do not need to 
tell anybody that. We are all feeling it. We know people who are 
suffering right now.
  I look at what has been done in the past when we have had economic 
downturns, and I look at President Kennedy, President Reagan, President 
Bush. They lowered taxes. What happened? The economy was spurred. Lower 
taxes have proven to spur the economy. Yet in this bill we see $\1/2\ 
trillion in new taxes on families and small businesses.
  Let's walk through some of these taxes.
  Employer taxes. Madam President, $28 billion in new taxes is imposed 
on businesses that do not provide health insurance to their employees. 
To avoid the tax, an employer has to provide the right kind of 
insurance--insurance that the Federal Government approves. It is going 
to be a certain percentage and have certain coverage requirements. 
Employers who do not provide the right kind of insurance could see a 
penalty as high as $3,000 per employee.
  We should be encouraging people to hire in this kind of environment. 
That should be job No. 1: creating jobs.
  Yet imposing taxes and fines are what is in this bill, and that is 
not going to encourage hiring; it is going to discourage hiring. That 
is economics 101.
  Individual taxes: There are $8 billion in taxes for those who don't 
purchase insurance on their own. The tax is $750 per person. Again, 
because you are insured today does not mean you will avoid the tax. You 
must have the right kind of insurance--insurance that the Federal 
Government approves and says is the right amount of insurance.
  How about the taxes on high-benefit plans? There are $149 billion in 
taxes on health insurance plans that the Federal Government says are 
too robust. These high-benefit plans--Cadillac plans some call them--
would be subject to a 40-percent excise tax. To make it worse, the tax 
is not indexed, so it is a new AMT, a new alternative minimum tax that 
everyone says was not supposed to encroach on lower income people, but, 
in fact, it has because it is not indexed for inflation.
  So here we are. In this bill, you get taxed if you don't provide 
enough benefits and you get taxed if you provide too many benefits. So 
this is beginning to sound like government-run health care to me, and I 
can only imagine how the unions feel because they are the ones that 
have these high-benefit plans and here they are under fire because they 
have too much coverage.
  Medicare payroll tax: This is the new payroll tax that is imposed on 
individuals making more than $200,000 and couples making more than 
$250,000. That tax raises another $54 billion. This additional payroll 
tax is a marriage penalty. It is not indexed to inflation, meaning it 
is another AMT in the making because today, that may sound high--
$200,000 and $250,000--but it is a huge marriage penalty, and it could 
begin then to go down in numbers so that more and more people are 
affected.
  This body voted unanimously during the budget debate--unanimously--
that a point of order would be made against legislation that would 
impose a marriage penalty in the budget. So we have voted unanimously 
that a budget point of order would stand if there is a marriage penalty 
in the budget. So now here we are a few months later, and the majority 
is not only retreating from the opposition to the marriage penalty, but 
we now have for the first time in our Tax Code--or will when this bill 
passes--a payroll tax marriage penalty. How on Earth can we do that?
  I am going to fight this marriage penalty, and I hope the Senate will 
vote against this concept. It is a new precedent that could be set in 
other areas that would say if you are married, you are going to get 
fewer benefits than if you are single. That is not a precedent we ought 
to be setting.
  Then there is the medical deduction cap. There is a change in our Tax 
Code that would limit the itemized deduction for medical expenses. We 
have always had one that said if your medical expenses go above 7.5 
percent of your income, that you would be able to deduct anything above 
that. This bill increases that threshold to 10 percent so that if you 
are going to get deductions--and this is going to affect people who 
have catastrophic accidents, really, really high medical bills, 
debilitating health conditions, or very, very expensive medicine--if 
you go above 7.5 percent today, you would be able to deduct. But in 
this bill, it is going to be 10 percent of your income before the 
government is going to allow you to deduct these added expenses.
  Then there is the drug, device, and insurance company taxes: $60 
billion in taxes assessed to insurance companies, $22 billion to 
prescription drug manufacturers, and $20 billion on medical device 
manufacturers. The experts have said, all of the economists have said 
these taxes will be paid by the public. Of course they are going to be 
passed on: higher premiums for every insurance policy that is already 
there, and higher prices for medications and medical equipment.
  So medications you take for diabetes or heart disease, medications or 
medical devices that you need to fight cancer would all become more 
expensive because every one of them would have a higher cost because 
the company is going to pay an added fee just for producing these 
medicines and equipment.

[[Page 29783]]

  So many people today are struggling with their medical bills. They 
are struggling to fill prescriptions. Why aren't we bringing costs 
down? Isn't medical cost part of the reason for reform because the 
costs are going up? Wasn't the point of reform to bring the costs down 
so more people would have affordable options for health care coverage? 
What happened to that? All of these taxes on individuals and businesses 
are going to drive prices and costs up.
  In closing, the bill before us imposes $\1/2\ trillion in new taxes 
at a time when unemployment is soaring and our economy is struggling. 
We have $\1/2\ trillion in cuts to Medicare which is going to severely 
hurt our senior citizens and their access to health care, and then $\1/
2\ trillion in tax increases, taxing marriage, taxing Tylenol, taxing 
high-benefit plans, taxing low-benefit plans, taxes if you offer 
employee health care coverage, and taxes if you offer not quite enough. 
This is a tax-and-spend bill.
  Republicans have repeatedly put forward ideas that would reform our 
health system, bring the costs down without burdening our employers 
with more taxes that would keep them from helping our economy by hiring 
more people; ideas that would increase competition and transparency and 
ensure access to affordable care.
  So I hope while our colleagues are meeting to try to get their 60 
votes--which we know they are--that maybe they might consider bringing 
everybody into this process and listening to other ideas that would not 
be a government takeover of our health care system; that would not be 
more government mandates, more taxes, cuts from Medicare services. This 
is a recipe for disaster for our country, and I hope it is not too late 
for the Democratic majority to say: OK, let's get together and try to 
put together a bipartisan plan that will not hurt the quality of health 
care that Americans have known and expected in our country, one that 
will bring costs down and make health care more affordable, one that 
will give carrots to our employers not sticks that will switch them if 
they don't have the right kind of coverage or the government-approved 
coverage or the right percentage of coverage.
  We can do better and I hope we will.
  Thank you, Madam President. I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.


         Amendment No. 2793, as Modified, to Amendment No. 2786

    (Purpose: to provide for the importation of prescription drugs)

  Mr. DORGAN. Madam President, I call up amendment No. 2793, as 
modified, and ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from North Dakota [Mr. Dorgan], for himself, 
     Ms. Snowe, Mr. Grassley, Mr. McCain, Ms. Stabenow, Ms. 
     Klobuchar, Mr. Brown, Mrs. Shaheen, Mr. Vitter, Mr. Kohl, Mr. 
     Leahy, Mr. Feingold, and Mr. Nelson of Florida, proposes an 
     amendment numbered 2793 to amendment No. 2786, as modified.

  Mr. DORGAN. Madam President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  Mr. DORGAN. Madam President, my understanding is that the Senator 
from Idaho is to be recognized next for laying down an amendment.
  The PRESIDING OFFICER. The Senator from Idaho.


                            Motion to Commit

  Mr. CRAPO. Madam President, I have a motion at the desk which I wish 
to call up and ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from Idaho [Mr. Crapo] moves to commit the bill 
     H.R. 3590 to the Committee on Finance with instructions to 
     report the same back to the Senate with changes that provide 
     that no provision of this Act shall result in an increase in 
     Federal tax liability for individuals with adjusted gross 
     income of less than $200,000 and married individuals with 
     adjusted gross income of less than $250,000.

  Mr. CRAPO. Thank you, Madam President.
  As the motion which has just been read clearly states, this motion 
would be to commit this bill to the Finance Committee for the Finance 
Committee to do one simple thing, and that is to make the bill conform 
to President Barack Obama's pledge to the American people about health 
care reform and who would pay for health care reform.
  In a speech he has given in a number of different places, President 
Obama has very clearly stated:

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

  All this motion does is to commit this bill to the Finance Committee 
to have the Finance Committee assure that its provisions comply with 
this pledge.
  Now, why would we want to do that? I think most Americans are very 
aware today that this bill comes at a huge price. There are $2.5 
trillion of new Federal spending, $2.5 trillion of new Federal spending 
that is offset, if you will, by about $500 billion worth of cuts in 
Medicare and $493 billion worth of cuts in the first 10 years are tax 
increases, $1.2 trillion of tax increases in the first real 10 years of 
the full implementation of the bill. There is no question but that much 
of the tax increase that is included in this bill to pay for this 
massive increase in Federal spending will come squarely from people in 
the United States who make less than $250,000 as a family or less than 
$200,000 as individuals.
  All we need to do is to go through this bill to see that by the 
analysis we have made so far, it appears that at least 42 million 
households in America will pay a portion of this $1.2 trillion in new 
taxes, people who are under these income levels to whom President Obama 
made the pledge.
  I will have a greater opportunity tomorrow to discuss this motion in 
more detail. Tonight I just had a few minutes to make the introduction 
and to call up the motion, and we will then get into a fuller 
discussion on how this bill provides a heavy tax burden on the middle 
class of this country in direct violation of the President's pledge.
  So as I conclude, I would simply say this is a very simple amendment. 
We can debate about whether the bill does or does not increase taxes--I 
think that is absolutely clear--on those in the middle class. But all 
the motion would do is to commit this bill to the Finance Committee to 
have the Finance Committee make the bill comport with the President's 
pledge.
  I will conclude by just reading his pledge one more time. The 
President, in his words, said:

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

  That is what this motion accomplishes.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. Madam President, the amendment I have offered with many 
colleagues--over 30 colleagues, Republicans and Democrats, a bipartisan 
legislation--deals with the issue of prescription drugs; specifically, 
the importation of FDA-approved drugs that the American people would be 
able to access for a fraction of the price they are charged in this 
country.
  The American people are paying the highest prices in the world for 
brand-name prescription drugs.
  It is not even close. Let me just show the first chart. I have many. 
I will show the first one to describe what brings me to the floor of 
the Senate.
  Here are prices for Lipitor. There are so many people who take 
Lipitor that they probably ought to put it in the water supply--the 
most popular cholesterol-lowering drug in America, perhaps in the 
world. Here is what the

[[Page 29784]]

American people pay for an equivalent quantity: $125. The same quantity 
costs $40 in Britain, $32 in Spain, $63 in the Netherlands, $48 in 
Germany, $53 in France, and $33 in Canada. Once again, it is $125 to 
the American consumer.
  Here are the two bottles for Lipitor. It is made in Ireland by an 
American company and then sent around the world. This happened to go to 
Canada, and this went to the United States. It is the same pill, same 
bottle, same company, made at the same manufacturing plant, and it is 
FDA approved. Difference? The American consumer gets to pay three to 
four times higher cost. Fair? Not for me.
  That is what this amendment is about. This amendment is about 
freedom, giving the American people the freedom in the global economy 
to buy the same FDA-approved drug from those countries that have an 
identical chain of custody as we do in this country, so an FDA-approved 
drug sold for a fraction of the price--why should we prevent the 
American people from being able to exercise and see the same savings 
every other consumer in the world sees?
  Let me see whether anybody recognizes this. Prescription drugs are a 
significant part of our lives. We are bombarded with ads every single 
day. Let me show a demonstration of the push for consumption of 
prescription drugs at the highest brand-name prices in the world.
  On television, Sally Field says to us--and I have seen it many 
mornings when I am brushing my teeth--she says this:

       I always thought calcium, vitamin D, and exercise would 
     keep my bones healthy. But I got osteoporosis anyway, so my 
     doctor started me on once-a-month Boniva. And he told me 
     something important: Boniva works with your body to help stop 
     and reverse bone loss.
       My test results proved I was able to stop and reverse my 
     bone loss with Boniva. And studies show that after one year, 
     9 out of 10 women did, too.
       I've got this one body and this one life, so I wanted to 
     stop my bone loss. But I did more than that; I reversed it 
     with Boniva.
       Ask your doctor if Boniva is right for you.

  Here is another one:

       Some of us need help falling asleep. Some of us need help 
     staying asleep. A good night's sleep doesn't have to be an 
     on/off thing anymore.
       From the makers of the most prescribed name in sleep 
     medicine comes controlled release Ambien CR. It's the only 
     one with two layers of sleep relief.
       Ambien CR is a treatment you and your doctor can consider 
     along with lifestyle changes and can be taken for as long as 
     your health care provider recommends.
       So ask your health care provider about Ambien CR, for a 
     good night's sleep from start to finish.

  Here is another one:

       Does your restless mind keep you from sleeping? Do you lie 
     awake exhausted? Well, maybe it's time to ask whether Lunesta 
     is right for you.
       For a limited time, you're invited to take the 7-night 
     Lunesta challenge. Ask your doctor how to get 7 nights of 
     Lunesta free and see if it's the sleep aid you've been 
     looking for.
       Get your coupon at Lunesta.com and ask your doctor today.

