[Congressional Record (Bound Edition), Volume 155 (2009), Part 23]
[Senate]
[Pages 31447-31452]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mrs. HUTCHISON. Mr. President, I think the Republican leader just 
stated the case for why it is so important that we have the votes and 
that we go back to the drawing board on this bill. Americans are 
looking at the fine print of this bill. They are seeing $\1/2\ trillion 
in taxes.
  Just this week, the President has had a jobs summit because we are 
all concerned about jobs. My goodness, since the President took the 
oath of office, more than 3.5 million Americans have lost their jobs--
300,000 Texans--our budget has tripled to $1.4 trillion, and the 
Federal debt as a portion of the U.S. economy has risen to its highest 
level since World War II. So we are very concerned about these taxes. 
In fact, the small businesses of our country have said: No, do not do 
this to us.
  The NFIB, which is the National Federation of Independent Business, 
sent a letter just this week saying:

       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?

  Well, the answer to the first question is clearly no because the 
business taxes start on January 1, 2010--3 weeks or so from now--and 
going forward, the mandates and taxes in 2014 to small business are 
egregious. It could be $750 per employee or it could be $3,000 per 
employee if you do not have exactly the right mix of health care 
coverage for your employees. Well, at $3,000 per employee, small 
businesses are telling me: I am out of here. We are just going to let 
people go to the government option because we cannot afford that.
  So the answer to question No. 2 in the NFIB letter--which is, ``Will 
the bill increase the overall cost of doing business?''--is, well, of 
course it will, at a time when we are seeing the numbers of people 
employed go down.
  We are in a financial crisis in this country. People are jobless. We 
are in a holiday season. People are very stressed, and here we have a 
health care bill being rushed through, without amendments being able to 
come forward with a real chance for passing them. The cost of business 
is going to go up, which means more people are going to be laid off.
  Now, I want to ask my friend, the Senator from South Dakota, a 
question because he and I are teaming up on an amendment. If we are 
going to have taxes increase in 3 weeks, you would say: Oh, OK, well 
taxes are going to start in 3 weeks, so, then, where is the package I 
signed up for that is going to lower my health care costs? So I would 
ask the Senator from South Dakota, when do the programs that are 
supposed to lower health care costs take effect?
  Mr. THUNE. I would say to my friend from Texas, Senator Hutchison, 
that as we have examined this legislation and have looked at its cost 
and its benefits and how that is distributed over time, it has become 
clear that what the other side has tried to do--the Democrats have 
tried to do--with this bill is understate its true cost by front-
loading the tax increases and back-loading the spending. In other 
words, the tax increases kick in right away, when much of the benefit 
of the bill does not kick in for several years.
  So I want to point something out, just to illustrate what the Senator 
from Texas has said; that is, the tax increases in the bill begin on 
January 1 of this year. So 21 days from now, Americans, individuals, 
families, and small businesses are going to see their taxes go up. 
Unfortunately, they are not going to see any benefit come until 1,482 
days later.
  What that, in effect, does is it understates the total cost of this 
legislation. They have said: We want to get this under $1 trillion. The 
President said: I need a bill under $1 trillion. So they have tried to 
come up with a bill that is about $1 trillion. But what they do not 
tell you is that by delaying the benefits and front-loading the tax 
increases, you are actually going to have a 4- or 5-year period where 
people are having to experience tax increases. That is going to impact 
the small businesses because you have a Medicare payroll tax increase, 
which, by the way, for the first time, will not be used for Medicare 
but will be used to create a whole new entitlement health care program.
  You have an employer mandate which is going to hit small businesses. 
You have the tax on medical device manufacturers, on prescription 
drugs, on health plans. You have all these taxes that kick in right 
away.
  So what happens? These taxes get passed on to the consumers in this 
country in the form of higher premiums, so people are going to see 
their premiums go up. Small businesses are going to see their taxes go 
up immediately--well, 21 days from now. But Americans are not going to 
see any benefit from this for 1,482 days. So what we have is a gimmick 
that has been used to disguise the total cost of this bill, which we 
all know when fully implemented is not $1 trillion but $2.5 trillion.

[[Page 31448]]

