[Congressional Record (Bound Edition), Volume 155 (2009), Part 24]
[Senate]
[Pages 33015-33021]
[From the U.S. Government Publishing Office, www.gpo.gov]




           SERVICE MEMBERS HOME OWNERSHIP TAX ACT--Continued

  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, I have control of the Democratic block of 
time, and I yield 25 minutes to the good Senator from Rhode Island.
  Mr. REED. Mr. President, I thank the chairman for yielding me the 
time and also thank him for his great effort on this legislation.
  It is a profound privilege to have the opportunity to serve the 
people of Rhode Island and in that capacity to support the legislation 
before us. This effort has been decades in the making. Every year that 
passes without health insurance reform has made the task more difficult 
and, the need for reform, more essential.
  Rhode Islanders have seen their health care costs double in just the 
last decade. In 2000, the average employer-sponsored family health 
insurance policy cost about $6,700. In 2008, the same plan cost nearly 
$12,700. Without reform, by 2016, that family will pay over $24,000 in 
premiums, consuming 45 percent of their projected median income. Such a 
course is unsustainable by the families of Rhode Island.
  Soaring health care costs are hurting family budgets, small 
businesses, and the national economy. In 1980, Americans spent $253 
billion on medical bills. Today, we are paying $2.5 trillion on medical 
bills. That pressure is pushing Medicare toward collapse and 750,000 
Americans into bankruptcy each year.
  This legislation will help contain health costs, extend insurance to 
millions, and give health consumers more protection against 
discriminatory insurance practices. By shifting the balance of power 
from insurance companies to consumers, we will make health care more 
affordable for individuals and businesses and provide families with 
greater health care access and stability.
  This bill is fiscally responsible. It is fully paid for. We trimmed 
wasteful programmatic spending and imposed new fees on drugmakers, 
reined in entitlement spending, and imposed taxes on things such as 
tanning beds, which lead to health care costs. But we also provided 
every American family with greater health care stability and extended 
affordable health insurance to 30 million more of our fellow citizens.
  The nonpartisan, independent Congressional Budget Office--the CBO--
estimates this bill will reduce the deficit by $132 billion over the 
next decade and $1.2 trillion over the following 10 years.
  We need urgent action. The delay tactics and the procedural obstacles 
employed by the other side are hurting our fellow citizens. Every day, 
14,000 more Americans lose their health coverage, and every day we 
remain here delaying this measure, 14,000 more Americans will lose 
their coverage. We have to, I think, reverse that trend and begin to 
fix our broken health care system.
  Since 1999, Rhode Island's uninsured population has nearly doubled, 
growing from 6.1 percent to 11.8 percent in 2008, and it has soared up 
to about 15 percent today in the wake of unprecedented economic issues. 
But while some of us have made this debate about trying to fix a broken 
health care system, others have made it clear their real intention was 
to use this issue to ``break President Obama'' and make health reform 
his ``Waterloo.'' Partisanship must not come before providing access to 
lifesaving health care to children, families, and seniors.
  I also don't understand how some party loyalists who spent the past 8 
years helping George W. Bush drive our economy into the ground and 
inflate the deficit to record levels are now obstructing every 
reasonable effort to fix these problems. How could they help George W. 
Bush double our national deficit, running it up more in 8 years than 
all 42 Presidents before him, and then turn around and claim President 
Obama isn't doing enough to control it?
  How could they say this $800 billion insurance reform bill--which is 
fully paid for and reduces costs to consumers--is too expensive, but 
the $1.2 trillion prescription drug bill they passed--which was 
financed through deficit spending and amounted, in many respects, to a 
giveaway to drug companies--was somehow good policy?
  How can they rail against health care reform right after overseeing 
the largest expansion of our government in decades? How will they 
change their approach when, through hard work, we do, in fact, extend 
coverage and reduce cost and begin to deal with the deficit that has to 
be dealt with in the years ahead?

[[Page 33016]]