  Here is another one:

       They're running the men's room marathon, with lots of guys 
     going over and over. And here's the dash to the men's room 
     with lots of guys going urgently. Then there's a night game 
     waking up to go.
       These guys should be in a race to see their doctors. Those 
     symptoms could be signs of BPH or enlarged prostate. Waking 
     up to go, starting and stopping, going urgently, incomplete 
     emptying, weak stream, going over and over, straining.
       For many guys, prescription Flomax reduces urinary symptoms 
     associated with BPH in one week. Only a doctor can tell if 
     you have BPH and not a more serious condition like prostate 
     cancer.
       Call 1-877-FLOMAX to see if Flomax works for you and to see 
     if you qualify for $40 off your prescription.
       For many men, Flomax can make a difference in one week.

  Here is another one:

       There are moments you look forward to, and you shouldn't 
     have to miss out on them. Sometimes a bladder control problem 
     can cause unwanted interruptions. It doesn't have to be that 
     way. Overactive bladder is a treatable medical condition.
       Enablex is a medication that can help reduce bladder leaks 
     and accidents for a full 24 hours. Ask your doctor about 
     Enablex.

  Well, I have a couple dozen more.
  Most people understand what this is because they have heard them 
all--things like: Go ask your doctor if the purple pill is right for 
you. They don't have the foggiest idea what a purple pill is for. They 
think that with all these scenes of trees and green grass and 
convertible cars and pillow clouds in the sky, if life is like that 
when you are on the purple pill, give me some purple pills. I mean, 
that is what this advertising is all about.
  I don't mean to make light or fun of all of it. Prescription drugs 
are important in people's lives. I understand that. But you know what, 
you can only get a prescription drug if your doctor prescribes it and 
believes you need it. These advertisements are telling people sitting 
at home watching a television program tonight that you need to get up 
and go talk to your doctor and see if you don't need some of these 
pills. It is trying to create consumer demand for something you can get 
only because a doctor believes you should have it.
  Well, that is where we are now with prescription drugs in our 
country. A lot of people are taking prescription drugs. A lot of these 
drugs are miracle drugs, and they allow people to stay out of a 
hospital. They don't have to be in an acute-care hospital bed if they 
manage the disease--whether it is high blood pressure, high 
cholesterol--with medicine. That is good, and I understand that. But 
this consumer demand-driven urge for prescription drugs is pretty 
unbelievable. Go talk to a doctor and ask that doctor what happens 
every single day in the doctor's office. Somebody is coming in and 
saying: I wonder if I shouldn't be taking some of this medicine. I read 
about it or saw the advertisement about this. I wonder if I shouldn't 
be taking some of it. It is quite a deal.
  You produce all of this demand with dramatic amounts of marketing, 
promotion, and advertising, and then you jack up the price and keep it 
up. The question is, Who can afford these prescription drugs? Who can 
afford them?
  So that is what brings me to the floor of the Senate today saying 
that when the American people are charged the highest prices for brand-
name drugs--and this year, it goes up close to 10 percent once again in 
price--at a time when we have almost no inflation, isn't that pricing 
prescription drugs out of the reach of too many Americans?
  We are now talking about health care reform. There is nothing in any 
of this legislation in the House or the Senate that addresses this 
question of the steep and relentless price increases on prescription 
drugs. There is nothing in any of this legislation that does that. The 
question is, Shouldn't we be addressing this as well?
  I talked about Lipitor. Let me show you Plavix. Do you see the U.S. 
price? The U.S. consumer pays the highest prices in the world.
  Here is Nexium. If you want to buy that, you get to pay $424 in the 
United States, and it is $41--one-tenth the price--in England, $36 in 
Spain, and $37 in Germany. The question is this: If Nexium is an FDA-
approved drug--and it is--made in plants approved by our FDA--and it 
is--why should an American citizen not be able to access this drug from 
here, from here, and from here? It is because the pharmaceutical 
industry doesn't want them to. They have had enough friends here to 
keep in place a law that prevents the American people from reimporting 
these drugs. That is why.
  That is what this amendment is about. This amendment says: Give the 
American people the freedom to access FDA-approved drugs where they are 
sold at a fraction of the price.
  Madam President, there is a lot to talk about, and I will describe a 
number of circumstances that have brought us to this point.
  This is the place for this amendment--not some other place; this is 
the place. It is about health care. We have been told over and over 
again that our problem is that health care is consuming too large a 
portion of the GDP of this country--roughly 17.3 percent, I believe. 
All right, part of health care--not the largest part but one of the 
fastest growing parts is prescription drugs. So if the issue is that 
health care is rising in cost relentlessly and consuming too large a 
portion of our GDP because

[[Page 29785]]

we spend much more on health care than anybody else in the world by 
far--it is not even close--if that is the case and if one of the 
fastest rising areas of health care is drug costs, then why would 
legislation that leaves this Chamber or the House of Representatives 
not include something that addresses these unbelievable price increases 
for prescription drugs? How is it that we would allow that to happen? I 
don't know how we got to this point without having it in the bill, but 
I aim to try to put it in.
  I understand, by the way, that there is tremendous pushback by the 
pharmaceutical industry. If I had the sweetheart deal they have, I 
would fight to the finish to try to keep it. I understand that.
  By the way, let me just say, as I have always said and nobody hears 
it very much--certainly the pharmaceutical industry will never hear 
this--that some of the things the pharmaceutical industry does for this 
country are laudable. I say, good for you. They talk about the 
prescription drugs they produce. Good for them. A substantial portion 
of that comes from research we have done and paid for at the National 
Institutes of Health with taxpayer funds. But that doesn't matter to 
me. That information ought to be available to the pharmaceutical 
industry--and it is--so they can produce these new miracle drugs. I 
commend them.
  My beef is not that they produce pharmaceutical drugs that help 
people. I am all for that. My beef is the way they price those drugs, 
saying to the American people: You will pay the highest prices in the 
world, and there is nothing you can do about it. It is their pricing 
policy. It is just not fair.
  How many in this Chamber have visited with somebody at a town meeting 
someplace--I have--and they come up to you--in this case, an elderly 
woman who was close to 80 touched me gently on the elbow and said, 
``Senator Dorgan, can you help me?'' She was talking about how many 
prescription drugs she had to take, how little money she had to pay for 
them, and how she always had to try to determine what her rent cost was 
and how much groceries she could buy to determine how much she had left 
to pay for prescription drugs. How many people have said to you: Yes, I 
take the drugs my doctor asks me to take, but I cut them in half 
because I cannot afford the whole dose. We have all heard that. So the 
question is, Are we going to do something about it?
  This is a chart that shows price increases in 2009. Enbrel, for 
arthritis, is up 12 percent. Singulair, for asthma, is up 12 percent. 
Boniva is up 18 percent. Nexium is up 7 percent.
  I want to talk a bit about the issue of drug prices versus inflation. 
This chart shows what has happened to the price of prescription drugs, 
the red line, and the inflation rate in this country, the yellow line. 
It describes why it is urgent that we do something, why we cannot allow 
a health reform bill to leave this Chamber and do nothing about the 
issue of prescription drugs. We must at least address this question of 
whether the American people should not have the freedom to access these 
identical drugs where they are sold elsewhere for a fraction of the 
price.
  This year, there was a 9.3-percent increase in brand-name 
prescription drug prices, at a time when inflation is going down. We 
have had deflation. That is not justifiable.
  Madam President, I know we are going to have a lot of debate here in 
the Chamber about a lot of things. I will describe tomorrow morning, 
when I speak, that 40 percent of the active ingredients in U.S. 
prescription drugs currently come from India and China. And they are 
worried about somebody from Sioux Falls, SD, buying prescription drugs 
from Winnipeg. Are you kidding me? Again, 40 percent of the active 
ingredients in U.S. prescription drugs currently come from India and 
China. In most cases, the places those active ingredients come from 
have never been inspected.
  I will talk about that, but I am not going to go into it tonight. I 
will talk about a number of issues related to drug safety of the 
existing drug supply and how what we have included in this legislation 
with respect to pedigree, batch lots and track and trace will 
dramatically improve the existing drug supply in our country and make 
certain we prevent safety problems coming from the importation of 
drugs.
  I am going to speak about this at some length tomorrow. But I just 
received a letter from the head of the FDA, Margaret Hamburg, who 
raises some questions about the amendment. I am not going to read the 
letter into the Record. I will talk more about it tomorrow.
  I must say, I am in some ways surprised by the letter and in some 
ways not surprised at all. Surprised, because this administration, 
President Obama, was a cosponsor of this legislation last year in the 
Senate--a cosponsor of my legislation. He was part of a bipartisan 
group that believed the American people ought to have this right and 
believed we could put together a piece of legislation that has 
sufficient safety capabilities and, in fact, dramatically enhances the 
safety of our existing drug supply.
  I am going to show tomorrow that the existing drug supply has all 
kinds of issues. I will show batch lots of existing drugs that have 
gone through strip joints, in the back room in coolers, and distributed 
out of strip joints. I am going to talk about that. But, first, I wish 
to say I was surprised to get this letter because both the President 
and the Chief of Staff at the White House were a cosponsor in the 
Senate and a leader in the House for reimportation of prescription 
drugs.
  I called the head of the FDA yesterday afternoon about this time and 
said: I have heard rumors that there was a letter coming to Capitol 
Hill on this issue. She told me she was not aware of such a letter. 
Twenty-four hours later, apparently she is aware of that letter because 
she signed it. I am interested in where it was written, but that is 
another subject I will save for tomorrow as well.
  We will be told, as we have been so often, that if you allow the 
American people to buy prescription drugs that are FDA approved from 
elsewhere, it will be somehow unsafe. The implication is, we are not 
smart enough and we are not capable enough of putting together a system 
that the Europeans have had together for 20 years.
  In Europe, they do this routinely. For 20 years, they have had 
something called parallel trading. You are in Germany and want to buy a 
prescription drug from Spain? No problem. You are in Italy and want to 
buy a prescription drug from France? No problem. They have a specific 
parallel trading system, and it works and works well.
  I am going to describe, in the words of someone who has been involved 
in that system for many years, that the Europeans can do, have done it, 
do it today with no problems at all. Are people saying they can do it, 
they are smart enough, they are capable enough, but we are not? Give me 
a break. That makes no sense to me at all. Of course, we can do this.
  It is just that those who do not want to do it have decided this 
current ``deal,'' which allows the pharmaceutical industry to price as 
they wish in this country and make certain the American people cannot 
do anything to get the lesser prices in other countries, lower prices 
for the identical drug, it means they will price this year up 9.3 
percent, just this year alone. They will do whatever they want to price 
those prescription drugs and too often will price them out of reach of 
the American people. It is not fair to me. It does not make any sense 
to me.
  I know some will view this as just an attack on the pharmaceutical 
industry. It is not intended to be that. As I said, I don't have a 
grievance against that industry at all. The only problem I have is the 
way they price their product, and I think it is not fair to the 
American people.
  We are dealing with health care, which is a big issue and an 
unbelievably controversial issue. This is one piece of it--not even the 
biggest piece--but it is an important piece.
  I have a lot to say tomorrow morning, and I will take substantial 
time. I know there are others who want to speak tonight. I wish to say 
this. I have watched and listened in this Chamber

[[Page 29786]]