  So the Senator from Texas and I have a motion, which I believe is 
supported by the Senator from Wyoming, who is in the Chamber, that 
would delay the tax increases until such time as the benefits begin so 
we synchronize or align the tax increases and the fees to begin at the 
same time the benefits do so we will reflect the true cost of this 
legislation to the American people and not unfairly begin punishing 
small businesses by raising their taxes before a single dollar of 
benefit is going to be distributed to the American people.
  Mrs. HUTCHISON. So I would ask the Senator from South Dakota--because 
it is our amendment, the Hutchison-Thune amendment--and surely the 
American people, who would look at the debate, would say: We are 
missing something. This cannot be right. We can't have taxes that are 
increasing our premiums, increasing our prescription drug costs, 
increasing our medical devices we must have for our health care for 4 
years. Did he say that right? Did he say we would be paying those 
higher costs for 4 years before there is any option available to allow 
more people to have health care coverage?
  Mr. THUNE. I would say to my friend from Texas, it is kind of the 
same old Washington game, the same old Washington gimmick, the same old 
backroom deal that has been cut basically that, of course, we have had 
no input into. Incidentally, there is another now, the latest 
permutation of this discussion, going on right now behind closed doors, 
which is the Medicare expansion, which is a subject for a whole other 
day.
  But I think the American people are looking at this and saying: How 
does this impact me? More than anything else, they are watching this 
big debate in Washington, DC, and saying: How does this impact me? I 
think what they are concluding is that 90 percent of the American 
public, according to the Congressional Budget Office, would see their 
premiums stay the same at best or at worst go up, and when I say ``stay 
the same,'' that means double the rate of inflation annual increases in 
their health insurance premiums.
  So the best you can hope for, if you are an American today, is the 
status quo when it comes to your health insurance premiums.
  If you buy in the individual marketplace, your premiums are going to 
go up 10 to 13 percent above the annual, double the rate of inflation 
increases that we are currently seeing.
  So that is what happens to the American public, the average person 
out there, in terms of their health insurance premiums. If you are a 
small business, you are looking at tax increases. You are looking at a 
whole new raft of tax increases that you are going to end up having to 
pay, which is why all of the small business organizations--the Senator 
from Texas pointed out the letter from the National Federation of 
Independent Business, which says this is going to drive the cost of 
doing business up. This is going to increase the cost of health care, 
not lower it. What they want to see in reform--small businesses that 
are the economic engine that creates jobs in this economy--is they want 
to see health care reforms put in place that drive health care costs 
down.
  We know from every estimate that has been done, such as from the 
Congressional Budget Office--we have some data now from the CMS actuary 
that just came out yesterday that says overall health care expenditures 
are going to go up, health insurance premiums are going to go up. So 
small businesses are looking at higher taxes.
  If you are a senior citizen in America, and one of the 11 million 
people who get Medicare Advantage, your benefits are going to be cut. 
So you have higher premiums, increased taxes on small businesses, 
Medicare benefit cuts to senior citizens across this country, and cuts 
to providers, and if you are a young American, you are faced with a 
$2.5 trillion new entitlement program that you are going to have to pay 
for.
  That is what the American people, as they are observing this debate, 
can expect to come out of this, if the bill that has been proposed by 
the majority is enacted. That is why we are working so hard to defeat 
that and put in place some commonsense reforms that actually make sense 
to the American people.
  I know the Senator from Wyoming, who is a physician, knows full well 
the impact of many of these policies from being on the front line. He 
is someone who has had to deliver health care services in a rural 
State. So I would ask him to give us his thoughts about what these tax 
increases and Medicare cuts are going to mean to health care delivery 
in places such as Wyoming.
  Mr. BARRASSO. I thank my colleague from South Dakota because South 
Dakota and Wyoming are very similar in many ways. Both have rural areas 
all spread across the State, with people needing health care.
  And I have seen it. I have seen the concerns from people, but also 
from small businesses. My colleagues mentioned the National Federation 
of Independent Business. A lot of businesses in Wyoming are members of 
that organization, and rightfully so, because small business is the 
engine that drives the economy. They are the job creators in this 
country.
  I see these taxes--4 years of taxes--before the first health care 
services are given as going to hurt our small businesses in Wyoming. It 
is going to hurt small businesses all around the country.
  In one of the morning papers, it talks about the plans that are being 
presented by the Democrats, with all the increases in health costs--the 
fines, the taxes, that this will cost 1.6 million jobs before the first 
health care services are given in 2013--1.6 million jobs across the 
country. That affects all of our States.
  At a time when unemployment is at 10 percent, at a time when 
Investor's Business Daily, this morning, says: ``Job Cuts Hit Hardest 
on Low-Skill Men; Outlook Is Gloomy,'' at a time when we are looking at 
an outlook which they call in the headlines of the front page of their 
paper ``gloomy,'' why would we say: Lets increase taxes on Americans, 
and then cut Medicare from our seniors who depend upon Medicare, and 
lets not improve services for 4 more years?
  It is no surprise then that the Republican leader would come to the 
floor and say we have now reached an all-time high of American people 
opposed, completely opposed, to this piece of legislation. The 
Republican leader read a poll that said 61 percent of Americans now 
oppose this bill. Well, it is because they are learning more about it. 
The more people of America see what is in this bill, the more they 
realize they cannot believe any of the promises that were made by the 
Democrats, by the administration, the promises that were made, and the 
polling shows it.
  Two specific questions that were asked in the poll were two specific 
promises that the President made. One is, he said he will not sign a 
bill if it adds one dime to the deficit. OK. We do not want to add to 
the deficit, although the Democrats want us to vote this weekend on 
raising the debt level by well over $1 trillion. And why? Because they 
cannot control the spending. But the question was, do you think the 
Federal budget deficit would or would not increase if this bill is 
passed--when the President said it will not raise it by a dime?
  Mr. President, 79 percent of Americans said this is going to increase 
the deficit. Only 19 percent believe what the President is telling the 
American people.
  Then the question of taxes. The President said: My plan will not 
raise your taxes one penny. What do the American people think when the 
President speaks? Question: Do you think your taxes would or would not 
increase? This is the CNN poll the Republican leader just talked about, 
done earlier this month: Do you think your taxes would or would not 
increase? The number of people who believe their taxes will increase if 
this passes, 85 percent. Eighty-five percent of the American people 
believe they are not getting it straight from the President of the 
United States. Only 14 percent believe him when he says he will not 
raise taxes a penny.
  So we have the Democrats bringing forth a bill--to me, as a 
practicing physician in Wyoming, taking care of families in Wyoming, 
talking to doctors,