  Health insurance reform hasn't always been this partisan. Indeed, 
many Republicans have said they support a great deal of what is in this 
bill but, for whatever reason, they refuse to support it. Indeed, by my 
count, this bill increases competition, which Republicans said they 
wanted. Indeed, by my count, this bill lowers cost, which Republicans 
said they wanted. Indeed, by my count, this bill does not contain a 
public option. I regret that, but that is the position I think most of 
the Republicans--not all--supported. And, indeed, this bill provides 
Americans with tax credits to purchase insurance, which Republicans 
said they wanted.
  So the bill we will pass seeks to tear down the inefficiencies in the 
current system, curb the cost, and reduce the waste and abuse Rhode 
Islanders and Americans experience every day.
  It is our responsibility to enact meaningful health reform. Just 
saying no may be a powerful political weapon, but this country is built 
on hope and a better future, not fear.
  Health insurance reform will offer Rhode Islanders access to stable 
and affordable health insurance coverage. Here are some of the changes 
that will happen immediately with the enactment of this bill:
  Insurance coverage for the uninsured with preexisting conditions will 
be provided through a high-risk pool within 6 months of this bill being 
signed into law. In my State, one plan already acts as the insurer of 
last resort and provides coverage for those who have preexisting 
conditions. This bill will support their efforts. And, all insurers 
will be prevented from denying coverage to children immediately due to 
a preexisting condition.
  There will be no lifetime limits on coverage for all new policies. 
This means no one will exhaust their coverage plan, no matter how sick 
they become.
  There will be restrictions on annual limits for all new policies. 
Insurance companies will have more difficulty denying care in the 
middle of treatment.
  All new policies sold will cover children up to the age of 26. This 
is particularly helpful since graduates from college often--
particularly in this economy--have a hard time finding employment with 
health care benefits.
  Insurers will no longer be able to rescind coverage upon illness--
when treatments, checkups, screenings, and medication are absolutely 
critical.
  Insurance companies will be required to cover--free of charge--
preventive care for new policyholders.
  Beginning next year, in 2011, small businesses will be eligible for a 
tax credit to purchase insurance for employees.
  Then, in 2014, after allowing the States a time to design and develop 
and prepare themselves, our bill will extend affordable coverage to 
over 30 million uninsured Americans through a new health insurance 
exchange which promises to expand choice, increase competition, and 
rein in cost.
  Rhode Islanders without a job will be able to purchase insurance on a 
newly established and government-regulated health insurance market. 
Many will receive Federal support for the purchase of coverage.
  Rhode Islanders employed by a company that does not provide 
insurance--or inadequate insurance--will be able to purchase insurance 
on this new market exchange.
  Small business owners will be able to easily compare the cost of 
insurance coverage offered by a multitude of plans through a new health 
insurance exchange, and it will allow small business owners to pick the 
coverage that fits the needs and budget of their employees.
  Rhode Islanders on Medicare will no longer have to pay out of pocket 
for important preventive services and no longer spend portions of the 
year in the so-called doughnut hole without paid drug coverage.
  Low-income adults, without children, will have access to Medicaid, 
which will provide them with insurance at reasonable costs.
  Having access to health insurance is important. Individuals, 
employers, employees, and families will have access to new insurance 
options after reform, which is important. However, affordability--the 
amount a family has to pay--is also critically important.
  We have examples of States that have already enacted insurance reform 
that covers their entire population, and what we found is, premiums 
have gone down significantly since this reform was enacted. We have 
learned a lot from their efforts, and Federal reform will improve upon 
those efforts for the rest of the country.
  As I suggested before, the average premium for a Rhode Island family 
is $12,700. If we don't do something, experts predict this premium will 
double in just 6 or 7 years. Rhode Islanders will be looking at health 
insurance bills--just the bills of annual premiums--of over $25,000. 
Again, that is not sustainable. It will literally bankrupt the families 
of Rhode Island, and they will make a very difficult choice: paying 
this much money--which for many, if not most, is extraordinarily 
difficult--or not having insurance or doing other things, such as 
limiting the access their children have for college or not saving for 
their retirement. We can change that today by moving forward with this 
legislation.
  The Congressional Budget Office has also analyzed the effect of this 
bill on the premiums that Rhode Islanders pay, and they expect premiums 
to decrease anywhere from 14 to 20 percent. CBO found these decreases 
will result from an influx of enrollees with below-average spending for 
health care.
  One of the problems we have in the health care system today is, 
healthy, young people--unless they are offered health insurance through 
their employer--don't typically purchase it. They are the classic free 
riders. If they get hurt in an accident, they will go to the emergency 
room and be treated for free. They will not have paid into the system 
that cares for them. The whole principle of insurance is spreading risk 
across the largest population to reduce cost. That is precisely what we 
are doing. This is fundamental to any insurance program.
  So this approach will actually lower the cost, as the CBO has 
reported. Additionally, the bill will provide permanent tax credits for 
Rhode Islanders to purchase insurance.
  Depending on income, individual Rhode Islanders can expect a $500 to 
$3,000 break on their insurance costs because of these tax credits. 
Rhode Island families can expect to save much more--$1,400 to $8,500--
on their insurance through these credits. Everyone should recognize the 
insurance reforms in this bill will mean people will get better 
coverage at lower costs.
  The bill also mitigates the costs facing small businesses, which in 
my State accounts for 95 percent of all businesses. Every year, these 
business owners face increasing premiums of 15 to 20 percent. They do 
not have much choice. Two companies control 80 percent of the market in 
Rhode Island, and you either accept what is offered or you go without 
insurance. Every year, they see double-digit increases. Again, this is 
not sustainable, not only over the long term but over the next several 
years.
  Starting a business and finding the right personnel is a challenging 
and expensive proposition. Innovation and entrepreneurship is risky. 
Often startup companies have difficulty hiring qualified individuals 
because the business owners can't face these increasing costs of health 
insurance. In Rhode Island, these kinds of pressures have led to the 
loss of employer-sponsored health care or reduction in premium 
assistance from employers.
  What has happened over the last several years is, real wages have 
been flat because health care has been taking all the extra money that 
in other times would have gone to increased wages. As a result, if you 
are a middle-income American and you look around through all the 
struggle and all the work you are doing and you have this sense that 
you haven't made a lot of real progress in terms of additional wealth 
or additional money put aside, it is no wonder. You have been paying 
the indirect costs of an ineffective, inefficient health care system. 
The money is going into health care. The money is going into--in many 
respects--health care that is not efficient or effective and it is not 
going into the paycheck of working Americans.

