[Congressional Record (Bound Edition), Volume 155 (2009), Part 23]
[Senate]
[Pages 30867-30909]
[From the U.S. Government Publishing Office, www.gpo.gov]




             SERVICEMEMBERS HOME OWNERSHIP TAX ACT OF 2009

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of H.R. 3590, which the clerk will 
report.
  The bill clerk read as follows:

       A bill (H.R. 3590) to amend the Internal Revenue Code of 
     1986 to modify the first-time homebuyers credit in the case 
     of members of the Armed Forces and certain other Federal 
     employees, and for other purposes.

  Pending:

       Reid amendment No. 2786, in the nature of a substitute.
       Dorgan amendment No. 2793 (to amendment No. 2786), to 
     provide for the importation of prescription drugs.
       Crapo motion to commit the bill to the Committee on Finance 
     with instructions.

  The ACTING PRESIDENT pro tempore. Under the previous order, the time 
until 11 a.m. shall be equally divided and controlled by the two 
leaders or their designees.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, for the benefit of all Senators, let me 
lay out today's program. It has been 3 weeks since the majority leader 
moved to proceed to the health care reform bill. This is the 11th day 
of debate. The Senate has considered 18 amendments or motions. It has 
conducted 14 rollcall votes. Today, the Senate will continue debating 
the amendment by the Senator from North Dakota on prescription drug 
reimportation, we will continue debating the motion by the Senator from 
Idaho on taxes, and we will continue debate on the bill. Under the 
previous order, the time until 1 p.m. today will be for debate only, 
with the time equally divided and controlled between the two leaders or 
their designees. Beginning at 11 o'clock, Republicans will control the 
first half hour, and the majority will control the second half hour. We 
will continue discussions to try to find a way forward.
  The ACTING PRESIDENT pro tempore. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I appreciate the statistics the Senator from 
Montana cited about how long we have been debating this and how many 
amendments we have done. That is how few amendments we have done, 
actually. The majority is now filibustering their own bill. I have no 
idea why that is happening. We have been calling for votes on both of 
these amendments that have been proposed so far and haven't been able 
to get the votes. I don't understand how they can talk about how many 
amendments are being done.
  I also have to voice some other frustration. I don't know how many 
times

[[Page 30868]]

I have heard the exact same speech by the Senator from Illinois, Mr. 
Durbin, on this floor talking about the amount of hours that have been 
spent together working on these bills in the HELP Committee and the 
Gang of 6 in the Finance Committee. It isn't about how many hours we 
spend together. It isn't about how many hours we spend on the floor. It 
is whether we are accepting ideas. I understand the other party won the 
last election, but somehow they will have to get over this attitude 
that they won the election, they get to write the bill, they don't have 
to take any ideas from anybody else.
  In the HELP Committee, I keep pointing out that most of the things we 
turned in were kind of punctuation corrections and spelling 
corrections. Any ideas we actually had that appeared to be accepted to 
be in the bill were ripped out of the bill before it was actually 
formally printed, without talking to us. What kind of bipartisan deal 
is that?
  Another thing with the HELP Committee, we have only had 10 days of 
debate on this. We did more than that in the HELP Committee when we 
were marking up the bill.
  But we are having, in the words of Yogi Berra, deja vu all over 
again. When we were having that markup, the majority withheld a 
significant part of the bill, a big part of the bill. It was the 
government-run option part of the bill. They wouldn't give us the 
wording on that. I think they were still writing it. Maybe that is what 
is happening right now too. But we couldn't get the text we were going 
to write amendments on so that we could deal with the bill. I think 
America noticed that in August. People said: How come everybody isn't 
reading the bill? You can't read what you don't have.
  The point I am making is, right now the newspapers are full of 
information--well, speculation; it has to be speculation--about what 
this new Medicare expansion does. I haven't run into anybody who has 
seen the text of that. I have asked some of the media, and they didn't 
see the text. They got a briefing. We haven't even had a briefing. The 
majority side has had a briefing, but our folks who have talked to 
those folks said: Wow, that was pretty general. How could you make up 
your mind on whether you are going to support it based on the little 
bit of information you received? That is not the way to run any kind of 
an organization, especially if you want bipartisan votes.
  You can't write the bill in secret, which is what was done with this 
bill. There wasn't a Republican involved in the behind-the-door stuff 
Leader Reid did to put together the bill we have now. That is not 
bipartisan. There hasn't been a single person from the Republican side 
briefed on this new proposal that is going to save the world.
  Actually, I noticed that the American Medical Association suddenly 
left the bill and said: This will be the worst thing that could happen 
to us. The hospital associations, which have been strong supporters of 
the bill, have also said this won't work, particularly the Mayo Clinic, 
which we have been holding up as one of the prime examples of the way 
to do health care, saying: If this Medicare expansion happens, it will 
cost us millions. We won't be able to provide the kind of care we have 
been providing.
  What is the deal around here? When are we going to actually get to 
see something? When is the majority actually going to share with us 
this marvelous idea they have had? What kind of a way to run a business 
is that?
  Are we going to recess for the weekend? I don't want to recess for 
the weekend. I am conscious of the 11 days we have been debating, and 
we have only covered 14 amendments. We have a lot of important 
amendments that either will be a part of the bill or will help the 
people in this country to understand what is being thrust on them. 
There has never been a bill of such importance as this one from the 
standpoint of how many people it affects. We are talking about 
reforming health care in America. That is everybody. That is every 
single individual, every single provider. Every single business will be 
affected by this bill.
  We talk about 2,074 pages, which seems like a lot. It would be for a 
normal bill that you could debate in a limited period, which is what we 
are being asked to do. But 2,074 pages isn't nearly enough to cover 
health care for America.
  So why is it only 2,074 pages? There are hundreds of references in 
there to how the Secretary of Health and Human Services is going to 
solve all the problems. The things we aren't able to put into detail in 
there we just assign to her, and she will magically be able to solve 
the problems for American health care. After all, it is her Department. 
But that is not going to happen. You can't give that many assignments 
to any agency, any department, any group of people and expect them, in 
a reasonable amount of time, to come up with solutions, solutions that 
ought to be decided on by this body, the elected officials--not 
appointed officials but elected officials. That is not going to happen 
with this bill.
  The only way that could happen is if we took significant parts of it 
and put it up one piece at a time and solved it. That is what seniors 
are asking for. They are asking for us to take the Medicare part and 
give them some assurance that when we are through, it will work. We are 
not even getting to see a significant part of it. We have been pointing 
out how taking $464 billion out of Medicare will break it, will ruin 
it. You just can't steal $464 billion out of Medicare and have it come 
out good. The majority recognizes that. That is why they put in the 
special commission that is going to come to us each and every year and 
suggest the kinds of cuts we ought to make to keep that solvent.
  The biggest thing we ought to do is take these cuts that are provided 
and make them actually apply only to Medicare. But how are you going to 
fund the expansion of Medicare now down to age 55? How do you do that? 
I guess you charge a premium to those people. That is kind of the rumor 
that is out there. How big of a premium? How big of a premium are you 
going to thrust on those people? I suspect it is going to be the older 
and the sicker people in that 55- to 64-age category who are going to 
want to shift over to Medicare.
  If it is a higher premium so the system stays solvent--having nothing 
to do, of course, with age, because we cannot do that under the bill, 
or sickness, because we cannot do that under the bill--and those are 
good ideas--but those better be up in that range of the high-risk pools 
that the States already have.
  People come to me and say: You have to do something about health care 
because we cannot afford that high-risk pool; it is too expensive. 
Well, how much more are we going to expect the young people to pitch in 
in their paycheck? That is where the Medicare money comes from right 
now. They deduct a portion of the paycheck from every single working 
American, and that goes into Medicare, and gets paid out right away to 
Medicare recipients, none of whom or hardly any of whom are the ones 
paying into the system. They are hoping that system is going to be 
there when they get older.
  What I am asking for is for the majority to show us the paper and 
give us a reasonable time to look at it and give America a reasonable 
time to look at it. I do not think it is unreasonable for that to be on 
the Internet. That is a significant part of the bill. That would be a 
significant bill all by itself. It was held from our view when the HELP 
Committee did it. Incidentally, that HELP Committee bill--that was put 
together in 2 weeks without our help and put on us--parts of it were 
withheld, as this has been withheld, until the last minute and then 
thrust in.
  That is what created this enormous outrage across America of: Did you 
read the bill? How can you read the bill if you have not seen anything 
in it, if it has not been given to you? I do not think it is intended 
to be given to us until we have to shuffle this thing through at the 
end.
  The anticipation was to get this done by Christmastime, and the 
majority side keeps talking about getting this done by Christmastime. 
Will we have time to read it before Christmastime?

[[Page 30869]]

Will we have a chance to do any amendments on it before Christmastime? 
I am willing to stay around and work through the weekend and keep doing 
amendments, but I would like to see this marvelous idea that is going 
to solve the whole problem. If it was that marvelous and that good of 
an idea, I think it would be shared already.
  Mr. President, I yield the floor and reserve the remainder of our 
time.
  The ACTING PRESIDENT pro tempore. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I suggest the absence of a quorum and I 
ask unanimous consent that the time be equally charged against both 
sides.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. BAUCUS. Mr. President, commenting on the budget process in the 
1980s, former CBO Director Rudy Penner said:

       The process is not the problem; the problem is the problem.

  The chairman and ranking member of the Budget Committee have proposed 
another new budget process. No one has shown greater zeal in taking on 
the budget deficit than the chairman and ranking Republican Member of 
the Budget Committee. I commend their good intentions. They work hard. 
But we should reject this process. Instead, we should solve the 
problem.
  In their press release yesterday, Senators Conrad and Gregg said that 
``Everything needs to be on the table, including spending and 
revenues.'' That is a quote: ``Everything needs to be on the table, 
including spending and revenues.'' But why stop there?
  If Congress is going to outsource its core fiscal responsibilities, 
why stop with those responsibilities? Why not cede to this Commission 
all of the legislation in the next Congress? Why don't we outsource the 
entire year's work and then adjourn for the year?
  Come to think of it, if we do cede all of our powers to this 
Commission, what is to stop them from inserting any and all business 
for the next Congress into the Commission's one, nonamendable, omnibus 
vehicle? No restrictions. They could put anything they want into it.
  There is the rub. For if the Commission were merely a farce, then we 
could be satisfied with ridiculing it. But this Commission and its new 
fast-track process are truly dangerous. If we were to cede all of our 
responsibilities to this Commission, and we were to tie our hands so we 
could not amend its recommendations, then we would risk setting in 
motion some truly terrible policy.
  Under the proposed fast-track procedures, we would not be able to 
amend the proposal. What if we did not like the Commission's 
recommendations? We would not be able to replace the Commission's 
recommendations with our own.
  It is clear from their press release that Senators Conrad and Gregg 
have painted a big red target on Social Security and Medicare. That is 
what this Commission is all about. It is a big roll of the dice for 
Social Security and Medicare.
  Advocates of the task force say the regular order is not working. 
They say we need a new process to address our long-term fiscal 
challenges. But they are wrong. The regular order is working. We are 
enacting health care reform. And serious people know that controlling 
the costs of health care is the central path to addressing our long-
term budget challenges.
  The lion's share of the reason why deficits are projected to grow so 
much in the long run is the enormous increase in the costs of health 
care. We are doing something about it. We are doing it the right way. 
We held open hearings. We legislated in committee. We are voting on 
amendments. We are legislating. We are doing what our people back home 
sent us here to do.
  The Congressional Budget Office says that health care reform will cut 
the deficit $130 billion in the first 10 years and $650 billion in the 
second 10 years. That is nearly $800 billion in CBO-certified deficit 
reduction in health care alone. And next year we will legislate 
fundamental tax reform.
  But some appear to want to throw in the towel. Some want to punt our 
responsibilities away. I can see that a commission may be attractive to 
some. After all, it is an easy way out. It takes away our 
accountability for what we do. Senators can blame it all on the 
Commission. Senators could say: The Commission made me do it.
  But this is no time to abdicate responsibility. This new Commission 
and this Congress are less than a year old. We should not shirk our 
responsibility. Rather, we should do the job our constituents sent us 
here to do.
  Luckily, we already have a process to address the budget. It is 
called the congressional budget process. Here is a novel idea: Why 
don't we use the budget process to address the budget deficit? If the 
chairman and ranking Republican Member of the Budget Committee are in 
such broad agreement on their goals, why don't they skip the Commission 
and go straight to their recommendation? That is exactly why Congress 
created the budget resolution and the reconciliation bill in the first 
place.
  We do not need a new commission to do our work. We do not need a new 
process to solve the problem. To solve the problem, we just need to 
solve the problem.
  I urge my colleagues to reject this Commission idea. Let's get back 
to solving the problem. Let's get back to enacting real health care 
reform.
  The ACTING PRESIDENT pro tempore. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I am fascinated by the speech we heard. 
There has been a bipartisan proposal. The chairman of the Budget 
Committee and the ranking member of the Budget Committee have proposed 
a commission, and that bipartisan deal is being chastised here. So we 
are on the bill, where 64 percent of the amendments that have been 
filed so far were filed by the Democrats, and I keep wondering why they 
are filibustering their own bill.
  Then when something bipartisan does come up, they are opposed to that 
too. I know they think the only good ideas come from the other side of 
the aisle, and I do get frustrated with that.
  Mr. BAUCUS. Mr. President, will the Senator yield on that one point? 
Just on that one point, will my good friend from Wyoming yield, on our 
time?
  Mr. ENZI. Certainly.
  Mr. BAUCUS. The question is this: Doesn't the Senator agree--it is 
kind of a hard question to ask--that this Senator spent an inordinate 
amount of time in the last year trying to get a bipartisan solution to 
health care reform; that is, in our committee, in the Finance 
Committee, having an open process, fully consulting on both sides of 
the aisle? Then we had that other group called the Group of 6, of which 
the Senator is a part. I think we had 130--I have forgotten how many 
days and meetings we had, how many hours we met.
  But isn't it true that at least this Senator tried as hard as he 
could to get a bipartisan solution?
  Mr. ENZI. I cannot fault the Senator from Montana for his efforts to 
get a bipartisan solution. As I have said many times, I am sorry he had 
to be cut off by phony time deadlines that kept us from reaching that 
kind of a solution, and then winding up with things that are in this 
bill we are talking about that were not a part of our discussions--
again, the things that were proposed by people on this side of the 
aisle that are not in that bill.
  There were some possibilities for solutions. But we wound up with 
that same situation of: We won the election, we get to write the bill, 
and it has to be done quickly. So I am disappointed in the whole 
process.
  Mr. GREGG. Will the Senator yield for a question on that point?
  Mr. ENZI. I will.
  The ACTING PRESIDENT pro tempore. The Senator from New Hampshire.
  Mr. GREGG. I certainly respect that the Senator from Montana worked 
very

[[Page 30870]]

hard to have a bipartisan initiative here, but this bill we are dealing 
with has no bipartisanship to it at all. Was this not written in camera 
behind closed doors for 8 weeks by the majority leader? Was there a 
Republican in that room at any time? And we have now been on it for 
what, 8 days or something, while they wrote it for 8 weeks. And 
furthermore, is there not rumored to be floating around this Congress 
somewhere, in some room, again--that we have not been invited to--a 
major rewrite of this bill called the managers' amendment, which 
supposedly is going to expand coverage to people under Medicare to 55 
years of age, with Medicare already being bankrupt, and already cannot 
afford the people they have on Medicare? It is going to expand it. We 
have not seen it. Yet this is going to change this bill fundamentally 
and change health care fundamentally.
  Is that bipartisan? I ask the Senator from Wyoming if that is the 
case? Was this bill written in a bipartisan manner? Were any 
Republicans in the room? Did it go through a committee process? Was it 
amended? Did it not take 8 weeks to write it, and it has now been on 
the floor for 8 days, and all of our amendments are being pushed to the 
side? And are we not hearing about a massive--a massive--rewrite of 
this bill that is going to appear deus ex machina from the majority 
leader's office and fundamentally change the way health care is 
delivered in this country? Is that going to be bipartisan?
  Mr. ENZI. The Senator is absolutely right. We have not even seen this 
new piece. Nobody wants to show us the new piece. They keep talking 
about it. They have leaked it to the newspapers, but they will not show 
it to us, and then they keep talking about how this bill is going to 
solve the deficits for this country; that there is $157 billion or 
something saved in the first 10 years. That is only--only--if you use 
the phoney accounting they are using. It is only if you don't do the 
doc fix. It is only if you don't solve the myriad of other things we 
have brought out.
  We have a bill they keep talking about as being the solution. America 
has figured it out, but the Democrats haven't figured it out.
  I see the leader is on the Senate floor. I yield the floor.


                   Recognition of the Minority Leader

  The ACTING PRESIDENT pro tempore. The Republican leader is 
recognized.
  Mr. McCONNELL. Mr. President, I apologize to my colleagues for 
interrupting their conversation. Hopefully, it can continue upon 
completion of my remarks, and I may well wish to join in.


                           Health Care Reform

  Mr. McCONNELL. Mr. President, the American people have seen what 
Democrats in Congress plan to do with seniors' health care. They have 
looked on in disbelief as almost every Democrat in the Senate voted 
again and again and again to slash Medicare. Now they are watching in 
disbelief as Democrats float the idea of herding millions more--
millions more--into this nearly bankrupt program as part of a backroom 
deal to force their plan for health care on the American people by 
Christmas.
  Every day it seems we hear new revelations about secret conference 
room deliberations where Democrats are frantically working to get their 
60 votes by Christmas. And every day we hear about some new idea they 
have come up with for creating a government plan by another name. This 
week's version would have the Office of Personnel Management running 
the program, an idea that was shot down almost as soon as it was 
announced by the former OPM Director who said it couldn't be done.
  This is what she said: ``I flat out think that OPM doesn't have the 
capacity to do this type of role.''
  This is precisely the kind of approach Americans are tired of in 
Washington, and this is precisely the kind of health care plan 
Americans did not want.
  Seniors thought they could expect lower costs. What they are getting 
instead is an assault on their Medicare. Small business owners thought 
they could expect lower costs. What they are getting instead are higher 
taxes, stiff fines, and costly mandates. Working Americans thought they 
would get more efficiency, less fraud, cheaper rates. What they are 
getting instead are new bureaucracies and higher costs.
  Business leaders from across the country enthusiastically support the 
idea of health care reform. They know better than anyone that costs are 
out of control and that something needs to be done. But they have read 
the bill Democrats in Congress have come up with and they are telling 
us this isn't it. This isn't it, they are saying. Not only won't this 
bill solve the problem, they say, it makes the existing problems 
actually worse.
  The Vice President of the U.S. Chamber of Commerce was here 
yesterday. He said there is a desperate need for reform--reform that 
bends the cost curve down. He said, unfortunately, this bill fails the 
test. He says this bill will only lead businesses to lower wages, 
decrease working hours, reduce hiring, and cut jobs. He said it adds to 
the deficit; it adds to the debt. It includes massive new spending 
programs and entitlements and incredibly, as I have noted, it also 
borrows from existing entitlement programs. It borrows from existing 
entitlement programs that are already in trouble.
  Businesses look at this bill and they see $\1/2\ trillion in new 
taxes, as many as 10 million employees at risk of losing coverage, and 
crushing new mandates. This is not reform. This bill doesn't solve our 
problems, it spreads them. That is why seniors don't like this bill. 
That is why job creators don't like this bill. That is why public 
opinion has dramatically shifted against this bill.
  Americans want reform, but this is not the one they asked for. This 
bill is fundamentally flawed and it can't be fixed. There is no way to 
fix this bill.
  Americans want us to stop, they want us to start over, and they want 
us to get it right. Democrats should stop talking at the American 
people and start listening to them.
  Now, Republicans are prepared to provide a platform for the debate as 
long as it takes--as long as it takes. The majority leader said we 
would be working every weekend. We take him at his word. We expect to 
be here this weekend, and we look forward to it. Republicans are 
convinced there is nothing more important we could do than to stop this 
bill and start over with the kind of step-by-step reforms Americans 
really want.
  We have amendments. We want votes. We have been waiting since Tuesday 
to have more votes. We are eager to continue the debate.
  Here is what my good friend, the majority leader, said when we 
started the debate on November 30:

       Debating and voting late at night. It definitely means the 
     next weekends--plural--we'll be working. I have events I'll 
     have to postpone, some I'll have to cancel. There is not an 
     issue more important than finishing this legislation. I know 
     people have things they want to do back in their States, and 
     rightfully so. I know people have fundraisers because they're 
     running for reelection. I know there are other important 
     things people have to do, but nothing could be more important 
     than this, and we notified everybody prior to the break that 
     we would be working weekends.

  We took the majority leader at his word when we started this debate 
on November 30 that we would be working weekends. Actually, it is a 
week later--this past Monday of this week--he said, ``It appears we 
certainly will be here this weekend again.''
  My Members understood we would be here on the weekends. We don't 
think there is anything more important we can do, and we are a little 
bit upset--maybe more than a little bit--that we were not able to vote 
on an amendment yesterday. We have been prepared to vote for several 
days. There are amendments that have been offered that we can't seem to 
get a vote on. The American people are expecting us to vote on this 
bill, and we are here and prepared to do it. We would like to get 
started voting on amendments today.
  Mr. GREGG. Mr. Leader, if I might ask a question through the Chair.
  The PRESIDING OFFICER (Mr. Bennet). The Senator from New Hampshire.

[[Page 30871]]


  Mr. GREGG. On that last point, it does seem there is a slowdown 
occurring on amendments. As I understand it, we have four or five very 
substantive amendments dealing with taxes, dealing with employer 
mandates, that we are ready to go to, and we are ready to vote on; is 
that not correct?
  Mr. McCONNELL. I say to my friend from New Hampshire, that is 
absolutely the case. We waited around all day to get a vote on the 
amendment by the Senator from Idaho, Mr. Crapo. We were told there 
would be a side-by-side, and it mysteriously has not yet appeared. But 
we are here ready to work. We share the view of the majority leader 
that this is an extremely important issue, and we want to vote.
  Mr. GREGG. I hope at some point today maybe we should propound a 
unanimous consent setting those four items up for votes on Saturday and 
Sunday.
  Mr. McCONNELL. Well, I think that is a good idea. Of course, we would 
prefer to vote today. We are going to be voting Saturday and Sunday 
too. I think the sooner the better. The American people are actually 
expecting us--they thought we were here voting and debating amendments 
on this bill, and we are going to continue to press forward and try to 
get that done.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  The Senator from Connecticut is recognized.
  Mr. DODD. Mr. President, could I inquire of the Chair before the 
Senator from North Dakota speaks how much time remains.
  The PRESIDING OFFICER. The majority has 14 minutes, and the 
Republicans have just under 8.
  Mr. GREGG. Mr. President, I would ask, is the Senator from North 
Dakota recognized under an order of a colloquy at this point?
  The PRESIDING OFFICER. The Chair simply recognized the Senator from 
North Dakota.
  Mr. CONRAD. Mr. President, was there a time reserved for a colloquy 
between myself and the Senator from New Hampshire?
  The PRESIDING OFFICER. No.
  Mr. CONRAD. Mr. President, the reason we are here on the floor is our 
understanding was we had time reserved at 10:30 for a colloquy between 
the Senator from New Hampshire and myself.
  Mr. GREGG. Mr. President, I ask unanimous consent that we have 20 
minutes equally divided between myself and the Senator from North 
Dakota at this time. I see the Senator from Connecticut obviously 
wishes to speak also.
  Mr. DODD. Mr. President, I was not a party to the request, but I am 
certainly prepared to yield 10 minutes of our time to our colleagues 
for a colloquy and whatever time the Republican side may want to yield 
to Senator Gregg from their time remaining for that purpose as well. Is 
that satisfactory?
  Mr. GREGG. Do we have time remaining on our side?
  Mr. DODD. Mr. President, I ask unanimous consent that 10 minutes of 
our time be allocated to Senator Conrad for the purpose of a colloquy 
or whatever other purpose he may have.
  Mr. CONRAD. Do the Republicans have 10 minutes remaining for Senator 
Gregg?
  Mr. ENZI. Mr. President, it is my understanding the leader spoke 
under leader time.
  The PRESIDING OFFICER. That is correct.
  Mr. ENZI. So we should have an adequate 10 minutes to allocate to the 
Senator.
  The PRESIDING OFFICER. Without objection, it is so ordered. The 
Senators may engage in a 20-minute colloquy.
  Mr. CONRAD. I thank the Chair. I thank our colleagues. I especially 
thank our colleague, the Senator from Wyoming, and our colleague from 
Connecticut. Thank you for your courtesy. We appreciate it very much.
  Mr. President, this is a headline from Newsweek, December 7. In fact, 
it was the cover story: ``How Great Powers Fall. Steep Debt, Slow 
Growth, High Spending Kill Empires--and America Could Be Next.''
  If you go to the story--by the way, interestingly enough, this was on 
December 7, Pearl Harbor day. If you go into the story that is in the 
magazine, it says:

       This is how empires decline. It begins with a debt 
     explosion. It ends with an inexorable reduction in the 
     resources available for the Army, Navy, and the Air Force. If 
     the United States doesn't come up soon with a credible plan 
     to restore the Federal budget to balance over the next 5 to 
     10 years, the danger is very real that a debt crisis could 
     lead to a major weakening of American power.

  All we have to do is look at the facts. This shows the debt of the 
United States from 2001 projecting to 2019. Obviously, the first half 
of this chart is not a projection. It has already happened. We are 
approaching a debt that is 100 percent of the gross domestic product of 
the United States, the highest the debt has been since after World War 
II and the only time in our Nation's history it has been that high. The 
projection is by 2019 the debt will be high. The projection is by 2019 
the debt will be 114 percent of the gross domestic product of the 
United States.
  More alarming, the long-term outlook of the Congressional Budget 
Office says we will have a debt that will reach 400 percent of the 
gross domestic product of the United States by 2050 on the current 
trend line. No one believes that is a sustainable circumstance. We have 
had testimony from the head of the General Accounting Office, the 
Congressional Budget Office, the Secretary of the Treasury, and the 
Chairman of the Federal Reserve all saying this is a completely 
unsustainable circumstance.
  The Congressional Budget Office said this in June of 2009:

       The difficulty of the choices notwithstanding, CBO's long-
     term budget projections make clear that doing nothing is not 
     an option.

  Doing nothing is not an option.
  The National Journal, in an article entitled ``The Debt Problem is 
Worse Than You Think'' said this in a story just weeks ago:

       Simply put, even alarmists may be underestimating the size 
     of the debt problem, how quickly it will become unbearable, 
     and how poorly prepared our political system is to deal with 
     it.