[[Page 31449]]

talking to patients, having townhall meetings in the State, having 
telephone townhall meetings, the Democrats bring forth a bill that the 
people of Wyoming and the people of America realize is going to cost 
them more, is going to add to the deficit, and hurt the health care 
they receive.
  Eighty-five percent of Americans are happy with the health care they 
receive. They do not like the cost. They do not like the price. But 
this bill we are looking at is going to raise premiums for people who 
have insurance. The President promised that for families all across 
America, their premiums would drop by $2,500 per family. But if you go 
out there trying to buy insurance, if this bill passes, you are going 
to end up paying $2,100 more than you would otherwise if nothing 
passes. That is why the majority of Americans say we would be better 
off if nothing passed. That is what the American people say. The 
Democrats seem to be ignoring the voice of the American people. At a 
time of 10 percent unemployment, at a time when the National Federation 
of Independent Business points out that we will lose over a million 
more jobs if this passes, we should be looking at ways to help small 
businesses hire more workers, hire more people.
  The small businesses continue to be the engines that drive up the 
economy. Senator Collins from Maine was on the floor and gave an 
explanation of some of the taxes on all of the small businesses in 
Maine. If you have 10 employees and you go to an 11th employee, if this 
bill passes, that small business gets penalized for growing their 
business.
  We want to have an opportunity to hire people.
  She also explained that if we actually try to work ways through small 
businesses to give raises to people, those businesses get penalized 
from a tax standpoint.
  As I look at this health care bill, we need health care reform that 
is going to bring down the cost of care. This bill is going to raise 
the cost of care for all Americans. It is going to hurt our seniors by 
taking almost $500 billion out of Medicare, a program on which the 
seniors depend. It is going to raise $500 billion in taxes which is 
going to hurt the engine that drives the economy. It is going to hurt 
small business. It is going to cause people to lose their jobs. I think 
it is foolish for people to continue to support this bill. It makes no 
sense.
  I listened to my colleague from South Dakota who showed the chart 
that says 21 days until the tax increases begin but almost 4 years 
until the benefits begin. What do the people in South Dakota have to 
say about this?
  Mr. THUNE. Let me, if I might, enter into a discussion with the 
Senator from Wyoming because, as he said, his State and my State are 
not unlike in terms of the composition of population. We have big 
geographies in Wyoming and in South Dakota and in the West and a lot of 
rural health care delivery. The primary job creator in places such as 
Wyoming and South Dakota is small business. Small businesses are the 
economic engine that creates jobs.
  As the Senator from Wyoming mentioned, according to many of the 
analyses that have been done of this legislation, it would be a job 
killer. It has been suggested by the National Federation of Independent 
Business that 1.6 million jobs would be lost.
  What is ironic about that is I have heard our colleagues on the other 
side repeatedly say this is going to be great for jobs. This is going 
to be good for the economy. If that is true, then why are all of these 
business organizations coming out and saying it would increase the cost 
of doing business and it would increase health care costs? We have that 
now validated by the Congressional Budget Office, by the CMS Chief 
Actuary at Health and Human Services saying overall health care costs 
under this legislation are going to go up, not down, both as a 
percentage of the gross domestic product as well as for individuals who 
are going to see it in the form of higher health insurance premiums.
  I say to my friend from Wyoming, because he and I represent similar 
constituencies and the economies are similar, although he has--we wish 
we had more oil and gas in South Dakota along the lines of what they 
have in Wyoming--but the small business sector is what creates jobs.
  He mentioned the National Federation of Independent Business. I wish 
to mention one other letter we received from an organization called the 
Small Business Coalition for Affordable Health Care. In it they state 
that these reforms fall short of long-term, meaningful relief for small 
business. Any potential savings from these reforms are more than 
outweighed by the new taxes, new mandates, and expensive new government 
programs included in the bill. This is signed by 50 small business 
organizations, one of which, by the way, is the American Farm Bureau 
Association, which is a big presence in my State, represents a lot of 
farmers and ranchers, small business people, and I am sure represents a 
lot of members in the State of Wyoming as well as in the State of 
Texas.
  I think what they are saying is, what all of these business groups 
are saying, and that is we don't find anything in this--there may be 
some good things in it, but we find the overall core elements of this 
bill to be a detriment to job creation, will kill jobs, and will drive 
up the cost of doing business in this country.
  It is hard for me to believe that some of the statements made by the 
other side--and I assume they are making them with the greatest 
sincerity, but they are factually wrong. If they weren't, we wouldn't 
have every business organization in this country coming out and saying 
we are opposed to this because it is going to increase the cost of 
doing business, it is going to kill jobs, and it is going to increase 
the cost of health care.
  So to our colleague from Texas I would say I suspect she has a lot of 
small businesses in her State, not unlike Wyoming and South Dakota, 
that share that view.
  Mrs. HUTCHISON. Mr. President, I am glad you mentioned the Farm 
Bureau because my constituents in the Farm Bureau, 400,000 members of 
the Texas Farm Bureau, have contacted me repeatedly about how bad this 
will be for the farmers, the small businesses they own, and the few 
people they employ. Maybe they have five employees. This will be a 
killer for them.
  To reinforce the letter that the Senator from South Dakota read from 
the Small Business Coalition for Affordable Health Care, they say in 
the letter:

       If this bill is enacted, the small business community will 
     be forced to divert resources away from hiring and expansion, 
     the very investments our country so desperately needs as it 
     continues to struggle in a faltering economy with double-
     digit unemployment.

  Then they go on to talk about what those costs are going to be: a 
small business health insurance tax; an employer mandate that 
encourages job cuts, not job creation; and the temporary small business 
tax credit falls short.
  I am glad they mentioned this temporary small business tax credit 
because I have heard them say on the other side of the aisle: But there 
is a tax credit for small business that will alleviate the pain.
  Well, that credit is for employers with fewer than 25 employees with 
average annual wages of less than $40,000. Very few small businesses 
are going to be able to qualify for this tax credit. That is a very 
strict standard. The average annual wages of less than $40,000 are 
going to be very difficult. However, if they qualify, the credit is 
temporary. The credit is temporary. It is not a permanent credit that 
helps people who would be able to qualify for this credit. So, in 
effect, this is not a tax credit at all, and certainly when it goes 
away it will help no one.
  I ask unanimous consent to have printed in the Record the letter from 
the Small Business Coalition for Affordable Healthcare.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                December 10, 2009.
       Dear Representative: Representing the country's largest, 
     oldest and most respected small business associations who 
     have spent

[[Page 31450]]

     more than a decade working to increase access and 
     affordability of private health insurance, the Small Business 
     Coalition for Affordable Healthcare is writing to express our 
     opposition to the Patient Protection and Affordable Care Act 
     (H.R. 3590).
       Small business has been a constructive participant in the 
     current healthcare debate. Our small business and self-
     employed entrepreneurs have been clear about what they need 
     and want: lower costs, more choices and greater competition 
     for private insurance. These reforms are critical, but to be 
     workable and sustainable, they must be balanced against the 
     overall cost of doing business. Unfortunately, with its new 
     taxes, mandates, growth in government programs and overall 
     price tag, the Patient Protection and Affordable Care Act 
     costs too much and delivers too little.
       While a few of the provisions in the bill reflect some of 
     the insurance market reforms that the small business and 
     self-employed communities have long sought, those reforms 
     fall short of long-term meaningful relief for small business. 
     Any potential savings from those reforms are more than 
     outweighed by the new taxes, new mandates and expensive new 
     government programs included in the bill. Those new costs of 
     doing business are also disproportionately targeted at small 
     business. If this bill is enacted, the small business 
     community will be forced to divert resources away from hiring 
     and expansion--the very investments our country so 
     desperately needs as it continues to struggle in a faltering 
     economy with double-digit unemployment. Those new costs 
     include:
     A small business health insurance tax
       Though small business has repeatedly called for reducing 
     the cost of health insurance, the Senate bill includes a 
     devastating new $6.7 billion annual tax ($60.7 billion over 
     ten years) that will fall almost exclusively on small 
     business and the self-employed because they purchase in the 
     fully-insured market. While the fee is levied on the 
     insurance company, a recent CBO report confirms the small 
     business insurance tax ``would be largely passed through to 
     consumers in the form of higher premiums for private 
     coverage.'' This will send costs upward--the opposite of what 
     the nation's small employers need.
     An employer mandate that encourages job cuts, not job 
         creation
       The only certainty of an employer mandate is that it 
     punishes both the employer and employee. The employer bears 
     the first blow in trying to afford the new unfunded mandate 
     and the second blow is borne by the employee in the form of 
     lower wages and job loss. The mandate in H.R. 3590 devastates 
     the small business community in two ways. First, since the 
     bill does little to make insurance more affordable and the 
     tax credit is so limited, few will be able to obtain 
     affordable insurance. Second, the penalties assessed on 
     firms--both offering and non-offering--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. 
     Overall, the mandate included in this legislation is 
     especially troubling because it fails to recognize how the 
     cost of health benefits directly impacts wages of the 
     employee. Instead, H.R. 3590 blames the employer for a cost 
     (health insurance) that is beyond their control.
     The temporary small business tax credit falls short
       A short-term tax credit only puts off the inevitable--
     increased cost in future years. The effectiveness of the tax 
     credit in H.R. 3590 is limited: the full value of the credit 
     is only available to those with wages of less than $20,000 
     and phases out at $40,000. While the credit is designed to 
     offset the cost of insurance, its ``savings'' potential is 
     merely temporary since it only applies if you buy insurance 
     in the exchange and it expires after just two years.
     Health insurance exchange plans lack affordable choices
       Small business has long sought a simpler and more efficient 
     way to shop for insurance. H.R. 3590 creates a framework for 
     exchanges that can help ease administrative and overhead 
     costs. However, those savings are quickly erased if the 
     exchange plans are more expensive than what small employers 
     can afford. A recent CBO analysis of premiums under H.R. 3590 
     paints a disheartening picture: small group premiums, at 