[[Page 33017]]

  The reforms set forth in the Patient Protection and Affordable Care 
Act will strengthen the employer-sponsored health insurance market. 
There has been some suggestion that this is going to create no 
opportunities or options for employers to continue to provide health 
insurance for their workers. But, according to the CBO, 83 percent of 
the privately insured Americans will be insured through their 
employers. That is a dramatic change, nearly double the total of 
Americans insured through their employer today.
  What we are going to see is not a decrease in employer insurance but 
an increase. I think this is something that will match the best aspects 
of our economy--individual business men and women making judgments 
about what plan is best for them and providing that benefit in a cost-
effective way to their employees. It will occur because of a few simple 
changes:
  First, as I mentioned, small business owners will actually receive a 
tax credit to purchase insurance for employees, should they choose, 
beginning next year, 2011. I will repeat, small businesses will get a 
tax credit, a tax break which they are not getting now, to help provide 
insurance for their workers.
  Second, individuals will have the option of finding affordable 
insurance on their own with increased competition to drive down costs, 
as more people shop effectively for health care insurance.
  Third, there will be lower administrative overhead and greater 
simplification of insurance as a result of this legislation.
  Under the proposal we are considering, premiums for small businesses 
will stop the never-ending trend of increase after increase and will 
begin to come down. Making health insurance more affordable for small 
business owners will help them by defraying their startup costs and 
ensuring individuals can seek employment regardless of the benefit 
options.
  It will foster innovation and put companies in a situation where they 
have an edge over foreign competitors and can win in the global 
marketplace. American companies today are competing against nations 
around the globe that either have a national system, which does not 
directly affect their balance sheet in terms of health insurance costs, 
or they have no health insurance at all, and as a result, that is not 
on the balance sheet of these companies. Every one of our businesses 
is, in some way or another, competing against other countries that 
heavily subsidize their insurance, that provide an advantage, a 
competitive advantage. We want to in some small way diminish--in fact, 
in a large way at least begin to diminish that advantage.
  While there have been many ill-founded claims about the reform 
package, the simple fact is that the tax credits provided in this bill 
is the largest health tax credit bill that has ever been considered in 
Congress. Over $400 billion in tax credits will be provided to 
Americans in order to increase affordability.
  Since health insurance reform will provide Rhode Islanders access to 
affordable health coverage, our providers should no longer face the 
financial pressure from uncompensated care. Hospitals will care for 
patients with insurance, and doctors will be able to prescribe 
preventive measures to patients so they do not become ill. Today, it is 
estimated that of all the private insurance premiums we pay in Rhode 
Island, at least $1,000 dollars of those premiums is to pay for 
uncompensated care in our hospitals, in our clinics throughout the 
State. When we have a significant number--95, 94-plus percent--of Rhode 
Islanders covered, those uncompensated costs won't be uncompensated. 
There will be an insurance program behind these individuals, so they 
can seek preventive care and they can pay for emergency care and pay 
for regular care.
  Each one of the hospitals in my state is contributing in our efforts 
to insure more Americans and doing so with the knowledge that they can 
potentially benefit from the fact that people will not be showing up in 
their emergency rooms without insurance but will bring their insurance 
card, and the support their card ensures, to the emergency room.
  In addition, the safety net providers throughout the country, our 
community health centers, will find great support in this legislation.
  There will be direct improvements for physicians in Rhode Island. The 
looming 21 percent Medicare payment reduction will be eliminated, as it 
is impending. We will continue to look for permanent solutions, not 
only to this issue of Medicare payments but also a payment formula used 
to pay doctors in a more equitable and more appropriate way.
  I am also pleased that we have taken steps to improve and enhance 
training of a new generation of primary care physicians who will be 
necessary to fill the increased demand. These improvements will help 
our overall efficiency.
  This bill will also provide seniors with an improved Medicare 
Program. Nearly one-fifth of my State is on Medicare; over 180,000 
Rhode Islanders rely on Medicare. Seniors have paid into Medicare 
during their lifetime. They deserve a program that will provide 
comprehensive coverage at the lowest cost without risk of coverage 
being terminated. However, that is not the Medicare coverage Rhode 
Islanders always receive today. Here is what Medicare does today. 
Medicare frequently allows the same test for the same complaint to be 
performed multiple times. This costs money, but it doesn't necessarily 
improve patient care. Medicare leaves over 31,000 Rhode Islanders 
without prescription drug coverage for parts of the year. This costs 
them money. And Medicare today is on the path toward insolvency in just 
8 short years, which will affect every senior in Rhode Island.
  Instead of allowing Medicare to go bankrupt, the comprehensive health 
reform bill we are currently debating would extend Medicare solvency 
for at least 5 additional years. Some predict it will be extended for 
nearly a decade. This is important for seniors enrolled in the program 
today and those who will soon enroll in the program.
  Solvency is extended by reforming the system. Seniors in my State 
will not have to make multiple trips to their doctors' offices for the 
same test for the same complaint because we will eliminate unnecessary 
duplication and tests and services. They will not fear being readmitted 
to a hospital after discharge because we will encourage care 
coordination after discharge. And they will not put off important 
preventive care because the out-of-pocket costs are just too great 
because the cost-sharing component for preventive care will be 
eliminated.
  Many of my seniors are on the Medicare Advantage Program, which is a 
privatized version of traditional Medicare. Over 65,000 seniors in my 
State have elected to enroll in this option, and there has been an 
effort to characterize the changes to this program as undermining that 
program. The private insurance companies have been saying that for over 
a month now. Why? Because they profit very handsomely from Medicare 
Advantage. They spent months telling seniors health reform will take 
away their coverage. These claims are inaccurate.
  We will eliminate excessive overpayments to private insurance 
companies. In my State, Medicare Advantage plans are paid over 20 
percent more per beneficiary than traditional Medicare fee-for-service. 
This overpayment is particularly astounding given the fact that the 
Government Accountability Office found that 19 percent of Medicare 
Advantage beneficiaries pay more than traditional Medicare for home 
health care and 16 percent pay more for inpatient services. Seniors 
should be angry and upset at insurance companies, that they continue to 
profit from the Medicare system while simultaneously taking more money 
from seniors' pocketbooks as they charge extra for these services. This 
was not the intent of the program. In fact, the intent of the program--
the argument the insurance companies made is: Give us the flexibility 
to manage Medicare patients, and we will lower costs. Very shortly 
after that, it became clear that they were not managing the costs that 
well.
  Of course, the bill is going to target waste, fraud, and abuse. For 
every $1