  I hope people are listening. I hope they are paying attention. I hope 
our colleagues are.
  Yesterday a group of us introduced legislation to confront this debt 
threat head on. There are now 31 cosponsors of that legislation: 19 
Republicans, 12 Democrats. This legislation offers the following: to 
address the unsustainable long-term fiscal imbalance; that a task force 
should be created with everything on the table. It would consist of 18 
Members: 8 Republicans from the Congress, 8 Democrats from the 
Congress, and 2 representatives of the administration.
  All task force members must be currently serving in Congress or the 
administration so they are accountable to the public. If 14 of the 18 
Members could agree on a report, that report would come to Congress for 
a vote.
  There would be no filibustering, a straight up-or-down vote on the 
recommendations. The report would be submitted after the 2010 election 
to insulate it from politics. And, the vote would be designed to occur 
before the end of the 111th Congress. It would receive fast-track 
consideration in the Senate and the House. There would be no 
amendments. It would be a straight up-or-down vote. A supermajority of 
the House and the Senate would have to vote for it, and the President 
would retain his ability to veto.
  This is legislation that is designed to get to the floors of the 
House and the Senate, legislation to deal with our long-term debt 
threat, to face up to it. All of us know that with a problem, the 
sooner you deal with it, the less draconian the solutions need to be. 
For those who say this poses a threat to Social Security and Medicare, 
the opposite is true. A failure to act is what threatens Social 
Security and Medicare.
  The trustees of Medicare have told us Medicare will go broke in 8 
years. They have also told us Medicare is cash negative today. That 
means more money is going out than is coming in. The

[[Page 30872]]

same is true of Social Security today. It is cash negative.
  Now is the time. We are the ones who have an opportunity to help our 
country face up to a critical threat to the economic security of 
America. Some suggest the bill before us on health care is an example 
that the regular order will deal with this problem. Again, I believe 
the reverse is true.
  I believe the health care bill before us does modestly deal with the 
deficit and debt--modestly. But it doesn't come close to dealing with 
the debt bomb I have outlined. In fact, the reality is, we are on a 
course that is absolutely unsustainable. It is our responsibility to 
face up to it.
  In our past, we have chosen special processes, commissions, a summit, 
or some other special process to deal with fiscal challenges because we 
have learned, in our history, that going through the regular process 
and regular order is simply not going to succeed.
  I have been here 23 years. I am on the Finance Committee. I am 
chairman of the Budget Committee. I have been on those committees for 
many years. If there is one thing that is absolutely clear to me, it is 
the regular order cannot and will not face up to a crisis of this 
dimension. It is going to take a special process, a special commitment 
of the Members and representatives of the administration to develop a 
plan that gets us back on track. It is going to take a special process 
to bring that plan to this floor for a vote up or down. That holds, I 
believe, the best prospects for success.
  I believe this is a defining moment for this Chamber, for this 
Congress, for this administration. It is imperative that we find a way 
to deal with this debt threat. It poses one of the most dramatic 
challenges to American economic strength that we have confronted in the 
history of this country. It is time to stand and be counted.
  Thirty-one of us have sent forward a proposal--a bipartisan 
proposal--that would assure a vote on a plan to bring America back from 
the brink. Let's give it a chance.
  I thank the chair, and I especially thank the ranking member, Senator 
Gregg, for his energy, his commitment, and his devotion to facing up 
to, I believe, one of the greatest challenges confronting America.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire is recognized.
  Mr. GREGG. Mr. President, I am privileged to join the Senator from 
South Dakota, the chairman of the Budget Committee, on this initiative. 
We have worked on it for a while, and we have come to a position of 
having a piece of legislation that accomplishes the goal as outlined by 
the Senator from North Dakota. That is good news.
  The outpouring of support in the Senate--over 31 cosponsors in just a 
brief period of time--is a sign that there is a willingness to move in 
a bipartisan way. That is good news.
  Right now, for this country, after the possibility of a terrorist 
getting a weapon of mass destruction and using it against us in the 
United States, the single biggest threat we have as a nation is the 
fact that we are on course toward fiscal insolvency. You cannot get 
around it. If we continue on the present course, this Nation goes 
bankrupt. We are already seeing the early signs of it. The early signs 
are devastating enough. We are seeing some of the nations who lend to 
us--and remember we are a debtor nation now of massive proportions--
saying: Hold on, you folks are not being responsible, especially about 
your outyear debt.
  Two days ago, we saw one of the rating agencies, Moody's, say England 
and the United States now are going to be put into a special category 
relative to the rest of the industrialized world because their fiscal 
situation is in such risk, and they are not managing their fiscal house 
correctly.
  We know, as the Senator from North Dakota has outlined so correctly, 
that within 10 years--maybe sooner--we are going to get to a point 
where our debt has gotten so large we simply cannot pay it or, if we 
have to pay it, we are going to have to do some extraordinary things to 
do that, such as inflating the currency or raising taxes to a level 
where we reduce productivity and the opportunity for jobs. It is akin 
to a dog chasing its tail when you get your debt to a certain level. 
When you have spent so much more than you have taken in and you have 
promised so much more than you can afford to pay and your debt gets to 
such a level, as a nation, you only have two choices: You inflate the 
currency and destroy the quality of people's lives, destroying the 
value of their savings, and you put in an inflation economy, which is 
one of the worst things that can ever happen to a country or you have 
to radically increase your tax burden to levels that are simply going 
to choke off the capacity of the Nation to create prosperity because 
people will not be able to be productive. You will start to lose tax 
revenues as a result of that.
  This is not a theoretical case. This is no longer something that is 
over the horizon. This problem is directly in front of us. We are 
hearing it from the people who lend us money, from the rating agencies, 
and we know it from intuitive common sense. Most Americans know this is 
an extraordinary problem.
  We talked about this for a long time and we worked on it for a long 
time. Yes, regular order should take care of this, but we know it will 
not because we have seen what happens. When you put an idea on the 
table to deal with major entitlement programs that affect so many 
people, in such a personal way, immediately, those ideas are attacked 
and savaged, misrepresented, exploited, exaggerated, and hyperbolized 
by the interest groups that populate this city and other parts of the 
country for the purpose of making their political agenda move forward 
or their money-raising formula move forward.
  When substantive, good ideas have been put on the table to try to 
correct this fiscal imbalance by dealing with questions of Social 
Security and Medicare or tax policy, we get clobbered on the policy 
side. We came to the conclusion from the right and the left that it is 
equally outrageous and equally destructive of constructive public 
policy. We came to the conclusion that the only way you can do this is 
to create a process that drives the policy, rather than put the policy 
on the table first, saying here is the policy and everybody jumps on it 
and kicks it and screams at it and so it never even gets to the 
starting line. We decided let's get to a process that leads to policy 
and leads to an absolute vote.
  The theory is, basically, threefold: One, the process has to be 
absolutely fair and bipartisan. Nobody can feel they are being gamed. 
The American people will not allow major policy to occur in these areas 
unless they are comfortable the policy is bipartisan and fair. So this 
process we have set up is a bipartisan affair. There will be 18 people. 
We decided to go with people who actually have a responsibility for 
making decisions and understand the issues intimately; 16 from the 
Congress, as was mentioned--8 Republicans and 8 Democrats--and the 2 
from the administration, with a supermajority to meet, to report, and 
there will be cochairmen from each party. That gives us the bipartisan 
nature.
  The second part that is critical to the exercise is that it be real 
and that it not end up being a game. We have seen so many commissions 
end up being just commissions. They put their report out and it ends up 
on a shelf somewhere.
  Something has to happen. What happens is, when this Commission 
reports with a supermajority and comes to Congress, by supermajority it 
must be voted up or down. So there is an absolute right to a vote, and 
the vote occurs on the policies proposed. That is critical. It is much 
along the lines of what we did for base closures, for many of the same 
reasons. You couldn't close bases politically, so we did it by fast-
track approval.
  Third, there will be no amendments. Why? Amendments allow Members to 
hide in the corners. It is that simple: Somebody throws an amendment 
up--even if it is well intentioned--and people vote for the amendment 
and then say it didn't pass or I will not vote for

[[Page 30873]]

the final product. You have to have a policy put forward, and it will 
either attract a bipartisan supermajority and be a fair policy or it is 
not. If it doesn't attract a bipartisan supermajority, clearly, it 
wasn't well thought out.
  That is the process we have come to. The amount of sponsors we have 
reflects the fact that it is viable and that it is bipartisan. We have 
12 Democratic sponsors already and 19 Republicans. What else around 
here has that with serious legislation? This is it.
  I congratulate the Senator from North Dakota for his efforts. I am 
hopeful we can get a vote on it. Then, I hope it can pass, and I am 
hopeful we can get White House support and House support to do this.
  We are running out of time. If we don't accomplish this fairly soon, 
the outcome is very simple: We will pass on to our children less 
opportunity, a lower standard of living, and a weaker Nation than we 
received from our parents. No generation in American history has done 
that. But that is what we are going to do if we don't take action. That 
is exactly what is going to happen. How can one generation do that to 
another? In American history, that has never happened. This is an 
opportunity to avoid having that occur or at least help avoid it. I 
hope it will move forward.
  I reserve the remainder of my time.
  The PRESIDING OFFICER. The Senator from North Dakota is recognized.
  Mr. CONRAD. Mr. President, how much time remains of the 20 minutes?
  The PRESIDING OFFICER. Two minutes 40 seconds.
  Mr. CONRAD. How much on my side?
  The PRESIDING OFFICER. The time is equally shared.
  Mr. CONRAD. Let me sum up by saying this: I have been here 23 years. 
We saw the debt double in the previous 8 years. We know the debt is 
scheduled to more than double over the next 8 years if we fail to act. 
That will be a debt, as I indicated earlier, of well over 100 percent 
of the gross domestic product of the United States.
  The Congressional Budget Office tells us, on the current trend line, 
we are headed for a debt that will be 400 percent of the gross domestic 
product of the United States. That is absolutely beyond the pale. We 
know, from every serious expert who advises the Congress of the United 
States, we can't go there. We can't possibly be on a course to have a 
debt that is 400 percent of the gross domestic product of the country.
  The question is, What do we do about it? There are some who say: 
Well, you stick with the status quo approach. It hasn't worked so far. 
Why is there any reason to believe it will work now? I would say the 
health care legislation before us is a perfect example. The President 
had a health care summit; he had a fiscal responsibility summit. At 
those summits, it was asserted--and I think it was well intended--that 
health care reform would deal with a major part of the debt projection 
facing us. Well, here we are. My belief is, this bill does modestly 
reduce the deficit in the short- and long-term. But it in no way deals 
with the trajectory that is headed for a debt of this country of 400 
percent of the GDP, because when you are in this circumstance, the 
regular legislative process cannot face up to short-term pain in 
exchange for long-term gain. It will not do it. This is our 
opportunity. We must act.
  I thank the Chair.
  The PRESIDING OFFICER. The Senator's time has expired.
  Under the previous order, the time until 1 o'clock will be controlled 
in 30-minute alternating blocks, with the majority controlling the 
first block and the Republicans controlling the second 30 minutes.
  The Senator from Connecticut.
  Mr. DODD. Mr. President, before my colleagues from North Dakota and 
New Hampshire leave, let me commend them for their efforts in this 
regard. There may be debates about the details of this legislation.
  One of the first amendments I ever offered, sitting back in the far 
corner, as a freshman Member of this body was a pay-as-you-go budget in 
the Reagan administration. Then I was a cosponsor of Gramm-Rudman-
Hollings back in 1985--that was 24 years ago--which was an effort to 
try to put some restraints on the exploding process at the time.
  While I am not prepared necessarily to sign on this morning, I would 
be remiss if I did not thank them for their efforts. And either 
something like this or a variation of it is needed so there is some 
process in place to allow us to deal with these issues.
  Before they wandered off and we were back on the health care debate, 
I wanted to thank them for their efforts.
  Let me once again address issues that need to be clarified. We have 
disagreements about the health care bill.
  I want the record to reflect the efforts that have been made for over 
a year now to involve our colleagues across the spectrum, beginning 
with my predecessor, Senator Kennedy, who would be otherwise standing 
at this very podium but for his illness and his death. My office and 
his staff worked closely together and I want to share the details of 
those meetings that occurred beginning about a year ago to formulate 
the very bill we are grappling with today. I was not a participant in 
those early meetings. Senator Kennedy was, with his staff and Members 
of the minority staff right after the elections. I began to work in his 
place starting around the first of the year or shortly thereafter.
  There were numerous meetings between Members from across the spectrum 
from the Budget Committee, the Finance Committee, the HELP Committee, 
countless meetings of staff in all three of these committees. Many of 
them occurred in Chairman Baucus's office, the chairman of the Finance 
Committee.
  Battling over the substance of the bill is a very legitimate process. 
There are 100 of us representing various constituencies and various 
ideas. There is nothing inherently wrong about that. In fact, it is a 
healthy process to go through. But I cannot stand here and accept the 
notion that people have been excluded from the process. That is not the 
case at all.
  There are times when the majority, who has the responsibility to pose 
ideas, will meet together to formulate an idea or a series of ideas to 
bring forward. To say this is a historical, unprecedented occurrence 
defies what anyone who has known 5 minutes of the history of this 
institution knows. I recall only a few years ago when the minority 
leader and others were excluded from conference meetings between the 
House and the Senate. If Tom Daschle showed up, the word was, the 
conference committee would be canceled. Imagine, the minority leader, a 
conferee, dealing with the House and Senate, would show up and the 
meeting would be canceled. With all due respect, it is that old line of 
Claude Rains in the famous movie ``Casablanca,'' walking into Rick's 
Cafe, looking around with Humphrey Bogart there and saying: ``Is there 
gambling going on here? Shocking.'' Is politics going on in the Senate? 
Yes, it is. And it has back to 1789, to the founding of the Republic. 
Politics has happened in this institution where people try to formulate 
ideas to bring together on behalf of our constituents across the 
country.
  It needs pointing out, as I will, and I will lay out and provide 
shortly every single amendment offered by the other side--hardly 
technical, so everybody can read them--the provisions in this bill that 
were specifically offered by Members of the minority that were accepted 
either in our committee or in other places and are reflected in the 
substance of this bill.
  Is it their bill? No. Obviously, they have not voted for it. But a 
lot of the substance in it is theirs, and to suggest otherwise is not 
true. The notion that people have been excluded from this process is 
just not the case at all. In fact, going back, if you will, since 
January of 2007 the HELP Committee has held 30 bipartisan hearings on 
health care reform, with 15 alone in 2009. Taken together, the HELP and 
Finance Committees held more than 100 bipartisan meetings. Beginning in 
December 2008, the bipartisan leadership of the HELP Committee, the 
Finance Committee, and the Budget Committee met 10 times to discuss 
health care reform legislation. Staff met even more frequently. Ideas 
discussed in those meetings are reflected in this bill. In 2008,

[[Page 30874]]

the HELP Committee held 15 bipartisan health reform staff roundtables, 
which included Republican and Democratic staff from the HELP, Finance, 
and Budget Committees. Over 80 stakeholders from the pharmaceutical 
industry, the insurance industry, those who advocated single-payer 
approaches--80 stakeholder meetings were held in the health care debate 
from across the political spectrum. Democrats, Republicans, patients, 
providers, employers, unions, insurers, and drug device manufacturers 
contributed recommendations to this bill. They were not all accepted. 
The idea that we would take everyone's idea that comes to the table is 
ludicrous on its face. But certainly the opportunity to affect the 
outcome of this bill was very much an open process.
  In addition, committee staff held regular meetings with smaller 
representative groups. Since April of 2009, these meetings have 
included staff from Senator Enzi's office, Senator Gregg's office, and 
Senator Hatch's office. These meetings included groups from across the 
political spectrum who met for 2-hour sessions twice a week to provide 
detailed and thoughtful contributions to this bill.
  In addition to these stakeholders, hundreds of groups attended larger 
stakeholder meetings on March 13 and May 15 where further 
recommendations on reform were heard.
  On June 10 and 11, prior to beginning of the markup of the HELP 
Committee bill, Members had detailed, bipartisan discussions of the 
draft legislation, including extensive options contributed by our 
Republican colleagues. Options provided by Republican Members were 
reflected in the legislation approved by the committee.
  On June 22, HELP Committee Senators also met with the nonpartisan 
Congressional Budget Office Director Doug Elmendorf and other CBO 
staff.
  The markup in the HELP Committee lasted almost a month--a record for 
that committee, by the way. The committee held 56 hours of executive 
consideration of the legislation, stretching across 23 different 
sessions over 13 days. Taken together with the Finance Committee, more 
than 20 days were devoted to the amendment process alone. During the 
HELP Committee markup--I have mentioned this over and over again--we 
considered 287 amendments, almost 300 amendments, and 161 of those 287 
were accepted Republican amendments.
  I ask unanimous consent to have printed in the Record all of those 
amendments that were accepted and the description of those amendments.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

[[Page 30875]]





[[Page 30876]]



[[Page 30877]]



[[Page 30878]]



[[Page 30879]]



[[Page 30880]]



[[Page 30881]]



[[Page 30882]]



[[Page 30883]]

  Mr. DODD. Mr. President, specific pages in this bill and the language 
of these amendments or a synopsis of the language is included. These 
were not just technical amendments. Let me mention some that were 
included.
  Our colleague from North Carolina, Mr. Burr, offered an amendment 
that subjects the public option to the same laws and requirements as 
private plans. This discussion that they were not involved in the 
public option--here are amendments offered by Republicans accepted in 
the committee dealing with the public option. Did we take all of them? 
Of course not. Of the 287 amendments, 161 of them, as you will now 
read, are reflected in these efforts.
  Follow-on biologics: A bipartisan, Enzi-Hatch-Hagan--Hagan, a 
Democrat, and Hatch and Enzi, Republicans--amendment establishes the 
pathway for biosimilar biological products. This Republican amendment 
is reflected in the bill on page 1859.
  Long-term care: Senator Gregg ensured that the new voluntary program 
to approve long-term care options would remain solvent for 75 years--
the CLASS Act--reflected on page 1931 of the bill.
  Prevention--again, a bipartisan amendment offered by Senator Gregg 
and Senator Harkin that expands and strengthens the incentives 
available for participation in workplace wellness programs, reflected 
in the bill on page 80.
  The Murkowski of Alaska amendment will allow insurance companies to 
offer discounts for those who do not smoke. This is a Republican 
amendment reflected on page 80 of the bill.
  Coverage: Several amendments were offered by Senators Enzi, Coburn, 
Roberts, and others to make certain that nothing in the legislation 
would allow for rationing of care and that no one would be denied care 
based on age, disability, medical dependency, or quality of life. That 
is reflected as well on page 105 of the bill.
  My colleague from Wyoming, the ranking member of the committee, had 
41 amendments that were included in the bill. For instance, in Title I, 
Enzi amendment No. 241 appears on page 185 of the marked-up bill. Line 
22: to ensure that individuals enrolled in the community health service 
option have access to all services. Senator Enzi's amendment is 
included in the bill. He offered amendments on page 272 to prevent 
denial of care based on patient age, disability, medical dependency, 
quality of life, and antirationing proposals; follow-on biologics; 
amendments to protect and ensure that data and prevention programs 
include rural populations. Again, I will provide a list of the 41 
amendments so my colleagues and others can read a synopsis of those 
amendments--hardly punctuation marks in the bill. We may not agree with 
every one. We accepted them. I thought they contributed to the bill, 
made a better bill. I did not decry them; I welcomed them.
  So the suggestion that this somehow has been jammed down the throats 
of people, with secret meetings going on--I don't think people ought to 
engage in that. You can vote against the bill if you want, but don't 
suggest to me this process denied people a chance to be heard, to be 
involved, to be engaged. I went out of way my in the markup of that 
bill to stay for as many hours as people wanted to, for as long as they 
wanted to, to offer as many amendments as they wanted to. Staff worked 
all during the weekends of that process to go through these amendments. 
I remember on one occasion, after work over one weekend, I proposed 
accepting 40 amendments. I offered to accept all 40 of them, and my 
Republican friends objected to a request to accept their amendments in 
the committee.
  So the notion we marked up titles of this bill without adequate 
notice of language is false. Titles of the bill had to be scored by 
CBO. The idea that we would markup our bill without notice of language 
or CBO scores again is false. The markup dates were postponed by me to 
allow more time to read language and to ensure that CBO scores were 
distributed to all Members as well.
  As someone who has been around here a number of years, I know when 
there is a true willingness to have a bipartisan effort and I know when 
there is one that is not going to happen. Senator Kennedy understood 
that as well. I have had numerous bipartisan agreements with my 
colleagues on committees I have served on over the years. It is 
certainly far better when you can achieve that, I don't deny that at 
all, but I will not accept the notion that there has been a refusal to 
accept or willingness to listen to bipartisan ideas as part of this 
bill.
  Again, there is a debate that I know is going on on the other side as 
to whether to have amendments or not have amendments, whether Rush 
Limbaugh is controlling the show, or the Republican leader. Those 
things happen. I understand that. But the fact is, we have a bill here, 
far from perfect--I will be the first to acknowledge it. It is not a 
bill I would have written on my own. But we serve in a body of 100 
coequals who bring to our debate and discussion various backgrounds, 
experiences, and viewpoints. It is not an easy task.
  Every Congress going back to the 1940s to one degree or another has 
tried to deal with this issue. Every administration, from Harry Truman 
through every Republican and Democratic administration since the 1940s, 
has, to one degree or another, grappled with this issue of health care. 
To a large extent, everyone has failed or has not tried because it has 
been so monumental an undertaking that it has been daunting. Certainly, 
we are seeing that as we grapple with it in our hour of watch. Those of 
us who are privileged to be here serving with an administration that 
has made this a priority have been challenged to do what no other 
Congress and no other administration has been able to achieve over the 
past 70 years. We are close to achieving a major beginning, and it is a 
beginning. Anyone who suggests otherwise does not understand the 
complexity or the largeness of this undertaking--a beginning, to begin 
to change and bring down costs, increase access, and affordability, as 
well as the quality of something that ought to be a basic right in the 
United States of America, and that is health care.
  I am excited and optimistic about the possibility of achieving that. 
It is less than what I wished we could have done, but it is far more 
than has ever been achieved by others.
  The product we have before us, while it is not one that has been 
endorsed on a bipartisan basis, reflects a lot of good contributions 
made by all Members. In fact, every single member of the HELP 
Committee--every single member--offered amendments that were adopted as 
part of our product--every single one. Substantive amendments were 
offered as well. I find it somewhat intriguing, that people claim to 
feel excluded from the public option idea. I had no idea they were 
interested in one. It is exciting to know they have some ideas on the 
public option. The reflection that occurred during our debate was they 
were totally opposed to any public option in this bill. So we adopted 
one as part of the HELP Committee process, under the leadership of 
Sherrod Brown and Sheldon Whitehouse and Kay Hagan of North Carolina, 
who sat together and, working with others outside, came up with an 
option that we thought would appeal on a bipartisan basis. It did not, 
and we are very much involved in that debate as we speak.
  Anyway, I wanted to respond to these earlier suggestions, and I will 
leave them as suggestions, that somehow this product and process has 
been totally written on a partisan basis. It is anything but that, and 
I want the Record to reflect that, hence the decision to include the 
specific amendments, the pages on which they exist in our product, and 
the substance of the ideas that were contributed by our Republican 
friends.
  Mr. President, I saw my colleague from Montana a moment ago, who may 
be interested in addressing some of these ideas and thoughts as well 
that are coming before us. But while I wait for him to come to the 
floor, let me say that, again, I hear constantly this talk about 
Medicare and the cutting of Medicare. Let me reflect on how false those 
allegations are.
  Again, what we are trying to do is to reduce the overpayments under 
the

[[Page 30884]]

Medicare Advantage Program. That is what has happened here. These 
private plans--and that is what they are--operating under Medicare 
Advantage have two options: They can cut benefits or reduce their 
profits. We have to bring down these costs when you have an average of 
14 percent overpayments occurring in the country that are being borne 
by 80 percent of Medicare recipients.
  We talk about the numbers. I have a number: 96,000 people in the 
State of Connecticut who utilize the Medicare Advantage plan. I am not 
opposed to that. I think it is a wonderful option for people. But the 
fact is 470,000 other people in my State, who are Medicare recipients, 
are paying $90 extra in order to subsidize the Medicare Advantage plan 
and they are getting none of the benefits for it. So there is a huge 
percentage--about 80 percent of the elderly in this country--who are 
writing a check every year to subsidize private health care plans. 
These plans are profiting at the expense of people who never get a 
benefit from it.
  What Senator Baucus and others have suggested is let's reduce these 
overpayments. It is up to the plans to decide what they want to do with 
that. They can decide to cut the benefits or take less profit. These 
are for-profit plans that are doing this. Maybe they don't want to take 
less profit. That might be a part of the motivation. But traditional 
Medicare, the guaranteed benefits under that--a nonprofit operation--
are not touched in this bill--not a single guaranteed benefit. For over 
a week now I have challenged any Member in this body to identify a 
single guaranteed benefit under Medicare that is affected by this bill. 
Not one. Eliminating the overpayments under Medicare Advantage are, 
clearly, because we don't think that 80 percent of the population who 
qualify for Medicare ought to bear the financial burden of financing a 
benefit they never get.
  None of us are opposed to Medicare Advantage, but we are opposed to 
the idea that these for-profit companies can play the game by 
suggesting they don't want to take less profit, they don't want to 
reduce any benefit, so they want to leave it exactly as it is. You want 
to know why Medicare is in trouble? That is why. If you want to put it 
on a solid footing for an additional 5 years, then take the proposal we 
have in the bill to reduce these overpayments. In the absence of doing 
that, the very people who are worried about the solvency of Medicare 
are going to be correct, because Medicare will be in financial jeopardy 
far earlier if we have these amendments adopted that would jeopardize 
the traditional Medicare Program.
  Clarity is needed on all of this. The fact something is called 
Medicare Advantage, as I have said repeatedly, doesn't make it Medicare 
and it is certainly not an advantage. It is only an advantage for those 
private companies that are benefitting in terms of the profits they 
make. In fact, studies done by independent analysts say, that these 
companies have seen a 75 percent growth in profits as a result of this 
program. They are doing very well financially as a result of this. But 
they shouldn't be doing necessarily that well at the expense of others 
who are paying an additional $90, on average per couple of retirees, 
elderly people, who are contributing that amount every year without 
receiving a single benefit under Medicare Advantage.
  Our simple question is: Why should they be asked to pay that much 
more? Ninety dollars a year may not sound like that much to a Member of 
Congress, but if you are a retired elderly person, living on a fixed 
income, that $90 a year can make a huge difference. It may not be much 
to a Member of Congress, many of whom, of course, are very wealthy 
indeed, but it is if you are sitting out there across America writing a 
check each year for $90 to go into a program you never get a benefit 
from, which serves 20 percent of the senior population.
  I don't blame the 20 percent at all. I understand how they feel. They 
wish to continue to get those benefits. And they can get them, provided 
the companies they are getting those benefits from are willing to take 
less in profits. That is what our bill is designed to do--to provide 
that choice. Obviously, we can't mandate that from them--although we 
were promised early on they would be able to reduce the cost of 
Medicare. That was the original proposal when Medicare Advantage was 
adopted many years ago--a number of years ago.
  Again, it is anything but Medicare and it is anything but an 
advantage, except for the profit-making companies that have done very 
well off this program. Our bill here merely restrains the overpayments. 
I know that may bother these companies. They would like to make more, 
if they could, and I respect that, from their vantage point. But we 
should not, as the Senate, sanction and necessarily approve a proposal 
that allows them to make more money out of the pockets of people on 
fixed incomes to support a fraction of the population at the expense of 
the overwhelming majority. Where is the equity in that, when 80 percent 
of Medicare recipients are writing a check each year to private 
companies, in effect, to pay for benefits they never get?
  I appreciate the support of organizations across the country--AARP 
and certainly the National Committee to Preserve Social Security and 
Medicare--and we thank them for their very strong letters. These major 
organizations, representing 43 million of our elderly in this country, 
have taken a very strong position against the assaults on this bill 
regarding the overpayments that are occurring, and we thank them for 
it. That may not be enough for some people to appreciate, but I believe 
if they look and listen to what is going on here, they will understand 
what is at stake. If you are part of the 80 percent of seniors out 
there who are writing those checks every year and getting none of the 
benefits, those who oppose our bill want to maintain and probably 
expand on it in the years ahead. So for you out there who are worried 
about the cost and solvency of Medicare, our bill is a major step in 
the direction of reducing those overpayments and providing the options 
that ought to exist to reduce profits or extend benefits.
  Again, I think it is important to remind our colleagues that under 
this bill, there is $130 billion in budget reductions in the first 10 
years. It is the largest single reduction. We listened to our 
colleagues from North Dakota and New Hampshire talk about deficit 
reduction. This bill provides $130 billion in deficit reduction in the 
first 10 years and $650 billion of deficit reduction in the second 10 
years.
  We are now told by the Congressional Budget Office there are the 
millions of people today who are paying insurance and watching the 
costs escalate almost on an hourly basis. Even with zero inflation, we 
are watching private companies raise the cost of premiums--going up 
dramatically. There are 32 million people in the individual insurance 
market, according to the Congressional Budget Office, and they would 
pay 14 to 20 percent less in premiums for an equivalent plan than under 
the status quo. That is a huge reduction, potentially, in the years 
ahead for 32 million of our fellow citizens in the individual market. 
If you are in the small-group market--there are 25 million people in 
that, according to the CBO's analysis--you are eligible for tax credits 
and would pay 8 to 11 percent less in premiums. If you work for a small 
business and don't qualify for a tax credit, you would see a reduction, 
potentially, of 2 to 3 percent in premiums. If you are in the large-
group market--and there are 134 million of our fellow citizens who are 
in that market, according to the Congressional Budget Office--again, 
you could see a reduction.
  So in any category, you have a choice here to make--and we do in the 
coming hours. Do you want to continue the present process? And when 
people say status quo, it is such a misnomer. The status quo might even 
be acceptable to people if you could freeze everything. But you can't 
freeze everything. The status quo allows for a dramatic increase in 
premiums--dramatic increase. If we don't take steps to deal with rising 
costs, as we do in this bill, you are looking at premiums going from 
$12,000 a year for a family of four