     best, would decrease by about 2 percent and could increase 1 
     percent. The impact on non-group premiums is even more 
     devastating, as they are expected to increase an average of 
     10-13 percent per person. Those estimates, in addition to the 
     financing provisions included in the bill, slam the `savings' 
     door shut. Steps must be taken to ensure that a greater 
     variety of more affordable plans are available to small 
     employers and their employees.
     Limited value of Simple cafeteria plans
       The inclusion of Simple cafeteria plans in H.R. 3590 has 
     the potential to bring about a new option for small employers 
     seeking to offer coverage in an employer-sponsored setting. 
     The bill, however, currently lacks language to permit owners 
     of many ``pass- through'' business entities to participate in 
     cafeteria plans. Unless owners can participate in the plan, 
     they will be less likely to provide insurance to their 
     workforce.
     Insurance rating reforms that result in ``rate shock''
       Employers in the small group and non-group market have long 
     lived with the fear that a single illness could either price 
     them out of affordable insurance or that they could be 
     rejected for coverage altogether. While H.R. 3590 attempts to 
     ensure that insurance will be more widely available to all, 
     the restrictive rating (3:1 on age) and lack of a phase-in 
     for existing plans threatens to undermine the viability of 
     both plans that people own today or plans that they will buy 
     in the future through the exchange. Only balanced rating 
     reforms that are phased-in over an appropriate timeframe have 
     the potential to transform these poorly functioning insurance 
     markets.
     New paperwork burdens and costs for small businesses
       The Patient Protection and Affordable Care Act imposes a 
     new tax-compliance paperwork burden on small businesses. The 
     ``corporate reporting'' provision is an expansion of 
     reporting requirements (for transactions of more than $600), 
     which adds another $17 billion to the cost of doing business 
     for small business.
     A waiting period that lacks flexibility
       Small employers, including those who employ full-time, 
     part-time, temporary and seasonal workers, face much higher 
     turnover rates than their large business counterparts. They 
     face significant challenges related to providing healthcare 
     benefits to their workforces. The Patient Protection and 
     Affordable Care Act presents two specific problems. First, it 
     defines a full-time employee as working an average workweek 
     of 30 hours. Second, it outlines a 90-day waiting period, but 
     then implements fines (at the 30-60-day and the 60-90-day 
     timeframe) of $400 and $600 per affected worker respectively. 
     In industries with above average turnover (e.g. the 
     restaurant industry has roughly a 75 percent turnover rate 
     annually) these provisions would lead to fewer full-time 
     workers and less hiring overall.
     Employers and employees lose flexibility and choice
       Small employers need more affordable health insurance 
     options. However, the prohibition of HSA, FSA and HRA funds 
     to purchase over-the-counter medications, along with the 
     $2,500 limit on FSA contributions, diminishes flexibility and 
     threatens to further limit the ever-shrinking options 
     employers have to provide meaningful healthcare to their 
     employees.
     An unprecedented increase in the Medicare payroll tax
       Since its creation the payroll taxes dedicated to Medicare 
     programs have been dedicated specifically to funding 
     Medicare. However, the Patient Protection and Affordable Care 
     Act changes the purpose of the tax while setting the 
     precedent to use payroll taxes to pay for other non-Medicare 
     programs. Furthermore, it will raise taxes for some small 
     businesses.
     No meaningful liability reform
       Our medical liability litigation system creates a 
     disincentive for affordability and efficiency while creating 
     a climate where the practice of defensive medicine increases 
     healthcare spending, and overall costs. Those increased costs 
     extract a particularly heavy toll on the ability of small 
     business to access affordable healthcare for their employees 
     and dependents. Meaningful liability reform will inject more 
     fairness into the medical malpractice legal system, and 
     reduce unnecessary litigation and legal costs.
     A public option that threatens choice and competition
       A government-run plan cannot compete fairly with the 
     private market and threatens to destroy the marketplace, 
     further limiting choices. We believe that, with proper 
     reforms, the private market can be held accountable and 
     provide greater competition and lower-cost solutions where 
     insurers compete based on their ability to manage, rather 
     than shed risk.
       While our nation's entrepreneurs in the small business and 
     self-employed communities strongly believe that the status 
     quo is unsustainable, the measure of success is not simply to 
     produce reform legislation. As some in the media have 
     recently emphasized, the choice is not between the status quo 
     and the bills we have seen emerge from this process. The 
     choice is between flawed legislation and workable 
     alternatives. In short, the legislation must improve the 
     status quo. H.R. 3590 fails to provide those much-needed 
     improvements, and instead makes things worse than they are 
     today. We greatly hope that the Senate will refocus its 
     energy and work with small business to develop the 
     commonsense solutions that make our core needs a top 
     priority.
           Sincerely,
         Aeronautical Repair Station Association; American Bakers 
           Association; American Farm Bureau Federation; American 
           Hotel & Lodging Association; American International 
           Automobile Dealers Association; American Rental 
           Association; AMT--The Association For Manufacturing 
           Technology; Associated Builders and Contractors, Inc.;