[[Page 33018]]

we spend in this effort--and you have to invest in this fraud 
detection--we expect to recover $17.
  Our efforts will improve health care of seniors and will stabilize 
Medicare.
  Also, we should note that we will be doing significant amounts with 
respect to children. I particularly applaud Senator Bob Casey's 
amendment to ensure that Rhode Islanders on Rite Care will not have to 
fear losing their safety net coverage.
  Finally, it is important to note, as I mentioned before, that these 
reforms are paid for. This is a stark contrast to others. We voted on 
the Medicare prescription bill in 2003, which I opposed. It was unpaid 
for, and it was more costly than the amendment which was originally 
presented to us.
  We voted on countless measures outside the normal process of 
budgeting to fund the wars in Iraq. We voted tax cut after tax cut for 
the wealthy, which has left my State not prosperous and wealthy but 13 
percent of my State unemployed and 15 percent of my neighbors are 
uninsured.
  We are moving forward to reduce the deficit with this bill, to 
provide valuable coverage, to ensure the promise of health care in the 
United States is fulfilled, not denied.
  I yield the floor.
  Mr. BAUCUS. Mr. President, pending a potential unanimous consent 
request by the two leaders, I now yield such time as the Senator from 
Massachusetts desires.
  The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
  Mr. KIRK. I ask unanimous consent to speak as in morning business, 
the time to be counted postcloture.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Mr. Kirk are printed in today's Record under 
``Morning Business.'')
  Mr. REID. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Udall of Colorado). The clerk will call 
the roll.
  The legislative clerk proceeded to call the roll.
  Mr. 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.
  Mr. REID. Mr. President, I ask unanimous consent that all postcloture 
time be considered expired on H.R. 3590 at 8 a.m., Thursday, December 
24, if cloture is invoked, and that immediately the bill, as amended, 
be read a third time, and the Senate vote on passage; that after 
passage of H.R. 3590, as amended, the Senate then proceed to the 
immediate consideration of Calendar No. 245, H.R. 4314, an act to 
permit continued financing of government operations; that no amendments 
be in order; that the bill be read a third time, and the Senate then 
proceed to vote on passage; that passage require an affirmative 60-vote 
threshold; and if that threshold is achieved, then the motion to 
reconsider be considered made and laid upon the table; further, that on 
Wednesday, January 20, 2010, at a time to be determined by the majority 
leader, following consultation with the Republican leader, the Finance 
Committee be discharged of H.J. Res. 45, increasing the statutory limit 
on the public debt and the Senate then proceed to the measure; that 
immediately after the joint resolution is reported, the majority leader 
or his designee be recognized to offer a substitute amendment and that 
the following be the only first-degree amendments in order to the joint 
resolution: Thune, TARP; Murkowski, endangerment EPA regs; Coburn, 
rescissions package; Sessions, spending caps; McConnell, relevant to 
any on the list; Reid, one relevant to any on the list; Reid, pay-go; 
Baucus, three relevant to any on the list; Conrad-Gregg, fiscal task 
force; that each of the listed amendments be subject to an affirmative 
60-vote threshold and that if any achieve that threshold, then they be 
agreed to and the motion to reconsider be laid upon the table; that if 
they do not achieve the 60-vote threshold, then they be withdrawn; that 
upon disposition of all amendments, the substitute amendment, as 
amended, if amended, be agreed to, the joint resolution, as amended, be 
read a third time and the Senate then proceed to vote on passage; 
further, that passage also be subject to an affirmative 60-vote 
threshold; further, as in executive session, I ask unanimous consent 
that on Wednesday, January 20, 2010, after a period of morning 
business, the Senate proceed to executive session to consider Calendar 
No. 421, the nomination of Beverly Martin to be a U.S. circuit judge 
for the Eleventh Circuit; that there be 60 minutes of debate with 
respect to the nomination, with the time equally divided and controlled 
between Senators Leahy and Sessions or their designees; that upon the 
use or yielding back of time, the Senate then proceed to vote on 
confirmation of the nomination; that upon confirmation, the motion to 
reconsider be considered made and laid upon the table, no further 
motions be in order, the President be immediately notified of the 
Senate's action, and the Senate then resume legislative session.
  The PRESIDING OFFICER. Is there objection?
  The Republican leader is recognized.
  Mr. McCONNELL. Mr. President, reserving the right to object, and I 
will not be objecting, I wish to make sure the Senate is aware of an 
understanding the majority leader and I have that the substitute 
amendment referred to in paragraph 1 will be limited to an actual 
amount when it is offered.
  Mr. REID. That is right. And if there are any amendments here that 
pass, of course, they would automatically be part of it.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, reserving the right to object, I wish to 
inquire whether, under that consent request that is being propounded, 
secondary amendments would be in order to any of the first-degree 
amendments on that list.
  Mr. REID. No.
  Mr. BAUCUS. I do not object.
  The PRESIDING OFFICER. Hearing no objection, without objection, it is 
so ordered.
  The Republican leader is recognized.