[[Page 30885]]

in this country to $24,000 to $35,000 in the next 7 to 10 years.
  If this gets defeated--and, obviously, our Republican friends want 
this bill defeated--the idea that we are going to jump back into this 
is a pipe dream. We will end up with dramatically increasing costs to 
millions of our fellow citizens, which this bill restrains because of 
the hard work done by the Finance Committee, particularly, that had to 
work on these issues. So for those who suggest the status quo is okay, 
it is anything but okay.
  In terms of cost reduction overall, as well as premium reduction, 
which is so important--and I thank my colleague from Indiana, Senator 
Bayh, who was the one who insisted CBO give us the analysis of what the 
impact of this bill would be on premiums--the fact is we see 
significant reductions of premium costs.
  I see my colleague from Montana is now here, but I would give the 
example that in Connecticut, premiums in the year 2000 for a family of 
four were about $6,000. In the year 2009, that family of four in 
Connecticut is now paying around $12,000. So in 9 years, premiums have 
jumped from $6,000 to $12,000. And those numbers continue to escalate. 
So for those who say no to this bill, then--if you succeed in these 
efforts--prepare to answer the question why is it the premiums of those 
people you claim you are defending around here--if they have 
insurance--will escalate to the rates we have talked about. That is 
what is at stake--nothing less than that.
  Whether it is so-called Medicare Advantage or cost reduction or 
premium reduction, this bill, with all of its imperfections, is a 
major, giant, positive step forward for our country. Again, I thank the 
members of the Finance Committee and Members of the HELP Committee, 
both staffs, and others who have worked to include many of the ideas 
that our friends on the other side wisely and thoughtfully made a part 
of these efforts.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I want to underline the huge bipartisan 
effort that this side undertook to put this bill together in many, many 
ways. I very much appreciate the comments of the Senator from 
Connecticut on that point.
  Let's go back. A year ago, I held an all-day health care summit at 
the Library of Congress for members of the Finance Committee, 
Republicans and Democrats. They were all there. We spent a whole day. 
In addition, I talked to all the groups. I called them up and said: 
Look, we are all in this together--we Americans--consumer groups, 
labor, big business, small business, the pharmaceutical industry, 
hospitals, hospice, all these CEOs. I said: We are all working together 
to get health care reform passed for our country--for all Americans.
  So we kept that process up to keep it--and I don't like that word 
``bipartisan.'' It is more accurate to say that everybody was working 
together. If you don't like something, maybe you will like something 
else somewhere else.
  The PRESIDING OFFICER (Mr. Kirk). The time of the majority has 
expired.
  Mr. BAUCUS. Just as I was getting wound up, Mr. President. I will 
continue when the majority's half-hour comes around.
  Mr. McCAIN. Mr. President, I ask unanimous consent the Senator from 
Montana be given 2 additional minutes.
  Mr. BAUCUS. I appreciate very much the 2 minutes from the Senator 
from Arizona. This could take a couple more than 2 minutes, but I very 
much appreciate the offer. I will just wait.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.
  Mr. McCAIN. I ask unanimous consent to enter into a colloquy with the 
Senators from Oklahoma, Tennessee, and Tennessee, both of them.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCAIN. Mr. President, we are here, obviously, as we are on a 
daily basis, to discuss the issue of health care reform. But we are in 
a rather unusual situation this morning because we don't know what we 
are discussing or debating. We find ourselves in an interesting 
situation.
  After almost a year of consideration of health care reform, with a 
measure that has been--at least a couple of the outlines of it we know 
but, frankly, we have had no details except that Medicare is going to 
be extended, eligibility for Medicare is going to be extended to age 
55.
  I just would quote: There was a meeting yesterday amongst Senate 
Democrats. Many Senate Democrats emerged from yesterday's caucus 
meeting saying they had learned little about the public option 
agreement and there were many outstanding concerns.
  Senator Mary Landrieu called the agreement ``a very good idea.'' 
Senator Blanche Lincoln said, ``More information is needed.'' And 
Senator Ben Nelson said, ``I just want to know what the costs are.''
  So do the rest of us. So do the rest of us. Here we have a proposal 
after nearly a year that is being assessed by the Congressional Budget 
Office, and here we are with no knowledge of what that bill is about, 
with the exception of some bare essentials that have been leaked.
  What did this have to do with change? What does this have to do with 
bipartisanship? What does this have to do with anything?
  Frankly, we have an editorial in the Washington Post this morning 
that calls it ``Medicare Sausage?''
  I ask unanimous consent the editorial from the Washington Post be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                       [From the Washington Post]

                           Medicare Sausage?


 the emerging buy-in proposal could have costly unintended consequences

       The only thing more unsettling than watching legislative 
     sausage being made is watching it being made on the fly. The 
     11th-hour ``compromise'' on health-care reform and the public 
     option supposedly includes an expansion of Medicare to let 
     people ages 55 to 64 buy into the program. This is an idea 
     dating to at least the Clinton administration, and Senate 
     Finance Committee Chairman Max Baucus (D-Mont.) originally 
     proposed allowing the buy-in as a temporary measure before 
     the new insurance exchanges get underway. However, the last-
     minute introduction of this idea within the broader context 
     of health reform raises numerous questions--not least of 
     which is whether this proposal is a far more dramatic step 
     toward a single-payer system than lawmakers on either side 
     realize.
       The details of how the buy-in would work are still sketchy 
     and still being fleshed out, but the basic notion is that 
     uninsured individuals 55 to 64 who would be eligible to 
     participate in the newly created insurance exchanges could 
     choose instead to purchase coverage through Medicare. In 
     theory, this would not add to Medicare costs because the 
     coverage would have to be paid for--either out of pocket or 
     with the subsidies that would be provided to those at lower 
     income levels to purchase insurance on the exchanges. The 
     notion is that, because Medicare pays lower rates to health-
     care providers than do private insurers, the coverage would 
     tend to cost less than a private plan. The complication is 
     understanding what effect the buy-in option would have on the 
     new insurance exchanges and, more important, on the larger 
     health-care system.
       Currently, Medicare benefits are less generous in 
     significant ways than the plans to be offered on the 
     exchanges. For instance, there is no cap on out-of-pocket 
     expenses. So would near-seniors who buy in to Medicare get 
     Medicare-level benefits? If so, who would tend to purchase 
     that coverage? Sicker near-seniors might be better off 
     purchasing private insurance on the an exchange. But the 
     educated guessing--and that's a generous description--is that 
     sicker near-seniors might tend to place more trust in a 
     government-run program; they might assume, with good reason, 
     that the government will be more accommodating in approving 
     treatments, and they might flock to Medicare. That would 
     raise premium costs and, correspondingly, the pressure to dip 
     into federal funds for extra help.
       In addition, the insurance exchanges proposal is being 
     increasingly sliced and diced in ways that could narrow its 
     effectiveness. Remember, the overall concept is to group 
     together enough people to spread the risk and obtain better 
     rates. But so-called ``young invincibles''--the under-30 
     crowd--would already be allowed to opt out of the regular 
     exchange plans and purchase high-deductible catastrophic 
     coverage. Those with income under 133 percent of the poverty 
     level would be covered by Medicaid. The exchanges risk 
     becoming less effective the more they are Balkanized this 
     way.
       Presumably, the expanded Medicare program would pay 
     Medicare rates to providers,

[[Page 30886]]

     raising the question of the spillover effects on a health-
     care system already stressed by a dramatic expansion of 
     Medicaid. Will providers cut costs--or will they shift them 
     to private insurers, driving up premiums? Will they stop 
     taking Medicare patients or go to Congress demanding higher 
     rates? Once 55-year-olds are in, they are not likely to be 
     kicked out, and the pressure will be on to expand the program 
     to make more people eligible. The irony of this late-breaking 
     Medicare proposal is that it could be a bigger step toward a 
     single-payer system than the milquetoast public option plans 
     rejected by Senate moderates as too disruptive of the private 
     market.

  Mr. McCAIN. ``The emerging buy-in proposal could have costly 
unintended consequences.''
  But we don't know what it is. But we know that never before in this 
entire year--I ask my colleagues--have we seen a proposal that would 
change eligibility for Medicare down to age 55, never before.
  The majority leader came to the floor this morning and said if we 
accept an omnibus, a multitrillion-dollar bill by unanimous consent--by 
the way, the Omnibus appropriations bill is six bills totaling $450 
billion, 1,351 pages long, with 4,752 earmarks totaling $3.7 billion. 
And, by the way, spending on domestic programs is increased by 14 
percent except for veterans, which is increased by only 5 percent.
  The majority leader wants us to go out for the weekend, after keeping 
us in all last weekend. Here we have an unspecified proposal--none of 
us know the details or the cost--so I am supposed to go home to Arizona 
this weekend and say: My friends, we have been working on health care 
reform for a year. And guess what. I can tell you nothing.
  We need to stay in, we need to know what the proposals are, we need 
to have votes on it, and we need to tell the American people what is 
going on behind closed doors.
  Mr. McCONNELL. Will the Senator from Arizona yield?
  Mr. McCAIN. Gladly.
  Mr. McCONNELL. I recall our good friend, the majority leader, telling 
us on November 30 that we would be here the next two weekends. Then I 
recall our friend, the majority leader, saying Monday of this week we 
would be here this weekend.
  My assumption was we were here to deal with this important issue that 
the majority has been indicating to everyone is so important, that we 
must stay here and do it. We are prepared to be here.
  Mr. McCAIN. And vote.
  Mr. McCONNELL. And vote. In fact, we have been trying to vote for a 
couple of days now, and it has been difficult to vote.
  Mr. McCAIN. If we are not going to have a vote, maybe we ought to 
have a vote to table the pending amendments, at least to have the 
Senate on record.
  Could I finally say, I know New Orleans is very nice this time of 
year, but perhaps we ought to stay here and get this job done?
  Mr. ALEXANDER. I think it is important to reflect on the season we 
have here. A couple of nights ago, the Senator from Arizona gave an 
impressive speech in front of the Capitol for the lighting of the 
Christmas tree. This is the Christmas season coming up, 2 weeks from 
tomorrow, a very important season. The majority leader said it is very 
important for us to stay through Christmas if necessary to debate this 
bill. We said: All right, that is what we will do. We will stay to New 
Year's Day. We will stay to Valentine's Day because this is indeed a 
historic bill and we don't want to make a historic mistake because it 
affects our children, our grandchildren, 17 percent of the economy, all 
300 million Americans.
  None of us have ever seen our constituents more involved in an issue 
than in this issue. So we are here ready to go to work.
  I am wondering, as I listen to the Senator from Arizona, not only do 
we not know what this bill is that we are supposed to enact by 2 weeks 
from today, our friends on the other side don't know what it is. They 
cannot tell each other what it is.
  They came out of--they had sort of a rally yesterday. One of the 
Senators described it as sort of a ``go team, go'' rally, but they did 
not know what they were going to. All we have heard they are going to--
and I imagine the Senator from Oklahoma, who is a physician, who has 
delivered many babies, seen many patients, still continues to do it, 
would have some comment on this--all we have heard is they may try to 
expand Medicare.
  We heard yesterday from the executive director of the Mayo Clinic 
Health Policy Center, I ask unanimous consent to have his letter 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                 Medicare Expansion Won't Get Us There


 Proposal Would Not Increase Access to Health Care Services or Control 
                                 Costs

       The current Medicare payment system is financially 
     unsustainable. Any plan to expand Medicare, which is the 
     government's largest public plan, beyond its current scope 
     does not solve the nation's health care crisis, but compounds 
     it. We need to fix Medicare by moving it to a system that 
     pays for value--quality health outcomes that are affordable 
     over time--and ensure its success, before bringing more 
     people into a broken system.
       Expanding this system to persons 55 to 64 years old would 
     ultimately hurt patients by accelerating the financial ruin 
     of hospitals and doctors across the country. A majority of 
     Medicare providers currently suffer great financial loss 
     under the program. Mayo Clinic alone lost $840 million last 
     year under Medicare. As a result of these types of losses, a 
     growing number of providers have begun to limit the number of 
     Medicare patients in their practices. Despite these provider 
     losses, Medicare has not curbed overall spending, especially 
     after adjusting for benefits covered and the cost shift from 
     Medicare to private insurance. This is clearly an 
     unsustainable model, and one that would be disastrous for our 
     nation's hospitals, doctors and eventually our patients if 
     expanded to even more beneficiaries.
       It's also clear that an expansion of the price-controlled 
     Medicare payment system will not control overall Medicare 
     spending or curb costs. The Commonwealth Fund has reported 
     this result for Medicare overall by looking at two time 
     periods--one four-year period where Medicare physician fees 
     increased and one four-year period where Medicare physician 
     fees decreased. Overall cost per beneficiary increased at the 
     same rate during each time period. This scenario follows the 
     typical pattern for price controls--reduced access, 
     compromised quality and increasing costs anyway. We need to 
     address these problems--not perpetuate them--through health 
     reform legislation.
       We believe insurance coverage can be achieved without 
     creating or expanding a government-run, price-controlled, 
     Medicare-like insurance model.
       Mayo Clinic supports the proposed insurance exchange model 
     based on the Office of Personnel Management's Federal 
     Employees Health Benefit Plan (FEHBP). This system will 
     improve access to insurance, make reforms to the current 
     insurance system that eliminate pre-existing condition 
     exclusions, and create an individual mandate where 
     individuals can purchase private insurance in various ways: 
     through employers; on the individual market; through co-
     operatives; or through an exchange model like the FEHBP.
       We also believe that the government should help people pay 
     for insurance premiums through sliding scale subsidies as 
     needed.

                                            Jeffrey O. Korsmo,

                                               Executive Director,
                                 Mayo Clinic Health Policy Center.

  Mr. ALEXANDER. I will just read one sentence from it:

       Expanding the current Medicaid system to persons 55 to 64 
     years old would ultimately hurt patients by accelerating the 
     financial ruin of hospitals and doctors across this country.

  I am very puzzled why ideas like this are being cooked up behind 
closed doors 2 weeks before Christmas, and we do not know what they 
are, they don't know what they are, and the suggestion is we not vote 
today and we go home this weekend.
  Mr. McCAIN. Not only are there questions--not only is there 
opposition from the Mayo Clinic but the American Hospital Association 
and the AMA. They have all come up steadfastly against this.
  Could I ask my colleague from Oklahoma--and I quote from this 
editorial. Here we are supposedly going out for the weekend and the 
editorial from the Washington Post says:

       Presumably, the expanded Medicare program would pay 
     Medicare rates to providers raising the question of the 
     spillover effects on a health-care system already stressed by 
     a dramatic expansion of Medicaid. Will providers cut costs--
     or will they shift them to private insurers, driving up 
     premiums? Will they stop taking Medicare patients or go to

[[Page 30887]]

     Congress demanding higher rates? Once 55-year-olds are in, 
     they are not likely to be kicked out and the pressure will be 
     on to expand the program to make more people eligible. The 
     irony of this late-breaking Medicare proposal is that it 
     could be a bigger step toward a single-payer system than the 
     milquetoast public option plans rejected by Senate moderates 
     as too disruptive of the private market.

  Mr. COBURN. I will answer my colleague as somebody who has practiced 
medicine for 25 years: MedPAC, last year, said 29 percent of Medicare 
beneficiaries it surveyed were looking for a primary care doctor and 
had great difficulty in finding somebody to treat them.
  That is now. In the State of Texas, 58 percent of the State's doctors 
took new Medicare patients, but only 38 percent of the State's primary 
care doctors took new Medicare patients.
  I would make the case to you that if you delay care, that is denied 
care. It is exacerbated in our older population because an older person 
with a medical need is much more susceptible to the complications that 
can come from that initial problem. So if you delay the care, you are 
denying the care and you are actually increasing the cost.
  There are 15 million people in this population. I have no idea if 
their plans include all of them. But if you add 15 million new people 
to Medicare, what you are going to have is 50 percent of them are not 
going to find a primary care physician to care for them because the 
rate of reimbursement does not cover the cost of care.
  I think the editorial you quote is exactly right.
  I would also note, if I may, that President Obama loves the Mayo 
Clinic, and rightly so. I had a brain tumor removed the summer before 
last by the Mayo Clinic. I am standing here on the Senate floor because 
of their expertise.
  Mr. McCAIN. There are many who believe the Senator from Oklahoma 
could not have a heart attack.
  Mr. COBURN. I will ignore that comment.
  The fact is, what Mayo says is we have to figure out how we create 
incentives in terms of how do we get people cared for at a lower cost. 
Medicare is not the way to do it.
  As a matter of fact, I heard our colleagues talk. We have had eight 
votes since last Saturday. We are ready to vote. This is a 2,074-page 
bill. I have 15 amendments in the queue. I want to vote on them.
  They don't want to vote because they don't want the American people 
to hear all the bad things about what is going to happen to their 
health care if this bill passes. If we do Medicare, what is going to 
happen is Medicare costs are going to skyrocket, but access is going to 
go down.
  Mr. McCAIN. Apparently, I would ask my colleague from Tennessee, we 
do not know what we would be voting on because there has been a whole 
rewrite of this health care reform here after a year. We do not even 
know what the provisions of that bill are except what has been leaked. 
Apparently, my colleagues on the other side of the aisle, with the 
exception of the majority leader, don't know what it is either.
  Mr. COBURN. If the Senator will yield, there are some things we could 
vote on. President Obama outlined some very specific things that ought 
to be in this bill. We ought to vote to put them in the bill.
  What he said he wanted and what this bill presents are two different 
things. We ought to vote on making sure everybody has access. We ought 
to vote on making sure we are under the same plan as everybody else we 
are going to put into any new expanded health care coverage. We ought 
to vote in making sure everybody is treated fairly in this country. We 
ought to vote on your prescription drug reimportation. We ought to 
vote. But what we are doing is we are getting a slowdown.
  We heard we are obstructing the bill. We are not obstructing the 
bill. Any other bill that comes before this body that had 2,000 pages 
in it we would allot 8 weeks, 10 weeks to debate.
  As our colleague from Maine knows, there is not a more complicated 
subject that will affect more people that this body has ever taken up. 
We are trying to squeeze that into 3\1/2\ weeks, and the last 2 weeks 
we don't know what is in the bill.
  Time out.
  Mr. CORKER. I would like to thank the Senator from Arizona for his 
great leadership on this issue. I agree with all here. I would like to 
continue to discuss this, ``colloquize,'' if you will, and vote. That 
is what we need to do all weekend is talk about this issue and vote.
  There are numbers of amendments. But the thing that is interesting to 
me, I say to the Senator from Arizona--he has been one of the great 
champions in this country as it relates to how we live within our 
means. He has pointed out waste in government. He has pointed out 
overspending.
  What has happened during this Christmas season is, for our friends on 
the other side of the aisle Medicare has become the gift that just 
keeps on giving.
  I know the Senator talked about, during his campaign--and all of us 
have--that we need to get Medicare to a point where it is solvent, 
where seniors actually have the ability to use the benefits later on 
that now are in place. We have all talked about the need to make it 
solvent.
  What does the base of this bill do? It takes $464 billion out of 
Medicare to create a whole new entitlement. It doesn't even deal with 
the doc fix, as we have said many times.
  The reason, by the way, we do not know what this says is the 
leadership on the other side--this is another one of those yellow post-
its. They are throwing it up on the wall just to see if it works. They 
are not telling us what the game plan is because they don't yet know 
whether it works. What they are hoping to do is to solve a major 
problem they have within their caucus, again, by taking from Medicare.
  If you think about the fact that the Mayo Clinic, which is the model 
for all of us, would not even take new Medicare patients, and yet our 
friends on the other side of the aisle are trying to throw a whole new 
decade of seniors into the plan, what that means is less and less 
seniors are going to have access to care. That is what this means.
  The other side of the aisle, I will have to say, based on history, I 
am surprised, but they continue, through their policies, to throw 
seniors under the bus.
  I do not understand what has happened. This must be about a political 
victory and not about health care reform. What we would do is more 
firmly put in place, again, bad policy. The problem with Medicare today 
is physicians and providers are paid fees to do more work. So now what 
we would be doing, instead of health care reform, which is what Senator 
Coburn and all of us have talked about for some time, we are putting in 
place, in cement, something that works poorly, that the Mayo Clinic 
said is damaging to them and their patients, we would be putting it in 
place for even more people.
  I thank the Senator for his leadership. I hope to be with him all 
weekend discussing amendments that are important and voting on those 
amendments. I can't imagine a better place for all of us to be.
  Mr. McCAIN. I thank the Senator. May I ask the Republican leader, 
again, to be very clear that it is his view and that of all Republican 
Members that we will stay in for as long as it takes to get this issue 
resolved and we are prepared to vote throughout the entire weekend. If 
the majority leader moves to the Omnibus appropriations bills, we will 
have a conference report, and we will certainly have discussion about a 
bill that has 4,752 earmarks totaling $3.7 billion. But we should not 
get off this, should we?
  Mr. McCONNELL. My friend is entirely correct. I can only quote the 
majority leader himself who said we were going to be here this weekend. 
We expect to be here this weekend. If he tries to leave, we will have a 
vote to adjourn, and I am confident every Republican will vote against 
adjourning. This either is or it isn't as important as the majority 
says it is. If it is that important, we need to be here. More 
importantly than being here, equally important to being here is to 
vote. We tried to get a vote all day yesterday on a motion by Senator 
Crapo. What we heard from the other side is: We are

[[Page 30888]]

working on a side-by-side. That is kind of parliamentary inside talk 
for delay. We are ready to vote. As several of our colleagues have 
suggested, we keep hearing about these new iterations of this bill. It 
reminds me of the end of a football game, trying to throw a ``Hail 
Mary'' pass, just somehow, some way find a way to pass this bill. I 
think it important to remember what happens to most Hail Marys. They 
fall to the ground incomplete. You get the impression they are far less 
interested in the substance of the bill than just passing something.
  When the President came up here last Sunday, he said: Make history. 
Make history? The American people are not asking us to make history by 
passing this bill. They don't believe it is about the President. They 
believe it is about the substance. We are out here prepared to talk 
about the substance of this measure, offer amendments, and we fully 
intend to do it for as long as it takes. As the Senator has suggested, 
if the majority leader pivots to a conference report, which he is able 
to do under our process, we will spend all the time it takes to deal 
with the conference report.
  Mr. McCAIN. May I point out, again, as the Senator from Maine, Ms. 
Snowe, pointed out--and it was highlighted in the Wall Street Journal--
no major reform in the modern history of this Senate has been enacted 
without bipartisan support, a reason for us to go back to the drawing 
board.
  I know the Senator from Texas has been heavily involved in the issue 
of hospitalization and the American Hospital Association's reaction to 
what appears to be an expansion of Medicare.
  Mrs. HUTCHISON. I thank the Senator from Arizona. I am pleased our 
leader is standing strong to say nothing should take precedence over 
our handling of this bill and making sure it is done right. That is 
what the Republicans are trying to do, to make sure this is done right. 
We talked about the Medicare expansion that is in the purported bill 
that we have not seen yet but that Democrats appear to be putting 
forward. We have also been spending the week talking about $\1/2\ 
trillion in cuts to Medicare. Now we are talking about possibly 
expanding Medicare at the same time we are cutting $\1/2\ trillion out 
of the care Medicare patients would get.
  I have an amendment. It would stop the $135 billion in cuts in the 
underlying bill to hospitals, cutting hospital reimbursements for 
Medicare patients. That is my amendment. Now we are talking about 
possibly expanding Medicare. The American Hospital Association put out 
an alarm, an action alert. It says:

       Medicare pays hospitals 91 cents for every dollar of care 
     provided. Medicaid pays just 88 cents for each dollar of care 
     provided.

  Medicaid, which may also be expanded, and the cuts in Medicare, which 
we are talking about possibly expanding, would go forward. Which means 
what? The hospital association knows what. ``What'' is rural hospitals 
that care for Medicare patients are going to go under. What kind of 
services can be provided if there is no hospital in the whole county 
that can provide care to these senior citizens? I ask the Senator from 
Arizona, who has been such a leader on this, we are going to cut $135 
billion out of Medicare coverage for hospitals. We are going to now 
talk about expanding the coverage of more Medicare patients, which will 
mean we will cut more from the hospitals than is even envisioned in the 
underlying bill. Help me understand this, Senator. How would you 
suggest that passes the commonsense test?
  Mr. McCAIN. May I say, having stood fifth from the bottom of my class 
at the Naval Academy, I cannot explain it. But perhaps before I turn to 
the Senator from South Dakota, maybe we could get a response from Dr. 
Coburn to that question.
  Mr. COBURN. They are going to cut care. We are going to have more 
complications and worse outcomes. That is what is going to happen. 
Rather than changing the payment formula, which is what we should do, 
by rewarding quality and rewarding outcome, rather than rewarding 
flipping a switch, that is what needs to happen. We are going to take 
the same antiquated system, we are going to cut $465 billion from it, 
and then we are going to add, as my colleague from Tennessee said, it 
is 34 million people, if they include everybody from 55 to 64 in the 
same program.
  Mrs. HUTCHISON. Is the Senator saying that whether you were at the 
top of your class, such as the Senator from Oklahoma or the Senator 
from Tennessee or the Senator from South Dakota, or the bottom of your 
class, as the Senator from Arizona has admitted he held down the fort, 
regardless of where you are on the quotient of where you stood in your 
class, you know what the bottom line is.
  Mr. COBURN. Care is going to be impacted. Here is a survey of 90,000 
physicians. That is more than the active practicing physicians of the 
AMA. More than 8 in 10 physicians surveyed think payment reform is best 
to improve the system for all Americans. Only 5 percent of the 
physicians surveyed rated the current government health care program as 
effective, 5 percent.
  Mr. McCAIN. I yield to the Senator from South Dakota.
  Mr. THUNE. I ask my colleague from Arizona if this is what happens 
when you end up with one-party rule, one party trying to go this on 
their own. This seems to be a model of dysfunction in how to come up 
with a solution to one of the major problems facing the American 
people, dysfunctional by Washington's twisted standards. They seem to 
be desperately throwing things at the wall, hoping something will 
stick. Surely, there has to be a better suggestion coming from the 
other side than to expand a program that is destined to be bankrupt in 
the year 2017. It is the equivalent of a ship that is sinking. It is 
similar to the Titanic. You will put more people on the deck of a 
sinking ship. Clearly, the overall objective, at least among some, and 
I think some have been very transparent about it--someone quoted 
earlier today the Congressman from New York in the other body who said 
this is the mother of all public options. He went on to say:

       Never mind the camel's nose. We have his head and neck in 
     the tent on the way to a single-payer system.