now for some while. I have not spoken a lot on health care. I have been 
pretty distressed about some of what has been said on the floor of the 
Senate. I especially have been distressed with the television ads that 
have been running that are unbelievably dishonest with respect to the 
facts. The first amendment allows all that. I would be the last to 
suggest we ought to alter the first amendment.
  This is a great country in which we live. Over the last century, for 
example, we have made a lot of changes, and in most every case--in most 
every single case--the changes have been unbelievably painful.
  I think of the Presiding Officer and think of the period in which the 
women in this country wanted the right to vote and were taken to the 
Occoquan Prison and beaten. Lucy Byrne and Alice Paul, they nearly 
choked to death one of them; the other hung with a chain from a prison 
door all night long with blood running down her arms. Why? Because they 
wanted the right to vote. Think of the pain of that.
  Now we look back and say: How could anybody have decided we are all 
Americans except women do not have full participation because they 
cannot vote? Think of that. You can go right up the line. Social 
Security: a Communist socialist plot. Medicare: What are you thinking 
about? A takeover of health care for senior citizens.
  I bet there is not--I was going to say I bet there is not one. I 
shouldn't say that. I bet there are not more than two or three people 
in this Chamber, if we said: Let's get rid of Medicare, who would say: 
Yes, let's do that. Almost everybody believes that providing health 
care for senior citizens was the right thing to do.
  There were no insurance companies in the fifties and early sixties 
that said: Here is our business strategy. Our business strategy is to 
go look for old people and see if we can't sell them health insurance 
because we think that would be a very good deal. They were not doing 
that. They would not even make health insurance available to a lot of 
old folks because they know, somewhere toward the end of their lives, 
they were going to need a lot of health care. One-half of the senior 
citizens in America had no access to health care. Think of that--lie 
down on your pillow at night frightened that tomorrow might be the day 
you have this dreaded disease and you have no coverage to see a doctor 
or go to a hospital. It is unbelievable.
  So some people in this Chamber said: Let's do Medicare. Man, that was 
radical. People said: Socialist plot, government takeover. But we did 
it. I was not here. They did it--God bless the ones who did it--and it 
enriched this country, to say all those who lived their lives and built 
the roads and built the schools and built the communities and left a 
better place for us: You are not going to have to lay awake at night 
frightened about your health care; we are going to provide health care 
for you.
  All these issues have been difficult, draining, wrenching issues, and 
they have all provoked great criticism and great anger, in many cases. 
This issue of health care brought to the floor of the Senate--I, 
perhaps, would have a different view of what is the priority.
  I have spent most of my time saying: The economic engine, restart the 
engine, get people back to work. But that does not mean health care is 
not important. It is. Health care continues to gobble up more and more 
of this country's economy. At some point, somebody has to say: How do 
we stop that? If we are spending much more than anybody else, how do we 
fix this?
  That is what this is about. It is going to take some courage to do 
it. One piece of it is this issue of prescription drugs and pricing. 
Some of us have been working on this for a long time. The breadth of 
the support of this issue in this Chamber extends from the late Senator 
Ted Kennedy, who sat in that seat back there--and God bless his 
memory--to John McCain over there; it extends to Senator Chuck 
Grassley, Debbie Stabenow, Amy Klobuchar--a whole series of Republicans 
and Democrats who have come together to say: You know what, let's make 
sure there is fair pricing of prescription drugs for the American 
people.
  We are not asking for anything other than fair pricing. How do you 
get it? My goal is not to ask the American people to buy their 
prescription drugs overseas. My goal is to say, if we allow the 
American people the freedom to do that, the pharmaceutical industry 
will be required to reprice their drugs in this country. It is as 
simple as that.
  I know others wish to speak. As I said, I have a lot to say tomorrow. 
I am going to go home kind of upset about this letter today from the 
FDA, which is, in my judgment, completely bogus. I will read it 
tomorrow. I am not surprised. I expected this. I heard rumors about it.
  Tomorrow my hope is with my colleagues--Republicans and Democrats--we 
will pass this legislation at last, at long last. Many of us have been 
working on this issue 6, 8, 10 years. We will pass this legislation. 
Why? Because this is the place for it. This is the bill that should be 
amended. This is the time to do this. We cannot walk out of this 
Chamber and say something happened in that Chamber to deal with health 
care. But did you do something about prescription drugs? No, no, we 
couldn't do that, couldn't do that. This is not the way I want this to 
end, and it is not the way it has to end if enough of us have the 
courage to take on this fight.
  As I said, I will have a lot more to say tomorrow morning. I 
appreciate the indulgence of my colleagues to listen tonight about why 
we have offered this legislation.
  I started and let me finish by saying this is broadly bipartisan. It 
is, first and foremost, a Dorgan-Snowe bill. Senator Dorgan--myself--
and Senator Snowe from the State of Maine, but many others--my 
colleague, Senator Grassley, who is on the floor, Senator McCain, who 
spent a lot of time on this issue--Republicans and Democrats have come 
together.
  By the way, this has not happened very often on this bill. But this 
is a bipartisan bill with Republicans and Democrats pulling their oars 
together to try to get this done.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Madam President, before the Senator from North Dakota 
leaves and before I speak on another issue, I wish to tell him I am 
going to speak in support of his amendment. But I would like to ask him 
a question now, if he will answer it for me--a friendly question, but 
it is something I don't know absolutely for sure, but I believe that 
pharmaceuticals are about the only thing a consumer in the United 
States cannot buy anywhere in the world that they want to buy. We ought 
to give them that same right we do on everything else. There may be 
some other items I am not aware of, but I think it is only 
pharmaceuticals that you cannot import from wherever you want to buy 
them.
  Mr. DORGAN. Madam President, I say to the Senator from Iowa, that and 
Cohiba cigars from Cuba, I reckon. We have a special embargo with 
respect to Cuba. With that exception, I don't think there is a legal 
product the American consumer cannot access anywhere else in the world.
  This is about giving the American consumer the freedom that the 
global economy should offer everybody. The big shots got it. The big 
interests can do it. How about the American people having the 
opportunity to shop around the world for the same product and pay a 
fraction of the price of the charges that are imposed on them in the 
United States.
  Mr. GRASSLEY. I thank the Senator from North Dakota.
  I would like to talk about a recent news----
  Ms. KLOBUCHAR. Madam President, we had a unanimous consent agreement. 
I am trying to figure out the order.
  The PRESIDING OFFICER. Under the previous order, the next speaker is 
to be the Senator from Minnesota, followed by the Senator from 
Delaware.
  Mr. GRASSLEY. I ask unanimous consent to speak now, if I may.
  The PRESIDING OFFICER. Is there objection?
  Mr. KAUFMAN. Will the Senator yield for a question? How long will the 
Senator be?

[[Page 29787]]


  Mr. GRASSLEY. Fifteen minutes.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Ms. KLOBUCHAR. Madam President, I believe our speeches are 10 minutes 
long. If the Senator from Iowa could wait for 10 minutes, then we will 
be able to complete our speeches, as recognized by the Chair.
  Mr. GRASSLEY. I will let the Senators speak, and I will speak 
tomorrow because I have to go to a meeting. I will let the unanimous 
consent agreement stand.
  Ms. KLOBUCHAR. I was not aware the Senator from Iowa had to leave. If 
he can keep it to 10 minutes, that would be helpful.
  Mr. GRASSLEY. I cannot keep it to 10 minutes, and I cannot shorten 
it. So I will let the unanimous consent agreement stand.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. KAUFMAN. Madam President, the Senator from Minnesota and I are 
going to engage in a colloquy.
  We rise to talk about health care fraud enforcement. It is no secret 
fraud represents one of the fastest growing and most costly forms of 
crime in America today.
  In no small part, our current economic crisis can be linked to 
financial fraud, starting with unchecked mortgage fraud generated by 
loan originators through securities fraud that hastened the eventual 
market crash and maximized its impact on Main Street and the average 
American investor.
  In response, this body passed the Fraud Enforcement Recovery Act, 
which directed critical resources and tools to antifinancial fraud 
efforts. I was proud to work on FERA with my friend from Minnesota, a 
former prosecutor, who understands both the harm that financial fraud 
causes ordinary Americans and the importance of deterring criminal 
behavior before it happens.
  Ms. KLOBUCHAR. Madam President, I thank Senator Kaufman. Before I 
begin, I wish to, first, acknowledge the amendment that has been 
offered by Senator Dorgan on drug reimportation, something I support 
and I know Senator Kaufman supports as well. We look forward to talking 
about that amendment in the days to come.
  The bill Senator Kaufman referred to, the Fraud Enforcement and 
Recovery Act, was passed in response to an unprecedented financial 
crisis.
  I was proud to work on that bill in the Senate Judiciary Committee 
along with Senator Kaufman.
  But Americans should expect Congress to do more than simply react to 
crises after their most destructive impacts have already been felt. We 
are always coming in after the fact and putting out the fire. That is 
not what we want to do. We owe it to our constituents to be proactive, 
to seek out and to solve problems on the horizon so that financial 
disasters can be averted.
  In the midst of the debate concerning comprehensive health care 
reform, we must be proactive in combating health care fraud and abuse. 
Each year, criminals drain between $72 billion and $220 billion from 
private and public health care plans through fraud, increasing the 
costs of medical care and health insurance and undermining public trust 
in our health care system. Think of all the money wasted--$72 billion 
to $220 billion each year--drained by criminals, that could be going to 
our seniors, that could be going for care.
  Let me give a couple of examples, Senator Kaufman, of the kinds of 
fraud we need to address. On June 23 of this year, eight individuals 
were indicted in Miami for cashing $30,000 to $80,000 several times a 
week at two check-cashing facilities they owned themselves. These 
crooks defrauded the U.S. health care system by creating a phony clinic 
that churned out medical bills in five States. They were not providing 
health care. They were phony clinics. Federal prosecutors announced 
this on Tuesday.
  Some of the purported clinics were empty storefronts with handwritten 
signs while others existed only as post office boxes, but none provided 
any actual medical services, according to prosecutors. By the time they 
were caught, in this one incident, this one group of con men, had 
bilked the government of $100 million. That is $100 million at a time 
when our taxpayers are trying to save every dime, while they are 
holding on to their jobs and trying to pay their bills. This one group 
of con men--$100 million.
  Here is another example. In November of 2007, the Department of 
Justice indicted a woman for billing Medicare for motorized wheelchairs 
that beneficiaries didn't need and for children's psychotherapy 
services never provided. According to the indictment, the woman then 
laundered the money through a Houston check-cashing business, cashing 
several Medicaid checks each for more than $10,000. Those are just 
examples of what we are dealing with.
  Mr. KAUFMAN. I say to the Senator, those are sobering examples of the 
kinds of fraud we must stop. As we take steps to increase the number of 
Americans covered by health insurance and to improve the health care 
system for everyone--and we will do that--we must ensure that law 
enforcement has the tools it needs to deter, detect, and punish health 
care fraud.
  The Finance and HELP Committees, as well as leadership, have worked 
long and hard to find ways to fight fraud and bend the cost curve down, 
and they have done a great job. But there is more work to be done. That 
is why Senator Klobuchar and I, along with Senators Leahy, Specter, 
Kohl, Schumer, and Harkin, have introduced our health care fraud 
enforcement, No. 2792.
  Ms. KLOBUCHAR. What I like about the amendment is it will protect our 
increased national investment in the health of Americans. We have 
decided Americans should be covered by health care; that people 
shouldn't be thrown off of their health insurance by preexisting 
conditions. The way we protect that investment, and the way we make 
sure the funds are there to help people, is by doing things such as 
increasing the tools we need to prosecute these kinds of cases.
  These criminals scheme the system to rob the American taxpayers of 
money that should be used to provide health care to those who need it 
most. We must put a stop to this, and we are doing that with this 
amendment. It provides straightforward but critical improvements to the 
Federal sentencing guidelines, to health care fraud statutes, to 
forfeiture, money laundering, and obstruction statutes, all of which 
would strengthen prosecutors' ability to combat health care fraud.
  As a former prosecutor, I can tell you that when we had these types 
of cases, we used every tool you could use to push someone to plead 
guilty, every tool you could use to make sure you got the maximum 
sentence so a message would be sent not just to that particular 
criminal but to other white collar offenders who thought this might be 
a quick way to make a buck. They need to hear they can be caught and 
they will go to jail.
  I know Senator Kaufman has worked on this and is taking a lead, and 
perhaps he can provide the details on this amendment.
  Mr. KAUFMAN. Sure. This amendment directs a significant increase in 
the Federal sentencing guidelines for large-scale health care fraud 
offenses. It is incredible that despite enormous losses in many health 
care fraud cases, analysis from the U.S. Sentencing Commission suggests 
that health care fraud offenders often receive--and I know this is hard 
to believe--shorter sentences than other white collar offenders in 
cases with similar loss amounts. For some reason, people think health 
care fraud is kind of okay.
  Ms. KLOBUCHAR. If people knew this, they would be shocked. In health 
care fraud, you are taking money from people who need it most--when 
they are at the hospital--and yet they would have shorter sentences 
than other types of fraud.
  Mr. KAUFMAN. There is data to show that criminals are drawn to health 
care fraud, when they are sitting around deciding what kind of fraud 
they are going to do, because the risk-to-reward ratio is so much 
lower. That is ridiculous. We need to ensure these offenders are 
punished not only commensurate with the costs they impose on our health 
care system but also

[[Page 29788]]

at a level that will offer real deterrence. People have got to 
understand they can't go out and commit health care fraud.
  There are so many different ways it can be presented; that if in fact 
they do it, they are going to get real time for the crime. As a result, 
our amendment directs changes to the sentencing guidelines that, as a 
practical matter, amount to sentence increases of between 20 and 50 
percent for health care fraudsters stealing over $1 million.
  Ms. KLOBUCHAR. The other thing that is great about this amendment is 
it updates the definition of ``health care fraud offense'' in the 
Federal criminal code so it includes violations of the anti-kickback 
statute, the Food and Drug and Cosmetic Act, and certain provisions of 
ERISA. These changes will allow the full array of law enforcement tools 
to be used against all health care fraud.
  The amendment also provides the Department of Justice with subpoena 
authority for investigations conducted pursuant to the Civil Rights for 
Institutionalized Persons Act--also known as CRIPA. Under current law, 
the Department of Justice must rely upon the cooperation of the nursing 
homes, mental health institutions, facilities for persons with 
disabilities, and residential schools for children with disabilities 
that are the target of these CRIPA investigations. While such targets 
often cooperate, they sometimes do not, and the current lack of 
subpoena authority puts vulnerable victims at needless risk.
  Finally, in addition to the very important piece of this amendment 
that Senator Kaufman has pointed out--where we are actually increasing 
the ability to get better criminal penalties--the amendment corrects an 
apparent drafting error by providing that obstruction of criminal 
investigations involving administrative subpoenas under HIPAA--the 
Health Insurance Portability and Accountability Act of 1996--should be 
treated in the same manner as obstruction of criminal investigations 
involving grand jury subpoenas.
  Senator Kaufman and I also plan to file an additional health care 
fraud amendment that would require direct depositing of all payments 
made to providers under Medicare and Medicaid. This amendment is 
incredibly important because the Medicare regulations already require 
direct depositing or electronic transfer, but these regulations have 
not been uniformly enforced and criminals are taking advantage of this 
system.
  Again, I ask the question: Why would we want this money--$60 billion 
estimated for Medicare fraud alone--to be going to con men and crooks, 
people who are setting up fake storefronts with fake signs that say 
doctor's office, instead of to the hard-working people in this country 
who can hardly afford their health care insurance? It is an outrage.
  That is why I am so glad Senator Kaufman would take the leadership 
here, that we have a group of us who were prosecutors working on this 
in the Judiciary Committee to include this in the health care reform 
bill, because Americans have waited too long for these kinds of 
changes.
  Mr. KAUFMAN. That is a great amendment that I think will be a big 
help in terms of cutting down this fraud, and that is what we are all 
about. This is a bipartisan issue, if there was ever a bipartisan 
issue. I don't know of anyone who doesn't think we have to do more in 
terms of health care fraud. When we have $70 billion to $220 billion a 
year in health care fraud, we have to do everything we can to stop it.
  As we consider and debate meaningful health care reform, we must 
ensure that criminals who engage in health care fraud--and more 
importantly those who contemplate doing so--understand that they face 
swift prosecution and substantial punishment.
  When the time comes, Senator Klobuchar and I, along with our fellow 
cosponsors, will urge our colleagues to support these amendments.
  Madam President, I yield the floor.
  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. KAUFMAN. 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. KAUFMAN. Madam President, I ask unanimous consent to speak as in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                          Afghanistan Strategy