       Thanking Senate Pages Martin Charboneau and Mikhaila Fogel

  Mr. McCONNELL. Mr. President, I wish to recognize two young pages who 
are actually on the floor with us today. Martin Charboneau and Mikhaila 
Fogel are the pages who energetically volunteered to stay until the 
Senate adjourns and actually have sacrificed some of their Christmas 
vacation. Also, they both volunteered their service over the weekend 
before the Thanksgiving break.
  We typically have seven pages at a time on each of the sides, the 
Democratic side and the Republican side, but both Martin and Mikhaila 
marvelously have worked hard and dutifully, on both sides of the 
floor--both the Democratic side and the Republican side--to make a 14-
person job work with just two people.
  One can imagine how hard a task it must be for just two individuals 
to prepare for the numerous speeches we have had over the course of the 
past week. I know Senator Reid joins me in thanking them for their 
gracious and impeccable service to the Senate.
  The PRESIDING OFFICER. The Senator from North Dakota is recognized.
  Mr. CONRAD. Mr. President, I wish to begin by recognizing the work on 
this legislation of Leader Reid, Chairman Baucus, Chairman Harkin, and 
Chairman Dodd.
  I believe, when the history of this bill is written, it will be 
recognized what a remarkable job of leadership Senator Reid has 
provided, bringing together a disparate caucus around extraordinarily 
complex issues to accomplish something that will be seen in the future 
as a leap forward for America in reforming the health care system in 
this country.
  Chairman Baucus--no one has made a deeper, more committed, personal 
sacrifice than Senator Baucus in advancing this legislation. His 
commitment to getting this bill done and getting it done right will 
stand the test of history.
  Chairman Harkin, who succeeded Chairman Kennedy, made major 
contributions on the wellness provisions.

[[Page 33019]]

  Chairman Dodd, who filled in for Chairman Kennedy and continued in 
the role of handling this legislation, even while being chairman of the 
Banking Committee, provided an example of legislative leadership that 
is unmatched.
  The four of them have done a superb job in putting together the 
pieces of the bill that I believe will lead the way to a dramatically 
improved health care system in our country.
  If we reflect, objectively, on the package before us, it is an 
entirely reasonable and responsible approach. There is no government 
takeover of health care, no rationing, no cuts to guaranteed Medicare 
benefits, no benefits for illegal immigrants, and the bill sets a goal 
of no taxpayer funding for abortion beyond the Hyde amendment 
provisions in current law.
  In fact, this bill does much of what Republicans said they want in a 
health care plan. It is fully paid for, and it reduces deficits in both 
the short and the long term. It expands coverage and provides 
assistance to help families and small businesses afford health 
insurance. It sets new rules to stop insurance company abuses. It 
reforms the delivery system to control costs and improve quality. It 
allows for the sale of insurance across State lines. It supports 
medical malpractice reforms.
  Those are facts. Every one of those elements is in this bill. This is 
an approach that Senators on both sides of the aisle, who want 
solutions rather than slogans, should embrace.
  The need to act is clear. The status quo is simply unsustainable. 
Health care costs are crushing families, businesses, and even the 
government. The premiums for individuals and families are rising three 
times as fast as wages. You can see where we are headed. It is as clear 
as it can be.
  Without action, families will see average health care premiums rise 
to $22,000 a family by 2019--$22,000, on average, for family health 
care premiums in 2019, unless we act.
  It does not stop there. Premiums, as I have indicated, are 
skyrocketing, and national health care costs are skyrocketing right 
along with them. Without action, total health care spending will equal 
38 percent of the gross domestic product of the country by 2050. 
Thirty-eight percent of the gross domestic product for health care? 
That would be one in every two and half dollars in this economy. 
Already, we are consuming one in every six in this economy on health 
care, and that is an unsustainable course. These costs are driving our 
long-term fiscal imbalances, threatening our future economic 
prosperity.
  Without action, Federal spending on Medicare and Medicaid will reach 
12.7 percent of GDP by 2050. This chart I have in the Chamber makes it 
very clear. In 1980, the two programs were consuming 2 percent of gross 
domestic product, but on the current trend line, by 2050, these two--
Medicare and Medicaid--will consume more than 12 percent of our GDP--
one in every eight dollars in our economy.
  The growth in health care costs threatens to bankrupt Medicare. 
Medicare went cash negative last year. Without action, Medicare will be 
bankrupt in 2017. The trustees have just told us that will happen. That 
is 2 years earlier than forecast just last year. Again, Medicare went 
cash negative already. That means more money is going out than is 
coming in, in the Medicare accounts, and it will be insolvent--broke--
in 8 years. This legislation extends its life by 9 years.
  These health care costs are hurting our competitive position in the 
world. We are spending far more than other countries on health care, 
leaving less money for research and development, investment, and higher 
wages for Americans. In fact, as a percentage of our gross domestic 
product, we spend twice as much as most other advanced countries.
  Here it is, as shown on this chart. We are now even higher than 16 
percent of our GDP. The latest numbers indicate we have gone to 17 
percent of our GDP for health care. That is one in every six dollars. 
Look at other countries. Japan and the United Kingdom are half as much; 
Belgium, Germany, Switzerland, France, a little over half as much as we 
are paying.
  But even with the fact that we are spending more, we are actually 
performing worse on virtually every metric on health care outcomes. We 
are ranked 19th in preventable deaths, 22nd in infant mortality, 24th 
in life expectancy; and we still leave 46 million people without 
insurance.
  Continuing the status quo is not an option. America can do better, 
and this bill proves it. The bill before us is fiscally responsible. 
The nonpartisan Congressional Budget Office--the official scorekeeper, 
relied on by both sides of the aisle--tells us the bill reduces the 
deficit by $130 billion over the first 10 years.
  Now, those aren't my numbers, those aren't the numbers of the 
chairman of the Finance Committee, those aren't the Democratic leader's 
numbers. Those are the numbers of the nonpartisan Congressional Budget 
Office. They say this bill will reduce the deficit by $130 billion over 
the first 10 years.
  The savings in the following decade are even more impressive: between 
$650 billion and $1.3 trillion. The Congressional Budget Office says:

       All told, CBO expects that the legislation, if enacted, 
     would reduce Federal budget deficits over the decade after 
     2019 relative to those projected under current law--with a 
     total effect during that decade that is in a broad range 
     between one-quarter percent and one-half percent of gross 
     domestic product.

  One-quarter and one-half percent of GDP for that second 10 years is 
$650 billion to $1.3 trillion. Shame on those who get up on the other 
side and say this is going to increase the deficit. Where is their 
evidence, other than claims, other than assertions? We are talking 
about the considered judgment of the Congressional Budget Office that 
is nonpartisan and is the official scorekeeper for the Congress of the 
United States.
  The bill bends the cost curve for the Federal commitment to health 
care in the long term. In its December 19 estimate, CBO reports that 
the proposal would generate a reduction in the Federal budgetary 
commitment to health care during the decade following the 10-year 
budget window. So, yes, it bends the cost curve for the Federal 
expenditure during that period.
  This legislation also reforms the insurance market. We have all heard 
the horror stories. I have loads of letters in my office from 
constituents telling me about what has happened to them: being dropped 
because they got sick, even after paying years of premiums; being 
denied coverage because of preexisting conditions, in many cases 
preexisting conditions that had nothing to do with the illness for 
which they now need assistance; and being denied even though they have 
paid the premiums. This is serious business.
  This bill puts a stop to these abuses. It prohibits insurers from 
denying coverage for preexisting conditions on new policies. It 
prohibits insurers from rescinding coverage when people become sick 
after they have paid premiums for years on new plans. It bans insurers 
from lifetime caps and annual limits on health care benefits, and it 
prevents insurers from charging more based on health status.
  It also expands choice and competition. The bill before us builds on 
our current market-based system and makes it better. It is not 
government-run health care. Instead, it embraces choice and 
competition. It sets up a new health exchange where consumers can shop 
for the best value. It creates consumer-run, co-op health plans not 
government-run plans but plans run by the members. It allows for 
insurance sales across State lines to further increase competition.
  The managers' amendment also creates a new national plan. The Office 
of Personnel Management, the same agency that currently oversees health 
plans for all Federal employees, including Members of Congress, would 
select private health insurance carriers to offer plans that would be 
available nationwide. These plans would provide new competition for 
State-based health plans, particularly in areas where just one or two 
insurers currently dominate the market. At least one multistate plan 
would have to be a not-for-profit

[[Page 33020]]