  Obviously, there are people here who want to see a single-payer 
system, who want to see government-run health care. We don't happen to 
believe that is the best solution for America's health care system, but 
the amazing thing about this proposal is, it takes a program that is 
destined to be bankrupt in a few short years, cuts $1 trillion out of 
it over 10 years, when fully implemented, and then adds millions of new 
people into that program. It is hard to come up with any rational 
explanation for what is going on here, other than that they are left 
with, in desperation, trying to throw something at the wall, hoping it 
will stick. Is this typically what happens around here when one party 
tries to go on its own on something that is this consequential to 
America? One-sixth of our economy is represented by health care.
  Essentially, what they are saying is, we want to expand that part of 
the economy that isn't working today, that is headed for bankruptcy, 
that underreimburses doctors and hospitals, put more money into that 
failed system, exacerbate the cost-shift problem by forcing people in 
the private-payer market to pay higher premiums. It seems like this 
creates all sorts of problems that make matters even worse.
  I appreciate my colleague's leadership on this issue of pointing out 
what inevitably is going to happen. When you have the Washington Post 
editorial this morning even acknowledging the terrible problems this 
creates for health care and the way this is being conducted, sausage 
being made here in Washington, DC. Even by Washington's twisted 
standards, this process has become so dysfunctional, I don't know how 
they can recover.
  One thing they could do is decide to sit down with Republicans and 
actually figure out some things we could do that would drive health 
care costs down, rather than making them go up.
  Mr. McCAIN. I thank the Senator from South Dakota. I have to say I 
have never, in the years I have been

[[Page 30889]]

here, seen a process such as this. It is incredibly bizarre that after 
a year, after hundreds of hours in the HELP Committee, after how many 
hundreds of hours in the Finance Committee, products are here on our 
desks. Yet there is a meeting yesterday of the Democrats. They come 
out, and they don't know what the proposal is either. Apparently, there 
is only one Senator who knows what the proposal is and that is the 
majority leader. Also, then it is OK to go home for the weekend. I 
honestly say to my colleague from South Dakota, I have never seen 
anything quite like this, especially when we are talking about one-
sixth of the gross national product. Of course, already from what they 
know, the hospitals and doctors and others have come out in strong 
opposition to expansion of a program, as the Senator points out, that 
is going broke.
  Mr. McCONNELL. I say to my friend from Arizona, he made reference 
today to the senior Senator from Maine and her very insightful and 
thoughtful and correct speech a couple weeks ago about how an issue of 
this magnitude was historically dealt with here and how it was not 
being dealt with this way. She pointed out, major domestic legislation 
in modern U.S. history was, without exception, done on a largely 
bipartisan basis. That whole process, as the Senator from Maine pointed 
out, has been entirely missing, as we have moved along toward 
developing this 2,074-page monstrosity of a bill, designed to entirely 
restructure one-sixth of our economy on a totally partisan basis.
  I don't think that is what the American people had in mind. They want 
us here, as we have all indicated, debating, discussing, and amending 
this proposal. That is what we would like to do for as long as it 
takes.
  Mr. ALEXANDER. Mr. President, if the Republican leader will think 
back when he first came to the Senate as a young aide in 1969, the year 
before I was a young aide in the Senate,
  I can remember President Johnson, a Democrat, and Everett Dirksen, 
the Republican leader, dealing with the open housing legislation in 
1968, a very controversial bill. How did they deal with it? The 
Democratic President had the bill literally written in the office of 
the Republican leader, with staff members and Senators trooping in and 
out. The country looked to Washington and said: Well, the Republican 
leader and the Democratic President both think it is important. They 
are trying to work it out. In the end, they voted for cloture. In the 
end, they got the bill.
  Mr. McCONNELL. My friend from Tennessee is entirely correct. Right 
before we got here--right before we got here--in 1964 and 1965, the 
Democrats had overwhelming majorities, as they do now, and the civil 
rights bill of 1964 and the voting rights bill of 1965 passed on an 
overwhelming bipartisan basis. The leader of the Republicans, Everett 
Dirksen, was every bit as much involved in that, if not more involved 
in it, than even the Democrats. Republicans supported it. On a 
percentage basis, a greater number----
  The PRESIDING OFFICER (Mr. Burris). The minority time has expired.
  Mr. McCONNELL. Mr. President, I ask unanimous consent for 1 more 
minute.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCONNELL. An even greater percentage of Republicans ended up 
supporting the civil rights bills of 1964 and 1965 than Democrats. But 
it was a truly bipartisan landscape for our country--a landmark, 
important. It was widely accepted by the American people because of the 
broad bipartisan support it enjoyed. That is what has been lacking here 
from the beginning.
  Mr. McCAIN. Mr. President, I ask unanimous consent that a list of 
physician organizations that oppose this act, representing nearly one-
half million physicians, be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  Physician Organizations That Oppose Senate's Patient Protection and 
                          Affordable Care Act

       To date over 40 state, county and national medical 
     societies, representing nearly one-half million physicians, 
     have stated their public opposition to the Senate healthcare 
     overhaul bill, the Patient Protection and Affordable Care Act 
     (H.R. 3590). It is time for Congress to slow down, take a 
     step back, and change the direction of current reform efforts 
     to ensure that it is done right!


                     National Medical Associations

       American Academy of Cosmetic Surgery, American Academy of 
     Dermatology Association, American Academy of Facial Plastic 
     and Reconstructive Surgery, American Academy of 
     Otolaryngology Head and Neck Surgery, American Association of 
     Neurological Surgeons, American Association of Orthopaedic 
     Surgeons, American College of Obstetricians and 
     Gynecologists, American College of Osteopathic Surgeons, 
     American College of Surgeons, American Osteopathic Academy of 
     Orthopaedics, American Society for Metabolic & Bariatric 
     Surgery, American Society of Anesthesiologists, American 
     Society of Breast Surgeons, American Society of Cataract and 
     Refractive Surgery, American Society of Colon and Rectal 
     Surgeons, American Society of General Surgeons, American 
     Society of Plastic Surgeons, American Urological Association, 
     Association of American Physicians and Surgeons, Coalition of 
     State Rheumatology Organizations, Congress of Neurological 
     Surgeons, Heart Rhythm Society, National Association of Spine 
     Specialists, Society for Vascular Surgeons, Society of 
     American Gastrointestinal and Endoscopic Surgeons, Society 
     for Cardiovascular Angiography and Interventions, Society of 
     Gynecologic Oncologists.


                 State and County Medical Associations

       Medical Association of the State of Alabama, California 
     Medical Association, Medical Society of Delaware, Medical 
     Society of the District of Columbia, Florida Medical 
     Association, Medical Association of Georgia, Kansas Medical 
     Association, Louisiana State Medical Society, Missouri State 
     Medical Association, Nebraska Medical Association, Medical 
     Society of New Jersey, Ohio State Medical Association, South 
     Carolina Medical Association, Texas Medical Association, 
     Westchester (NY) County Medical Society.
                                  ____

                                                 December 1, 2009.
     Hon. Harry Reid,
     Majority Leader, U.S. Senate,
     Washington, DC.
       Dear Leader Reid: On behalf of the over 240,000 surgeons 
     and anesthesiologists we represent and the millions of 
     surgical patients we treat each year, the undersigned 19 
     organizations strongly support the need for national health 
     care reform and share the Senate's commitment to make 
     affordable quality health care more accessible to all 
     Americans. As you know, we have been working diligently and 
     in good faith with the Senate during the past year and have 
     provided input at various stages in the process of drafting 
     the Senate's health care reform bill. To this end, we have 
     reviewed the Patient Protection and Affordable Care Act of 
     2009.
       As you may recall, on November 4 our coalition sent you a 
     letter outlining a number of serious concerns that needed to 
     be addressed to ensure that any final health care reform 
     package would be built on a solid foundation in the best 
     interest of our patients. Since those concerns have not been 
     adequately addressed, as detailed below, we must oppose the 
     legislation as currently written.
       We oppose:
       Establishment and proposed implementation of an Independent 
     Medicare Advisory Board whose recommendations could become 
     law without congressional action;
       Mandatory participation in a seriously flawed Physician 
     Quality Reporting Initiative (PQRI) program with penalties 
     for non-participation;
       Budget-neutral bonus payments to primary care physicians 
     and rural general surgeons;
       Creation of a budget-neutral value-based payment modifier 
     which CMS does not have the capability to implement and 
     places the provision on an unrealistic and unachievable 
     timeline;
       Requirement that physicians pay an application fee to cover 
     a background check for participation in Medicare despite 
     already being obligated to meet considerable requirements of 
     training, licensure, and board certification;
       Relying solely on the limited recommendations of the United 
     States Preventive Services Task Force (USPSTF) in determining 
     a minimum coverage standard for preventive services and 
     associated cost-sharing protections;
       The so-called ``non-discrimination in health care'' 
     provision that would create patient confusion over greatly 
     differing levels of education, skills and training among 
     health care professionals while inappropriately interjecting 
     civil rights concepts into state scope of practice laws;
       The absence of a permanent fix to Medicare's broken 
     physician payment system and any meaningful proven medical 
     liability reforms; and
       The last-minute addition of the excise tax on elective 
     cosmetic medical procedures. This tax discriminates against 
     women and the middle class. Experience at the state level has 
     demonstrated that it is a failed policy which will not result 
     in the projected

[[Page 30890]]

     revenue. Furthermore, this provision is arbitrary, difficult 
     to administer, unfairly puts the physician in the role of tax 
     collector, and raises serious patient confidentiality issues.
       This bill goes a long way towards realizing the goal of 
     expanding health insurance coverage and takes important steps 
     to improve quality and explore innovative systems for health 
     care delivery. Despite serious concerns, there are several 
     provisions in the Patient Protection and Affordable Care Act 
     of 2009 that the surgical community supports, strongly 
     believes are in the best interest of the surgical patients, 
     and should be maintained in any final package. Specifically 
     these include: health insurance market reforms, including the 
     elimination of coverage denials based on preexisting medical 
     conditions and guaranteed availability and renewability of 
     health insurance coverage; strengthening patient access to 
     emergency and trauma care by ensuring the survival of trauma 
     centers, developing regionalized systems of care to optimize 
     patient outcomes, and improving emergency care for children; 
     well-designed clinical comparative effectiveness research, 
     conducted through an independent institute and not used for 
     determining medical necessity or making coverage and payment 
     decisions or recommendations; and the exclusion of ultrasound 
     from the increase in the utilization rate for calculating the 
     payment for imaging services.
       Further, while redistribution of unused residency positions 
     to general surgery is a positive step in addressing the 
     predicted shortage in the surgical workforce, we believe that 
     the Senate should look more broadly at the issue of limits on 
     residency positions for all specialties that work in the 
     surgical setting that are also facing severe workforce 
     problems.
       Finally, we are pleased that you have accepted our 
     suggestion and removed language which would reduce payments 
     to physicians who are found to have the highest utilization 
     of resources--without regard to the acuity of the patient's 
     physical condition or the complexity of the care being 
     provided. We thank you for making this important change.
       While we must oppose the Patient Protection and Affordable 
     Care Act as currently written, the surgical coalition is 
     committed to the passage of meaningful and comprehensive 
     health care reform that is in the best interest of our 
     patients. We are committed to working with you to make 
     critical changes that are vital to ensuring that this 
     legislation is based on sound policy, and that it will have a 
     long-term positive impact on patient access to safe and 
     effective high-quality surgical care.
           Sincerely,
         American Academy of Facial Plastic and Reconstructive 
           Surgery; American Academy of Otolaryngology-Head and 
           Neck Surgery; American Association of Neurological 
           Surgeons; American Association of Orthopaedic Surgeons; 
           American College of Obstetricians and Gynecologists; 
           American College of Osteopathic Surgeons; American 
           College of Surgeons; American Osteopathic Academy of 
           Orthopedics; American Society of Anesthesiologists; 
           American Society of Breast Surgeons.
         American Society of Cataract and Refractive Surgery; 
           American Society of Colon and Rectal Surgeons; American 
           Society for Metabolic & Bariatric Surgery; American 
           Society of Plastic Surgeons; American Urological 
           Association; Congress of Neurological Surgeons; Society 
           for Vascular Surgery; Society of American 
           Gastrointestinal and Endoscopic Surgeons; Society of 
           Gynecologic Oncologists.
                                  ____

                                                 December 7, 2009.
     Hon. Harry Reid,
     Majority Leader, U.S. Senate,
     Washington, DC.
       Dear Senator Reid: The undersigned state and national 
     specialty medical societies are writing you on behalf of more 
     than 92,000 physicians in opposition to passage of the 
     ``Patient Protection and Affordable Care Act'' (H.R. 3590) 
     and to urge you to draft a more targeted bill that will 
     reform the country's flawed system for financing healthcare, 
     while preserving the best healthcare in the world. While 
     continuance of the status quo is not acceptable, the shifting 
     to the federal government of so much control over medical 
     decisions is not justified. We are therefore united in our 
     resolve to achieve health system reform that empowers 
     patients and preserves the practice of medicine--without 
     creating a huge government bureaucracy.
       H.R. 3590 creates a number of problematic provisions, 
     including:
       The bill undermines the patient-physician relationship and 
     empowers the federal government with even greater authority. 
     Under the bill, (1) employers would be required to provide 
     health insurance or face financial penalties; (2) health 
     insurance packages with government prescribed benefits will 
     be mandatory; (3) doctors would be forced to participate in 
     the flawed Physician Quality Reporting Initiative (PQRI) or 
     face penalties for nonparticipation; and (4) physicians would 
     have to comply with extensive new reporting requirements 
     related to quality improvement, case management, care 
     coordination, chronic disease management, and use of health 
     information technology.
       The bill is unsustainable from a financial standpoint. It 
     significantly expands Medicaid eligibility, shifting 
     healthcare costs to physicians who are paid below the cost of 
     delivering care and to the states that are already operating 
     under severe budget constraints. It also postpones the start 
     of subsidies for the uninsured long after the government 
     levies new user fees and new taxes to cover expanded coverage 
     and benefits. This ``back-loading'' of new spending makes the 
     long-term costs appear deceptively low.
       The government-run community health insurance option 
     eventually will lead to a single-payer, government run 
     healthcare system. Despite the state opt-out provision, the 
     community health insurance option contains the same 
     liabilities (i.e., government-run healthcare) as the public 
     option that was passed by the House of Representatives. Such 
     a system will ultimately limit patient choice and put the 
     government between the doctor and the patient, interfering 
     with patient care decisions.
       Largely unchecked by Congress or the courts, the federal 
     government would have unprecedented authority to change the 
     Medicare program through the new Independent Medicare 
     Advisory Board and the new Center for Medicare & Medicaid 
     Innovation. Specifically, these entities could arbitrarily 
     reduce payments to physicians for valuable, life-saving care 
     for elderly patients, reducing treatment options in a 
     dramatic way.
       The bill is devoid of real medical liability reform 
     measures that reduce costs in proven demonstrable ways. 
     Instead, it contains a ``Sense of the Senate'' encouraging 
     states to develop and test alternatives to the current civil 
     litigation system as a way of addressing the medical 
     liability problem. Given the fact that costs remain a 
     significant concern, Congress should enact reasonable 
     measures to reduce costs. The Congressional Budget Office 
     (CBO) recently confirmed that enacting a comprehensive set of 
     tort reforms will save the federal government $54 billion 
     over 10 years. These savings could help offset increased 
     health insurance premiums (which, according to the CBO, are 
     expected to increase under the bill) or other costs of the 
     bill.
       The temporary one-year SGR ``patch'' to replace the 21.2 
     percent payment cut in 2010 with a 0.5 percent payment 
     increase fails to address the serious underlying problems 
     with the current Medicare physician payment system and 
     compounds the accumulated SGR debt, causing payment cuts of 
     nearly 25 percent in 2011. The CBO has confirmed that a 
     significant reduction in physicians' Medicare payments will 
     reduce beneficiaries' access to services.
       The excise tax on elective cosmetic medical procedures in 
     the bill will not produce the revenue projected. Experience 
     at the state level has demonstrated that this is a failed 
     policy. In addition, this provision is arbitrary, difficult 
     to administer, unfairly puts the physician in the role of tax 
     collector, and raises serious patient confidentiality issues. 
     Physicians strongly oppose the use of provider taxes or fees 
     of any kind to fund healthcare programs or to finance health 
     system reform.
       Our concerns about this legislation also extend to what is 
     not in the bill. The right to privately contract is a 
     touchstone of American freedom and liberty. Patients should 
     have the right to choose their doctor and enter into 
     agreements for the fees for those services without penalty. 
     Current Medicare patients are denied that right. By 
     guaranteeing all patients the right to privately contract 
     with their physicians, without penalty, patients will have 
     greater access to physicians and the government will have 
     budget certainty. Nothing in the Patient Protection and 
     Affordable Care Act addresses these fundamental tenets, which 
     we believe are essential components of real health system 
     reform.
       Senator Reid, we are at a critical moment in history. 
     America's physicians deliver the best medical care in the 
     world, yet the systems that have been developed to finance 
     the delivery of that care to patients have failed. With 
     congressional action upon us, we are at a crossroads. One 
     path accepts as ``necessary'' a substantial increase in 
     federal government control over how medical care is delivered 
     and financed. We believe the better path is one that allows 
     patients and physicians to take a more direct role in their 
     healthcare decisions. By encouraging patients to own their 
     health insurance policies and by allowing them to freely 
     exercise their right to privately contract with the physician 
     of their choice, healthcare decisions will be made by 
     patients and physicians and not by the government or other 
     third party payers.
       We urge you to slow down, take a step back, and change the 
     direction of current reform efforts so we get it right for 
     our patients and our profession. We have a prescription for 
     reform that will work for all Americans, and we are happy to 
     share these solutions with you to improve our nation's 
     healthcare system.
       Thank you for considering our views.
           Sincerely,
         Medical Association of the State of Alabama, Medical 
           Society of Delaware,

[[Page 30891]]

           Medical Society of the District of Columbia, Florida 
           Medical Association, Medical Association of Georgia, 
           Kansas Medical Society, Louisiana State Medical 
           Society, Missouri State Medical Association, Nebraska 
           Medical Association, Medical Society of New Jersey, 
           South Carolina Medical Association, American Academy of 
           Cosmetic Surgery, American Academy of Facial Plastic 
           and Reconstructive Surgery, American Association of 
           Neurological Surgeons, American Society of Breast 
           Surgeons, American Society of General Surgeons, 
           Congress of Neurological Surgeons.
         Past Presidents of the American Medical Association: 
           Daniel H. Johnson, Jr., MD, AMA President 1996-1997; 
           Donald J. Palmisano, MD, JD, FACS, AMA President 2003-
           2004; William G. Plested, III, MD, FACS, AMA President 
           2006-2007

  Mr. McCAIN. Mr. President, I thank the Senator from Montana for his 
courtesy.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, I must say, some of the debate on the 
other side of the aisle is a little surreal. They say they want to move 
ahead, and then they refuse to enter into any reasonable time agreement 
to consider a necessary appropriations measure. I find it very 
impressive--I am very impressed--how the minority can maintain both 
that they want to move more quickly and not move at all--surreal.
  I wish to also explain, despite what the claims on the other side 
are, that we have attempted mightily to work together on both sides of 
the aisle to get health care reform passed. They claim it is all one-
party rule. Nothing could be further from the truth. Let me explain 
why.
  When we began this effort over a year ago, we had many hearings. In 
fact, last year I think I had 10 hearings in the Finance Committee on 
health care reform to educate ourselves because we knew health care 
reform was going to be a big issue in the year 2009. So, in 2008, we 
had many Finance Committee hearings on all different aspects of health 
care. How does our system work? How do parts fit together? How does 
this all work? We were there to educate ourselves. We did not have a 
political ax to grind. We were not trying to make points. We got the 
experts in and asked: How does it work? How do the different parts of 
our system work together?
  Then we issued a white paper. It was in November of last year. It was 
basically a call to action, which is what we called it. It was about an 
80-, 90-page paper. It was a statement of the health care options: 
delivery system reforms, various ways to get increased health care 
coverage, various ways to help with insurance market reform--lots of 
different provisions.
  I might say, casting all modesty to the wind, that white paper, that 
call to action, back in November of 2008, is probably the basis and 
springboard from which most of the ideas we have been debating, both in 
the House and in the Senate and on both sides of the aisle, come from. 
They basically come from there.
  I might say, it has all been totally transparent. It is all on the 
Internet. It has all been open for everybody. Republicans and Democrats 
participated fully. First was the Library of Congress all-day session, 
both sides fully--that was over a year ago.
  Since then, in 2009, this year, we have had a countless number--in 
the Finance Committee--of what we call roundtables, a countless number 
of walk-throughs, a countless number of hearings on all the various 
aspects of health care reform--bipartisan, fully open.
  Also, I instituted something else here; that is, we got to the point 
where we finally got to the markup, and we put the marked up bill on 
the Internet, again, so everybody sees everything. We also made sure 
all amendments were on the Internet and fully debated by both sides--
totally open, totally transparent. I prided myself on doing that.
  In fact, one very well-known health journalist who works for a very 
major paper walked up to me and said: Max, is this a new way of doing 
things? Maybe you started something, Max, in being so transparent and 
working so much together. Do you think this is the model for the 
future? I said: I don't know. But it impressed him how much we tried to 
work together and did work together with people on both sides of the 
aisle.
  I cannot think of a more comprehensive, more transparent, more 
bipartisan effort than this.
  So what happened? Well, the HELP Committee had their version passed. 
So we in the Finance Committee worked on ours. To move the ball, I 
shifted it to another group--we called it the Gang of 6; three 
Republicans, three Democrats--to try to get a core provision together 
that we could take to the full committee.
  We had a countless number of meetings. I have forgotten the number of 
days we met--I think in the nature of 30 or 40 meetings and close to 
100 hours and with Republicans and Democrats to and fro. Guess what. It 
was very, very constructive. I wish the American public could have been 
an eye on the wall at those meetings and watched these meetings 
proceed. There were very good questions asked by Senators on both 
sides, Republicans and Democrats.
  I highly compliment my friend from Wyoming, Senator Enzi. I highly 
compliment my friend from Maine, Senator Snowe. I highly compliment 
everybody who was there. They asked very good questions--and Senator 
Grassley, of course, he is the ranking member of the Finance Committee; 
and the same on the Democratic side--in an effort to try to find a 
good, solid health care reform bill.
  Well, we kept working--bipartisan--working together for days, days, 
hours, hours. Then, unfortunately, we got to the point where--I am just 
calling it as I see it; one of my failings is I am too honest about 
things--and the Republicans started to walk away. They pulled away from 
the table. They had to leave.
  I ask you, why? Why did that happen? The answer--to be totally fair 
and above board--is because their leadership asked them to. Their 
leadership asked them to become disengaged from the process. I know 
that to be a fact. Why did their leadership ask Republicans to leave 
and become disengaged from the process? To be totally candid, it is 
because they wanted to score political points by just attacking this 
bill. They were not here to help be constructive, to find some 
bipartisan solution. They were for a while. Then, when the rubber 
started to meet the road, when it came time to try to make some 
decisions, they left and began to attack.
  I think a big, unfortunate circumstance in all this--we are going to 
pass health care reform. It is going to pass. It is going to do wonders 
for the American people. We are going to dramatically reform the health 
insurance market. People are going to have health insurance they do not 
now have. We are going to help put in place delivery system reforms. 
That is just a fancy term for saying changing the way we reimburse 
hospitals and doctors in a very positive way, so we are focusing more 
on quality and less on quantity and volume. This bill is going to pass. 
It is going to be a very good bill when it finally does pass and people 
understand it.
  But the unfortunate part is this: It is unfortunate, in my judgment, 
that the other side pursued a strategy of just saying no, just saying 
no, and attack, attack, attack. That is basically what we have heard 
here in the last several weeks, instead of coming up with a 
comprehensive alternative, instead of coming up with a comprehensive 
alternative health care reform package. Then it would have been 
wonderful if we had an honest-to-goodness, solid debate on the pros and 
cons of each side, the merits of each side, a constructive dialog, 
pursuit, inquiry, focus on which portions of this should be put in the 
bill and which should not. But that did not happen. We did not have 
this constructive alternative provision presented to us. We had no 
provision presented to us--and by ``to us,'' I mean the American 
public--so we could debate here. But, rather, they just said no.
  We have worked as hard as we could to be bipartisan. But to be honest 
and

[[Page 30892]]

candid about it, the other side walked away. They walked away, and I 
think it is very unfortunate that happened.
  Mr. President, I yield 5 minutes to the Senator from Massachusetts, 
Mr. Kirk.
  The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
  Mr. KIRK. Mr. President, before I say anything else, I wish to, once 
again, commend the Senator from Montana for his leadership on this 
historic piece of legislation. It is going to have an impact on people 
more widely and broadly than our Social Security system, and this will 
be as important a domestic piece of legislation as that. Every American 
who looks forward to their golden years knows what Social Security 
means.
  The Senator from Montana has quite correctly mentioned how this 
legislation will have an impact on people's lives. I have only been in 
the Senate a short period of time, but I cannot tell you the numbers of 
constituents who have communicated with me about their situation in the 
Commonwealth of Massachusetts; whereas, in 2006, Massachusetts enacted 
health care reform, many of the aspects of that legislation are 
contained in the bill we are debating.
  For the record, today the Boston Globe published a story indicating 
that more than 96 percent of the State's adult taxpayers had health 
insurance in 2008. This is close to universal coverage, and I am sure, 
before too long, we will be able to say we hit the 100-percent mark.
  This is providing affordable insurance to people who otherwise would 
never have had it. When the Senator from Montana talked about how this 
bill would impact people's lives, I am going to tell you a story that 
was told to me by a family who had a situation. I will call them Daniel 
and Brenda. Those are their names.
  They had been living without health insurance for years. In fact, 
Brenda said she could barely remember when they had last gone to the 
doctor because they did not have health insurance. But she learned 
about our Health Care for All on the Helpline that is in existence in 
Massachusetts from a close friend. Soon after she contacted it, her 
husband was diagnosed with a serious heart condition. With the 
indispensable assistance of the Helpline, her family was able to enroll 
in coverage they could afford.
  Brenda's husband Daniel had started to feel constant fatigue. He 
never imagined that someday he would need to have a strong supporting 
device inserted in his heart. Brenda said they truly appreciated all 
the assistance given to them through the Helpline. But there is more.
  Brenda and Daniel recently welcomed a new addition to their family. 
Unfortunately, their son was born with respiratory problems and had to 
stay in the intensive care unit for 7 days immediately after his birth. 
Brenda told us she had a hard time leaving the hospital without her 
newborn son in her arms. But she could also take comfort in being 
surrounded by top medical professionals who were dedicated to caring 
for her son. Here is what she wrote:

       Health Care for All has been such a gift to our lives. 
     First, my husband had no idea of the seriousness of his 
     health issue. If it wasn't for our eligibility with the 
     [State's new health care reform] programs, we would probably 
     have found out about his heart disease too late. And right 
     after came the unexpected surprise of having my son in 
     neonatal care for a week. Both of these situations were hard 
     to go through just emotionally. We just couldn't imagine how 
     it could have been hard financially speaking. That's why, and 
     for many other reasons, we are just so amazed to be 
     Massachusetts residents and count on the tremendous support 
     we have been receiving from the Helpline counselors.