[[Page 31451]]

           Associated Equipment Distributors; Associated General 
           Contractors of America.
         Association For Manufacturing Technology; Association of 
           Ship Brokers & Agents; Automotive Aftermarket Industry 
           Association; Automotive Recyclers Association; 
           Commercial Photographers International; Electronic 
           Security Association; Independent Electrical 
           Contractors; Independent Office Products & Furniture 
           Dealers Alliance; International Foodservice 
           Distributors Association; International Franchise 
           Association.
         International Housewares Association; International Sleep 
           Products Association; National Association of 
           Convenience Stores (NACS); National Association of Home 
           Builders; National Association of Manufacturers; 
           National Association of Mortgage Brokers; National 
           Association of Wholesaler-Distributors; National 
           Automobile Dealers Association; National Club 
           Association; National Federation of Independent 
           Business.
         National Lumber Building Material Dealers Association 
           (NLBMDA); National Retail Federation; National Retail 
           Lumber Association; National Roofing Contractors 
           Association; National Tooling and Machining 
           Association; National Utility Contractors Association; 
           Northeastern Retail Lumber Association; Precision 
           Machined Products Association; Precision Metalforming 
           Association; Printing Industries of America.
         Professional Photographers of America; Self-Insurance 
           Institute of America (SIIA); Service Station Dealers of 
           America and Allied Trades; Small Business & 
           Entrepreneurship Council; Society of American Florists; 
           Society of Sport and Event Photographers; Stock Artist 
           Alliance; The PGA of America; Tire Industry 
           Association; U.S. Chamber of Commerce.

  Mrs. HUTCHISON. Mr. President, I am from a State that has big cities, 
but the vast majority of my State is rural, as is Wyoming and as is 
South Dakota. I see my employers, my small business owners, which are 
the largest bulk of the employers in my State, every day. I talk to 
them or I see them. Unfortunately, we are in Washington every day right 
now, 7 days a week, but when I am home I see them and when I am here 
and talking to them on the phone, or they are visiting me, I talk to 
them and they are aghast. They are aghast that Congress would actually 
be putting more strain on small business at a time when we know the 
jobless rate is the highest since World War II and people are trying to 
do their part to increase our economy and they can't do it with more 
taxes, more mandates, more burdens. So it is time we look at the tax 
burden and do something about it.
  The Senator from South Dakota and I are trying to do something about 
it. We are saying, at the very least we should not allow this bill to 
go forward when the taxes start next month--January 2010--because none 
of the programming gets up and running until 2014. So we are going to 
have the mandates and the business taxes and we are going to have the 
program that is supposed to alleviate the health care crisis in our 
country in 2014. Shouldn't we start all of the taxes in 2014 rather 
than asking people to pay for 4 years the taxes that will increase 
insurance premiums, increase prescription drug costs, and increase 
medical equipment costs--$100 billion in new taxes on those items--
shouldn't we at least put it off until the supposed program comes into 
place. Because in 4 years, with any luck in America, we won't have 
these programs start.
  There is hope for America that we can stop this program by 2014 as 
people learn what is in it and protest enough that the Members of 
Congress who are elected in 2010, elected in 2012, will say: No, we now 
know that this would be a disaster for our country. There is hope.
  I would ask the Senator from Wyoming, when people start learning 
about the Medicare cuts about which you have spoken so eloquently, and 
the taxes on the small businesses in your State and all of our States, 
do you think that perhaps not putting these taxes in place is a good 
policy, because maybe we can still stop this when people find out what 
is in it, when it is supposed to take effect 4 years from now?
  Mr. BARRASSO. Mr. President, I would respond to my colleague from 
Texas that I think she is absolutely right. The more people learn about 
this bill and the details of the bill, the more the American people 
oppose this bill.
  My colleague from Texas made a wonderful point yesterday and again 
today when she said if they start this tax collecting right now, do we 
even know the money is going to be there 4 years from now to start 
supplying the services. There was a story in today's USA TODAY talking 
about unemployment in this country, and the story says:

       Public Gain, Private Pain. For Federal workers there is a 
     hiring boom. The Federal Government is adding jobs this year 
     at a rate of nearly 10,000 per month.