insurer, such as one of the newly created co-ops. I am particularly 
excited by this development.
  When we look around the world at the countries with the best outcomes 
and the lowest cost, one feature stands out: these countries rely on 
primarily not-for-profit insurance. Germany, France, Switzerland, 
Belgium, Japan, all have adopted this model. They don't have 
government-run health care, but they do have universal coverage. They 
do have extremely high-quality health care outcomes and much lower 
costs than we do. So I believe the not-for-profit national plans and 
the co-op option may, in the long run, play a key role in transforming 
our system into a more efficient, higher quality system.
  This legislation also expands coverage. According to the 
Congressional Budget Office, it covers 94 percent of the American 
people. It creates State-based exchanges for individuals and small 
businesses. It provides $476 billion in tax credits to help working 
Americans and small businesses buy coverage. You don't hear that much 
from the other side about this $467 billion of tax assistance for 
people to afford better health care coverage. It also reforms the 
delivery system to focus on quality and not quantity. The bill before 
us slows cost growth while improving quality. The sad fact is that 30 
percent of current health care spending does nothing to improve health 
care outcomes. We are wasting about $750 billion a year on unnecessary 
and counterproductive procedures. Again, that is not a congressional 
estimate; that comes from a Dartmouth nationwide survey that concluded 
30 percent of health care expenditure in this country is wasted. This 
bill reforms the delivery system in a fundamental way. It contains 
every delivery system reform health care experts believe is needed to 
provide better care while slowing cost growth.
  This proposal also extends the solvency of Medicare. Medicare's 
actuary says the Senate bill extends the life of Medicare by 9 years. 
Some on the other side say that because Medicare is heading toward 
insolvency, we can't have Medicare savings. What? What are they talking 
about?
  Perhaps the oddest thing I have seen in this debate is the contrast 
with the last year of the Bush administration. The previous 
administration sent up a proposal to have nearly $500 billion in 
savings under Medicare, and we didn't hear one peep from the other 
side, not one. In fact, they all said it was critically important to 
do. Now all of a sudden it is the death of Medicare.
  What is even more bizarre about their argument is that now there is 
an offset for the savings from Medicare providers. The offset is they 
are going to get 30 million new customers, 30 million Americans who 
haven't had insurance who will now have it so their uncompensated care 
costs will go down, making it more affordable for providers to provide 
these savings.
  Most of these savings have been negotiated with providers. Why have 
they been willing to agree to savings--hospitals, nursing homes, and 
home health care? It is because they know they are going to get 
substantially expanded business--30 million customers with insurance 
who previously did not.
  This is important legislation. These Medicare reforms don't hurt 
seniors. Some on the other side have said you can't reduce the growth 
in Medicare costs without taking benefits away from seniors. That is 
just scare tactics. The Medicare savings provisions lower cost growth 
without harming beneficiaries.
  This legislation also helps my State. I am proud to say it. Some have 
said the Medicare changes will hurt North Dakota providers. Clearly, 
they haven't read the bill. Right now, we get paid way below the 
average for Medicare reimbursement. In fact, we are the second or third 
lowest State in the country in Medicare reimbursement. North Dakota 
providers get $5,000 a year per Medicare beneficiary.
  In Miami, they get three times as much, more than $16,000 a year to 
take care of seniors there. Now I would be the first to say it may cost 
more to provide medicine in Miami than it does in Minot, but it doesn't 
cost three times as much. The fact is, moving to a system that is based 
on outcomes rather than procedures will benefit, not hurt, a State such 
as North Dakota.
  In addition, this legislation includes the frontier States provision 
that Senator Dorgan and I offered as an amendment. Our provision puts a 
floor under payments to North Dakota providers and in other States like 
ours that are rural States that have not received fair levels of 
reimbursement. It will mean an additional $66 million a year in 
Medicare payments to my State.
  Overall, this bill is a win for North Dakota, a win for the Nation. 
It reduces the deficit, it controls costs, it saves Medicare--or at 
least extends its life for at least 9 years--it embraces choice for 
American consumers and competition and expands coverage. It reforms the 
insurance industry, and it rewards quality and efficiency.
  This legislation is an excellent start. I urge my colleagues to allow 
it to continue because we all know this isn't the last step. Next we go 
to the conference committee where we will have a chance to write the 
final legislation. No doubt this bill will be further improved as it 
has been at every step of the process.
  Again, let me conclude as I began by thanking the leadership who has 
made this bill a possibility: Senator Reid, who has done a remarkable 
job of bringing people together; Senator Baucus, who has spent more 
than a year and a half in as dedicated an effort as I have ever seen by 
a committee chairman in this body to bring major legislation to 
conclusion; Senator Dodd, who filled in for Senator Kennedy on a pinch 
hit basis but worked so hard to produce a result in that committee; and 
Senator Harkin, the new chairman of the committee, for all of his 
assistance in getting the job done.
  When the history of this legislation is written, those four will be 
recognized as producing something that was critically important for 
this country. We should salute them.
  I thank the Chair and yield the floor.
  Mr. BAUCUS. Mr. President, I very much thank my good friend from 
North Dakota for his generous statements. As he knows, this is all 
teamwork. We are all in this together, all Senators, especially on this 
side of the aisle, with the President, to get health care reform 
finally passed for all Americans. Teddy Roosevelt started this many 
years ago, and many Presidents since have been unable to get health 
care reform passed. I think finally this time we are going to do it, 
and it is a moment of which we are all very proud.
  Mr. President, I yield the remainder of my time to the Senator from 
Washington. I don't know how much that is, but whatever it is, it is 
all hers.
  The PRESIDING OFFICER. The Senator from Montana has 7\1/2\ minutes 
remaining.
  The Senator from Washington is recognized.
  Mrs. MURRAY. Mr. President, I thank my colleague from Montana, the 
chairman of the Finance Committee, who, I remember, months ago, with a 
smile on his face, said we can get this done. We are on the verge, and 
we owe him a huge debt of gratitude. So I thank the Senator very much.
  As this debate now moves forward, it has become apparent that some of 
our colleagues are losing sight of what we are working on. What should 
be a robust debate about a critical issue that is facing all of our 
families and businesses is being bogged down by distractions and 
political gimmicks and obstructions and a lot of delay while American 
families watch and wait and wonder where they exactly fit into this 
conversation. So I want to be clear with my colleagues and with 
Americans across the country today: This bill is about you. It is about 
your loved ones. It is about the people just like you across the 
country to bring down your premiums, expand your options, and increase 
your stability.
  It is about helping our economy and creating jobs by reducing the 
drag that has been created by the skyrocketing premiums and unlocking 
the potential for new health care careers. It is about supporting the 
doctors and the nurses, the hospitals and the clinics that work every 
day to take care of you. It is about helping you or your father or