  Mr. KAUFMAN. Madam President, I rise today to speak about the 
Afghanistan strategy President Obama announced last week. The dilemma 
facing the President and our national security team in Afghanistan is 
one of the most complex and difficult I have seen in more than three 
decades of public service.
  President Obama's speech laid out a bold plan, and he has been both 
deliberative and courageous in his approach. At the same time, I share 
the concerns of many Americans about the challenges that lie ahead for 
our troops. Sending young men and women into harms way is the most 
difficult choices we must face. Each life lost is one too many.
  The decision in Afghanistan is especially difficult because four 
primary questions remain. The first question is do we have a trusted 
and effective partner in President Karzai? No matter how many troops we 
deploy, we cannot succeed with an Afghan government plagued by 
corruption.
  The second question is to what length is Pakistan willing to go to 
help? We cannot defeat al-Qaida and degrade the Taliban without 
Pakistan's support.
  The third question is can we accelerate the training of Afghan 
National Security Forces? Today, there are too few Afghan security 
forces to clear and hold against the Taliban, and they are not capable 
of taking over from U.S. troops. And in light of the President's 18-
month deadline, it is clear that self-sufficiency for the Afghans is 
not optional; it is mandatory. Secretary Gates confirmed for me in last 
week's Senate Foreign Relations hearing that July 2011 is a firm 
deadline. In 18 months, we will begin our withdrawal and we will not 
send additional troops after this time. This was reiterated by 
Secretary Clinton and Chairman of the Joint Chiefs Mullen.
  The fourth question is do we have enough qualified U.S. civilians in 
Afghanistan to partner with the Afghan people in promoting governance 
and economic development? We must send even more and ensure that the 
``civilian surge'' extends to all 34 provinces, so they can partner 
with Afghans in the field.
  I visited Afghanistan in April and September and had the opportunity 
to speak with our military and civilian leaders, President Karzai, and 
numerous Afghan ministers. I traveled to Helmand and Kandahar 
Provinces, and met with local government officials and tribal elders at 
a ``shura,'' or community council. What I heard from the Afghan people 
was frustration with their government's inability to provide security, 
administer justice, and deliver basic services. They welcomed 
international assistance in the short-term but sought improved security 
and governance. Most importantly, they wanted control transferred to 
Afghan security forces once they were capable of holding against the 
Taliban themselves.
  Since returning from Afghanistan, my No. 1 concern has been the 
ability of the Karzai government to be an effective and trusted 
partner. In his second term, President Karzai must eliminate 
corruption, strengthen rule of law, and deliver essential services in 
order to win the trust of the Afghan people. Ultimately, the battle is 
not between the U.S. and the Taliban. It is a struggle between the 
Afghan government and the Taliban, and the fight must be won by the 
Afghans themselves. The notion of a corrupt government has emboldened 
the Taliban and further undermined trust between President Karzai and 
his people. President Karzai must translate promises in his 
inauguration speech into action,

[[Page 29789]]

because increased government transparency and accountability is 
absolutely critical.
  For me, the key point in President Obama's speech was that our 
military commitment is not open-ended. In July 2011, we will begin our 
troop drawdown. This has created an 18-month deadline for progress, 
injecting a sense of urgency to our mission that has been missing for 
the past 8 years. It sends a message that the clock is ticking for the 
Afghan government to eliminate corruption. They will no longer get a 
``blank check'' because the time for action is now. On the security 
front, the Afghan National Army and Police have no choice but to assume 
greater responsibility given the certainty of a U.S. withdrawal.
  As President Obama outlined, Pakistan is central to this fight. We 
cannot succeed without its cooperation because developments in the 
region are inextricably tied to both sides of the border. After my 
April visit, I was concerned about the Pakistani commitment. When I 
returned in September, however, I was impressed by the Pakistani 
military's decision to go after elements of the Taliban in the Swat 
Valley and South Waziristan. At the same time, Pakistan must take 
action against the Afghan Taliban and al-Qaida, which continue to find 
safe haven in Pakistani tribal areas. If extremists continue to operate 
freely between Afghanistan and Pakistan, it will undermine security 
gains made on the Afghan side of the border. And the stakes are even 
higher in Pakistan, which has both nuclear weapons and delivery 
vehicles.
  In Afghanistan, we must break the momentum of the Taliban by 
improving security and strengthening our ability to partner with the 
Afghans. That is why I support efforts to accelerate the training of 
Afghan National Security Forces, ANSF. I am concerned that the 
President's goal of increasing the Afghan Army to 134,000 in 2010 does 
not go far enough in building the capacity of the ANSF. By comparison, 
Iraq--a geographically smaller country with the same sized population--
has 600,000 trained security forces. This is why we must accelerate our 
targets for building the army and improve the capability of the police, 
which has faced even greater challenges in terms of corruption, 
incompetence, and attrition.
  Finally, our success in Afghanistan depends on more than troops--we 
need an integrated civilian-military strategy in order to sustain 
progress. Many dedicated U.S. civilians continue to serve in 
Afghanistan, and we must further augment these numbers and ensure they 
can directly interact with Afghans in the field. Given their role as a 
force multiplier for the military and international nongovernmental 
organizations, NGOs, this is an area where we must channel even more 
resources and people in the near term. We need a stronger civilian 
capacity, because counterinsurgency cannot and should not be conducted 
with the military alone.
  Over the coming months, I will closely monitor our progress in Afghan 
governance, partnering with Pakistan, building the Afghan National 
Security Forces, and increasing the U.S. civilian surge. Improvements 
in these areas are critical to our overall success in Afghanistan, and 
will determine when our brave men and women in uniform can return home.
  I yield the floor.
  Mr. SESSIONS. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Udall of Colorado). The clerk will call 
the roll.
  The legislative clerk proceeded to call the roll.
  Mr. SESSIONS. Mr. President, I ask unanimous consent the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. The Senator from Alabama. Without objection, 
it is so ordered.
  Mr. SESSIONS. Mr. President, I see my good friends, Senators Kaufman 
and Klobuchar, had talked about actions we could take to deal with 
fraud in health care. I support that. I had the opportunity in the 
past, as U.S. attorney, to lead a group that would do that. But 
something is troubling me today a great deal. I am uneasy about it. It 
goes to the heart of how the legislation that is before us today has 
been put together.
  Earlier today, we had Senator McCain offering an amendment to say 
that every State should have the same policies with regard to Medicare 
Advantage that the State of Florida will under this bill. Presumably, 
that was an effort to gain some support. We have seen other situations 
such as that with Louisiana and other places getting special 
advantages.
  Let me tell you about something that is particularly troubling to me. 
It was written about by Robert Reich, who was Secretary of Labor in 
President Clinton's Cabinet. He is a prolific writer about economic and 
health care matters. He starts his Sunday August 9 article this way on 
his blog. It says:

       I'm a strong supporter of universal health insurance--

  He is not pulling any punches there. He believes in a single-payer 
government policy. Then he goes on to say--

     and a fan of the Obama administration. But I am appalled by 
     the deal the White House has made with the pharmaceutical 
     industry's lobbying arm to buy their support.

  That is a pretty serious charge. He goes on to say:

       Last week, after being reported in the Los Angeles Times, 
     the White House confirmed it had promised Big Pharma that any 
     healthcare legislation will bar the Government from using its 
     huge purchasing power to negotiate lower drug prices. That's 
     basically the same deal George W. Bush struck in getting the 
     Medicare drug benefit, and it's proven a bonanza for the drug 
     industry.

  I will say, as I recall, that Mr. Reich was a critic of that at the 
time. Right or wrong, it was done and he was a critic of it. I give him 
credit for it. He said a continuation of that would be an even larger 
bonanza. He goes on to describe why he thinks it is a bonanza.
  Right or wrong, as a matter of policy and so forth, it is no doubt 
that is something Big Pharma would like. He goes on to say this:

       In return, Big Pharma isn't just supporting universal 
     health care. It's also spending lots of money on TV and radio 
     advertising in support. Sunday's New York Times reports that 
     Big Pharma has budgeted $150 million for TV ads promoting 
     universal health insurance, starting this August--

  I am quoting him--

     (that's more money than John McCain spent on TV advertising 
     in last year's presidential campaign), after having already 
     spent a bundle through advocacy groups like Healthy Economies 
     Now and Families USA.

  I don't know what has happened. There is a memorandum in, I believe, 
one of the blogs here, the Huffington Post. That is supposed to be the 
memorandum that documents the agreement. I don't know what the facts 
are, but I know this, it is not a healthy thing, as somebody who has 
been involved in Federal law enforcement, for a government official, 
under color of right, to say to a private individual that you will help 
me with an advertising campaign and spend your private money, or I will 
do you a favor in exchange for an $150-million television campaign.
  I wish to tell you that is not good. That is beyond the pale. If 
things such as this have been done in the past, it is not the kind of 
thing that ought to be continued. I think it is a big deal.
  The New York Times has reported, as they go forward:

       Shortly after striking that agreement, the trade group--the 
     Pharmaceutical Research and Manufacturers of America, or 
     PhRMA--also set aside $150 million for advertising to support 
     health care legislation.

  I am quoting a New York Times article by Duff Wilson.

       But an industry official involved in the discussions said 
     the group and its advertising money would now be aimed 
     specifically at the approach being pushed by Mr. Baucus, 
     Democrat of Montana and chairman of the Senate Finance 
     Committee.

  Is that the way this thing is being done? I hope not. I will examine 
these circumstances in more detail, but I would like to say, right now 
and today, that I am not happy about it. I don't like the looks of it, 
it doesn't smell good to me, it does not strike me as something that is 
legitimate, and I think maybe we need to find out more about it, 
frankly.
  I wish to share with my colleagues a fundamental concern I have with 
this

[[Page 29790]]

health care bill. Supporters of the bill have made a great deal of 
promises. They alleged it would do a lot of very great sounding things, 
and we were asked to support it on the basis of their promises. But a 
careful examination of the legislation shows it fails to deliver on 
almost all the major promises it made and is likely to cause a great 
deal of adverse, unanticipated consequences. As a result, I think the 
American people have intuitively understood this; that is, why they are 
so strongly opposed to it. They cannot imagine why the leadership of 
this Senate continues to try to push down on their brow this piece of 
legislation that does not do what it promised to do.
  For example, the sponsors of the legislation say the bill's total 
cost is $848 billion. However, they do not begin the benefits of the 
bill until 5 years after enactment and that $848 billion is the cost of 
expenditures over 10 years. So when you move forward to when the 
benefits actually start for those who will be receiving them and go 10 
years from that point, the total costs are not $848 billion, they are 
$2.5 trillion. That is a huge difference. It is a monumental 
difference. It is a difference so large I cannot understand how we can, 
with a straight face, try to contend that we have a sound budget-minded 
bill that is going to cost $848 billion, and we have tax increases of 
about half of that, and raids on Medicare for about half of that and 
that is how we are going to pay for it. It is not working in that way, 
in my view.
  Another promise for the bill that was made by the President in the 
joint session to the Congress, he said this:

       This bill will not add one dime to the deficit.
  That is just not accurate. You can make anything deficit neutral if 
you pay for it by slashing Medicare and taking the money from Medicare 
to pay for it. Or you can make a bill be deficit neutral if you raise 
enough taxes. So they are raising $494 billion in taxes. They are 
cutting Medicare by $465 billion. That is the plan.
  They claim they have a $130 billion surplus. So don't worry about the 
budget. We have created a bill that is going to reduce the deficit. 
That is what they have said repeatedly.
  But they forgot something. They forgot we have to pay our physicians. 
That was always supposed to be part of health care reform. In fact, the 
physician groups were told they were going to be paid. But under this 
bill, to show you how it has been doctored--and this has been done 
before, Republicans have participated in this in the past, and it has 
been something that has been going on for a decade, but it is really 
relevant today, particularly in this legislation because this 
legislation was supposed to fix this problem--they keep the physician 
rates slightly above last year's rate for 1 year. Then for 9 years in 
the 10-year budget, they assume that doctor payments, physician 
reimbursements are going to be cut 23 percent. That is unthinkable.
  We are not going to cut physicians 23 percent. We can't cut the 
physicians at all because they are already wondering whether they will 
continue to take Medicare patients and, even more so, Medicaid 
patients, where they get paid less.
  We could have a mass walkout of physicians who couldn't afford to see 
seniors if we were to cut their pay by 23 percent. In fact, we are not 
going to do that. We all know this. So what did they do? I know they 
were meeting down in the hallways somewhere, and they were plotting out 
this bill. They said: The President said it will not add to the debt. 
What are we going to do? The numbers don't add up. We can't raise taxes 
any more. We can't cut Medicare any more. We have done all we can do. 
What are we going to do?
  So what they obviously decided was to take the physician pay portion 
of the bill out, that one that would have fixed this aberrational law 
we have that requires it to be cut 23 percent, and so they put it in a 
separate bill. Every penny of this separate bill would be paid for by 
increased debt, so not really paid for at all. They offered that bill 
on the Senate floor, and it got voted down because Republicans all 
voted against it as being utterly fiscally irresponsible. Enough 
Democrats joined in to kill the bill. They wouldn't support it either. 
A number of Democrats know the budget has to have some rationality. So 
they failed to do that.
  But if you put the doctor fix in, you are increasing the costs of the 
bill by $250 billion, so the $130 billion surplus is reduced to a $120 
billion deficit. So it does add to the deficit. It adds more than one 
dime to the debt; it adds $120 billion to the debt.
  Another fiction was their promise that they would fix the physician 
payments and make a permanent policy of paying them so every year they 
wouldn't have to run to Congress and hire lobbyists to come here and 
meet with Senators to beg them not to have a 23-percent cut. That 
happens every year. It is ridiculous. But this bill does not deal with 
that. It only has a 1-year fix, and for 9 years it is reduced just like 
it has been done in the past. There is no reform in that part of health 
care that needs to be done.
  Another fiction is that they are not cutting Medicare benefits. They 
say: We are not cutting Medicare benefits. We are cutting that bad old 
Medicare Advantage that 11 million seniors are benefiting from and 
enjoy and participate in. They are cutting that $100-plus billion which 
is about one-fourth of what the cuts to Medicare are. They say that is 
not truly cutting Medicare. But that clearly is cutting Medicare 
because Medicare Advantage is part of the Medicare Program. It is 
cutting Medicare. However you feel about Medicare Advantage, this is a 
cut to Medicare Programs that millions of seniors favor.
  That is why Florida didn't want to have their Medicare Advantage cut. 
So they got a special deal in this legislation. Everybody else in 
America won't get that. They want to keep it.
  Let's go on a little bit further just to show you why the American 
people are unhappy with Congress. They have a right to be unhappy. 
People say: Those people out there at the tea parties and townhall 
meetings, they were just upset. They are poor Americans. They are not 
good Americans. Good Americans would come in and say: How much more 
money can we give you, big government, to take care of all our needs 
from cradle to the grave?
  The people at the tea parties understand the kind of games that are 
being played here. They understand the cuts to home health care, to 
hospice programs, to hospitals, the hospitals that care for a 
disproportionate share of the poor people, and the $23 billion from 
just general Medicare accounts represent cuts to Medicare, which is our 
seniors program.
  How is it, then, that we have this disagreement? How is it possible 
that you can't agree on where $465 billion comes from? The sponsors of 
the bill, this is what they say. They say: We promised we wouldn't cut 
Medicare benefits. Any guaranteed benefit any senior citizen has, we 
promised not to cut it. All we are doing is cutting the providers, the 
people who provide the benefit.
  Give me a break. So you come in and you cut hospice, nursing homes, 
other providers, $118 billion from Medicare Advantage, $192 billion 
from the hospices, nursing homes, and other providers, $43 billion from 
hospitals that serve a disproportionate number of poor and uninsured, 
$23 billion from unspecified Medicare accounts, and that this doesn't 
weaken Medicare. If we could cut that, why haven't we done it already? 
If this didn't reduce the quality of care for seniors, if we could 
reduce these hospitals and others and they could still provide care to 
our seniors, why haven't we done it already?
  Mike Horsley, head of our hospital association in Alabama, tells me 
that as a result of an abominable wage index program that helps to 
determine how much hospitals get paid primarily and lien payments in 
general, two-thirds of the hospitals in Alabama are operating in the 
red. They don't need to be cut any more.
  I guess what I would say is, this is the way the game has been 
played. My colleagues are saying we are not cutting guaranteed 
benefits. We are just cutting the money from the people who provide the 
benefits. How many of them are going to keep doing so, as the

[[Page 29791]]

CMS Actuary's report questioned? How many of those will give it up?
  Fiction No. 6--I have 10, and I will not go through all of them 
tonight--is that hospitals that treat the poorest and sickest will 
somehow be better off under this program. But they are not feeling that 
way. They are not feeling they are going to make up for the fact that 
the hospitals that qualify as disproportionate share hospitals, those 
who serve a high percentage of individuals who are very low income or 
who have no insurance, they are going to lose $43 billion in cuts under 
this bill. These hospitals that provide so much charity care and 
provide a safety net in the communities are going to suffer under this 
legislation. They are telling me that. I don't know who in Washington 
may say they are not, but that is what they are telling me. I think 
they are telling the truth.
  Fiction No. 5 is that average family premiums are going to decrease. 
Have you heard that through this proposal? Senator Evan Bayh asked the 
CBO about this, and they said families who do not receive coverage from 
their employer would see their premiums rise ``about 10 to 13 percent 
higher by 2016'' than under the current law. The ones who claim they 
are seeing some reductions, those reductions are only the slightest 
reduction, less than 3 percent in most cases, of the 5- or 6-percent 
increase expected to occur every year under current law.
  So instead of going up 5.56 percent, it goes up 5.41 percent. They 
are claiming, I guess, that is some sort of cut. But it is 
misrepresentation to say that family premiums are going to decrease, 
when people who are not in group health plans through their employers 
are the ones who are going to see the largest increases, perhaps 10 to 
13 percent by 2016, more than would occur under present law.
  I am pleased to be able to serve in the Senate with Senator Grassley 
who chaired the Finance Committee, is ranking member now, who does over 
100 townhall meetings a year or something in the counties in Iowa. He 
met with thousands of people and got the same message I got, which is 
you people are irresponsible. The debt is surging and will double in 5 
years, the whole debt of America, and triple in 10. I want to say that 
the American people are concerned about this. Senator Grassley worked 
so hard to see if he could get a bill that would be bipartisan, that we 
all could support, or large numbers of the Senate could support. But we 
got off track.
  I talked to one person who dealt with this issue. He said the way 
things got off track was that we abandoned ways to legitimately contain 
costs increases. The way to create more competition, the more personal 
stake in your health care, other things that would actually help reduce 
the cost of health care, is what we got away from, and it became driven 
by President Obama's determination to have a government option. That, 
in my estimation, may have been the decisive event in the negotiations 
breaking down.
  This is a serious piece of legislation. It seeks to alter one-sixth 
of the American economy. It does not do what it promises. It surges 
spending. It increases taxes dramatically. It represents a major 
governmental takeover and will ultimately undermine the special 
relationship between patients and their doctors. It will also 
substantially threaten the viability of Medicare. This money that is 
being taken out of Medicare will only accelerate its insolvency. By 
2017, Medicare--I believe Senator Grassley will agree--is expected to 
go into default. It will go down rapidly, actually.
  Is that correct, Senator Grassley, that by 2017, under current law, 
Medicare is projected to go into default and go rapidly into default, 
and if we could save any money out of Medicare, if we can save $400 
billion, shouldn't it be kept in the Medicare Program to try to extend 
its life and make it a viable program that seniors can rely on rather 
than creating a whole new spending program with that money?
  Mr. GRASSLEY. Mr. President, if the Senator is asking me that 
question, I will tell him that he is absolutely right, not based upon 
what I say or what the Senator says, but every spring the trustees of 
Social Security and Medicare look ahead 75 years and they predict what 
the income and the outlays are going to be based upon the population 
and the projected growth of the economy and all that stuff. Right now, 
they are projecting $37 trillion of shortfall over that 75-year period 
of time. They already told us, and it has materialized, that in the 
year 2008 we started paying more money out of Medicare than was coming 
into Medicare, and by the year 2017, as the Senator correctly stated, 
the trust fund will be out of reserves.
  Mr. SESSIONS. So we are spending the reserves in Social Security, 
which will be exhausted by 2017.
  Mr. GRASSLEY. In Medicare.
  Mr. SESSIONS. Medicare. Excuse me.
  I am going to yield the floor to Senator Grassley. I say to the 
Senator, I appreciate your leadership and insight into this issue. I 
value your whole approach to it. I think most Americans--if they 
understood this information as the Senator does and as the Senator has 
articulated, the opposition to the bill would be even greater than it 
is.
  I urge my colleagues to examine the fact that the bill simply does 
not do what it sets out to do. It does not meet its promises, and as a 
result, we absolutely should not go down this road to a major Federal 
takeover of health care, with ramifications that go far beyond what it 
might appear today.
  I thank the Chair and yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, I had a chance to hear a great deal of 
what the Senator from Alabama said. I think I would highlight that what 
he said is what he is hearing from the grassroots of his State, which 
is very much what I hear from the grassroots of my State: people are 
very concerned about this piece of legislation leading to the 
nationalization of health care, similar to what they have seen this 
administration previously do this year with the nationalization of 
General Motors, partial nationalization of the financial system--a big 
deficit. And then they see the money being spent on this bill--$2.5 
trillion after it gets fully implemented. And where are you going to 
get money? And what is that going to do to the economy? And, more 
importantly, what sort of a legacy is that leaving to our children and 
grandchildren?
  He also correctly stated that I do visit every county every year. The 
number of counties the Senator had was just a little bit high. We only 
have 99 counties. But for the 29 years I have been in the U.S. Senate, 
I have held a town meeting in each one of our counties every year. So I 
do have the benefit of 2,871 town meetings as a basis for suggesting 
what people tell me face to face, besides the large number of phone 
calls we get.
  You cannot believe the number of phone calls that are coming in now, 
the number of e-mails we are getting--historically high. I have never 
had that before on any issue. I assume it is the same for the State of 
Alabama, contacting their two Senators as well.
  Mr. President, I rise to bring up an issue that is a relatively new 
issue in this debate, as in the secrecy of the negotiations that are 
going on around Capitol Hill on the issue of health care reform. These 
secret negotiations actually started about October 2 when Senator Reid, 
the leader, had to merge the bill out of the Senate Finance Committee 
and the bill out of the Senate HELP Committee into one bill. It took a 
long period of time to do that.
  We are in the second week of debate. I hope people realize that 99 
Senators ought to have the same privilege that 1 Senator had of getting 
a grasp of this huge 2,074-page bill. There are still negotiations 
going on because the leader still does not have locked down the 60 
votes that it is going to take to get to finality.
  So some of these discussions are: what can we do to get a few votes 
if we do not have a so-called public option? And the latest of that is: 
Well, allow people to buy into Medicare. So I want to speak about that 
issue because it sounds pretty simple. It may get 4 more votes and may 
get 60 votes, but it is bad. It may be good politically, but

[[Page 29792]]

it is bad for Medicare and particularly for Medicare in rural areas 
where we have a difficult time keeping hospitals open, and we have a 
difficult time recruiting doctors in rural America.
  So I would talk about the recent news reports of a proposal being 
concocted behind closed doors to allow 55- to 64-year-olds to buy into 
the Medicare Program. Supposedly, this idea has been put on the table 
to get the votes for supporters of having a brandnew government-run 
health plan and the people who do not like that.
  Back in the spring, such a proposal came up during the early stages 
of our Finance Committee's health care reform efforts. The idea was 
originally proposed by President Clinton even going back to 1998. I 
opposed such a proposal back then, and I oppose such a proposal now. I 
oppose the proposal because of its negative effect on the Medicare 
Program and our senior citizens who use Medicare.
  The best way to describe the effect of this proposal on the Medicare 
Program and its beneficiaries is to quote former Senator Phil Gramm of 
Texas when he was asked about President Clinton's proposal when 
President Clinton put that proposal on the table back in 1998. Senator 
Gramm said this about President Clinton's proposal, which would be 
applicable today as our colleagues are studying it:

       If your mother is on the Titanic, and the Titanic is 
     sinking, the last thing on Earth you want to be preoccupied 
     with is getting more passengers on the Titanic.