  This is just one example of countless families I have heard from in 
Massachusetts.
  It clearly shows how important it is to pass national health care 
reform and enable all Americans to have the quality, affordable health 
care that Brenda, Daniel, and their son were able to have.
  So I wanted to bring to the attention of our colleagues in the Senate 
a real life story of what health care reform can mean and what will be 
great relief for the financial and health security to American families 
when we enact this legislation.
  I ask unanimous consent that the Boston Globe article I mentioned be 
printed in the Congressional Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                 [From the Boston Globe, Dec. 10, 2009]

      Fewer Taxpayers Are Penalized for Not Having Health Coverage

                         (By Elizabeth Cooney)

       Fewer Massachusetts taxpayers were penalized for lacking 
     required health insurance last year than were fined in 2007, 
     the state said yesterday in a report reflecting the second 
     year that residents had to report on their tax returns 
     whether they were covered under the state's near-universal-
     coverage mandate.
       More than 96 percent, or 3.8 million, of the state's 3.95 
     million adult taxpayers said they had health insurance for at 
     least part of 2008, according to the state Department of 
     Revenue, and 3.65 million had coverage for the entire year.
       About 45,000 tax filers did not have health insurance, 
     although they were classified as able to afford it under 
     state guidelines. They paid a penalty of up to $76 for each 
     month they went without coverage, depending on a sliding 
     scale matched to their income. Another 8,000 successfully 
     appealed their penalties, based on hardship, to the 
     Commonwealth Health Insurance Connector Authority.
       In 2007, when 95 percent of tax filers said they were 
     insured, more people were fined: 60,000 people lost their 
     personal exemption, about $219 for an individual, for not 
     having health insurance that year.
       ``This report gives us yet another data point demonstrating 
     the continued success of health reform with exceptionally 
     high rates of insurance and a smooth system for the mandate 
     in the Commonwealth,'' Lindsey Tucker, health reform policy 
     manager at the advocacy group Health Care For All, said in an 
     e-mailed statement.
       ``The report also reminds us of one of the major gaps in 
     our reform: the thousands of residents unable to purchase 
     insurance due to its lack of affordability,'' she said. ``We 
     must continue to search for ways to keep quality coverage 
     affordable for all our residents.''
       The penalty, which is pegged to one half the cost of the 
     lowest premium offered by the Commonwealth Connector, went up 
     to a maximum of $89 a month for 2009, and the Revenue 
     Department has proposed raising it to $93 in 2010.
       People who are deemed unable to afford insurance are not 
     penalized, and those who have a lapse of up to three months 
     in their coverage are also not subject to the penalty.
       The high percentage of tax filers reporting they have 
     insurance fits with other state reports saying that 97 
     percent of all residents have coverage, Navjeet K. Bal, 
     commissioner of the Department of Revenue, said in an 
     interview.
       ``From 2007 to 2008, we did not see a real drop in health 
     insurance,'' she said. ``Even with the economic turmoil that 
     started in [fall] 2008, people still had health insurance. A 
     year from now, we'll see.''

  Mr. KIRK. Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
  Mr. CASEY. Mr. President, I rise this afternoon to speak on two 
subjects as part of our health care debate. The first is what happens 
to our children. We have had an opportunity over the last couple of 
weeks, and will continue to have a full debate about so many aspects of 
this legislation. When it comes to the question of what happens to our 
children--and I speak of in this case poor children and special needs 
children--I have said from the beginning of this debate and even before 
the debate began many months ago that the standard ought to be four 
words: No child worse off. It is a very simple standard. I think it is 
a standard we can meet and I believe it is a standard we should meet 
for the most vulnerable children in America--those who happen to be 
poor or suffer from or are burdened by special needs, both the impact 
on that child, that individual life, as well as the impact on his or 
her family.
  The good news is that over the last couple of years, we have gotten 
it right with regard to children's health insurance, a program I am 
proud to say had a good bit of its foundation and its origins in 
Pennsylvania. It became a national effort in 1997 when President 
Clinton signed the legislation. We have had, frankly, a lot of 
bipartisan support for this program over many years, although we had 
less bipartisan support when it was reauthorized this past year when 
President Obama signed it into law.
  Here is what it means. The Children's Health Insurance Program, known 
by

[[Page 30893]]

the acronym CHIP, has provided millions of children with health 
insurance coverage they would never have absent that program. We don't 
know the exact number as we speak today, but we are at a point now 
where we have in the range of 7 million or more children covered. Over 
the next couple of years, we will have 14 million American children 
covered. That is an enormous achievement, but more important than any 
kind of legislative achievement, it will mean that 14 million children 
or their families won't have to worry about whether they get quality 
health care.
  In the first year of a child's life, the experts tell us they should 
get to the doctor at least six times for a so-called well child visit. 
A Children's Health Insurance Program in America ensures these children 
receive many benefits, including dental, immunization, and preventive 
care. But the fact I always point to is that for six times in the first 
year of a child's life, he or she will get to see a doctor because they 
are in the CHIP program, and that has an enormous impact for that one 
life, for that one family, but I would argue--and I think the evidence 
is irrefutable--it will have a positive impact on all of our lives, 
because of the impact of millions of children getting that kind of help 
in the early years of their life.
  We know this program works. The Children's Health Insurance Program 
works. That is an understatement. It works well.
  What we are worried about, though--what I am worried about--is that 
there have been people in Washington who have advocated putting the 
Children's Health Insurance Program in the new insurance exchange. The 
exchange is going to be a very positive development for our health care 
system and for adults, but I would argue strongly and vigorously that 
it is not good for kids. So we are going to be debating that maybe in a 
couple of years, but we want to make sure as we debate that question 
that we have as much evidence to show that and put forth the reasons 
why the Children's Health Insurance Program should not--should not--be 
part of the exchange.
  In terms of why we say that, the research on this question is 
indisputable. The director of CBO, the Congressional Budget Office, 
Doug Elmendorf--and we know a lot about CBO. They make determinations 
about this bill and about costs. CBO has said that children will have 
better benefits and more cost savings in CHIP than they will in the 
exchange.
  Yesterday, an organization many people here know as First Focus 
released a white paper which compared Children's Health Insurance 
coverage versus coverage those children would get in the exchange. Here 
are some of the results of that research paper.
  No. 1, the question of children's coverage from 2009 through 2013:

       If health reform were to repeal CHIP in 2013, States would 
     not invest in improving coverage for those children when 
     those very efforts will be dismantled just a few years later.

  It stands to reason. Why would a State go forward to strengthen a 
program they know is going to change as a matter of Federal policy a 
couple of years later?

       The increased coverage of 4 million children that is 
     expected from passing Children's Health Insurance legislation 
     earlier this year would be largely lost.

  That whole effort that took years--years--and two Presidential 
vetoes, before President Obama became President, to get to continue the 
CHIP program and expand.
  No. 2, First Focus, another one of their conclusions:

       Children in most State Children's Health Insurance Plans 
     receive coverage for all approved vaccinations, dental care 
     and well-baby and well-child visits. This level of benefits 
     stand in contrast to private plans, like those in the 
     exchanges.

  What is good for an adult may not be good for a child. Children are 
not small adults as so many advocates have said over and over. But the 
level of benefits that children get in CHIP stands in contrast to the 
provisions in private plans such as those in the exchange which often 
impose limits that are particularly harmful to low-income children and 
children with special needs.
  That is conclusion No. 2 by First Focus.
  Conclusion No. 3 is the following:

       An actuarial study--

  A recent study--

     finds that children moved from CHIP to the exchange plans 
     would dramatically increase out-of-pocket costs for those 
     kids. Out-of-pocket costs for a child living in a family 
     earning 225 percent of the Federal poverty level would 
     increase by 1,100 percent--

  not 1,100 dollars, but 1,100 percent--

     if the Senate were to join the House in repealing Children's 
     Health Insurance Program.

  This is another reason why it is a bad idea. We want to make sure 
this program is strong. We know it works. We also don't want to 
exponentially, radically increase out-of-pocket costs.
  Conclusion No. 4, premiums:

       Because Children's Health Insurance keeps premiums and 
     other out-of-pocket costs for children at low levels, the 
     cost of health insurance exchange plans will be many times 
     higher than that, even for just covering children.

  An increase in premiums will lead to a number of children currently 
enrolled in CHIP to lose coverage--to lose coverage--according to the 
Congressional Budget Office.
  No. 5, reason to do the right thing, access to pediatric providers:

       Children's Health Insurance plans specifically focus on the 
     unique health care needs of children, which is not the case 
     in the proposed exchanges. The recent Children's Health 
     Insurance reauthorization--

  For those who watch these Senate debates, we use words such as 
``reauthorization.'' My simple way of saying that is we do it again. We 
take an existing program, evaluate it, see if it is working, and keep 
doing it. That is what reauthorization is all about. But we did that 
earlier in the year, thank goodness, for children's health insurance.
  The recent effort to continue CHIP included improvements to 
pediatric-specific quality measures that may get lost in the conversion 
of CHIP as a stand-alone program put into the exchange. We don't want 
to do that for kids. We want to make sure every pediatric-specific 
quality measure that we have in place now, all of these years later, is 
maintained. We don't want to injure that. We don't want to cut that 
back.
  Finally, in terms of another item on the list of reasons, guarantee 
to care:

       In exchange plans, some children currently eligible for the 
     Children's Health Insurance Program may be barred--may be 
     barred--from receiving subsidies for coverage due to the cost 
     of employer-sponsored plans.

  Once again, what is good for an adult may not be good for our kids. 
We have to watch this.

       Moreover, the families that are eligible for subsidies and 
     coverage through exchange plans may find coverage so 
     unaffordable that they are left without insurance entirely.

  So we don't want to send a family into the exchange who is trying to 
get insurance for themselves and their kids and find out that they 
can't cover their kids because it costs too much. We have an existing, 
stand-alone Children's Health Insurance Program that we know works.
  This amendment I filed for this debate on health care--the children's 
health insurance amendment to guarantee that we keep it strong, 
strengthen it and continue it--the Children's Health Insurance Program 
has the support of over 500 national and State organizations that focus 
on children's health, health policy generally, social workers, 
children's mental health advocates, school educators, health plans in 
particular, faith groups across the country, and more. These 500 
national and State organizations speak volumes about why this amendment 
is so important. We must strengthen and ensure the continuity of CHIP 
in this health care reform bill. That is what our amendment is all 
about.
  Mr. President, I ask unanimous consent to hae printed in the Record a 
letter addressed to me, dated December 9, from more than 500 
organizations.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

[[Page 30894]]

                                                 December 9, 2009.
     Hon. Robert P. Casey, Jr.,
     U.S. Senate,
     Washington, DC.
       Dear Senator Casey: As organizations committed to ensuring 
     that all of our nation's children get the health coverage 
     they need and deserve, we are writing to thank you for your 
     commitment to making children an important priority by filing 
     Amendment #2790 to the Patient Protection and Affordable Care 
     Act (H.R. 3590). Your amendment builds on the provisions of 
     the underlying bill, continuing to protect and improve the 
     country's successful Children's Health Insurance Program 
     (CHIP) and ensuring that no child ends up worse off as a 
     result of health reform. We applaud your leadership.
       America's children have a lot at stake in health reform. 
     More than eight million children remain uninsured, and more 
     are losing employer-sponsored coverage daily. Families are 
     just one playground accident away from medical bankruptcy. 
     Each day a child is uninsured is a lost opportunity to 
     strengthen our next generation, America's future. Your 
     amendment goes a long way toward protecting and improving 
     coverage for millions of children in low-income working 
     families across the nation by:
       Providing full funding for CHIP through 2019;
       Maintaining current CHIP eligibility through 2013, and 
     setting a floor for income eligibility for children in all 
     states at 250 percent of poverty ($55,125 for a family of 
     four) beginning in 2014;
       Streamlining enrollment procedures making it easier for 
     children to get coverage and keep it;
       Ensuring that coverage for children remains affordable;
       Guaranteeing all children in CHIP the comprehensive care 
     they need from head to toe; and
       Requiring an HHS report in 2016 that will compare coverage 
     for children in CHIP with coverage for children in the new 
     Health Insurance Exchange and if coverage (including 
     benefits, cost-sharing, premiums, and other features) is 
     comparable or better, children can be transitioned from CHIP 
     into the Exchange in 2019.
       Our nation has made great strides over the last decade in 
     securing health coverage for low-income children of working 
     families. We must now seize this historic opportunity to 
     build on the success of prior efforts and the bipartisan CHIP 
     program, and ensure that children will be better off, not 
     worse off, as a result of health reform. Your amendment will 
     do just that.
       We offer our strong support for your CHIP Amendment 
     (#2790). We stand ready to work with you and your Senate 
     colleagues to achieve our common goal of reforming our 
     nation's health care system and ensuring that all children, 
     indeed everyone in America, have access to the health 
     coverage they need and deserve.
           Sincerely,
                                           National Organizations.

  Mr. CASEY. Thank you very much. I wish to inquire as to how much time 
I have.
  The PRESIDING OFFICER. There is 3\1/2\ minutes remaining.
  Mr. CASEY. I will move quickly.
  The second part of my remarks focuses on pregnant and parenting teens 
and women. We have an amendment that focuses on a group of pregnant 
women in America that we are not doing enough about. Neither party, in 
my judgment, is doing enough about them, enough about help for those 
women. I will come back to this maybe later today. But it is vitally 
important, whether we are Democrats, Republicans, or Independents, but 
as Americans, that we give integrity and meaning to the sentiment that 
is often expressed that we care about pregnant women, that we care 
about a teen mother who decides to bear a child, that we are going to 
help her through if she makes that decision.
  If a woman on a college campus becomes pregnant and decides to have 
that child, we want to give her all the help we can. If a woman is a 
victim of domestic violence or other sexual violence or stalking, and 
through all of the horrific nightmare of that violence, she determines 
that she is going to go through with a pregnancy and have a child, that 
we help her in the midst of that darkness, that we give her some light 
in that darkness. What we don't want to have is women who are deciding 
to bear a child who feel all alone, who have to walk that path all by 
themselves.
  That is what this amendment is about. I will return to it later 
today.
  With that, Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mrs. HUTCHISON. Mr. President, I ask unanimous consent that we be 
able to go into a colloquy for the next half hour.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. HUTCHISON. Mr. President, I rise today to talk about the taxes 
that are in this bill--taxes that are imposed in 3 weeks--not 3 weeks 
from 6 months from now, not 3 weeks from 2014, but 3 weeks from now, 
January 1, 2010. Three weeks from now, on January 1, 2010, we are going 
to see the taxes in this bill start.
  I know people are saying: Wait a minute. This bill doesn't take 
effect until 2014. That is what we have been talking about. It is what 
we have been hearing. But, no, the tax part starts in 3 weeks--January 
of 2010.
  I have partnered with Senator Thune, who has been working on this 
problem, and Senator Grassley and Senator Hatch and many others who 
will be speaking today.
  I see my colleagues from Florida, Nebraska, Wyoming, as well as my 
colleague, Senator Crapo, from Idaho, all of whom--Senator Crapo, of 
course, is waiting for a vote on his amendment, which would stop the 
taxes on everyone who makes $200,000 or less.
  We are talking about the taxes because it is such a huge issue. Here 
is what is going to happen with the taxes in the bill that start in 3 
weeks. Americans will pay more in insurance premiums. Americans will 
pay more in prescription drugs. Americans will pay more for medical 
equipment. Let's walk through those taxes.
  In a few weeks, in January of 2010, this will begin: $22 billion in 
taxes on prescription drug manufacturers; $19 billion in taxes on 
medical device manufacturers; $60 billion in taxes on insurance 
companies. That is around $100 billion, which starts in 3 weeks. Then, 
in 2013, the taxes on high-benefit plans take effect. That is $150 
billion in taxes. So for every union member who has a good plan that 
gives them the benefits they have negotiated for over the years, those 
taxes come in at 40 percent of the benefits. That starts in 2013.
  You are still saying: Wait a minute. I thought the bill started in 
2014--and that is right. But the taxes start in 3 weeks, and they keep 
right on going. In 2013, the high-benefit plans start getting a 40-
percent excise tax.
  Mr. President, when the $100 billion in taxes start in 3 weeks on 
drug manufacturers, medical device manufacturers, and insurance 
companies, what happens? Premiums go up immediately, prescription drug 
prices go up immediately, and the medical devices--hearing aids and 
things people need for medical treatments--go up immediately.
  We have been talking about health care reform and the need for it, 
and the need to make history. Yet the reform we are going to see go 
into effect right away is huge tax increases. I am here with many 
colleagues, who are so concerned about this for their constituents.
  I ask the Senator from Wyoming, who is one of the two physicians in 
the Senate--he has been so active in this area. When the taxes go up on 
our insurance premiums, our prescription drugs, and our medical 
equipment, I ask the Senator from Wyoming, as a physician, what does he 
think is going to happen to the cost of health care.
  Mr. BARRASSO. Mr. President, I have great concern about the cost of 
health care for American families. We see it with our seniors 
certainly, as they will be seeing Medicare cuts. In this bill, there is 
$464 billion in Medicare cuts, but there are taxes that are going to go 
up, which will impact all of the people in this country.
  I remember a promise the President made. He said his plan would not 
raise taxes one penny. He went on to say: not your income taxes, 
payroll taxes, capital gains taxes--any of your taxes.
  We are seeing that taxes are going up, and in a way that is 
basically--you hate to say it, but it is a gimmick in this bill, where 
they are going to collect taxes for 10 years but only give benefits for 
6, and it is the last 6 years.
  As my colleague from Texas said, they are going to start collecting 
taxes--today is December 10--on the 31st of this month, 21 days from 
now,

[[Page 30895]]

but the services would not be given for 4 years. That is how they get 
the number under $1 trillion, and it is at a time when the President 
makes a statement that this would not add a penny or a dime to the 
deficit. Eighty percent of the American people don't believe it because 
they know what is in front of them. They know what it is like to live 
their own lives. Is this what the Senator from Texas is seeing as well?
  Mrs. HUTCHISON. The President said, in his address to the joint 
session of Congress, that this bill had to come in at a cost of no more 
than $900 billion. So the CBO scored the bill at $847 billion. But the 
Senator from Wyoming has brought up a point that is because they 
started scoring the bill in 2010, but the services in the bill don't 
start until 2014.
  If you take the years from 2010 to 2019, it probably comes in at $847 
billion. But if you start when the spending starts and go to 2023, the 
cost is $2.5 trillion.
  I just ask the Senator from Nebraska if his constituents are hearing 
of this $2.5 trillion cost, with one-quarter of it coming from Medicare 
cuts and about one-quarter of it in new taxes that start next week. 
What does the Senator from Nebraska say about this?
  Mr. JOHANNS. Mr. President, the citizens from Nebraska are absolutely 
on to this gimmick. They know it is a gimmick. Here is what I tell the 
Senator from Texas: I had an opportunity, as she knows, to be their 
Governor for 6 years. Every year, I had to walk in front of the 
unicameral--our one-house system--and give a state of the State address 
and lay out a budget plan. If I had walked into that chamber with a 
budget plan with these kinds of gimmicks, they would have been rolling 
in the aisles laughing at me, literally. They would have been rolling 
in the aisles.
  I always did a State fly-around, where I visited the communities and 
talked about my budget vision and my legislative package, et cetera. 
The people of Nebraska would have run me out of the State had I tried 
to balance the State budget based upon this kind of gimmicky approach.
  The Senator has absolutely hit the nail on the head. What we have 
here is a situation where those who wrote this bill--as we all know, it 
was written behind closed doors and nobody knew what the bill was until 
a few weeks ago--but those who wrote the bill said: Oh my goodness, the 
President has said we have to bring this bill in under $900 billion. 
That is what he said. How are we going to get that accomplished? So 
they used gimmicks. They uploaded the bill, front-end loaded the bill 
on the revenues, so that starts right away. Then the benefits don't 
start for 3 or 4 years. So it is magic; we have made the bill come in 
under $900 billion.
  Let me offer this thought: Who loses on this crazy accounting 
gimmick? Do you know who loses? The constituents we represent in the 
United States--not just in Nebraska. They are going to pay the taxes. 
They are not going to see the benefits. It is like buying a car and 
paying on it for 4 years but not getting the car for 4 years. They are 
going to pay on it.
  Sadly, and most concerning to me, is that this gimmickry is going to 
be passed on to the next generation because, when it doesn't work, 
somebody has to pick up the bill. The full cost of this bill, we have 
come to recognize, is $2.5 trillion. This bill doesn't fit together. It 
doesn't pass the smell test, as we say back home in Nebraska.
  My hope is that sanity will revisit what we are doing and people will 
say: Time out. We can't ask the American people to go along with this. 
We have to call a timeout and get this right.
  Mrs. HUTCHISON. I thank the Senator from Nebraska. I think having 
been a former Governor, his view is especially important. What we have 
heard through the grapevine--we haven't seen any new proposals, but we 
heard there is going to be an expansion of Medicare and an expansion of 
Medicaid. Medicaid, in particular, is going to be very costly to States 
because they have a matching requirement for Medicaid. Many Governors 
are concerned about that.
  I know the former Governor of Nebraska, in his background, realizes 
that is one of the biggest issues in a State's budget.
  I know the Senator from Florida also has experience with being in a 
Governor's office, being a chief of staff for a Governor. He has been 
very active, especially because the population of Florida has a very 
high rate of senior citizens. The cuts in Medicare in the bill are 
huge. He is on the Senate floor. I am just wondering, when we are 
looking at the cuts in Medicare and the huge taxes, how that will 
impact the State of Florida, and how he thinks we are going to have to 
deal with that.
  Mr. LeMIEUX. Mr. President, I thank the Senator from Texas. This is 
budget gimmickry. As the Senator from Texas said, as a former chief of 
staff who worked on trying to balance the budget because our 
constitution in Florida requires that, we try to figure out how much 
revenue we have and how much we can spend. If there were not enough 
revenues, we either had to cut spending or find a new source of 
revenues. We could not engage in this budget gimmickry.
  If I may borrow an analogy from my friend from Nebraska, this is like 
paying for a car for 4 years before you even get to drive it. Imagine 
you are going to make a substantial purchase--a house or car--and they 
show you the house, and they say here is your mortgage payment, and you 
will live in the house for 10 years, but you will start paying for it 
today. But you can't move in until 2014. That is what this bill does.
  In order to make this ``budget neutral,'' we steal $\1/2\ trillion 
from Medicare--health care for seniors, which seniors have paid into--
and we raise taxes, which is going to increase, not decrease, the cost 
of insurance. When we tax pharmaceutical companies and tax the 
providers of medical devices, what happens? They pass those costs right 
along to the citizens. Not only are we stealing from Medicare, not only 
are we raising taxes, which will be passed on to the citizens, now we 
are going to tell the States we are going to increase Medicaid.
  We are hearing about this secret deal that has been put together 
behind closed doors. My friends are in the dark, and a lot of Democrats 
don't know what is going on either. They are trying to figure out what 
the deal is. The deal will put more of a burden on the States.
  I know my friend from Nebraska knows this, being a former Governor. 
The American people need to know, when you increase Medicaid, the 
States pay the vast majority of that; and because they have to balance 
their budget, they will have to cut something else. So they are going 
to have to cut teachers or law enforcement. So we steal from seniors, 
steal from the States, raise taxes, and we don't cut the cost of health 
care for most Americans.
  I am new to this Chamber, and perhaps my friend from Idaho can help 
me understand this. It doesn't make a lot of sense as to how we should 
proceed with health care reform.
  Mr. CRAPO. No, it does not. I appreciate the comments of my colleague 
from Florida, all my colleagues on the Senate floor today.
  As the Senator from Texas indicated, one of the items of business 
before us today is my motion to commit this bill to the Finance 
Committee to take out the taxes that the President pledged would not be 
in there. The President pledged that no one who makes less than 
$250,000 as a family or $200,000 as an individual will pay any taxes 
under this bill. Yet in the very first 10 years, there is almost $500 
billion of those taxes, a huge portion of which falls on people who are 
in that category.
  As has been indicated, the real implementation of the bill on the 
spending side does not happen until 2014. If you count the amount of 
taxes that start when the spending starts, it is about $1.2 trillion of 
new taxes. Really, the only thing that is transparent--because this was 
all crafted behind closed doors--the only thing that is transparent is 
the gimmick.
  The President said, as the Senator from Texas pointed out, that he 
would not let a bill come across his desk and get a signature if it 
spent more than $900 billion. First of all, you have to

[[Page 30896]]

say: Wow, why do we need almost $1 trillion of new spending? But when 
they went behind closed doors and came up with this bill, it turns out 
it cost around $2 trillion or $2.5 trillion.
  How did they make it meet the $900 billion test? They just said: 
Look, let's delay its implementation for long enough that the number 
comes out to under $900 billion. That happened to be the year 2014. So 
if you don't count the first 4 years and only count 6 of the 10, then 
in this budget window we are working in you can get your number. It is 
just remarkable.
  Before I ask the Senator from South Dakota about his perspective, 
because I know he is working with the Senator from Texas on an 
amendment to try to correct this gimmick, I would like to respond to 
one quick point I know our opposition on the other side has continued 
to make, and that is they actually say there are no tax increases in 
the bill.
  How do they say that? Here is the way they say it. There are 
subsidies in the bill that are provided to people with low income who 
do not have adequate access to insurance. Those subsidies total about 
$400 billion in the bill in the first 10 years, which is really only 6. 
They count those subsidies as a tax cut. The technical term given to 
them is a ``refundable tax credit,'' although $300 billion of those 
subsidies do not go to taxpayers. The people who receive them do not 
have a tax liability. But then they offset those subsidies against the 
taxes the rest of America will pay and say, therefore, there are no 
taxes in the bill.
  I think that is another form of gimmickry. I ask my colleague from 
South Dakota what his perspective is on the types of gimmicks we are 
seeing and whether the American people should insist that these kinds 
of things be removed from the bill.
  Mr. THUNE. I say to my colleague from Idaho that I support his 
motion. I hope we get a chance to vote on it. I know right now they are 
scrambling to find an alternative to put up so they can have something 
on which to give their side political cover because they know the 
reason they are trying so hard is because they know this raises taxes. 
To say with a straight face this does not raise taxes--the American 
people get this. I think the gig is up. They figured out there are huge 
Medicare cuts in this bill, huge tax increases in this bill. And as the 
Senator from Idaho pointed out, when they say these refundable tax 
credits are going to go back in the form of premium subsidies and there 
are not that many people who are going to pay, as he pointed out, 73 
percent of the people who will get those premium subsidies are people 
who do not have an income tax liability already. Therefore, it is hard 
to say you are going to reduce taxes on somebody who does not have an 
income tax liability.
  More important than that, there are still 42 million Americans with 
incomes under $200,000 a year, according to the Joint Tax Committee, 
who are going to see their taxes go up under this bill. So you 
literally have millions and millions of Americans under $200,000 a 
year. And as the Senator from Idaho mentioned, the President's promise 
was he would not raise taxes on anybody earning under $250,000 a year. 
This flatly contradicts that, flatly violates that pledge. I cannot 
fathom anybody coming here with a straight face and saying: Oh, yes, 
this doesn't raise taxes. Of course it raises taxes.
  What the Senator from Texas and I intend to do on our motion--and I 
hope we have a chance to vote on it and the Senator's motion--we will 
go back to the committee and figure this out. We want to offer a motion 
that we think makes sense because it aligns and synchronizes the dates 
of all this.
  What has happened here, I would say, in a very deceptive way, is they 
understated the costs of the bill. My colleagues on the floor already 
alluded to this. They tried to get it under $1 trillion, and in attempt 
to get it under $1 trillion, they had to come up with budget gimmicks.
  To illustrate that with a bar chart, we can see in the first 10 years 
of this bill--starting today and going to 2019--the spending in the 
early years does not show up much. That is because most of the spending 
gets put off until January 1, 2014.
  So if we look at that first 10-year period, the spending under the 
bill is less than it will be when the bill is fully implemented. When 
the bill is fully implemented, looking at the years 2014 to 2023, it 
explodes the spending in the bill from about $1 trillion over the first 
10 years to $2.5 trillion over the 10 years when it is fully 
implemented.
  The reason they were able to do that is because of this sort of 
smoke-and-mirrors way of enacting the tax increases immediately and 
delaying the spending. The American people are going to end up spending 
$71 billion in tax increases out of their pockets, out of the American 
taxpayers' pockets, about $600 per taxpayer, before they ever see a 
benefit under this bill.
  What the Senator from Texas, Mrs. Hutchison, and I are offering is a 
motion that would delay the tax increases until such time as the 
benefits begin. That, to me, seems to be a fair way to go about making 
public policy.
  What they have done, in an effort to obscure the overall cost of this 
bill, is to say that 22 days from now, we are going to raise your 
taxes. On January 1 of this year is when most of these taxes--the taxes 
on prescription drugs, taxes on medical devices, taxes on health 
plans--all the taxes in the bill begin to take effect January 1 of next 
year. For 4 years, people will be paying taxes out of their pockets. I 
might add, because of the taxes that are going to go on all the device 
manufacturers, prescription drugs, and health plans, they will get 
passed on in the form of higher premiums. They are going to see tax 
increases and premium increases before they ever see a dollar of 
benefits.
  It is 1,483 days until the benefits under this bill kick in. That is 
unfair. It is unfair to the American taxpayer, it is unfair to the 
American people, and it is unfair to try to obscure and mask the total 
cost of this bill and say we are only spending $1 trillion on this bill 
when we know full well when it is fully implemented, the total cost of 
that is $2.5 trillion.
  I appreciate the discussion that is being held here in pointing out 
the smoke and mirrors, the sort of underhanded way to try to shield the 
cost of this bill but also to support the Senator from Idaho with his 
motion that would commit this bill and get these tax increases out of 
here because the one thing small businesses are saying right now is we 
want to invest, we want to create jobs. But you cannot raise taxes on 
small businesses when you want them to create jobs. That is what this 
bill does.
  The National Federation of Independent Business, the Chamber of 
Commerce, the National Association of Wholesalers and Distributors--all 
the major business organizations--have come out opposed to this bill.
  The National Federation of Independent Business in a letter yesterday 
said: We do not support policies that increase the cost of doing 
business and that raise taxes. Clearly, that is what this bill does.
  Our motion is very simple; that is, it simply delays tax increases 
until such time as the benefits begin.
  Mrs. HUTCHISON. I am very pleased that the Senator from South Dakota 
talked about what we are trying to do because it is very simple. It is 
very simple. The Hutchison-Thune motion to commit says, if we do 
nothing else, if we do nothing else in this bill, we have to be fair 
and transparent with the American people; that is, we do not start the 
taxes, we do not start the increases in premiums, increases in 
prescription drug benefits, increases in medical devices until at least 
there is an implementation of this insurance program that we hear is 
going to be offered to the American people. We have not seen it, but we 
are told that there is going to be an insurance program that Americans 
can sign up for, but they are going to be paying higher taxes and 
premiums and costs in health care for 4 years before they ever see it. 
All we are saying is, let's send this bill back to committee and fix 
that.
  It does not--as the Senator from Nebraska said earlier--pass the 
smell test. It does not pass the smell test in

[[Page 30897]]

Nebraska, Wyoming, Florida, Idaho, South Dakota, or Texas. To tax 
people for 4 years, to raise their costs until they basically are going 
to say, Give me an alternative, and the alternative is, guess what: A 
big government takeover of our health care system. That is like saying: 
I am from the Federal Government, and I am here to help you. We have 
heard that before.
  I do not think the American people will in any way believe that this 
bill is fair or honest with them if we start the taxes 22 days from 
now, as the Senator from South Dakota has pointed out, but they do not 
see a program. They are going to go online and say: Oh, my premiums are 
going up, my prescription drugs are going up; my goodness, where is the 
insurance program they have been talking about? They are going to go 
online, but, hey, there is no program.
  How can we go home--I ask any of the Senators who would like to add 
their perspective on this--how are you going to go home and tell your 
constituents that your taxes start in 22 days, and maybe in 4 years, 
roughly, maybe you are going to see a program, and we are from the 
Federal Government, and we are here to help you?
  Mr. BARRASSO. You cannot go home and say that with a straight face. 
There are many rural areas in our States. People see through all this.
  There are two articles next to each other in today's New York Times. 
One talks about the details of the secret agreement they are working on 
behind closed doors. It says: ``Details Are Scanty.'' Right next to it 
it talks about: ``For Rural Elderly, Times Are Distinctly Harder.'' 
These are the people who are going to see taxes going up, these are the 
people who are going to see cuts in Medicare.
  I want to read the first paragraph because this is from Lingle, WY, a 
community in my State. It talks about Norma Clark, 80. It says:

       Norma Clark, 80, slipped on the ice out by the horse corral 
     one afternoon and broke her hip in four places.