[[Page 33021]]

your mother, your grandfather or your grandmother, by increasing 
benefits, cutting waste, and strengthening the Medicare on which you 
depend. And it is about Katerina.
  Katerina is a woman from Redmond, WA, and she is one of my more than 
10,000 constituents from my home State who have sent me their stories 
about their experiences with our broken health care system. Katerina is 
a single mom. She has a good education, she told me, and she has a good 
job and a solid middle-class lifestyle. But like a lot of Americans 
this year, struggling in the toughest economy since the Great 
Depression, she was laid off from her job, and she lost her employer-
provided health care. She was able to scrape enough money together to 
pay for COBRA coverage, but she told me she didn't dare go to the 
doctor because she knew she wouldn't be able to afford the copays. So 
though she was technically covered right now, in practice, neither she 
nor her child have access to true health care or preventive services. 
She found that living that way had some real consequences.
  Last month she told me she got an eye infection and eventually had to 
go to the doctor for treatment. She said after all of her out-of-pocket 
costs and still with no job and no income, she had to make some very 
serious and very tough choices about her family's food and clothing 
budget. Who knows what would have happened if Katerina or her child got 
seriously ill.
  Our broken health insurance system is failing Katerina, and she is 
not alone. Millions of people have lost jobs in this current recession.
  Millions of families have been tossed out of their employers' plans--
families who had health care, who felt secure, all of a sudden 
understand how broken the system really is and how few options they 
actually have today for affordable care. That is why we need health 
insurance reform for Katerina and millions of Americans in similar 
situations and the hundreds of millions of Americans who may switch 
jobs or move or start small businesses or who just want more options 
for high-quality affordable health care.
  Mr. President, let me talk for a minute about how this bill will 
specifically help Katerina and many others. Our plan sets up a market 
where people can shop for and purchase insurance, where insurance 
companies would have to compete for your business, and where people 
such as Katerina would be able to choose a plan that fits her family 
best from among a range of options in an open marketplace.
  It would inject competition into the insurance market, it will lower 
costs, and it will give families, such as Katerina's, more choices. 
That means instead of just having one choice when she is laid off, 
which was to purchase high-priced COBRA, Katerina will be able to 
compare the price and performance of plans and make a decision for her 
family with the benefit of true options.
  That will increase stability and keep insurance companies 
accountable. Never again will insurance companies be able to drop a 
family's plan simply because somebody got sick. No longer will losing 
your job mean losing access to affordable coverage, and no longer will 
people such as Katerina have to choose between food, clothing, and 
health care for herself and her child.
  It will also keep families secure by ensuring that all insurance 
plans offer an adequate level of coverage, including free preventive 
care that will keep them healthy and ensure that minor, inexpensive 
medical issues can be treated before they become major, expensive 
medical problems.
  Our plan will increase options, enhance security and stability, and 
it will reduce costs for people such as Katerina by providing credits 
and premium assistance. So families will no longer have to worry about 
their coverage if they lose a job, switch jobs, move, or get sick.
  Mr. President, that is what this plan is about. It is about Katerina, 
it is about her child, and it is about the millions of Americans in 
similar situations.
  If the status quo wins out, things will only get worse. If some of my 
colleagues continue to play politics with this issue, Katerina will 
continue to struggle.
  If we continue to have delay and distraction and obstruction, 
families will pay more for less, they will lose coverage, and they will 
be denied treatment and continue to have to fight insurance company 
redtape to get the care they deserve.
  That is what this is all about. I am going to continue to stand up 
and tell the stories of families and small business owners from 
Washington because they are counting on us to fix this broken system. I 
urge my colleagues to focus on their States' families and join with us 
to pass true health insurance reform.
  Before I yield, I want to take this opportunity to make an additional 
point. As everybody knows, we have been working incredibly demanding 
schedules in recent weeks. Senators have seen this floor at every 
conceivable hour--late at night, early in the morning, in the face of a 
blizzard. Far too frequently, we forget that every time we are here, 
there are literally hundreds of staff forced to be here along with us. 
In fact, they are often here long before we arrive and long after we 
leave. This body could not function without the tireless dedication of 
these men and women.
  Many of them are here now: the clerks, Parliamentarians, cloakroom 
staff, doorkeepers, Capitol Police officers, and the maintenance 
workers. They work very long hours, nights, mornings, and weekends--
with no regard to a government closure, dangerous snowstorms, or the 
need to complete their holiday shopping. If we are here, they are here. 
They deserve our thanks.
  I want to express my gratitude to every one of them and to my own 
staff as well. It hasn't been an easy time. You should all know we are 
deeply appreciative of your service.
  I, for one, am strongly supportive of bringing this debate to a close 
so that each one of you can be home with your families enjoying some 
well-deserved time off for the holidays.
  I yield the floor.

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