  Since its inception in 1965, the Medicare Program has helped ensure 
senior access to health care. But, as the Senator from Alabama and I 
were just discussing, the problems with health care and Medicare are 
such that Medicare is already under extreme financial pressure. So why 
would you load more people into a system that Senator Gramm of Texas 
was referring to as the Titanic? You would not load more people on it 
as it was going to sink.
  This is not to say that this entitlement program, Medicare, is not in 
need of improvement, but having the 36 million Americans who are age 55 
to 64 buy into the program is not an improvement. Even groups 
supporting the Reid bill, such as the AARP, are pointing out the severe 
shortcomings of such an approach.
  Last summer, the AARP Public Policy Institute published an analysis 
of the Medicare buy-in concept. In their report, the AARP points out 
the potential for increased Federal entitlement spending. AARP said:

       Expanding the program to more people could raise federal 
     spending even further if their care is made affordable 
     through subsidies that would be funded by the existing 
     Medicare trust funds.

  And do not forget the effects of adverse selection from a Medicare 
buy-in program. Here AARP has studied it, and this is what they say 
about that:

       . . . the premium may be too uncompetitive for those who 
     don't use much health care and unaffordable for those with 
     modest incomes. This may limit buy-in enrollment and drive up 
     cost further.

  So this means that this buy-in proposal is likely unsustainable. And 
we all know what happens when the government creates an unsustainable 
new program. What happens? The taxpayers end up on the hook for bailing 
it out down the road sometime.
  We all know the Medicare Program has $37 trillion in unfunded 
obligations. We all know about the pending insolvency of the Medicare 
Program. The trustees say so every spring.
  The Medicare hospital insurance trust fund started going broke last 
year. In 2008, the Medicare Program began spending more out of this 
trust fund than was coming in through the payroll tax. The Medicare 
trustees have been warning all of us for years that this trust fund is 
going broke. They now predict that it will go broke right around the 
corner in 2017. Well, as the AARP has pointed out, adding millions to 
the Medicare Program would almost certainly make things much, much 
worse for the fiscal health of a program that is not in very good 
financial shape. This proposal would also make things worse for the 45 
million Medicare beneficiaries who paid into the program over the years 
and are receiving benefits under the program.
  Since we started debate on this 2,074-page bill, Members on this side 
of the aisle have questioned the wisdom of slashing Medicare by $\1/2\ 
trillion and then using the savings to start a new Federal entitlement 
program. We on this side have stressed that provider cuts of this 
magnitude will make it financially harder for providers to care for 
beneficiaries. We have pointed out that this will worsen beneficiary 
access to health care, as providers stop treating Medicare patients.
  Adding millions more Americans to Medicare on top of the $\1/2\ 
trillion in Medicare cuts in this Reid bill would make beneficiaries' 
access to care much worse. But do not take my word for it. Even 
national hospital associations such as the American Hospital 
Association and the Federation of American Hospitals are opposing this 
proposal. They are mobilizing their ranks against this proposal even as 
I speak. Yes, the same groups that agreed already--and this was back in 
June--to $155 billion in Medicare cuts--and they did that in an 
agreement with the White House and got sweetheart deals in this bill--
do not want the Senate to go the route of expanding Medicare for people 
under 65 years of age. The American Medical Association has also 
opposed this proposal. These groups recognize the potential for 
financial disaster by boosting the number of patients with coverage 
that pays well below cost.
  This Medicare buy-in proposal would also jeopardize retiree benefits. 
Going back to the same AARP analysis that I have quoted, they concluded 
that a Medicare buy-in program could further reduce employer-sponsored 
health benefits.
  According to the AARP:

       . . . a buy-in program might displace retiree coverage now 
     available through [their] employers.

  Still quoting AARP, they said:

       As health care costs tend to rise with age, employers might 
     have the incentive to find ways to avoid offering private 
     coverage for early retirees. . . .

  So with fewer patients with higher paying private coverage, there is 
less opportunity for providers to cost-shift to make up for low 
Medicare payments, because everybody recognizes the Federal Government 
does not pay 100 percent of costs. This would make it even harder for 
providers to treat Medicare beneficiaries, and as a result, 
beneficiaries would have an even harder time finding a provider to 
treat them.
  I come from a rural State where Medicare reimbursement is already 
lower than almost every other State in the Nation, so I have serious 
concerns about the ability of the Iowa providers to keep their doors 
open if more and more of their reimbursement is coming from Medicare. I 
know this is a concern that is shared by rural State Members of this 
body from both sides of the aisle. But losing providers to serve 
Medicare beneficiaries would only be the beginning of access problems 
caused by a Medicare buy-in program. Because if you think it would be 
tough to keep existing Medicare providers, think how hard it would be 
then to recruit new ones.
  Provider recruitment is already a major problem in rural States, 
particularly my State of Iowa. This issue comes up during my meetings 
with constituents in Washington or during the townhall meetings I hold 
in each of Iowa's 99 counties every year. It is already a challenge 
under the current Medicare Program for Iowa to compete for providers 
with urban areas where Medicare reimbursement is higher.
  I hear countless stories from constituents where they make great 
efforts to recruit doctors only to lose them to areas where Medicare 
reimbursement is higher. The Medicare buy-in will only make this 
situation worse in my State of Iowa, because more and more 
reimbursement would come from Medicare. So the current and future 
Medicare beneficiaries would be assured of limited access to providers 
because of this buy-in.
  AARP pointed out another flaw in this buy-in proposal. In their 
analysis, AARP warned that there are large cost-sharing requirements in 
Medicare, so buy-in enrollees would still be exposed to significant 
cost sharing. Maybe these buy-in enrollees would

[[Page 29793]]

have the resources to purchase supplemental Medicare policies to defray 
these cost-sharing requirements. Perhaps AARP is thinking of making 
even more money by selling supplemental policies to these retirees.
  I share the goal of getting more Americans covered, but expanding the 
Medicare Program to early retirees is not the answer. Medicare 
beneficiaries have paid in to this program all these years and 
rightfully have the expectation to receive the benefits to which they 
are entitled under the program. The Medicare buy-in proposal would 
jeopardize these benefits. It would jeopardize existing retiree 
benefits. It would leave retirees exposed to significant cost sharing. 
It would be unsustainable and taxpayers would end up footing the bill.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, thank you very much. I rise tonight to 
continue the discussion and debate on health care. I had the chance 
over the last couple of months not only to do a good bit of work on a 
number of issues that relate to the bill and the two bills that came 
before and were merged into one bill, but also to hear from 
constituents across Pennsylvania. Some of them are writing to us and 
urging us to pass a bill and some are urging us to go in the other 
direction. But the communications I get from people who write about 
their own stories, their own family, their own challenges are, of 
course, the most compelling and the most worthy of time and attention.
  Often they come from Pennsylvania families who are not only facing 
health care challenges but facing economic challenges that I don't 
think anyone in this Chamber can fully understand, at least not at this 
point in someone's life. Because when you become a Member of Congress, 
you are usually in pretty good shape. You may not have a lot of wealth, 
but you at least have a job to go to every day, you have a lot of 
people helping you, and you have health care. That is not something 
that can be said for tens of millions of Americans.
  This legislation is the culmination of a lot of debate and discussion 
and analysis and study over many decades now. It is nice that we have 
been talking for years and years about preventing a preexisting 
condition from barring someone's coverage or treatment. It is nice to 
talk about it, but it is a lot better when we do something about it. It 
is nice we have talked about limiting out-of-pocket costs for families 
who are trying to take care of their children, trying to care of 
themselves, but it is a lot better to do it, to enact it into law.
  This bill makes it illegal to use preexisting conditions to deny 
someone coverage. This bill makes it illegal for insurance companies to 
put a lifetime cap on services, or an annual cap. This bill makes it 
illegal to discriminate so that no longer, if we do what we must do and 
get this bill passed, can an insurance company discriminate against a 
woman, which they do all the time now, just as they prevent people from 
getting coverage due to a preexisting condition. We have an opportunity 
to change the way we provide health care in ways we haven't been able 
to imagine, let alone enact into law.
  One issue that has motivated me throughout this whole debate is what 
happens to our children at the end of the debate, at the end the 
legislative line, so to speak. Will children in America--and I am 
speaking about poor children and those with special needs because they 
are the ones who need help. If you are in a wealthy family, you will 
figure it out, and your family will figure it out. If you happen to be 
a child of a poor family or a child who has special needs, will you be 
better off at the end of this debate or will you be worse off.
  As it relates to poor children and children with special needs, the 
goal here has to be no child worse off. It is very simple. It is a very 
simple test. That is what we have been working on. I believe this bill 
that is on the floor right now is a dramatic improvement in the lives 
of so many families. I still think we have some more work to do as it 
relates to children, but there is no question that the bill we are 
debating will make children a priority in ways we haven't been able to 
do in any kind of other legislation, other than the children's health 
insurance legislation that Congress enacted going back more than a 
decade ago and that we reauthorized this past year.
  I wish to speak about two families tonight. This isn't a discussion 
about theory or about the nuances of a policy. This is about real 
people and what has happened to them under our existing system. I wish 
to put up the first chart. This chart depicts one family, the Ritter 
family in Manheim, PA. I spoke with them several days ago and I spoke 
with these two young girls. One daughter's name is Hannah--one twin, I 
should say, is Hannah and her sister--after I spoke on the floor I 
called their mom to talk about what I had said on the floor and I said 
to her, I think I referred to one of your daughters as Madeline, and 
that is incorrect, it is Madeline. So I want Madeline to know I 
correctly pronounced her name my second time around. Part of that is 
because of a story I read to my daughters when they were kids all the 
time. But there was a story about Madeline, and a lot of parents know 
that story. So I apologize to Stacie Ritter.
  But here is the story that Stacie Ritter has told me through this 
communication, but has told a lot of other people, and now we try to 
tell her story on the Senate floor to give meaning to what we are 
talking about here. But this isn't some public policy discussion about 
health care; this is about what happens to real families when we don't 
get the policy right, when we talk and talk year after year, decade 
after decade, and talk about good intentions, but never get it done, 
never get a bill passed. This is what happens to people.
  Stacie Ritter had to declare bankruptcy after her twins were 
diagnosed with leukemia at the age of 4. My wife Teresa and I have four 
daughters, and thank goodness they are all healthy. Two of them are in 
college, one is in high school, and one is in seventh grade. We have 
never had to face that kind of diagnosis, thank goodness. Thank God I 
have never had to face that, nor has my wife Teresa had to face that as 
a parent. But if we did, we would have been given some protection and 
so would our daughters if we faced that horrific diagnosis, because 
when I was working as a lawyer or when I was a public official, I had 
health care. Sometimes, for a lot of that time period, a decade in 
State government health care, because I was a State employee, I had a 
tremendous health care plan, a kind of public option, a good public 
health care plan. So I never had to worry about that as a parent nor 
did my wife if something horrific were diagnosed.
  These two little girls pictured here--and you can see even though 
because of that diagnosis they are facing the kind of challenge I can't 
even imagine, let alone endure--I hope I could, but I am not sure I 
could if I were in their place. But you can see that even though it is 
obvious they are facing a real challenge with regard to the leukemia, 
they are very hopeful, aren't they, in that picture. They have their 
arms around each other. They have these stethoscopes and they are 
dressed up like two doctors. So even in the midst of the horror of that 
kind of a diagnosis, you have these two brave little girls who are 
looking forward, not just worried about their one situation but looking 
forward with hope and optimism.
  Here is a picture down here taken last year in Washington, DC, then 
at the age of 11. Here is what their mother said:

       Without meaningful health reform my girls will be unable to 
     afford care, that is if they are even eligible for care, that 
     is critically necessary to maintain this chronic condition.
       Punished and rejected because they had the misfortune of 
     developing cancer as a child.

  What is the particular problem here with this case? The obvious 
problem is that these young girls were diagnosed with leukemia. That is 
bad enough. But we have a system that made their life a lot worse than 
the leukemia, because we had a system that said--basically what the 
system said to them is:

[[Page 29794]]

We can help you and maybe cure you, but we are going to put limits on 
it. We are going to say that it is nice to have all of this technology 
and all of this great medical knowledge and great doctors and hospitals 
across America--and we do. We are the envy of the world on some of this 
stuff: the doctors and the nurses and the health care professionals, 
and the hospitals and the technology and the know-how. We are the envy 
of the world. We should acknowledge that. But then we have this 
ridiculous system that says to these two little girls: But the care we 
want to give you and the results we can get from that care are going to 
be limited. So we hope it works out for you.
  That is ridiculous. It is an abomination. I don't understand why we 
have gone year after year and settled for this. Why do we have limits 
on the kind of care people get? Because insurance companies thought 
that was a good idea. I don't know why. I don't know whether it is for 
their bottom line or for whatever reason, but there is no excuse--no 
rationale--for saying to someone: We can cure you, but we are going to 
limit your care.
  You are in real trouble, and we know how to help you. But we are 
going to limit it. Here is what Stacie said about her kids:

       When my identical twins were both diagnosed with [this 
     leukemia] . . . at the age of four, we were told they would 
     need a bone marrow transplant in order to survive. That's 
     when I learned that the insurance company thought my 
     daughters were only worth $1 million each.