  We have read about all of the different bureaucracies that will be 
brought into play if this passes: over 70 new bureaucracies, 150,000 
more Federal employees, more Washington bureaucrats to make rules and 
regulations that affect the people of America. It talks about the 10-
percent unemployment in the country. It says, it is the new Federal 
jobs--not the small business jobs, the Federal jobs--that have helped 
bring down the unemployment rate from 10.2 to 10 percent. It is the 
Federal jobs.
  I am looking at all of this money that Washington is going to 
collect. I used to think it was a big gimmick so they could say, Well, 
we have kept the number under $900 billion. I still believe it is a big 
gimmick, but I am concerned they are going to spend the money as well 
so the money won't be there, which is the point of the Senator from 
Texas, who has been very fiscally conservative, out there always making 
sure we are not spending the taxpayer money in any way that is not a 
wise use of the money.
  Is that one of the concerns the Senator has? I know the Senator from 
South Dakota has similar concerns: Will the money be there if they are 
going to hire more Washington bureaucrats, which is what USA TODAY 
says?
  Mr. THUNE. That is exactly what our concern is. I would also add this 
recent study that came out yesterday by the CMS chief actuary sheds a 
lot of additional light on what is a very bad proposal, a big 
government proposal that does create 70 new programs here in 
Washington, DC, but does nothing to affect in a positive way the health 
care costs that most Americans are dealing with right now. The actuary 
goes on to say that access to care problems is plausible and even 
probable under the Reid bill.
  So the issue we have talked about in States such as Wyoming and South 
Dakota, where people travel long distances to get access to health 
care, would be aggravated by this legislation because there would be a 
need for more and more providers--hospitals, physicians--who currently 
don't take Medicaid patients. You expand Medicare, which is the latest 
proposal the Democrats have put forward, and as a consequence of that 
you get fewer and fewer hospitals, fewer and fewer physicians who are 
accepting Medicare patients, because Medicare and Medicaid are both 
underreimbursed, therefore creating a cost shift where the cost is 
shifted over to private payers whose premiums continue to go up and up.
  So that is why we see all of these studies coming out saying premiums 
are going to go up, taxes are going to go up, and Medicare benefits are 
going to be cut, particularly for seniors who have Medicare Advantage. 
At the end of the day, this ends up being a $2.5 billion expansion of 
the government here in Washington, DC.
  But to the point the Senator from Texas made--and I think--I know we 
are running out of time. We want to vote. We want to vote on this 
motion. We don't think you ought to start taxing people in 21 days and 
not start delivering benefits for almost 1,500 days.
  The ACTING PRESIDENT pro tempore. The time of the Senator has 
expired.
  Mr. THUNE. That is what our motion would do: Synchronize the tax 
increases with the benefits.
  I yield the floor.
  Mrs. HUTCHISON. Mr. President, I ask unanimous consent that until the 
Democrats take over, we may continue to talk.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

[[Page 31452]]


  Mrs. HUTCHISON. Mr. President, to continue with the Senator from 
South Dakota, I am glad he made the point because we are very much 
hoping our amendment will be in the order when we start voting on the 
health care amendments.
  The amendment is so clear; it is very simple. I have it here. For 
Washington, it is half a page. That is something everyone will be able 
to appreciate--the motion to commit with instructions:

       Senator Hutchison and Senator Thune move to commit the bill 
     to the Committee on Finance with instructions to report back 
     to the Senate with changes to align the effective dates of 
     all taxes, fees, and tax increases levied by such bill so 
     that no such tax, fee, or increase takes effect until such 
     time as the major insurance coverage provisions of the bill, 
     including the insurance exchanges, have begun.
       The committee is further instructed to maintain the deficit 
     neutrality of the bill over the 10-year budget window.