  I am an orthopedic doctor. I have taken care of these over the years.

       Alone, it took her three hours--

  These are the kind of wonderful Americans we have--

       Alone, it took her 3 hours to drag herself 40 yards back to 
     the house through snow and mud, after she had tied her legs 
     together with rope to stabilize the injury.

  This is a person who is on Medicare, and they are going to cut $464 
billion from Medicare, and they are going to use gimmicks that are 
going to harm our people.
  I have a former Governor and a former chief of staff for a Governor's 
office. You know in the rural parts of your community, I say to 
Governor, now the Senator from Nebraska, you have people like that--
hard-working people who expect honesty from a government, and they are 
not getting it in this bill which is going to tax for 10 years and only 
give services for 6.
  Mr. JOHANNS. That is such a compelling story. I want to add something 
to that. When you think the policy could not get more crazy and insane, 
you hear about this idea that they are going to expand Medicare, which 
is due to be insolvent in 2017. But the tragedy of that in relating it 
to the story you just told us is this: That will hammer our rural 
hospitals. Why? Because they cannot stay open on Medicare reimbursement 
rates. They cannot stay open on Medicaid reimbursement rates.
  This poor woman who dragged herself to try to get some care all of a 
sudden could be faced with the possibility that the hospital she relies 
on will not stay open under this health care bill.
  I have been to those hospitals. I have seen the struggles they are 
going through with Medicaid and Medicare reimbursement. Every hospital 
administrator tells me the same thing: We would close our doors if we 
had to live on that.
  So what is their solution? Expand Medicaid and Medicare. You have got 
to be kidding me. Who are they listening to? You know what. Take this 
bill out to the rural areas of Nebraska. You will get an earful.
  Mrs. HUTCHISON. How much time is left on our side?
  The PRESIDING OFFICER. Seven seconds--2, 1, 0. Time has expired.
  Mrs. HUTCHISON. Let me give the last 5 seconds to the Senator from 
South Dakota.
  The PRESIDING OFFICER. Time has expired.
  Mr. THUNE. I yield back my 5 seconds. I don't have enough time to 
distribute equally. It would not be fair.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. NELSON of Florida. Mr. President, I ask unanimous consent that 
the time for debate only be extended until 2 p.m., with the time 
equally divided, with Senators permitted to speak for up to 10 minutes 
each, with no amendments in order during this time.
  Mrs. HUTCHISON. Reserving the right to object, I ask the Senator from 
Florida, it is 10 minutes and going back and forth. It is not 30 
minutes allocated per side; is that correct?
  Mr. NELSON of Florida. It is back and forth.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The PRESIDING OFFICER. The Senator from Missouri is recognized.
  Mr. BOND. Mr. President, I ask to be advised when I have used 8 of my 
10 minutes.
  The PRESIDING OFFICER. The Senator will be so notified.
  Mr. BOND. Mr. President, small businesses are the backbone of our 
economy. They make up 99.7 percent of all employer firms. They employ 
just over half of all private sector employees. They pay 44 percent of 
the total U.S. private payroll. They have generated 64 percent--a 
majority--of the net new jobs over the past 15 years. They create more 
than half of the nonfarm private gross domestic product, and they hire 
40 percent of all high-tech workers.
  Small businesses drive this economy. They are also the sector most in 
need of real health reform that will reduce cost and make it easier to 
buy insurance. It is estimated that 26 million of the uninsured are 
small business owners, employees, and their dependents. That is a 
majority of the uninsured. They continue to struggle to be able to 
afford health care.
  Here are two examples: Jim Henderson, president of Dynamic Sales in 
St. Louis, has made every adjustment in the book to continue to provide 
health insurance to his employees. He covered both employees and their 
families back in the 1980s, but he is now at a point where he can only 
afford to provide for his employees. He pays 70 percent, his employees 
30 percent. Jim is one of the very few small businesses that right now 
have weathered the storm despite the economy. He wants reform that 
lowers cost and helps individuals better spend their health care 
dollars.
  Unfortunately, the Democratic health care bills we have seen so far--
and I guess we haven't seen all of them--won't help Jim to continue to 
provide his employees health care.
  Kathie and Tom Veasey own True Value Hardware in Wilmington, DE, the 
hometown of Vice President Biden. They employ 28 people, most of whom 
they consider family. They cover 100 percent of the cost for their 
employees and half for their families. But they have seen huge 
increases in premiums over the years, with a 36-percent increase just 
this year after an employee got sick. Each year, they are forced to 
shop for health insurance, but they continue to have limited choices 
due to an uncompetitive market.
  Unfortunately, the Democratic bills won't fix the problem or help 
Kathie and Tom continue to provide their employees health care.
  If we really want to get out of this recession, if we really want to 
address the problem of affordable and accessible health insurance, then 
the majority party needs to take a hard look at health care reform.
  First of all, we need to allow small businesses to go together and 
purchase health care across State lines so they have true competition 
and so they can lower costs. We need medical malpractice reform, which 
would cut $120 billion to $200 billion out of the cost of health care.
  However, when we look closely, the bills we see before us do not 
address the real health care needs, and, in fact, by imposing more 
taxes--and taxes which the CBO said will be passed from

[[Page 30898]]

health care companies down to those who are paying the private bills--
not only will it make health care less affordable for these small 
businesses, it will force many of them to drop whatever coverage they 
have now.
  Tax equity is extremely important. An employee of a large corporation 
or a union member who gets health care premiums paid for by their 
employer or by their union doesn't have to record them as income. Small 
businesses, their employees, farmers, and individual purchasers need 
the same benefit that the employees of large corporations and union 
members get.
  Now, instead of proposing commonsense health care solutions for small 
businesses, the bills we have seen coming out of the smoke-filled rooms 
run by the majority leader continue to heap costly new burdens on small 
businesses that are trying to keep their doors open. More and more it 
seems small businesses are under attack, and that is what they are 
telling us. One of the universities that visited me this past week is 
trying to do something to help small businesses, and I said: What is 
the attitude? They say: The attitude of small business is that they are 
under attack by what is being done in Congress and what is being 
proposed by the administration.
  The 2010 budget calls for tax increases on those earning $250,000 or 
more. For small businesses that are taxed at their personal rate--
proprietorships, partnerships, and sub S corporations--these tax 
increases hit the returns of those small businesses, and they are taxed 
at the punitive rate. Higher energy taxes on businesses in the cap-and-
trade plan will put many small businesses in my part of the country out 
of work. New taxes and new mandates in the health care bill will be 
passed on.
  Randy Angst of Lebanon, MO, says the following about the Senate bill:

       The new taxes would eliminate roughly half of my profits. 
     It would force me to let employees go, refrain from hiring 
     new employees and prevent me from reinvesting in my business. 
     The mandates would be very harmful and make it much more 
     costly for me to operate my business.

  This bill--the last bill we have seen--requires a costly $28 billion 
new mandate on businesses that do not offer health care. Who pays that 
mandate? Anybody looking for a job. If you tell businesses they have to 
spend big money on a mandate, they cannot spend it on hiring new 
workers. The mandates do nothing to reduce insurance costs, and because 
they are focused on full-time workers, the mandate gives companies an 
incentive to classify more of their workers as part time.
  Gene Schwartz, with K&S Wire Products in Neosho, MO, says:

       We are in a recession and I am in manufacturing. The 
     legislation would be nothing but detrimental to us. Our 
     workforce is already down 25 percent from last year, and if 
     this bill goes through in its current form, the new taxes and 
     mandates will force me to make further cuts. Also, this bill 
     will increase my costs by further raising my already sky-high 
     insurance premiums.

  This bill also includes more paperwork which is costly for a small 
business. Section 9006 requires that every time a business vendor sells 
a service or property exceeding $600 to another business, the receiving 
business must report the transaction to the IRS. That is an enormous 
new costly paperwork burden that will hit almost every business 
regardless of how small.
  These mandates and regulations disproportionately affect small 
businesses and come at a high cost. According to the SBA's own Web 
site, very small firms with fewer than 20 employees annually spend 45 
percent more per employee than larger firms to comply with Federal 
regulations. These very small firms spend 4\1/2\ times as much per 
employee to comply with environmental regulations and 67 percent more 
per employee on tax compliance than their larger counterparts.
  The bill clearly fails to bring down the cost of health care for 
small businesses. It fails to bring down the cost of health care at 
all, but it is especially hard on small businesses that can't afford 
coverage under the current law.
  Small business owners from my State have come to me for two decades 
looking for more affordable ways to make health insurance available. 
They want to be able to provide insurance for their people. That is why 
I have long been a champion of small business health care reform.
  Does the majority's bill include strong reform that will allow small 
businesses and the self employed access to more affordable, more 
accessible health care? No.
  Does the bill include protections for small businesses that 
disproportionately feel the burden of increased government mandates and 
taxes? No.
  In fact, CBO has said that this bill will increase premiums for 
individuals in the non group market by 10-13 percent.
  Premiums for small businesses could increase by 1 percent or be 
reduced by 2 percent but it is easy math. If a small business cannot 
afford to provide health insurance now, they will not be able to afford 
to do so under this bill.
  According to CBO, under current law families in a small group plan 
today pay about $13,300. In 2016, they will pay about $19,200 if this 
bill becomes law.
  That is the wrong direction.
  Health care is already too expensive for small businesses. We need to 
make it cheaper. It should not cost a family $19,200 in 2016 for health 
insurance.
  This bill continues down the path of unsustainable health care costs.
  In fact that is one of the main reasons the National Federation of 
Independent Businesses opposes this bill. They say, ``Small businesses 
can't support a proposal that does not address their number 1 problem--
the unsustainable cost of healthcare. With unemployment at a 26-year 
high and small business owners struggling to simply keep their doors 
open, this kind of reform is not what we need to encourage small 
business to thrive.''
  This bill also imposes new taxes and fees, like the $6.7 billion per 
year tax increase on health insurance companies.
  Yes, the majority wants to sock it to the insurance companies.
  Well, guess what. The insurance companies are going to pass the costs 
along to consumers.
  Small businesses cannot self-insure, they must purchase products 
available in the marketplace. That is why CBO has found that increased 
costs due to fees being passed on to the consumer will be more 
pronounced for small businesses. NFIB has also said this new tax will 
fall almost exclusively on small businesses.
  This bill just does not help small businesses.
  I know the argument my colleagues on the other side offer.
  They say they provide a tax credit to help small businesses.
  What they don't say is that this is a bait and switch.
  First of all, in order to get the full credit, you cannot have more 
than 10 workers who get paid an average of $20,000.
  After that, the credit begins to phase out for each employee you have 
above 10. It also phases out for each $1,000 increase in average wages 
above $20,000. If you have 25 employees or you pay more than an average 
wage of above $40,000, you don't even get the credit.
  The real kicker is that the full credit is only available for 2 years 
after the exchange takes effect. Then that is it.
  A small business will either have to offer an employee health 
insurance--which will really not be any cheaper than it is today--or 
they will have to pay a fine. Or an employee can go into the exchange 
as an individual where insurance will cost 10-13 percent more.
  Let us examine a realistic situation using Jim from St. Louis as an 
example.
  As I mentioned before, the small business tax credit is filled with 
thresholds and variations that make it of limited value for the few 
small businesses that are eligible to claim the credit.
  The full value of the credit, which is equal to 50 percent of the 
business owner's costs, is available for small businesses with 10 or 
fewer workers that pay their employees an average annual wage of 
$20,000 or less. But the credit also starts to phase out as the 
employer adds employees or gives raises, so the entire credit is gone 
if the employer has 25 or more employees and

[[Page 30899]]

pays them an average wage of $40,000 or more.
  Jim has six employees and his average annual wage is about $39,000. 
Jim has to ask if he meets the two threshold questions before he can 
determine whether he gets the tax credit. He passes the first test, 
since he only has six employees. But Jim's credit is reduced because he 
has paid his employees too much in wages.
  Today, Jim's health care costs are $30,540. If he qualified for the 
full value of the credit, his annual health care costs would be 
$15,270--about half of what he pays now.
  But the value of his small business tax credit is directly related to 
wage, so the value of Jim's credit is reduced to $763 based on the 
formula. That is a small fraction of his health care costs and wouldn't 
even cover the cost of hiring an accountant to figure out how much the 
credit is worth.
  Because Jim is already so close to the highest average wage to be 
eligible for any credit at all, this means if he gives his employees a 
well-earned and well-deserved raise, he will lose the credit 
altogether.
  In these tough economic times, the government is encouraging small 
business owners like Jim to create more jobs, but if they create too 
many or pay people too much, then the government will reward them by 
taking away their small business tax credit.
  And even worse, the phase-outs mean that Jim has a disincentive to 
hire more workers.
  So this bill completely misses the mark for small businesses.
  Mr. President, our small businesses are struggling. We owe more to 
this critical sector of our economy which is responsible for half of 
the private-sector jobs and employees than a bill that mandates taxes 
and fails to provide real health care reform.
  In a recent letter to Senator Reid, the NFIB outlines how the bill 
will adversely affect business owners.

       When evaluating healthcare reform options, small business 
     owners ask themselves two specific questions. First, will the 
     bill lower insurance costs? Second, will the bill increase 
     the overall cost of doing business? If a bill increases the 
     cost of doing business or fails to reduce insurance costs, 
     then the bill fails to achieve their No. 1 goal--lower costs.
       In both cases, the Patient Protection and Affordable Care 
     Act (H.R. 3590) fails the small business test and, therefore, 
     fails small business.

  They further say in the letter:

       Despite the inclusion of insurance market reforms in the 
     small-group and individual marketplaces, the savings that may 
     materialize are too small for too few and the increase in 
     premium costs are too great for too many. Those costs, along 
     with greater government involvement, higher taxes and new 
     mandates that are disproportionately targeted at small 
     business and are being used to finance H.R. 3590, create a 
     reality that is worse than the status quo for small business.

  It is worse than the status quo.
  Mr. President, it is time to stop attacking small business and work 
on real reform. We should defeat this proposal that does not make 
insurance more affordable, is a massive government intrusion into 
health care and that will pay for new entitlement programs on the backs 
of our small businesses.
  Let us put this debate in context. If small businesses do most of the 
hiring, and we are counting on them to help lead us out of the 
recession, why would we want to increase their costs of doing business 
and make it less likely they will hire new workers?
  President Obama hosted a Forum on Jobs and Economic Growth last week, 
where he invited ideas to jump start job growth in our sluggish 
economy.
  Now, he and the majority are considering a new plan to jump-start job 
growth using ``unspent'' or returned TARP funds. Have they forgotten 
that it is all borrowed money, and thus deficit spending, in the first 
place?
  Let me submit that the bill before us will hurt job creation.
  Before practicing medicine, doctors often take an oath, the 
Hippocratic Oath, where they promise to refrain from doing harm. I 
would like to see Congress and the President take the same oath.
  How can you on the one hand legislate new taxes on businesses in the 
name of health reform--coupled with new energy taxes in the name of 
climate protection--and on the other hand ask businesses to generate 
new jobs? It cannot be done. Massive tax increases and job creation are 
mutually exclusive.
  Employers who face uncertainty regarding new, oppressive taxes and 
mandates are not going to want to sink money into new jobs. It is that 
simple.
  We should think about the harm we will do to small businesses through 
this legislation and instead work on commonsense reforms that have 
bipartisan support.
  Mr. President, I ask unanimous consent to have printed in the Record 
the letter from the National Federation of Independent Businesses.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                               National Federation


                                      of Independent Business,

                                                 December 8, 2009.
     Senator Harry Reid,
     Majority Leader, Hart Senate Office Building, Washington, DC.
     Senator Mitch McConnell,
     Minority Leader, Russell Senate Office Building, Washington, 
         DC.
       Dear Senators Reid and McConnell: As the Senate continues 
     to debate the future of comprehensive healthcare reform, the 
     National Federation of Independent Business, the nation's 
     leading small business association, is writing in opposition 
     to the Patient Protection and Affordable Care Act (H.R. 
     3590).
       When evaluating healthcare reform options, small business 
     owners ask themselves two specific questions. First, will the 
     bill lower insurance costs? Second, will the bill increase 
     the overall cost of doing business? If a bill increases the 
     cost of doing business or fails to reduce insurance costs, 
     then the bill fails to achieve their No. 1 goal--lower costs.
       In both cases, the Patient Protection and Affordable Care 
     Act (H.R. 3590) fails the small business test and, therefore, 
     fails small business. The most recent CBO study detailing the 
     effect that H.R. 3590 will have on insurance premiums 
     reinforces that, despite claims by its supporters, the bill 
     will not deliver the widely-promised help to the small 
     business community. Instead, CBO findings report that the 
     bill will increase non-group premiums by 10 to 13 percent and 
     result in, at best, a 2 percent decrease for small group 
     coverage by 2016. These findings tell small business all it 
     needs to know--that the current bill does not do enough to 
     reduce costs for small business owners and their employees.
       Despite the inclusion of insurance market reforms in the 
     small-group and individual marketplaces, the savings that may 
     materialize are too small for too few and the increase in 
     premium costs are too great for too many. Those costs, along 
     with greater government involvement, higher taxes and new 
     mandates that are disproportionately targeted at small 
     business and are being used to finance H.R. 3590, create a 
     reality that is worse than the status quo for small business. 
     The shortcomings of the Patient Protection and Affordable 
     Care Act include:
     A New Small Business Health Insurance Tax
       Unlike large businesses, which self-insure and find 
     security under the blanket of ERISA, most small businesses 
     are only able to find and purchase insurance in the fully-
     insured marketplace. The Senate bill includes a new $6.7 
     billion annual tax ($60.7 billion over 10 years) that falls 
     almost exclusively on small business because the fee is 
     assessed on the insurance companies. CBO's most recent study 
     reinforces those costs will ultimately be passed on to their 
     consumers, leaving the cost to be disproportionately borne by 
     small business consumers in the individual and small-group 
     marketplace whose only choice is to purchase those products 
     or forgo insurance altogether.
     A New Mandate That Punishes Employers, Employees and Hinders 
         Job Creation
       Employer mandates fail employers and employees in two ways. 
     First, mandates do nothing to address the core issue facing 
     small business--high healthcare costs. Second, mandates 
     destroy job creation opportunities for employees. The job 
     loss, whether through lost hiring or greater reliance on 
     part-time employees, harms low-wage or entry-level workers 
     the most. The employer mandate in H.R. 3590 sets up 
     potentially troubling outcomes for this sector of the 
     workforce. The multiple penalties assessed on full-time 
     workers will most certainly result in a reduction of full-
     time workers to part-time workers and discourage the hiring 
     of those entrants into the workforce who might qualify for a 
     government subsidy, hardly an outcome that contributes to a 
     greater insured population.
     A Poorly-Structured Small Business Tax Credit
       As structured, the small business tax credit will do 
     little, if nothing, to propel either more firms to take-up 
     coverage or produce greater overall affordability. Due to its 
     short-term temporary nature and the limitations based on the 
     business' average wage, its benefit is, at best, a temporary 
     solution

[[Page 30900]]

     to the long-term cost and affordability problem. A tax credit 
     that is poorly structured is not going to provide sustainable 
     and long-term relief from high healthcare costs, and the 
     recent CBO finding that the tax credit would benefit only 12 
     percent of the small business population illustrates its lack 
     of effectiveness.
     A Benefit Package That Is Too High a Hurdle for Small 
         Business
       NFIB has voiced concern over establishing a benefit 
     threshold that is too high a price tag for small businesses 
     to meet. Small businesses are especially price sensitive. 
     They need purchasing choices that provide the flexibility in 
     coverage options that reflect their marketplace and business 
     needs. If Congress doesn't adjust the actuarial value 
     standards in the legislation, what may be affordable this 
     year may be unaffordable next year. As a result, small 
     business owners will be at risk of having to drop coverage 
     due to cost increases that outpace their healthcare budgets.
     Destructive Rating Reforms and Phase-In Timelines That 
         Threaten Affordability for All
       NFIB supports balanced federal rating reforms that protect 
     access and affordability, regardless of an individual or 
     group's health status. However, the excessively tight age 
     rating (3:1) in H.R. 3590 will increase more costs than it 
     will decrease, and make coverage unaffordable for the very 
     populations that are most beneficial to the insurance pool--
     the young and the healthy. Independent actuaries have 
     analyzed the negative impact of such tight bands and have 
     indicated that there will be devastating effects to the long-
     term viability of a pool without action to correct this 
     rating imbalance.
       Additionally, to prevent volatile spikes in insurance 
     premiums, also known as ``rate shock,'' federal rating 
     reforms must be appropriately applied to all marketplaces and 
     phased in over a responsible period of time. If this is not 
     done, then certain plans, including ``grandfathered plans,'' 
     will utilize different rating practices when underwriting 
     risk, which can create adverse selection issues. Those 
     selection problems will have a striking negative impact on 
     the new exchanges--exchanges that are meant to improve, 
     rather than decrease, affordability for small business and 
     individuals.
     National Plans That Provide Limited Promise for Success
       Leveling the playing field for small business starts with 
     allowing uniform benefit packages to be purchased across 
     state lines. If done right, this can provide a greater 
     security that, as people change jobs and move from state to 
     state, they can keep the benefit plan that meets their 
     healthcare needs. National plans would be particularly 
     helpful for states with smaller populations and where 
     consumers lack a robust marketplace with choice and 
     competition for private plans. Specifically, the state ``opt-
     out'' language in the Patient Protection and Affordable Care 
     Act would create more disincentives than incentives for 
     carriers to embark on these new opportunities. If the 
     national plan section is not significantly restructured to 
     make national plans a viable option, then these new 
     opportunities will never materialize for small business.
     Threatens Flexibility and Choice for Employers and Employees
       Small employers need more affordable health insurance 
     options and new alternatives for employers to voluntarily 
     contribute to individually-owned plans. Provisions also need 
     to be structured to insure that options are widely available 
     to both employers and employees. The simple cafeteria plan 
     language in H.R. 3590 excludes the owners of many ``pass-
     through'' business entities from participating in these 
     arrangements. If owners are unable to participate in the 
     plan, they will be less likely to provide insurance to their 
     workforce. Finally, small business needs the freedom and 
     flexibility to preserve options that are already proven to 
     work. Prohibiting the use of HSA, FSA and HRA funds to 
     purchase over-the-counter medications, along with the $2,500 
     limit on FSA contributions, diminishes that flexibility and 
     threatens to further limit the options employers have to 
     provide meaningful healthcare to their employees.
     New Paperwork Costs on Small Businesses
       The cost associated with tax paperwork is the most 
     expensive paperwork burden that the federal government 
     imposes on small business owners. The Senate bill 
     dramatically increases that cost with a new reporting 
     requirement that is levied on business transactions of more 
     than $600 annually, leaving small business buried in 
     paperwork and increasing their paperwork compliance expenses.
     An Unprecedented New Payroll Tax on Small Employers
       Since its creation the payroll taxes that fund the Medicare 
     programs have not been wage-based and are dedicated 
     specifically to funding Medicare. The Senate bill changes the 
     nature of the tax and creates a precedent to use payroll 
     taxes to pay for non-Medicare programs.
     The Absence of Real Medical Liability Reform
       NFIB strongly supports medical liability reform as a means 
     to both inject more fairness into the medical malpractice 
     legal system, and to reduce unnecessary litigation and legal 
     costs. Taking serious steps to adopt meaningful medical 
     liability reform is a significant step toward restoring 
     common sense to our medical liability litigation system. It 
     also is especially critical to improving access to healthcare 
     for those living in rural areas, where it is becoming 
     increasingly difficult for those in need to locate 
     specialists such as OB/GYNs and surgeons.
     The Creation of a New Government-Run Healthcare Program
       A government-run plan will drive the private healthcare 
     marketplace out of business. Private insurers will be unable 
     to compete in a climate where the rules and practices are 
     tilted in favor of a massive government-run plan. This means 
     millions could lose their current coverage. This will 
     decrease choice and increase costs. On both accounts, the 
     government-run plan will leave small business with a single 
     option--the government-run plan, which is the exact opposite 
     outcome small businesses want from healthcare reform.
       There is near universal agreement that, if done right, 
     small business has much to gain from healthcare reform. But 
     if it is done wrong, then small business will have the most 
     to lose. The Patient Protection and Affordable Care Act, 
     which is short on savings and long on costs, is the wrong 
     reform, at the wrong time and will increase healthcare costs 
     and the cost of doing business. NFIB remains committed to 
     healthcare reform, and urges the Senate to develop common 
     sense solutions to lower healthcare costs while ensuring that 
     policies empower small business with the ability to make the 
     investments necessary to move our economy forward.
           Sincerely,

                                                Susan Eckerly,

                                            Senior Vice President,
                                                    Public Policy.