  I don't know a parent in America who believes their son or daughter--
in this case, two daughters, her twins--is worth any amount of money or 
their care is worth any amount of money. Why does the insurance company 
do it? We hear they say that is policy, and then they get pressure from 
a TV station or news organization and they give the care.
  If the policy makes sense, why would public pressure change a policy? 
The policy is ridiculous and insulting. It should be changed. It is one 
of those things we have to make illegal, and this bill does that. We 
should make it illegal for an insurance company to do that to children. 
But it doesn't make a lot of sense unless you talk about it in terms of 
a real story.
  Here is what Stacie Ritter said after she talked about the limit--
very flatly, she said two words about whether a $1 million is enough to 
care for two daughters with leukemia over many years:

       It's not! When you add up the costs involved in caring for 
     a patient with a life-threatening disease like cancer, $1 
     million barely covers it.

  We have lots of stories like this.

       Fortunately, the hospital social worker recommended we 
     apply for secondary insurance through the State considering 
     the highly probable chance we would hit the cap. And we did 
     hit that cap before the end of treatment.

  The State program sounds a lot like a public option. I may be wrong, 
but it sounds an awful lot like that.

       Thankfully, the State program kicked in and helped pay for 
     the remainder of treatment.

  So that part of the story worked itself out. It didn't work itself 
out because the insurance company said: We have a way to help you, and 
we are going to do it and figure out the cost in another way. No, the 
insurance company didn't help them. It was the State program in this 
case--the kind of public option that helped these kids. That part of 
the story has somewhat of a positive outcome. These kids are only 11. 
When they were 4 and 5, they didn't have that kind of an option.
  This story gets worse. This is what Stacie says:

       During this time, my husband had to take family medical 
     leave so we could take turns caring for our one-year-old son 
     and our twins at the hospital. . . .
       For the 7 months my husband was out on family medical 
     leave, he was able to maintain his employer-based insurance 
     for us via a $717.18 a month COBRA payment.

  Let me get this straight. We are now talking about COBRA--the 
extension of insurance coverage for people who are hurting, laid off or 
unemployed. That is another government initiative enacted by Congress. 
I am sure there were some folks who thought let's not use government to 
extend health insurance. But in this case, it was helpful to this 
family. But it wasn't enough.
  Here is what Stacie says, as she keeps going:

       After spending all our savings to pay the mortgage and 
     other basic living expenses, we had to rely on credit cards.

  We have a health care system that forced Stacie Ritter, and lots of 
other families in America, to rely upon credit cards so they could get 
the health care for their daughters who have leukemia and make ends 
meet so they could pay the mortgage and all the other things they had 
to pay for for themselves and their daughters and their son. That is 
what this health care system has forced them to do.
  This isn't unambiguous. This is exactly the result of the worse part 
of our health care system. This last sentence might be the most 
poignant. She mentions they filed bankruptcy:

       And when you file bankruptcy, everything must be disclosed. 
     We even had to hand over the kids' savings accounts that 
     their great grandparents had given them when they were born.

  That is another problem with this messed up system we have. It forced 
this family not only to worry about whether their daughters were going 
to be taken care of with leukemia, it not only said they probably had 
to declare bankruptcy to take care of themselves and get the care they 
needed, but in the course of the bankruptcy proceedings, they had to 
turn over savings accounts.
  I don't care if it was $1 or $1,000 or a much higher amount. I don't 
care what the amount was. We should never allow a system to force two 
little girls with leukemia to turn over their savings accounts that 
their great grandparents started for them. That is how bad the system 
is.
  I will spend lots of time complimenting doctors, hospitals, and 
nurses. We have a lot of good things. We have good technology. OK. I am 
acknowledging all that. But this system is messed up when we have this 
happen to one family. I don't care if it is one family or 1 million, 
but we know there are lots of them out there who face similar 
circumstances.
  Some people might say you are talking about the family and all these 
problems. What does your bill do? It so happens the first provision in 
the bill--go by the table of contents and go to the page--I think page 
16. The first provision of the bill talks about not having limits on 
lifetime coverage. If that were in effect when Stacie Ritter and her 
husband got the diagnosis for their daughters--if that was in effect, 
the following would have happened, and this is irrefutable: No. 1, they 
were upset, and as worried as they were about their daughters, at least 
they would have had the peace of mind to know they didn't have to worry 
about it costing too much to get them care. They would not have had to 
worry about this causing bankruptcy. So at least we would have given 
them some peace of mind and some security. Then on top of that, we 
would have given them the kind of care they needed, including the 
follow-up care.
  When some people say we need to debate a little longer, 3 months or 6 
months more, or let's talk about it for a couple more years--we have 
talked this issue to death for years. We know exactly what is wrong. 
This is what is wrong. That story alone is reason to pass the bill. 
There are a lot of other reasons, a lot of other tragedies that are 
preventable if we do the right thing.
  We have a bill that we are going to pass, and the first provision 
speaks to this family's challenge.
  Let me read one more letter and I will stop. I know I am over my 
time. We have heard a lot of discussion in the last couple of days 
about people whose personal tragedies bring all of us to our senses as 
we get lost in the politics. I received a letter this fall that I think 
sums it up in a way that both Hannah's and Madeline's story does as 
well. This is a letter that I received from a woman in Havertown, PA, 
suburban Philadelphia. She says:

       On September 9, 2009, my sister-in-law's cousin had to take 
     her three-week-old son off of life support. He took two 
     shallow breaths

[[Page 29795]]

     and passed away peacefully. He did not have to die, he did 
     not have to be on life support, he did not even have to be in 
     the [neonatal intensive care unit] NICU.
       At 36 weeks gestation, his mother was told that she had 
     Placenta-previa, but the insurance company and the doctor 
     were at a tug of war on getting it covered.

  This is America. Why should a doctor have to be in any tug of war 
about whether this mother, who is pregnant, will be covered? That 
should not even be a discussion. There should not have to be any 
discussion about that. But that is how messed up our system is.

       At 39 weeks, Brandon's umbilical cord ruptured. His mother 
     Karen was rushed to the hospital and Brandon was taken to 
     Jefferson [hospital] in Philadelphia to undergo brain cooling 
     treatment to return brain activity.
       It was too late. After minimal return of brain activity, it 
     was decided after 3 weeks to remove life support.

  She concludes with this haunting sentence, this haunting reminder of 
how bad a case this is:

       Who saved money here? Was it worth a child's life to save a 
     few dollars? And I am sure 3 weeks of life support costs more 
     than a C-section.

  That is the end of her letter. So anybody who says that we have to 
make a couple little changes on the margins, but we have a great system 
that is not in need of major reform--I need only point to these two 
examples. That is all the information I need.
  Unfortunately, we have thousands--hundreds of thousands of additional 
examples--literally millions of people who are denied coverage because 
of a preexisting condition. Sometimes because a woman has been a victim 
of domestic violence, that has been used as a preexisting condition in 
terms of whether she gets health care. So we have a messed up system.
  When we allow these tragedies to happen day after day, year after 
year, and we have people in Washington saying: We just could not get it 
done, we have to debate a little longer--we have to get a bill passed. 
We are going to do that in the next couple of weeks. We will take 
whatever steps are necessary to get this legislation passed because we 
cannot say to this woman who wrote to me from Havertown, PA, nor can we 
say to these two girls and their parents--we can't walk up to Hannah 
and Madeline and other kids like them in the country and say we tried 
to get that lifetime limit matter done, but it got a little 
contentious.
  We have to get it done, and we will get it done because we are 
summoned by a lot of things. But I think we are summoned by our 
conscience to get this done and make sure we can do everything 
possible--no system is perfect--to prevent these tragedies.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont is recognized.
  Mr. SANDERS. Mr. President, let me begin by thanking Senator Casey 
for his consistent efforts in fighting to make sure that every American 
has good-quality, cost-effective health care. He has been a leader and 
I congratulate him.
  Mr. President, I wish to touch on some of the health care issues that 
are out there and tell you what I think is positive in the bill we are 
dealing with in the Senate and tell you what I think is not so 
positive.
  To begin with, as Senator Casey has aptly described, we have a system 
which, in many ways, is disintegrating. It is an international 
embarrassment that in the United States of America, we remain the only 
Nation in the industrialized world that does not guarantee health care 
to all its people as a right. The result of that is, some 46 million 
Americans today have no health insurance. Even more are underinsured, 
with large copayments and deductibles.
  We have some 60 million Americans today who, because of our very poor 
primary health care outreach network, do not have access to a doctor on 
a regular basis. The result of that is, as incredible as it may sound, 
according to a recent study at Harvard University, some 45,000 people 
die every single year because they do not get to a doctor when they 
should. As a result, by the time they walk into a doctor's office, 
their illness may be terminal. In addition to that, God only knows how 
many people end up in a hospital, at great expense to the system, 
because they did not get care when they should have.
  Meanwhile, as Senator Casey indicated, bankruptcy is an enormous 
problem because of our health care system. Close to 1 million Americans 
this year will be going bankrupt because of medically related bills. 
Furthermore, when we talk about economic growth in America, all of us 
understand that small businesses, medium-sized businesses are plowing 
an enormous amount of money into health care for their workers rather 
than reinvesting that money and expanding their operations and creating 
the kind of jobs we need as a nation in the midst of our very deep 
recession.
  We have a major problem. At the end of the day, despite so many 
people uninsured, underinsured, so many people dying because they do 
not get health care when they need it, so many people going bankrupt, 
we end up spending almost twice as much per capita on health care as 
any other nation.
  It is clear to me and I think it is clear to the vast majority of the 
American people that we need real health care reform. What real health 
care reform must be about is at least two things. No. 1, providing 
coverage to all Americans as a right of citizenship and, No. 2, doing 
that in the most cost-effective way we possibly can.
  To my mind, quite frankly, there is only one way that I know of that 
we can provide universal, cost-effective, and comprehensive health care 
for all our people, and that is a Medicare-for-all, single-payer 
system. Very briefly, the reason for that is we are wasting about $400 
billion every single year on administrative costs, on profiteering, on 
advertising, on billing--all in the name of profits for the private 
insurance companies that have thousands and thousands of separate plans 
out there, creating an enormously complicated and burdensome system. 
With each one of their thousands of plans, if you are young and do not 
get sick and are healthy, they have a plan for you. If you are older 
and you get sick, they have another plan for you. There are 1,300 
private insurance companies with thousands and thousands of plans, and 
to administer all of this costs hundreds and hundreds of billions of 
dollars.
  That is money not going into doctors--we have a huge crisis in 
primary health care physicians--not money going into dentists. Many 
areas, including Vermont, have a serious dental access problem. That is 
money not going to nurses. We have a nursing shortage. This is money 
going into bureaucracy, profiteering, and salaries for the CEOs of 
insurance companies. It is going into inflated prices for prescription 
drugs in this country. As a nation, we pay the highest prices in the 
world for prescription drugs.
  To my mind, as a nation, what we have to finally deal with is that so 
long as we have thousands of separate plans, each designed to make as 
much money as possible, we are not going to get a handle on the cost of 
health care in America.
  In the bill we are now talking about in the Senate, we have to be 
clear that the projections, according to the CBO, are that, everything 
being equal, over a 10-year period, the cost of health care for most 
Americans is going to continue to soar. That is the reality. This is 
bad not only for individuals, not only for businesses, this is bad for 
our international competitive capabilities because we are starting off 
from the position that today we spend much more than any other country. 
Guess what? While this bill does a number of very good things, it is 
not strong on cost containment.
  If we are going to try to improve cost containment--and I wonder how 
much we can do within the context of this particular approach to health 
care without being a Medicare-for-all, single-payer system--at the very 
least, we need a strong public option. We need that for two reasons. 
First of all, there is widespread mistrust of private health insurance 
companies for all the right reasons.
  Most Americans understand that the function of a private health 
insurance company is not to provide health care; the function is to 
make as much money as possible. People do not trust private