  That is what was promised. This was going to be deficit neutral. It 
is not deficit neutral. The cost of this bill is $2.5 trillion over the 
10-year period when it starts, in 2014 until 2023. It is $2.5 trillion. 
The ``offset''--I put that in quotes because the offsets are $500 
billion in tax cuts to Medicare, which will lower the ability of 
hospitals to stay in business and treat Medicare patients and doctors 
to be able to treat Medicare patients.
  So the quality of Medicare is going to go down. Medicare Advantage 
will be severely restricted. So you have $500 billion in cuts to 
Medicare, and then you have $500 billion in tax increases and mandates. 
That is a total of $1 trillion in offsets in a bill that costs $2.5 
trillion.
  What the Senator from South Dakota and I are trying to do is let's 
keep our word. Let's keep our word and do two things that the American 
people should expect: No. 1, that we would not start the taxes until 
the program takes effect; No. 2, that it would be deficit neutral.
  By my math, I ask the Senator from South Dakota, it looks to me like 
we are $1.5 trillion into the deficit, and we are already at a debt 
ceiling that is higher than we have had as a percentage of our GDP 
since World War II. So it is a $12 trillion debt ceiling we are hitting 
right now, and we are talking about a $1.5 trillion deficit in the bill 
we are being asked to vote for.
  I ask the Senator from South Dakota, who is my cosponsor on this very 
important amendment, don't we owe the American people the transparency, 
as well as the policy, that we would eliminate the deficit and we would 
stop these disastrous taxes from taking effect, so maybe we would have 
a chance to change this product going forward in the next 4 years so 
the American people will not be saddled with these expenses, taxes, and 
mandates?
  Mr. THUNE. We do want to get a vote--a vote on our amendment and on 
other amendments. Right now, that is being prevented or blocked. We 
haven't had a vote since Tuesday. We have amendments that are ready to 
go.
  The other side said they are open to amendments and they want to get 
the bill moving forward, but we are being prevented from getting votes 
on amendments. In the meantime, this backroom deal that is being cut, 
which we haven't seen--supposedly it has been sent to the CBO to find 
out what it will cost. We are waiting for that deal to emerge. In the 
meantime, we are looking at a piece of legislation that costs $2.5 
trillion when fully implemented.
  As the Senator said, it relies on Medicare cuts and tax increases to 
finance it. Just yesterday, the chief actuary at the Center for 
Medicare and Medicaid Services basically said the savings that are 
relied upon, in terms of Medicare cuts, are unlikely to be sustainable 
on a permanent basis. They raise the question about whether those cuts 
are actually going to occur and, if they do, whether they will be 
sustained. If they are not, then you have the question of whether a lot 
of these providers out there--if the cuts do occur, and they continue 
to lose more and more every time they see a Medicare patient, then they 
are going to quit participating in the Medicare Program. You will have 
fewer providers offering services, making it more difficult for 
people--especially in places such as Wyoming and South Dakota--to get 
access to health care.
  You are assuming all these cuts in Medicare are going to occur, and 
you are assuming all these tax increases. Even with all that, you have 
a $2.5 trillion expansion of the Federal Government, which inevitably 
is going to rely more and more on borrowing. You are going to see more 
and more of this going on the debt, and we will pass it on to future 
generations.
  As CMS pointed out, it is unlikely these Medicare payment cuts are 
going to be sustainable without driving hospitals and doctors and other 
health care providers out of business. When they start reacting to this 
and those Medicare cuts are no longer sustainable, then you have built 
in all this new spending, and there is no way to pay for it without 
raising taxes dramatically, which would be, I guess, something the 
other side--since they have already demonstrated a significant 
willingness to raise taxes in this bill or borrowing, neither of which 
is good for the future of the country or our economy.
  Right now, our economy is trying to come out of a recession. Small 
businesses, which create the jobs in our economy, are faced with higher 
taxes under this bill. They have come forward and said--every 
conceivable business is saying this will drive up the cost of doing 
business, and it will raise the cost of health care in this country.
  So you have all these small businesses saying we are not going to be 
able to create jobs. You have that specter out there. You also have the 
idea of the Medicare cuts, which are, according to the CMS actuary, 
unlikely to be sustainable, leading to borrowing and debt, which means 
we are already running a $1 trillion deficit every year and piling more 
on the Federal debt and there will be a movement here to raise the debt 
limit by almost $2 trillion. So we will pass this on to future 
generations, future young Americans, who are going to bear the cost of 
this massive expansion of the Federal Government.
  There isn't anything in this that is good for the American public, 
which is why they are reacting the way they are, and why you are seeing 
these 61 percent of Americans coming out in the polls against it.
  I say to my friend from Wyoming, his thoughts with regard to this 
issue, these Medicare cuts being sustainable, how it is going to impact 
the delivery of health care around this country, and what it will do to 
future generations in terms of the additional debt and borrowing.
  Mr. BARRASSO. As my friend knows, small communities----
  Mrs. HUTCHISON. I am sorry to interrupt my friend. I ask unanimous 
consent that he have 1 minute to finish, after which the floor would go 
to the majority.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. BARRASSO. To follow up, the small communities of this Nation have 
great concerns about these cuts in Medicare because the small community 
hospitals that stay open know they have to live within their means. 
When Medicare cuts total over almost $\1/2\ trillion, it is the small 
communities that have just one hospital in a frontier medicine mode 
taking care of people who may live 50, 100, or 150 miles away, those 
hospitals' very survivability is at stake.
  That is why we cannot pass this bill, which will hurt seniors, raise 
taxes on the American people, cost jobs, and cause people who have 
insurance to have their premiums raised. For all these reasons, this 
bill is the wrong prescription for America.
  The ACTING PRESIDENT pro tempore. The Senator from North Dakota is 
recognized.
  Mr. DORGAN. Mr. President, first of all, I ask unanimous consent that 
the amount of time by which the other side went over the allotted time 
be added to our block of time.
  The ACTING PRESIDENT pro tempore. Is there objection?
  Without objection, it is so ordered.

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