  Mr. BOND. Mr. President, I have a couple of other comments I wish to 
add.
  We have now learned that there is a new proposal coming out of the 
back rooms--the smoke-filled rooms. Every time something new is thrown 
up on the wall, we stand around with a great deal of interest to see 
whether it sticks. When you look at this one, I don't believe it 
sticks. I think it stinks.
  If you read the Washington Post's lead editorial today, its headline 
is ``Medicare sausage? The emerging buy-in proposal could have costly 
unintended consequences.''
  Mr. President, I ask unanimous consent to have printed in the Record, 
after my remarks, the Washington Post article.
  The PRESIDING OFFICER (Mr. Udall of New Mexico). Without objection, 
it is so ordered.
  (See exhibit 1.)
  Mr. BOND. At the end of the article, it says:

       The irony of this late-breaking Medicare proposal is that 
     it could be a bigger step toward a single-payer system than 
     the milquetoast public option plans rejected by Senate 
     moderates as too disruptive of the private market.

  To say that it moves toward a public takeover is confirmed by one of 
the most outspoken backers of the public option, the one most 
interested in getting public control or governmental control of all of 
health care, New York Representative Anthony Weiner. He is quoted in 
Politico today as having hailed the expansion of Medicare as an 
unvarnished triumph for Democrats like himself who have been pushing 
for a single-payer run health care system. In the article, he says: 
``Never mind the camel's nose, we've got his head and his neck in the 
tent.''
  I think that is clear. Trying to expand Medicare will almost 
assuredly drive all the private plans out of the market. Why? Medicare 
pays 80 percent of the cost of hospitals and less for doctors, and they 
have to make up the rest of their cost by charging privately covered 
patients more money. It will raise the cost so that private health care 
can no longer succeed.

                               Exhibit 1

               [From the Washington Post, Dec. 10, 2009]

                           Medicare Sausage?

       The only thing more unsettling than watching legislative 
     sausage being made is watching it being made on the fly. The 
     11th-hour ``compromise'' on health-care reform and the public 
     option supposedly includes an expansion of Medicare to let 
     people ages 55 to 64 buy into the program. This is an idea

[[Page 30901]]

     dating to at least the Clinton administration, and Senate 
     Finance Committee Chairman Max Baucus (D-Mont.) originally 
     proposed allowing the buy-in as a temporary measure before 
     the new insurance exchanges get underway. However, the last-
     minute introduction of this idea within the broader context 
     of health reform raises numerous questions--not least of 
     which is whether this proposal is a far more dramatic step 
     toward a single-payer system than lawmakers on either side 
     realize.
       The details of how the buy-in would work are still sketchy 
     and still being fleshed out, but the basic notion is that 
     uninsured individuals 55 to 64 who would be eligible to 
     participate in the newly created insurance exchanges could 
     choose instead to purchase coverage through Medicare. In 
     theory, this would not add to Medicare costs because the 
     coverage would have to be paid for--either out of pocket or 
     with the subsidies that would be provided to those at lower 
     income levels to purchase insurance on the exchanges. The 
     notion is that, because Medicare pays lower rates to health-
     care providers than do private insurers, the coverage would 
     tend to cost less than a private plan. The complication is 
     understanding what effect the buy-in option would have on the 
     new insurance exchanges and, more important, on the larger 
     health-care system.
       Currently, Medicare benefits are less generous in 
     significant ways than the plans to be offered on the 
     exchanges. For instance, there is no cap on out-of-pocket 
     expenses. So would near-seniors who buy in to Medicare get 
     Medicare-level benefits? If so, who would tend to purchase 
     that coverage? Sicker near-seniors might be better off 
     purchasing private insurance on the an exchange. But the 
     educated guessing--and that's a generous description--is that 
     sicker near-seniors might tend to place more trust in a 
     government-run program; they might assume, with good reason, 
     that the government will be more accommodating in approving 
     treatments, and they might flock to Medicare. That would 
     raise premium costs and, correspondingly, the pressure to dip 
     into federal funds for extra help.
       In addition, the insurance exchanges proposal is being 
     increasingly sliced and diced in ways that could narrow its 
     effectiveness. Remember, the overall concept is to group 
     together enough people to spread the risk and obtain better 
     rates. But so-called ``young invincibles''--the under-30 
     crowd--would already be allowed to opt out of the regular 
     exchange plans and purchase high-deductible catastrophic 
     coverage. Those with incomes under 133 percent of the poverty 
     level would be covered by Medicaid. The exchanges risk 
     becoming less effective the more they are Balkanized this 
     way.
       Presumably, the expanded Medicare program would pay 
     Medicare rates to providers, raising the question of the 
     spillover effects on a health-care system already stressed by 
     a dramatic expansion of Medicaid. Will providers cut costs--
     or will they shift them to private insurers, driving up 
     premiums? Will they stop taking Medicare patients or go to 
     Congress demanding higher rates? Once 55-year-olds are in, 
     they are not likely to be kicked out, and the pressure will 
     be on to expand the program to make more people eligible. The 
     irony of this late-breaking Medicare proposal is that it 
     could be a bigger step toward a single-payer system than the 
     milquetoast public option plans rejected by Senate moderates 
     as too disruptive of the private market.

  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. BOND. I thank the Chair, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois is recognized.
  Mr. BURRIS. Mr. President, over the past several months, I have come 
to the floor of this body many times to speak about the urgent need for 
comprehensive health care reform. I have said that our bill must 
accomplish three goals in order to be effective: It must bring 
competition to the insurance market--competition to the insurance 
market--it must provide significant cost savings to ordinary Americans, 
and it must restore accountability to an industry that has run 
roughshod over the American public for far too long. I would like to 
focus on this last point with my remarks today.
  We need real accountability in the insurance market. After almost 100 
years of debate about health care reform, this Senate stands on the 
verge of making history. There are many good elements in the 
legislation that is before us today, but without accountability, any 
reform measure would be toothless and inconsequential. If we don't give 
the American people a chance to hold their insurance providers 
accountable, quality care will continue to elude certain segments of 
our population. We can't stand for this any longer. We must prevent 
insurance companies from discriminating against people by charging them 
higher rates or denying coverage because of certain conditions.
  Everyone knows it is hard for uninsured patients to get quality 
medical care. Under the current law, in the case of catastrophic injury 
or illness, anyone admitted to the emergency room should receive equal 
treatment to save their life. Shockingly, Harvard researchers have 
found that this is not the case. They examined 690,000 individual cases 
over 4 years and found that uninsured patients are nearly twice as 
likely to die in the hospital as patients with similar injuries who do 
have insurance. And even after these results were adjusted to account 
for age, race, gender, and the severity of the injuries, they found 
that the uninsured were still 80 percent more likely to die than those 
with health coverage, including Medicaid.
  I just had a delegation of physicians in my office. I listened to 
their comments in reference to wanting us to make sure we passed a 
health care reform bill this session. One of those physicians began to 
relate to me the story of his brother, who was employed but was without 
health insurance. At 41 years old, he died of cancer because he waited 
too long to try to get treatment. And because he was uninsured and no 
one would treat him, that took his life at the young, tender age of 41.
  So this new evidence is conclusive, and it is truly disturbing. The 
poor and the uninsured suffer disproportionately under our current 
system. In the most advanced country on Earth, there is no excuse for 
this stunning inequality.
  Big corporations know there is a lot of money to be made out of the 
poor and they do not hesitate to rake in large profits and their 
expenses. These companies exploit minor technicalities to deny coverage 
to people who are sick. They use gaping holes in the system to refuse 
treatment for those with certain conditions. That is because they do 
not see patients as real people who need help, they see them as numbers 
in the corporate ledger. They see risk and expenses and lower dividends 
for their shareholders. That is why we need to prioritize patients over 
profits. That is why we need to extend coverage to more people and make 
these companies accountable for the first time in decades.
  If we pass insurance reform with a strong public option it would be 
illegal to deny coverage because of a preexisting condition. For the 
first time in many years, ordinary Americans would be able to shop 
around if they are paying too much, or they are not being treated 
fairly. Costs would come down, coverage would improve, and lives would 
be saved.
  Let us pledge ourselves to this cause. Let us make sure every 
American can get the treatment they need in the emergency room 
regardless of their income, need, or the insurance coverage they have. 
We must not fall short in this regard. We must not settle for anything 
less.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, my friends on the other side of the 
aisle have consistently stated that this 2074-page Reid bill, according 
to the Joint Committee on Taxation, is a net tax cut. I want to put 
emphasis throughout my remarks on the word ``net.''
  Yesterday a chart was used to illustrate this point. This chart had 
multiple bars with dollar figures. For example, in 2019 the chart 
showed a $40.8 billion net tax cut. My Democratic friends said this 
number came from the Joint Committee on Taxation, a very responsible, 
intellectually honest group.
  Unfortunately, the chart my friends were using was not entirely clear 
on how they came up with this net tax cut for Americans. So it was 
natural for most of the fellow Senators and the country at large to 
wonder how my Democratic friends got this number. They said show me the 
data.
  To clear up any confusion, right here is the Joint Committee on 
Taxation table that the Democrats relied on to claim that the Reid bill 
results in a net tax cut. Here it is. We can see the negative $40,786, 
for example. That is the figure that was used. As the chart indicates, 
these dollar amounts are in the

[[Page 30902]]

millions, so $40,786 million. The Joint Committee on Taxation says it 
this way: This means negative--the negative mark there--negative $40.8 
billion.
  My friends on the other side unfortunately did not explain what was 
going on here. It appears my friends simply made an assertion that they 
hoped many of us and those in the media would believe. But I cannot let 
my Democratic friends get off the hook this easily. Why? Because the 
entire story is not being told, so let me take a moment to explain.
  First, in simplest terms, where you see negative numbers on this 
chart, the Joint Committee on Taxation is telling us there is some type 
of tax benefit going to the taxpayers. So this group and these groups 
here, wherever there is a negative here, those are tax benefits to the 
benefit of the taxpayers.
  For example, families making $50,000 to $75,000 have a negative of 
$10,489 in their column. This means the Joint Committee on Taxation is 
telling us that this income category is receiving $10.4 billion in tax 
benefits.
  I hope you will listen closely. When we see a negative number on this 
chart, the Joint Committee on Taxation tells us there is a tax benefit 
so, conversely, where we see a positive number the Joint Committee on 
Taxation is telling us that these taxpayers are seeing a tax increase. 
I have actually enlarged those numbers, the number of tax returns and 
the dollar amounts where there is a positive number for individuals and 
families. Again, these positive numbers indicate tax increase.
  My friends have said that all tax returns in this chart are receiving 
a net tax cut. If that were so, why aren't there negative numbers next 
to all of the dollar amounts listed? Because not everyone in this chart 
is receiving a tax cut, despite what my friends have said. Quite to the 
contrary, a group of taxpayers is clearly seeing a tax increase and 
this group of taxpayers in middle income is seeing tax increases.
  I didn't come down to the floor to say my friends on the other side 
of the aisle are wrong. After all, you can see here the negative 
$40,786 million figure they used is right there, out in the open. What 
I am doing is clarifying that my Democratic friends cannot spread this 
$40.8 billion tax cut across all the affected taxpayers on this chart, 
and then say that all have received a tax cut.
  You want to know why. Because this chart, produced by the nonpartisan 
Joint Committee on Taxation, shows that taxes go up for those making 
more than $50,000 and families making more than $75,000. It is right 
here in the yellow, as you can see.
  The numbers obviously do not lie. I say the nonpartisan Joint 
Committee on Taxation, I think everybody agrees, is very intellectually 
honest. So let me give you my read on what the Joint Committee on 
Taxation is saying here as evidenced by the figures on the chart.
  First, there is a group of low- and middle-income taxpayers who 
clearly benefits under the 2074-page bill that is before the Senate. 
They benefit from the government subsidy of health insurance. This 
group, however, is relatively small.
  There is another much larger group of middle-income taxpayers who are 
seeing their taxes go up due to one or a combination of the following 
tax increases: the high-cost plan tax increase, which actually is a 
brandnew tax; the medical expense deduction limitation, which used to 
be 7.5 percent, and now before you can deduct you have to have 10 
percent of your income be medical expenses or you don't deduct 
anything, so that is a tax increase; and then a Medicare payroll tax 
increase, where everybody is going to pay--well, everybody over a 
certain income is going to pay an additional half a percentage point 
or, if you are self-employed, pay 1 percent more of payroll tax. In 
general, this group is not benefiting from the government subsidy. 
After all, how can a taxpayer see a tax cut if they are not even 
eligible for the subsidy?
  Also, there is an additional group of taxpayers who would be affected 
by other tax increase provisions in the Reid bill that the Joint 
Committee on Taxation could not distribute in the way people are 
distributed on this chart. These undistributed tax increases include, 
among others, the cap on Federal savings--flexible savings accounts. 
Then there is a tax on cosmetic surgery.
  My friend from Idaho, the author of the amendment before us, Mr. 
Crapo, recently received a letter from the Joint Committee on Taxation 
stating that this additional group exists and many in this group will 
make less than $250,000 and, hence, have a tax increase that is not 
accounted for here and also a tax increase if they are under $250,000. 
That is a violation of the President's promise in the last campaign 
that nobody under that figure would get a tax increase--only people 
over $250,000.
  So you see, my Democratic friends cannot, No. 1, say that all 
taxpayers receive a tax cut--I have proven that here--and, No. 2, say 
that middle-income Americans will not see a tax increase under the Reid 
bill.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, some of the charges from the other side of 
the aisle have taken us down some detours to essentially try to 
distract us from some of the main points of this legislation. I want to 
take a few moments to discuss one of the key features of the bill and 
that is insurance market reform.
  The bill would change the way insurance companies do business in 
America. Sometimes I think this reform is part of the reason some on 
the other side are fighting this bill so hard. Our bill will end the 
practice, widespread today, of insurance companies denying coverage 
altogether, or charging someone an exorbitant amount of money if they 
have some preexisting condition, something in their health history 
which is an issue. Our bill would make those changes right away. They 
start going into effect in 2010. That is, the prohibition on companies 
denying coverage for preexisting conditions or health care stats, and 
right down the list, would take effect right away, 2010.
  We all have countless numbers of examples, either directly or through 
friends or relatives of small insurance companies that either denied 
insurance coverage or you have to pay much greater increase in premiums 
because of a preexisting condition, whatever it may be, of something. 
It is wrong, flat, outright, 100 percent wrong. This bill stops that, 
stops those practices by insurance companies.
  I think it is important that we not get sidetracked by some other 
very important matters but keep focused on what this legislation does. 
It reforms the health insurance industry.
  What else does our bill do with respect to reforming the health 
insurance industry? It would prohibit lifetime limits on payments to 
people who get sick. Right now, insurance companies limit how much they 
pay out to people when they get sick. They have lifetime limits, annual 
limits. No matter how sick you are, some catastrophic coverage you 
have, the insurance company says: Sorry, we are putting a limit on it. 
That is not right. Sometimes people have conditions that require a lot 
more attention, more hospitalization, more attention by doctors. Our 
legislation would prohibit lifetime limits on payments to people who 
get sick.
  Our bill also prohibits unreasonable annual limits. These are limits 
that insurance companies impose on policyholders. This reform would 
apply in both the group market and the individual market. What does 
that mean, that gobbledygook. It implies that for everybody, whether 
you are an individual or whether you are working for a company, this 
would take effect 6 months after enactment. That is pretty important. A 
lot of people have insurance policies with limits, where the insurance 
company will only pay so much to an individual or during the person's 
lifetime or in any year. It is not right because some conditions 
require a significant increase in payments or coverage for the person.
  Our bill would require any insurance plan that provides dependent 
coverage

[[Page 30903]]

for children to continue to make that coverage available until the 
child turns age 26. We know that is a problem today. Often, in a State, 
once a child turns 21 or 22, that person can't find health insurance. 
In today's economic recession, with unemployment so high, it is kind of 
hard for kids to find jobs, and that is how they would otherwise get 
their health insurance. We say family coverage covers your child until 
the child turns age 26. This reform would take effect 6 months after 
enactment.
  In addition, when the exchanges are up and running, our bill would 
prohibit insurance companies from discriminating against consumers 
because of health status, generally. Sometimes the insurance industry 
says it is not a preexisting condition, but you have not been healthy 
lately so we will not give you insurance. No longer can insurance 
companies refuse to sell or renew policies because a person gets sick. 
If you pay your premiums, the insurance company has to renew your 
coverage.
  When the exchanges are up and running, the legislation before us 
today would limit the ability of insurance companies to charge people 
much more just because of their age. That is what they do today. 
Sometimes, depending upon the State, the insurance company is able to 
charge somebody much more for the same coverage because of that 
person's age. Right now it is not at all unusual for insurance 
companies to charge more than five times as much just because a person 
is, say, age 55. Our bill would prohibit insurance companies from 
charging more than three times as much because of age. In some States, 
there is no limit whatsoever. In my State of Montana, we have no limit. 
Some States have five. We are saying down to three.
  When the exchanges are up and running, our bill would prohibit 
insurance companies from charging women more than men. Think of that. 
Some insurance companies charge women more than men. That is not right. 
This is also a widespread practice among insurance companies that is 
charging women more than men. It is just plain wrong. Our legislation 
would stop that.
  Health insurance reform also means real insurance market reform. It 
means real change in the way insurance companies do business. No longer 
will insurance companies be able to build their business by cherry-
picking only the healthiest and the youngest. That is what they do 
today, especially for individuals, to some degree, in smaller 
organizations. No longer will they be able to insure only those who 
don't need insurance. We bring real reform. It would make insurance 
much more fair, and that is literally a matter of life and death.
  As a recent Harvard study reported, people without insurance are 40 
percent more likely to die prematurely than people with private 
insurance. Think of that. People without insurance are 40 percent more 
likely to die prematurely than people with private insurance. Tens of 
thousands of Americans die each and every year because they do not have 
insurance. Is that America? That doesn't sound like the United States 
we are all so proud of, where we allow tens of thousands of Americans 
to die each and every year simply because we have not set up a system 
for them to have health insurance. That is something we stop in this 
bill.
  I suggest the absence of a quorum and ask unanimous consent that the 
time be charged equally against both sides.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. GRASSLEY. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GRASSLEY. Mr. President, I have said, for the last 2 days, I was 
going to speak on the Dorgan amendment, a bipartisan amendment to allow 
the importation of drugs into the United States. I haven't done it 
until now, so I am glad to rise in support of this bipartisan amendment 
to add provisions of the Pharmaceutical Market Access and Drug Safety 
Act to this bill. That legislation is the result of a collaborative 
effort by Senators Dorgan, Snowe, McCain, and this Senator to finally 
make drug importation legal.
  I have, for a long time, been a proponent of drug reimportation. In 
2000, 2002, and 2003, I supported an amendment permitting the 
importation of prescription drugs into the United States from one 
country, Canada. This amendment is much broader than only Canada.
  In 2004, the late Senator Kennedy and I worked together on a bill 
that would authorize drug importation, but it did not survive the 
partisan politics of this Chamber. I then introduced my own 
comprehensive drug importation bill in 2004. That was S. 2307, the 
Reliable Entry for Medicines at Everyday Discounts Through the 
Importation with Effective Safeguards Act. The REMEDIES Act is what the 
acronym finally spells out. In 2005, I combined my bill with a proposal 
sponsored by Senators Dorgan and Snowe. In 2007, we reintroduced a 
version of that legislation with the hope that our combined efforts 
would finally lower the cost of prescription drugs for all Americans. 
That is what we are still working together to do this very day. I thank 
Senator Dorgan for his leadership.
  This time around, I should be confident that this effort will finally 
pass. Historically, Democrats claim to be champions of holding the big 
pharmaceutical companies accountable. Now we have a Democratic 
supermajority in the Congress and a Democratic President who has 
supported drug importation in the past. I am not as confident as maybe 
I should be. That is because the White House has participated in some 
back-room negotiations since the last time this legislation was brought 
before the Senate and then Senator Obama supported it. Behind closed 
doors, the Democratic White House found new friends in the 
pharmaceutical industry. Last summer, the head of the pharmaceutical 
lobbying group bragged that drug manufacturers had negotiated a ``rock-
solid deal''--those are their words--with the present administration.
  An article in the New York Times detailed the administration's deal 
with big drug companies. This quote comes from the New York Times:

       Foreseeing new profits from the expansion of health 
     coverage, big drug companies are spending as much as $150 
     million on advertisements to support the President's plan.

  But in 2008, when President Obama was campaigning for the position he 
now holds, he promised that:

       We'll take on drug and insurance companies, hold them 
     responsible for the prices they charge and the harm they 
     cause.
  Certainly, the President knows that a great way to hold drug 
companies accountable is to allow drug importation. In fact, in 2004, 
when he was a candidate to be a Member of this Chamber, he challenged 
his opponents to support drug importation. He said at that time:

       I urge [my opponent] to stop siding with the drug 
     manufacturers and put aside his opposition to the re-
     importation of lower-priced prescription drugs. . . .

  But, unfortunately, it has been reported that during backroom 
negotiations at the White House, the big pharmaceutical companies have 
convinced the President to drop his strong support for drug 
importation.
  The New York Times reports that:

       On July 7--

  Meaning this year--

     Rham Emanuel, [President] Obama's chief of staff . . . 
     assured at least five pharmaceutical companies during a White 
     House meeting that there would be no provision in the final 
     health care package to allow the reimportation of cheaper 
     drugs. . . .

  I thought we were going to hold drug companies accountable. I thought 
health care reform was supposed to drive down the cost of health care, 
including the cost of prescription drugs for all Americans. The Dorgan 
amendment is a commonsense, bipartisan approach to achieve both of 
these goals. Drug importation achieves these goals without imposing 
arbitrary fees, and without flexing the muscles of the Federal 
Government.
  I have always considered this a free trade issue. I know most people 
see it as a health issue, and it is a health issue. But I come at it 
from the point of view that there are only a couple

[[Page 30904]]

items Americans cannot buy in this country from anyplace else in the 
world they want to buy it. One class is pharmaceutical drugs, the other 
class is Cuban----
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. GRASSLEY. Mr. President, I ask unanimous consent for 4 additional 
minutes and that it come off the next block of time from our side.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GRASSLEY. So I see this as a free-trade issue. Imports create 
competition and keep domestic industry more responsive to consumers. In 
the United States, we import everything consumers want. So I ask again, 
why not pharmaceuticals? That is why it is a trade issue for me as much 
as a health issue. Consumers in the United States pay far more for 
prescription drugs than those in other countries. If Americans could 
legally and safely access prescription drugs outside the United States, 
then drug companies would be forced to reevaluate their pricing 
strategies. They would no longer be able to gouge American consumers by 
making them pay more than their fair share for research and 
development.
  It is true that pharmaceutical companies do not like the idea of 
opening up America to the global marketplace. They want to keep the 
United States closed to other markets in order to charge higher prices 
here.
  Based on the reports I just read, it seems that the White House has 
already sided with the drug manufacturers and promised them the ability 
to continue to gouge American consumers, otherwise known as the status 
quo.
  The debate is not over. With the Dorgan amendment, prescription drug 
companies will be forced to be competitive and establish fair prices in 
America. The drug companies will try to find loopholes in order to 
protect their bottom line.
  The Dorgan amendment would make such action illegal. It would not 
allow manufacturers to discriminate against registered exporters or 
importers. It would prohibit drug companies from engaging in any 
actions to restrict, prohibit, or delay the importation of a qualifying 
drug.
  The Dorgan amendment would give the Federal Trade Commission the 
authority to prevent this kind of abuse. It develops an effective and 
safe system that gives Americans access to lower prices. Our effort 
goes to great lengths to ensure the safety of imported drugs. The 
Dorgan amendment requires that all imported drugs be approved by the 
FDA. It puts in place a stringent set of safety requirements that must 
be met before Americans can import drugs from that country.
  The amendment requires all exporting pharmacies and importing 
wholesalers to be registered with the FDA and inspected. It gives the 
authority for the FDA to inspect the entire distribution chain for 
imported drugs. It sets very stringent penalties for violations of the 
safety requirements in this bill, including criminal penalties and up 
to 10 years imprisonment.
  We need to make sure Americans have even greater, more affordable 
access to innovative drugs by further opening the doors to competition 
in the global pharmaceutical industry.
  If my colleagues on both sides of the aisle are serious about bending 
down the cost curve of health care inflation--and doing it in that 
direction, the right direction--then they will support the Dorgan 
amendment, a bipartisan amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio is recognized.
  Mr. BROWN. Thank you, Mr. President.
  I echo the comments of the senior Senator from Iowa. He is exactly 
right about the Dorgan amendment. There are a lot of reasons, as he 
pointed out, why the Dorgan amendment makes sense for the American 
people.
  It makes sense for taxpayers because we pay way too much for 
prescription drugs as taxpayers. It makes sense for government 
programs--whether it is TRICARE, whether it is Medicare, whether it is 
Medicaid, whether it is the Federal Employees Health Benefits Program. 
It makes sense for small businesses and large businesses alike who are 
paying too much for prescription drugs. And it makes sense for seniors 
and all Americans who are paying too high a price for prescription 
drugs out of their pockets. It also makes sense in terms of, sort of, 
internationally as to what we do on the buying and selling of 
prescription drugs.
  I was part of these discussions in the House where we had the same 
amendment. We would pass it, and then it would die in the Senate, or 
things would happen in the conference committees or whatever, where the 
drug companies really did exert their influence over the Congress and 
with the President during the Bush years.
  But one of the arguments they always make is to question the safety 
of these drugs, that these drugs coming from Canada or these drugs 
coming from France are not safe, as if they did not have a food and 
drug administration as efficient and effective as ours in terms of 
protecting the public.
  But what sort of shoots a hole in that argument is how many American 
drug companies--over and over and over, and in increasing numbers--how 
many American drug companies are importing ingredients especially from 
China.
  Senator Kennedy, 1\1/2\ years or so ago, asked me to chair an 
oversight hearing with the Health, Education, Labor, and Pensions 
Committee on this issue of what is happening when these American drug 
companies are increasing their outsourcing of jobs, particularly to 
China. It was in response to what happened in Toledo, OH, among other 
places, where a number of Americans died because of contaminated 
heparin.
  Heparin is a blood thinner drug that is a very important drug to keep 
people healthier and live longer and live better. But some of the 
ingredients for heparin were made in China, and the drug company is not 
able to trace back, if you will, the supply chain, where they are 
getting their ingredients. They know they get them from China. The 
American drug companies--whether it is Pfizer or another drug company--
when they outsource their production to China, may know where the plant 
is that puts all these ingredients together, but they cannot trace 
back--or at least they will not tell us or cannot tell us--all their 
ingredients. So they may get this ingredient from Wuhan, and this 
ingredient from Shanghai, and that ingredient from a rural outpost in 
Hebei or Henan Province, but they cannot tell us exactly where they 
come from. So no wonder these drugs are not as safe as they should be.
  So if they were interested in drug safety, it would not be that they 
would stop us from drug importation because we know if we buy it from 
France or Canada or Germany, they have a food and drug agency, an FDA 
equivalent, that keeps their drugs safe. They know that. It is all 
about protecting their profits. There is simply no doubt about that. 
Their profits get to be bigger because they make some of these drugs in 
China.
  So let's not have it both ways. Let's not say we cannot import drugs 
safely into this country--when they are exporting jobs, as so many 
other industries are doing, to China, exporting jobs to little villages 
where they manufacture these ingredients. They end up in America's 
medicine cabinets. Let's not talk out of both sides of our mouths, as 
the drug industry is doing.
  A couple other comments about the underlying bill and how important 
it is we move on this legislation. There are more than 400 people every 
day--in Defiance, OH, in Gallipolis and Zanesville and Saint 
Clairsville and Cadiz and all over my State--400 people every single 
day who lose their insurance.
  Every day my friends on the other side of the aisle delay, every day 
they offer amendments and then will not let us vote on them, and stand 
up and object to even voting on things, every day they try to 
filibuster, every day they put up another hurdle, 400 more people in my 
State lose their insurance. It is about 1,000 people in this country 
every week--1,000 people in this country every week--who die because 
they do not have health insurance. It is 45,000 people a year, so 900-