[[Page 29796]]

health insurance companies, and they are right in terms of their 
perceptions.
  People are entitled to a choice. If you want to stay with your 
private health insurance company, great, you can do it. But as many 
people as possible in this country should be able to say: You know 
what, I am not comfortable with a private insurance company. I would 
rather have a Medicare-type plan.
  Poll after poll suggests that the American people want that public 
option. That is point No. 1, freedom of choice. People should have that 
choice. If they do not want it, that is fine.
  Point No. 2 may be even more important, if we are going to get a 
handle on exploding health care costs, somebody is going to have to 
rein in the private insurance companies whose only function in life is 
to make as much money as they possibly can. We need a nonprofit, 
government-run public plan to do that. If we do not have that in this 
bill, I am not sure how we are going to get any handle on cost 
containment.
  I will fight to make sure we have as strong a public option as we 
possibly can. As I have said publicly many times, my vote for this 
legislation is not at all certain. I have a lot of problems with this 
bill. We have to have at least, among other things, a strong public 
option.
  Let me tell my colleagues something else I think we have to address 
in this bill. As I mentioned a moment ago, we have a disaster in terms 
of primary health care in America. Some 60 million Americans are 
finding it difficult to get to a doctor on a regular basis, and that is 
dumb in terms of the health and well-being of our people. It is also 
dumb in terms of trying to control health care costs.
  If somebody does not have a doctor they can go to when they get sick, 
where do they end up? They end up in the emergency room, and everybody 
knows the emergency room, by far, is the most expensive form of primary 
health care. Yet millions of people have no other options. They end up 
in an emergency room. If they have a bad cold, Medicaid may pay $500 to 
$600 for their visit to the emergency room. That is totally absurd.
  Furthermore, if you have a primary health care physician, that person 
can work with you on disease prevention--helping you get off cigarette 
smoking or helping you with alcohol, a drug problem, a whole myriad of 
issues in terms of good prevention, good nutrition. That we have a 
disaster in primary health care which is driving people to the ER makes 
no sense at all.
  As I mentioned the other day, there is a provision in this 
legislation in the Senate which authorizes a very significant expansion 
of federally qualified community health centers which, in a nonpartisan 
way, a bipartisan way is widely supported by, I suspect, almost 
everybody in the Senate and in the House as well.
  These community health centers today allow 20 million people to 
access not only good, quality primary health care but dental care, 
which is a huge issue all over this country, mental health counseling, 
a very big issue, and low-cost prescription drugs.
  The problem is, while the community health centers today do an 
excellent job, there are not enough of them. So in this legislation, we 
have greatly expanded community health centers. If we as a Congress are 
talking about bringing 13, 14, 15 million more people into Medicaid, I 
am not quite sure how a struggling Medicaid Program is going to 
accommodate those people, unless we provide the facilities and the 
medical personnel to treat them.
  We need this. We need to expand primary health care. Community health 
centers are the most cost-effective way I know how to do that. There 
are studies that suggest providing that primary care, keeping people 
out of the emergency room, keeping them out of the hospital because 
they have gotten sicker than they should have gotten, we can, in fact, 
pay for these community health centers over a period of years by simply 
saving money.
  In the Senate, we have very good language authorizing an expansion. 
In the House, they have similar language, except in the House they have 
a trust fund which actually pays for this. I am going to do my best to 
make sure we adopt the House language, which pays for, through a trust 
fund, a substantial increase in community health centers and, in 
addition, a very significant expansion of the National Health Service 
Corps, which is a Federal program which provides debt forgiveness and 
scholarships for medical students who are prepared to serve in 
medically underserved areas in primary health care.
  We desperately need more primary health care physicians, nurses, 
dentists. That is what the National Health Service Corps does. My hope 
is the Senate will adopt the House provision to greatly expand the 
National Health Service Corps and the Health Service programs. That is 
an issue that is very important to me.
  Let me touch on another issue, which is clearly going to be 
contentious; that is, at the end of the day, we are going to be 
spending on health care somewhere around $800 billion to $1 trillion. 
The American people want to know a couple of things. They want to know: 
Is this going to raise our national deficit? What CBO tells us is, no, 
it will not. More money is going to come in than goes out. There will 
be savings incorporated in the legislation, and that is a good thing. 
We have a $12 trillion national debt, and we do not want to add to 
that.
  But people are also asking how are you going to raise the money? How 
are you going to pay for this? Where does the $800 billion to $1 
trillion come from? Here is where we have a bit of differences of 
opinion.
  In the House, I think they have, once again, done the right thing. 
What the House has done is raise $460 billion, with a surcharge on the 
top three-tenths of 1 percent of taxpayers. These are the wealthiest 
people in this country. What the House has said, quite appropriately, 
is that at a time when the gap between the rich and everybody else is 
growing wider and at a time when the top 1 percent earn more income 
than the bottom 50 percent, it is appropriate, especially after all of 
President Bush's tax breaks, to ask the wealthy to start paying their 
fair share of taxes so we can provide health insurance to tens of 
millions of Americans. That, in my view, is exactly the right way to 
go.
  Unfortunately, in the Senate, we have not done that. What we have 
chosen to do in the Senate is to raise about--I do not know the exact 
number--but we have chosen to impose an excise tax of 40 percent on so-
called Cadillac plans. The problem is, given the substantial increase 
in health care costs in this country, a Cadillac plan today in 5 or 10 
years may be a junk car plan.
  I believe with a struggling middle class, with people desperately 
trying to hold onto their standard of living, the last thing the Senate 
wants to do is impose a tax on millions and millions of working people 
who have fought hard to get a halfway decent health care plan.
  Let me very briefly read from a fact sheet that came from the 
Communications Workers of America. CWA is one of the largest unions in 
this country. Similar to almost every union, they are strongly opposed 
to this excise tax on health care benefits. This is what they say. I 
read right from it. This is a document from the CWA:

       The U.S. Senate will soon vote on legislation that would 
     tax CWA-negotiated employer health plans. The tax will be 
     passed directly onto working families. To avoid the tax, 
     employers will try to significantly cut benefits for active 
     workers and pre-Medicare retirees.
       How the House Benefits Tax Works.
       A 40-percent excise tax would be assessed on the value of 
     health care plans exceeding $23,000 for a family and $8,500 
     for an individual starting in 2013. (Levels are higher for 
     pre-Medicare retiree plans and high-risk industry plans--
     $26,000 and $9,850.)

  And here is an important point. Because while people may not have to 
pay this tax in a couple of years, with health care costs soaring, they 
will have to pay this tax in the reasonably near future.
  Quoting from the CWA document:

       These ``thresholds'' would increase at the rate of general 
     inflation, plus 1 percentage point, or 3 percent. This is 
     well below the medical inflation rate (4 percent) and about 
     half the rate (6 percent) at which employer and union plan 
     costs have been increasing.


[[Page 29797]]


  In other words, the cost of health care is rising a lot faster than 
inflation, which today is almost zero. It may actually be below zero, 
the point being that in a number of years, so-called Cadillac plans are 
going to reach the threshold upon which middle-class workers are going 
to be forced to pay a lot in taxes.
  Let me go back to the CWA now. They write:

       Health Benefits Tax Will Hit CWA--

  And they are talking about many union workers here.

     --CWA-negotiated Plans Hard and Result in Deep Cuts. In 40 of 
     43 states examined over 10 years (2013-2022) the average 
     excise taxes assessed on each worker in CWA's most popular 
     plans will be: $13,300 per active worker in the family plan.

  That is for a 10-year period, $13,300.

       $5,800 per active single worker, $13,600 for pre-Medicare 
     retiree in the family plan, and $4,400 for pre-Medicare 
     retiree in the single plan.

  The bottom line is that the middle class in this country is 
struggling. We are in the midst of the most severe recession since the 
Great Depression of the 1930s. People are working longer hours for 
lower wages. The middle class is on the verge of collapse. The Senate 
should not be imposing an additional tax on middle-class workers. The 
House got it right; the Senate got it wrong, and I intend to offer an 
amendment to take out this tax and replace it with a progressive tax 
similar to what exists in the House.
  Let me conclude by simply saying this: I understand that the 
leadership wants to move this bill forward as quickly as possible. I 
understand that. But in my view, we have a lot of work in front of us 
to improve this plan. Among many other things--many other things--and I 
know other Members have different ideas--at the very least, States in 
this country--individual States--if they so choose, should be able to 
develop a single-payer plan for their States. Because at the end of the 
day, in my view, the only way we are going to provide comprehensive, 
cost-effective, universal care is through a single payer.
  I know some people are saying: Well, we are dealing with health care, 
we are not going to be back for a long time. If this bill were passed 
tomorrow, trust me, we would be back in a few years, because health 
care costs are going to continue to soar. Winston Churchill once said: 
``The American people always do the right thing when they have no other 
option.'' And I think that is what we are looking at right now. We are 
running out of options.
  What we have put together is an enormously complicated patchwork 
piece of legislation. It is going to help a lot of people. It involves 
insurance reform, which is absolutely right. We have a lot of money 
into disease prevention, which we should have. There are a lot of very 
good things in this bill. But it is not going to solve, in my view, the 
health care crisis. Costs are going to soar. If we don't have the 
courage as a body to take on the insurance companies, to take on the 
drug companies, at the very least let us give States--whether it is 
Vermont, Pennsylvania, California, or other States--the right to become 
a model for America; to provide health care to all people in a cost-
effective way through a Medicare-for-all, single-payer system. We have 
to do that.
  The other thing we have to do, in my view, is to get rid of this tax 
on the middle class by taxing health care benefits. Mr. President, you 
will recall that a year ago we were in a highly controversial and 
difficult Presidential campaign. One candidate, who happened to have 
lost that election--a Member of the Senate, Senator McCain--came up 
with a plan that was exactly--or very close to it--to what we are 
talking about today. Then-Senator Barack Obama, who won that election, 
came up with a different plan, because he said that wasn't a good idea. 
Well, how do you think millions of American workers are going to feel 
when they say: Wait a second, the guy who won told me he was against 
taxing health care plans, and now we are adopting the program of the 
guy who lost. How do the American people who voted in that election 
have faith in their elected officials if we do exactly what we said we 
would not do?
  So I believe we have to move toward a progressive way of funding this 
health care plan. As I stand here right now, this plan has a lot of 
good stuff in it, but there are a lot of problems in it. I very much 
look forward to the opportunity to be able to offer a number of 
amendments to strengthen this bill. It is very important to the people 
of Vermont and to people all over this country that not only I but the 
Presiding Officer and other Members have a right to offer amendments. 
Because if this bill gets whizzed right through, and is not as strong 
as it possibly can be, I think we will not have done the job we need to 
do.
  Mr. President, with that, I yield the floor.
  Mr. KOHL. Mr. President, as chairman of the Special Committee on 
Aging, the plight of vulnerable seniors is a subject of great concern 
to me. The committee is charged with uncovering problems that endanger 
the health and welfare of older adults and developing policy to prevent 
seniors from becoming victims of fraudulent scams and abuse.
  During this Congress, I have been fortunate to be joined by my 
colleagues, Senators Lincoln and Hatch and Stabenow, in advancing 
policy to reduce elder abuse. The Senate health care reform bill now 
includes both the Elder Justice Act and the Patient Safety and Abuse 
Prevention Act, and we will do our utmost to see that they become law.
  Today I am pleased to continue the effort to protect America's 
vulnerable seniors by introducing an amendment that combines two very 
valuable bills, the Elder Abuse Victims Act and the National Silver 
Alert Act. Both have been passed by the House of Representatives.
  Elder abuse is a sad scourge on our society, often hidden from sight 
by the victis themselves. Even so, experts conservatively estimate that 
as many as 2 million Americans age 65 and older have been injured, 
exploited or otherwise mistreated by someone on whom they depend for 
care or protection.
  As Federal policymakers, it is time that we step forward and tackle 
this chaenge with dedicated efforts and more vigorous programs that 
will make fighting elder abuse as high a priority as ongoing efforts to 
counter child abuse.
  It is in this spirit that I am offering an amendment to give the 
Department of Justice a roadmap for how to establish programs to 
bolster the frontline responses of state and local prosecutors, aid 
victims, and build a robust infrastructure for identifying and 
addressing elder abuse far more effectively than we do today.
  We need to provide assistance to our courts, which would benefit from 
having access to designated staff that boast particular expertise in 
elder abuse. Specialized protocols may be required where victims are 
unable to testify on their own behalf, due to cognitive impairments or 
poor physical health. And there is a great need for specialized 
knowledge to support successful prosecutions and enhance the 
development of case law. Today, many state elder abuse statutes lack 
adequate provisions to encourage wide reporting of abuse and 
exploitation, more thorough investigations and greater prosecution of 
abuse cases.
  For the victims of elder abuse, many of whom are physically frail and 
very frightened, we must do much more. First and foremost, we must be 
more responsive. Not too long ago, it was difficult to even get an 
abuse case investigated. While that is starting to change, we have much 
work ahead. For example, sometimes emergency interventions are 
necessary, particularly if the older person is being harmed at the 
hands of family members or trusted ``friends.'' It may be necessary to 
remove the older adult from his or her home to a temporary safe haven. 
To do this, we must build a much more robust system of support.
  And there is more we must do to assist vulnerable seniors who may not 
be abused, but who are nonetheless vulnerable because they suffer from 
cognitive impairment. As the prevalence of dementia rises in our aging 
society,

[[Page 29798]]

we have a special responsibility to ensure that those who ``go 
missing'' from home are returned promptly and safely. This is the 
purpose of the second part of the amendment, which proposes to create a 
national program to coordinate State Silver Alert systems.
  The Amber Alert system, on which the Silver Alert Act is modeled, was 
created as a Federal program to rapidly filter reported information on 
missing children and transmit relevant details to law enforcement 
authorities and the public as quickly as possible. Using the same 
infrastructure as Amber Alerts, 11 States have already responded to the 
problem of missing seniors by establishing Silver Alert systems at very 
little additional cost. These programs have created public notification 
systems triggered by the report of a missing senior. Postings on 
highways, radio, television, and other forms of media broadcast 
information about the missing senior to assist in locating and 
returning the senior safely home. Now we have an opportunity to finish 
the job and create Silver Alert programs across the country.
  Both of the provisions in this amendment are strongly supported by 
the Elder Justice Coalition. I ask my colleagues to support this 
amendment, and by doing so to markedly reduce the risk of harm to our 
most vulnerable citizens.
  Mr. SANDERS. Mr. President, it appears I am going to be closing 
tonight.
  The PRESIDING OFFICER. The Senator from Vermont is recognized.

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