[[Page 30905]]

some people every week in this country die because they do not have 
health insurance.
  A woman with breast cancer without insurance is 40 percent more 
likely to die than a woman with breast cancer with insurance. I heard 
President Bush, in Ohio, maybe a couple years ago, say every American 
can get health care. They can go to an emergency room. Well, a woman 
suffering from breast cancer, who did not get a mammogram because she 
could not afford it, did not get the kinds of tests she should have 
because she did not have a doctor she could afford to pay, and because 
she did not have insurance--the emergency room does not do those kinds 
of things. Even if she got sick, the emergency room would not take care 
of her until she was almost dead. Then she could go into the emergency 
room and they will take care of her in her last few days or her last 
few weeks of life.
  That is not the way we should do health care. This kind of delay, 
hearing these kinds of delaying actions, these kinds of delaying 
tactics, these kinds of ``we can't pass this,'' ``chicken little,'' 
``the sky is following''--every day we have Republicans coming down 
here saying ``the sky is falling,'' and it simply is not.
  I want this bill to be bipartisan. I am a member of the Health, 
Education, Labor, and Pensions Committee, as is my friend, Senator 
Roberts from Kansas, who is in the Chamber. During that markup in June 
and July, we passed 160 Republican amendments. Some of them were major, 
some of them were not so major. But this bill had a bipartisan flavor 
to it.
  It is only on the big questions--the role of Medicare, the role of 
the public option--some of the bigger questions, where there are 
philosophical differences; the same reasons that back in the 1960s, 
when Medicare passed, it was passed almost only by Democrats because 
Republicans did not agree there should be a major role in government in 
our health care system.
  So it is a philosophical difference. It is not so much partisan as 
that. So even though there are many good Republican ideas in this bill, 
on the big questions there is that difference.
  So, Mr. President, I think it is so important--when I hear that many 
Ohioans, every day, lose their insurance, this many Americans, every 
week, die because they do not have insurance--to pass this legislation.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. ROBERTS. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Is there objection?
  Mr. BROWN. I object.
  The PRESIDING OFFICER. Objection is heard.
  The bill clerk continued with the call of the roll.
  Mr. ROBERTS. Parliamentary inquiry, Mr. President.
  The PRESIDING OFFICER. The Senator is advised the Senate is in a 
quorum call.
  Mr. ROBERTS. I will try it again. I thought it was worked out.
  I ask unanimous consent for the second time that the order for the 
quorum call be rescinded so I may be--
  The PRESIDING OFFICER. Is there objection?
  Mr. ROBERTS. So I may proceed for 15 minutes.
  Ms. CANTWELL. Objection.
  The PRESIDING OFFICER. Objection is heard.
  Mr. ROBERTS. Is this a bipartisan objection, I would ask the 
Presiding Officer?
  The bill clerk continued with the call of the roll.
  Mr. DODD. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DODD. Mr. President, I ask unanimous consent that over the next 
30 minutes, the time be equally divided with 15 minutes for the 
majority and 15 minutes for the minority for debate purposes only.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Kansas is recognized.
  Mr. ROBERTS. I thank the President. I rise today to talk about health 
care in general and the latest proposal to come out in the form of the 
so-called compromise, if there is no objection. I wish to talk about 
the latest proposal to come out from what some of us have determined is 
the majority leader's behind-closed-doors effort for the compromise on 
the government-run health insurance plan. I will admit very readily I 
do not know all of the details of this plan, although I hope to in the 
very near future. I think most of my friends across the aisle are in 
the same boat and we are all getting our information from the Post, the 
Times, and the rest of the catch-up media.
  But this is the compromise, as I understand it: The majority leader 
will drop the government plan in exchange for two major policies: 
first, a national insurance plan run by nonprofit insurance companies 
and supervised by the Office of Personnel Management; and second, a 
massive expansion of Medicare to tens of millions of people age 55 and 
older.
  Putting aside the first policy which, frankly, I don't understand how 
it could possibly work, I cannot believe anyone is seriously 
considering expanding Medicare as a compromise to the government-run or 
so-called public option. It doesn't take a genius to see that a huge 
expansion of Medicare is, as one single-payer advocate in the House 
dubbed it, ``the mother of all public plans,'' further quoting: ``An 
unvarnished and complete victory'' for advocates of single-payer health 
care and socialized medicine. That is a very strong quote, but that is 
the way it was.
  In other words, this is not a compromise to the public option--it is 
worse. Maybe we need to remind ourselves why moving toward more 
government control of our health care system is such a bad idea. We 
need look no further than our current government-run insurance plans, 
Medicare and Medicaid, for examples. Government-run insurance plans 
currently control nearly half of the market. With the government's 
power, they have the ability to set payment levels for doctors and 
hospitals and home health care agencies and even hospices and all other 
health care providers, not based on the actual costs those providers 
incur when treating patients, but instead based on whatever arbitrary 
spending target the budget crunching bean counters determine the 
government can afford.
  To paraphrase one observer: These types of global government budgets 
transform patients from sources of revenue over which providers compete 
to attract and serve, into sources of cost for the government to avoid, 
shunt off, and treat as cheaply as possible. That is not right. This 
has clearly been the result in the Medicare Program, often heralded as 
the best of all of the government's health care programs.
  So to review: Medicare has been on an ever shrinking path toward 
bankruptcy for years. The latest reports from the Medicare trustees say 
the hospital insurance trust fund will go broke within the next 8 
years. The program has $38 trillion in unfunded liabilities. How has 
the government responded? By severely underpaying Medicare providers 
and denying Medicare patients' claims. Medicare only pays doctors 
around 80 percent of their costs, and hospitals even lower.
  Privately insured Americans pay a hidden tax of nearly $90 billion a 
year to make up for these underpayments. But even that hasn't been 
enough to keep some providers in business and able to afford to accept 
Medicare patients. Medicaid is even worse. Medicare is also a huge 
denier of claims. I think many of my colleagues would be surprised to 
hear that Medicare denies claims more often than most private insurance 
companies. In fact, in 2008, Medicare had the highest percentage and 
the highest number of denied claims in the country. Think about that 
when you hear some Senators demonize private insurance companies

[[Page 30906]]

for denying claims. Medicare is even worse.
  This bill already exacerbates these Medicare problems by cutting 
almost $\1/2\ trillion from this already woefully underfunded program. 
Now we are considering adding even more people. This is a sinking ship 
with no lifeboats, and we are adding more folks to the deck.
  By underpaying health care providers and denying claims, Medicare 
already rations health care. Expanding Medicare to tens of millions of 
new people as envisioned by this compromise we hear about will take 
government rationing to a whole new level. Because as the government 
takes over more of the health care system and becomes responsible for 
more of the increasing costs of that system, the only way it will be 
able to afford this commitment is to ration health care. As I have said 
countless times before, this bill gives the government all the tools it 
requires to ration care.
  From Comparative Effectiveness Research, to the independent Medicare 
advisory board, to the new powers granted to the Centers for Medicare 
and Medicaid Services, CMS and the U.S. Preventive Services Task Force, 
this bill puts the rationing infrastructure into place. The U.S. 
Preventive Services Task Force's recent change to its guidelines 
pertaining to mammograms was a perfect illustration of how your health 
care will be rationed under this bill. For those who don't know, the 
task force recently reversed its longstanding advice that women should 
start getting regular mammograms to detect breast cancer at age 40.
  Why is this important? Because under this bill, the recommendations 
of this task force will carry the weight of law for both government-
run--i.e., Medicare--and private insurance. If the task force 
recommends a particular treatment or a particular set of patients, then 
Medicare and private insurers must cover it. If it doesn't, they don't.
  What do you think will happen to treatments and tests that don't get 
the task force's recommendation? They simply will not be covered. That 
is how the government will hold down health care costs, by rationing 
access to treatments and tests such as mammograms.
  Some government-controlled health care systems such as the one that 
exists in the United Kingdom are much more explicit about rationing. 
The rationing in this bill, quite frankly, is not as honest. Since 
Americans would never stand for the government explicitly rationing 
their health care, the authors of this bill had to come up with a 
pseudoscientific justification for rationing, and that justification is 
the main feature of this bill: Comparative Effectiveness Research, or 
CER.
  Very generally, it is very simple. CER is the comparison of two or 
more treatment options to see which one is better. Sounds great, right? 
Except when you realize that CER is not being conducted for the purpose 
of improving patient care but for the purpose of saving the government 
money instead.
  I read the CER section of the bill and I remember my amendment on CER 
and the distinguished chairman of the HELP Committee was very helpful, 
and said he would study it overnight. Because I had the word 
``prohibit'' in the amendment we got into a great debate on what 
prohibit means. I thought it was pretty clear but, unfortunately, that 
was dropped from the bill, from the HELP Committee bill. We tried that 
again in Finance. It didn't work. We would like to try it again if we 
have time.
  This bill establishes a CER institute to conduct this research for 
the purpose of justifying government rationing of health care. CER will 
be the golden ring of rationing.
  So what we have here is a recipe for disaster: a bill that already 
significantly weakens the woefully underfunded Medicare Program and 
lays the foundation for a rationing infrastructure, plus a 
``compromise'' that apparently will pour millions of more people into 
the program.
  In the no-holds barred search for a proposal that can attract 60 
votes, I don't understand how any Senator can support this idea.
  This is just another Trojan horse, another incremental step toward 
the single-payer system. Again, as one House Member in the leadership 
observed:

       This gets not only the camel's nose under the tent, but his 
     whole head and neck, too.

  It is another step toward socialized medicine and increased 
government rationing of health care.
  The American Hospital Association, American Medical Association, and 
the Federation of American Hospitals are finally taking notice of the 
advice they are receiving from their State and local hospitals and 
doctors. They, finally, have seen the light and have come out in 
opposition to this deal at least.
  I urge my friends across the aisle to resist this latest misguided 
attempt at deal making. The consequences are too dangerous.
  There is an awful lot of cactus in this health care world. I don't 
think we need to sit on each and every one of them.
  Before yielding back my time, I truly thank the distinguished Senator 
from Connecticut for his comity and allowing me to make these debate 
comments. I thank the acting Presiding Officer in his effort to be 
bipartisan.
  I think we will have a sad day in this body if one side or the other 
gets into a situation where we do not allow people to make remarks on 
not only the pending bills and specifically on the general issue of 
health care.
  Mr. DODD. If my colleague will yield, he raises an interesting point. 
I am going back several months. As we get older, it is hard enough to 
remember what happened yesterday. The Presiding Officer is on the 
committee, as is my colleague from Vermont. There was a debate over the 
word ``construed'' to prohibit. I remember that word, talking about 
various practices. As I recall, the compromise that was offered either 
by my friend and colleague from Kansas or some other member was to 
strike the word ``construed,'' so nothing would be prohibited. I still, 
to this day, am not quite sure why we should not accept language that 
eliminates the word ``construed.'' That went on for about a day back 
and forth. I invite my colleague, again, to maybe get our staffs 
together and talk about that. I don't think he is wrong about this. I 
think it is good to have best practices. If a physician and patient 
decide, as a certainty, it is essential for that patient, then you 
should not be prohibited from doing that. As I recall, the debate was 
over the word ``construed.'' I don't want to take time from the Senator 
from Vermont.
  Mr. ROBERTS. Mr. President, I agree with the Senator. I point out 
that in the specifics of the bill, I think it says shall not, in regard 
to cost containment on Medicare A and B, but the rest is encouraged. 
That is where we get into problems because CER is the blueprint on how 
we allot health care dollars in this country.
  I might mention to the Senator, I had a chart on what CER 
recommended, and it had a figure of a humpback whale and how much money 
we would be devoting to different age groups. If you are 60--and, by 
the way, the average age of the Senate is 62--you are out of luck. If 
you are 70, you better get something fixed real quickly before this 
bill passes. That is my point. I thank the Senator for his comments.
  Mr. DODD. Mr. President, I thank Senator Roberts for his amendment in 
the HELP Committee to protect patients by preventing rationing of 
health care. That is in the Senate bill. That was language we adopted, 
I say to my friend from Vermont. It was a Roberts amendment that was 
adopted in our markup that prohibits any rationing of health care in 
our bill. I thank him for that.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont is recognized.
  Mr. SANDERS. Mr. President, when Republicans controlled the White 
House, the Senate, and the House, they had the opportunity to do 
something about the health care disaster in America. From 2000 to 2008, 
some 7 million Americans lost their health insurance. Where were the 
Republicans? During that same period, health care costs soared in 
America. Small

[[Page 30907]]

businesspeople found themselves unable to provide health care to their 
workers.
  Where were our Republican friends? I am delighted they are down on 
the floor every single day criticizing an effort to try to improve the 
situation. But it might have been a little better if they were here 8 
years ago, bringing forth their ideas. But they were not.
  Having said that, let me suggest that in the midst of this health 
care crisis, in which 46 million Americans have no health insurance and 
health care costs are soaring and, as the President indicates, that 
will double in 8 years if we do nothing, at a time when 45,000 
Americans this year will die because they don't get to a doctor when 
they should, when close to 1 million Americans are going to go bankrupt 
from medically related bills, we need real health care reform.
  That is something that I, and I know many other Members in Congress, 
have been fighting for for years. More than anything, I wish to see us 
pass strong health care reform. I must express a disagreement with some 
of my colleagues on the Democratic side, who think we are on the 2-yard 
line, we are almost there. I don't think so. I think there are a number 
of problems that remain in this legislation that have to be resolved. I 
wish to touch on a few of them.
  One of the parts of this legislation is that, finally, we are going 
to add some 30 million Americans to health care insurance. That is a 
good thing. About half of them will be added to an expanded Medicaid--a 
huge expansion of Medicaid. But here is my concern. Right now, our 
primary health care system is extremely weak. Everybody knows we don't 
have enough primary health care doctors. We know that Medicaid, today, 
is on wobbly legs as it tries to take care of the people who access 
that program. I am not quite sure how you add 15 million more people to 
Medicaid if you don't have a primary health care infrastructure to 
accommodate their needs.
  In this regard, I have fought very hard for authorization language in 
the Senate to greatly expand community health centers and the National 
Health Service Corps, for which we will train and make sure that we 
have the primary health care doctors, dentists, and nurses we need, 
desperately need.
  In the House bill, there is language introduced by Representative 
Clyburn, supported by the Democratic leadership, that would provide $14 
billion over a 5-year period to expand community health centers, enable 
tens of millions more to access health care, and make sure we have the 
primary health care doctors and dentists we need.
  It would be a cruel hoax to tell people they now have health 
insurance--Medicaid or another program--but not create a situation by 
which they can get into the doctor's office. I fear that may happen. I 
am going to fight as hard as I can to make sure we have the primary 
health care infrastructure we need. That means, in the Senate, adopting 
the language that currently exists in the House bill for $14 billion 
over a 5-year period--money which, according to a variety of studies, 
will pay for itself as we keep people out of the emergency room and 
keep people from getting sicker than they otherwise should be and 
ending up in a hospital. This makes a lot of sense. Community health 
centers have had wide bipartisan support. We have to support the House 
language.
  On another issue, I found it interesting that my friend from Kansas, 
a moment ago, was denouncing the United Kingdom's health care system, 
denouncing socialized medicine, single payer. Well, I got a little 
confused by my Republican friends, who have been in Congress, saying: 
We love Medicare. My word, do we love Medicare. We are very angry that 
those Democrats are trying to cut back on that.
  Republicans who, year after year, wanted to privatize Medicare, this 
week they love it. If they love it so much, why don't they join us in 
trying to expand Medicare and address some of the problems in Medicare? 
Let's work together.
  Last week, we were criticized, but now, I guess, the tune has changed 
a little. Get your act together, my Republican friends. Either you 
continue the line you have had for many years about detesting Medicare 
because it is a single-payer health care program, a government health 
care program--that is what it is, a single-payer government health care 
program. You have been on the floor defending it all week long, until a 
couple days ago.
  I support Medicare. In fact, what I believe and am fighting for is a 
Medicare-for-all, single-payer program because, at the end of the day, 
I disagree with many on this side of the aisle. I think, at the end of 
the day, the only way you are going to provide comprehensive universal 
health care to all Americans, in a cost-effective manner, is through a 
Medicare-for-all, single-payer system, which ends the hundreds of 
billions of dollars of bureaucracy and waste engendered by the private 
insurance companies.
  One of my concerns, as we seem to be hurtling down the finish line, 
is I don't know who is going to be able to offer amendments. I have an 
amendment that speaks to what millions of Americans want, including the 
Physicians for a National Health Program--17,000 doctors, mostly 
primary health care doctors but not exclusively. They want to see this 
country have a Medicare-for-all, single-payer system. I understand I am 
not going to get very many Republicans supporting that amendment--or 
any Republicans. I also understand I will get few enough Democrats 
supporting that amendment. In the years to come, we are going to have a 
Medicare-for-all, single-payer system. I want that debate on the floor 
of the Senate. I have offered an amendment and I want to have that 
debated. I don't need 20 hours or 5 days. I would love to discuss that 
issue with my Republican friends.
  Democrats, I think it is an amendment that has a right to be offered 
and it should be. I understand that will not pass. I will tell you what 
could pass and what could have Republican support, it is the provision 
I have been working on that at least says that in our Federalist 
system, where each State learns from other States, at least give States 
the option. If the Governor or the legislature wants to go forward with 
a single-payer model; maybe it works, maybe it doesn't work. I have the 
feeling if one State--whether it is Vermont, California, Pennsylvania, 
States that have strong single-payer movements, a lot of support for 
that concept--if one State does it well, then other States will be 
saying we want the same thing. It is a cost-effective way to provide 
comprehensive health care to all our people.
  I want to touch on another issue, where I think my colleagues in the 
Senate are wrong and my former colleagues in the House are right. This 
is an issue the occupant of the chair has worked on with me. We held a 
press conference this morning. It is to understand this legislation is 
going to cost between $800 billion and $1 trillion.
  How do you get the money? Well, the Senate bill contains a tax on 
health insurance benefits. I think that is wrong. I think that is 
regressive. It is called a tax on Cadillac plans. Given the soaring 
cost of health care in America today, what may be a Cadillac plan today 
will be a junk car plan 5 years from now. Millions of Americans are 
going to be forced to pay taxes on their health care benefits or else 
their employer will cut back on those benefits, and they are going to 
have to pay out of their own pockets. That is wrong. It is a regressive 
and unfortunate and unfair way to raise the revenue we need.
  Our friends in the House did the right thing. They said that 
millionaires should be asked to pay a little bit more in taxes to make 
sure we expand health care coverage in this country. I support what our 
friends in the Senate and the House did, and I disagree with what is in 
the Senate bill. There will be a poll coming out this afternoon in 
which 70 percent of the American people, as I understand it, disagree 
with the tax on health care benefits. They understand that is a tax on 
the middle class.
  Let's be clear. We are in a terrible recession now. Working families 
are struggling. It is wrong for us to propose a tax on health care 
benefits, which in a few years will be impacting millions

[[Page 30908]]

of middle-class workers. We should follow what the House has done and 
say to people at the top--millionaires who have received huge tax 
breaks under President Bush--that they have to pay a little bit more in 
taxes so we can provide health care to all our people.
  There is a lot in the bill in the Senate that makes a lot of sense to 
me. I congratulate Senator Dodd and Senator Baucus and all those people 
and their staffs who have worked so very hard on this bill. We have 31 
million more people who will get insurance. There is insurance reform 
dealing with preexisting conditions. We made progress in disease 
prevention. There are a lot of good things in it.
  I want to be very clear: I do not think we are at the 2-yard line. I 
think a lot of work has to be done to improve this bill. We need to, as 
I mentioned a moment ago, make major improvements in primary health 
care. We need to change how we fund many parts of the expansion of 
insurance and do away with the tax on health care benefits. We have to 
give States the option, the flexibility to go forward with a single-
payer system if that is what they want to do.
  Also, I hope very much that this afternoon we will vote and adopt the 
reimportation prescription drug legislation championed by Senator 
Dorgan. It is an absurdity in this country that we remain the country 
that pays by far the highest prices in the world for prescription 
drugs. When I was in the House, I was the first Member of Congress, as 
I understand it, to take Americans over the Canadian border. Back 
then--10, 15 years ago--women were able to purchase the breast cancer 
drug Tamoxifen for one-tenth the price they were forced to pay in the 
United States. I know the drug companies are very powerful. I know they 
have a lot of influence in this institution. But I hope we can do the 
right thing and provide affordable medicine to all Americans through 
reimportation. And I hope we can adopt that amendment.
  I did want to say I have some very serious concerns about this 
legislation, and I hope they will be addressed in the coming days and 
weeks. I very much want to be able to vote for this bill, but I am not 
there now, not by any means.
  I yield the floor.
  Mr. WYDEN. Mr. President, at the end of the day, Americans don't care 
if a health reform proposal originated with a Democrat or a Republican, 
what matters to them is that it works. That is why I am proud to join 
forces with Senator Collins to offer commonsense amendments that will 
hold down premium costs and make health care more affordable for 
American families and their employers. As I have long said, the best 
way to hold down health care costs and make insurance companies 
accountable is to put Americans in the driver's seat and empower them 
to pick the plan that best fits their needs.
  Along with Senator Collins, I am proposing as amendments to the 
Patient Protection and Affordable Care Act three amendments that will 
improve the Senate bill by doing more to hold down premium increases 
for all Americans while expanding health care choices for more 
Americans and their employers. Our amendments are as follows:
  First, we are offering an amendment to provide more choices for 
employers and workers. While the current Senate legislation will 
eventually make it possible for employers to insure their workforce in 
the new health insurance exchanges, the legislation does not contain a 
mechanism to make it possible for employers to offer their workers the 
ability to choose any plan offered in the exchange. This Wyden-Collins 
amendment would correct that by making it possible for employers--who 
want to offer their employees the full range of choices in the 
exchange--to do just that while increasing competition in the new 
marketplace.
  Under the amendment, any employer that sponsors a health plan would 
have the option to offer tax-free vouchers to its workers equal to the 
amount the employer contributes to its own health plan. Workers could 
then use that voucher to purchase the exchange plan that works best for 
them and their family. If a worker decides to purchase a less-expensive 
plan, the worker would keep the savings as added income just as workers 
wanting to purchase more generous plans in the exchange will be able to 
pay the additional cost out of pocket. Whatever employers pay for 
vouchers will remain tax deductible for employers and tax free for 
employees and while no employer will be required to offer vouchers 
under the new system, in order to encourage participation, employers 
who want to offer their employees tax-free vouchers will be given 
accelerated access to the new health insurance exchanges. Under the 
amendment, any employer offering its workers vouchers would have access 
to the exchange in 2015 rather than 2017, which is the schedule for 
employer access in the bill.
  Our second amendment offers more choices to individuals and families 
in the insurance exchanges. This amendment will make it possible for 
individuals who are not eligible for a subsidy to purchase a 
catastrophic plan, regardless of age. Catastrophic plans will typically 
have much lower premiums than other plans offered through the exchange 
but subscribers will pay for most of their health care expenses out of 
pocket up until they exceed their plan's catastrophic limit.
  Americans should have the choice to purchase more affordable 
coverage, if that is what works best for them. Under the Patient 
Protection and Affordable Care Act, individuals up to the age of 30 are 
eligible to purchase these plans. This Collins-Wyden amendment will 
extend that option to individuals--not receiving government subsidies--
over the age of 30. This amendment would give consumers more choice and 
help ensure that more people can purchase coverage that fits their 
needs and is affordable to them.
  The amendment includes aggressive disclosure requirements that will 
require catastrophic subscribers to certify that they understand the 
terms of the coverage and know that they are purchasing the lowest 
level of coverage available.
  Finally, we are sponsoring an amendment to help hold down premium 
increases for consumers. Starting in 2010, the Patient Protection and 
Affordable Care Act will impose an annual fee on insurance companies 
based on the number of premiums written each year. This Wyden-Collins 
amendment will modify that fee to create an incentive for insurers to 
hold down rates. So, for example, insurance companies that hold down 
premium increases will pay lower fees, while insurers who jack up their 
premiums will pay much higher fees. Starting in 2010 the fee will be 
varied by as much as 50 percent based on how aggressively insurers 
control costs which will give them a strong incentive to hold the line 
on overhead, executive salaries, provider payments, and inefficiency. 
As under the bill, the total amount of the annual fee will be $6.7 
billion per year.
  I urge our colleagues on both sides of the aisle will support these 
bipartisan, commonsense amendments.
  Mr. JOHNSON. Mr. President, as more American families struggle in the 
face of job loss and rising health care costs, the urgency with which 
the Senate health care debate must progress is clear.
  Americans feel a growing insecurity about the future of their family 
and the future of our country. The recent economic crisis demonstrated 
the interconnectedness of Wall Street and Main Street. It confirmed 
what we already knew: that the strength and stability of our economy is 
intimately tied to the welfare of working families and our ability to 
direct spending down a more sustainable path.
  In 2008, the United States spent $2.4 trillion on health care. By 
2018, national health spending is expected to almost double, reaching 
$4.4 trillion and comprising 20 percent of our economy. If the growth 
of health care costs is not addressed, America's economy won't be able 
to keep up and more jobs will be lost, wages will drop, and health care 
benefits will be cut.
  In addition to the unsustainable growth of health care costs, further 
faults in our current health care system leave millions of Americans 
one illness or job loss away from losing their health care benefits. 
Guaranteed access to affordable and meaningful

[[Page 30909]]

health benefits would provide Americans with the security they deserve.
  I recently heard from Brad and Joanne in Goodwin, SD. Brad is a 
cancer survivor and Joanne is a heart attack survivor. They had health 
insurance coverage at the time of their illnesses but still carry 
medical debt. After the economy forced the plant Joanne worked for to 
close in October 2008, she fell back on the health insurance coverage 
offered by Brad's employer. She relies on medication to manage her 
heart health and Brad requires regular checkups to make sure he stays 
cancer-free. In March of this year, the family hit hard times again 
when Brad's employer downsized and he was laid off.
  Today, Brad and Joanne are still unable to find work and their 
unemployment benefits are set to run out at the end of the year. Even 
if they could find an insurance policy that approved them for coverage 
despite their pre-existing conditions, the price of health insurance in 
the individual market is far beyond their reach. So Joanne pays 
entirely out-of-pocket for her pricey heart medication and Brad can't 
afford to visit his doctor as often as he should. They do not know what 
they will do in the event they suffer another medical emergency or if 
their unemployment benefits run out before they are able to secure a 
new job.
  Joanne and Brad's story illustrates the insecurity of many American 
families who are one job loss away from losing access to the health 
care they need. While South Dakota has been fortunate not to have as 
high of unemployment rate as other parts of the country, the economic 
crisis has put more and more South Dakotans on unsteady financial 
footing.
  It is estimated that over 88 percent of South Dakotans have health 
insurance. This too is an impressive figure compared with other states, 
but it does not paint the whole picture. Nearly 61 percent of South 
Dakotans either purchase health insurance in the individual market or 
have coverage through their employer. These families are at risk of 
losing their coverage for reasons out of their control, such as those 
experienced by Brad and Joanne.
  The Patient Protection and Affordable Care Act will guarantee these 
families access to affordable health insurance through life's ups and 
downs. Insurers will be barred from denying coverage for pre-existing 
conditions, discriminating based on gender or medical history, and will 
not be able to drop your coverage the moment you become ill and need 
costly treatment. New health insurance exchanges in every state will 
provide a menu of quality, affordable health insurance plans for the 
self-employed and those not offered coverage through their employer. 
Families who need assistance will be eligible for tax credits to make 
the plan of their choice affordable.
  These commonsense solutions will give every American one less thing 
to worry about when they get sick, change or lose their job. As we 
continue to work out the details of health care reform, let us keep in 
mind the American families who are struggling to make ends meet in the 
face of job loss and rising health care costs. When we think of them, 
the urgency of health care reform is clear.
  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. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________