[Congressional Record (Bound Edition), Volume 156 (2010), Part 12]
[Senate]
[Pages 17181-17202]
[From the U.S. Government Publishing Office, www.gpo.gov]




  CONGRESSIONAL DISAPPROVAL OF RULE RELATING TO GRANDFATHERED HEALTH 
                        PLAN--MOTION TO PROCEED

  Mr. ENZI. Mr. President, I move to proceed to S.J. Res. 39.
  The PRESIDING OFFICER. There will be 2 hours of debate equally 
divided.
  The Senator from Wyoming is recognized.
  Mr. ENZI. Mr. President, the resolution we are debating today is 
about keeping a promise. The authors of the new health care law 
promised the American people that if they liked their current health 
insurance, they could keep it. On at least 47 separate occasions, 
President Obama promised: ``If you like what you have, you can keep 
it.''
  Unfortunately, the Obama administration has broken that promise. 
Earlier this year, the administration published a regulation that will 
fundamentally change the health insurance plans of millions of 
Americans. The reality of this new regulation is, if you like what you 
have, you can't keep it. The new regulation implemented the 
grandfathered health plan section of the new health care law. It 
specified how existing health plans could avoid the most onerous new 
rules and redtape included in the 2,700 pages of the new health care 
law.
  This provision was a critical part of the new law. It allowed 
supporters to argue that current health insurance plans would be exempt 
from all of the rules and regulations created by the new law. Employers 
and health plans were told that the grandfathered protections would 
mean if you have coverage on the day the law passed, you could keep 
that coverage without having to make any major changes.
  Employers and employees thought the bill would have cost-cutting 
measures, but now they find only cost increases. The new law will 
provide no relief to increasing costs until at least 2014. But this 
rule and its higher costs kick in now. Unfortunately, the regulation 
writers at the Departments of Treasury, Labor, and Health and Human 
Services broke all those promises. The regulation is crystal clear. 
Most businesses--the administration estimates between 39 and 69 
percent--will not be able to keep the coverage they have.
  Under the new regulation, once a business loses grandfathered status, 
they will have to comply with all of the new mandates in the law. This 
means these businesses will have to change their current plans and 
purchase more expensive ones that meet all of the new Federal minimum 
requirements. For the 80 percent of small businesses that will lose 
their grandfathered status because of this regulation, the net result 
is clear: They will pay more for their health insurance.
  The Wall Street Journal recently reported costs as going up between 1 
and 9 percent because of the mandates included in the new health care 
law. Couple this increase with inflation, and small businesses are 
looking at a 20-percent cost increase. I actually know something about 
small business; I used to run one.
  I ran a shoe store in Wyoming. I stocked the shelves, worked the 
customers to fit shoes, ran the cash register. I placed the orders with 
suppliers. I did the accounting, I swept the sidewalk, I cleaned the 
toilets. I knew what it was like to worry about making payroll at the 
end of the month. I know firsthand about the struggles and challenges 
America's small businesses face. I understand what this regulation will 
do to small businesses across the country. Small businesses are 
struggling every day to find the resources to provide health insurance 
to their employees. Rather than making it easier for those businesses 
to continue to provide this coverage, the new regulation will mean that 
employers will simply drop their health coverage altogether. That is 
why I am so concerned about this grandfathered health plan regulation, 
and that is why I introduced the resolution we are debating today.
  My resolution would force the administration to actually keep their 
promises. The resolution would overturn this grandfathered health plan 
regulation and allow tens of thousands of businesses across the country 
to keep their current plans. If we pass the resolution, millions of 
Americans will be spared from paying higher health care costs as a 
result of new Federal mandates. If we pass the resolution, small 
businesses across the country will not have to drop health insurance 
for their workers.
  Congress created the Congressional Review Act we are using today 
specifically to overturn Federal regulations such as the one we are 
discussing. The sponsors of the Review Act recognized that too often 
Washington bureaucrats impose sweeping new regulations with little 
thought to the impact these changes will have in the real world. In 
particular, the Review Act was intended to protect small businesses 
across the country that are often most vulnerable to new government 
mandates and regulations.
  That is precisely what happened with the grandfathered health plan 
regulation. The regulation writers went above and beyond what the law 
said and came up with a whole slew of requirements businesses must 
comply with if they want to keep what they have. The regulation 
includes a long list of things that will disqualify businesses from 
being able to keep what they have. If a business does anything to try 
to keep costs under control, they lose their grandfathered status.
  Earlier this year, when the grandfathered regulation was first 
published by the administration, I came to the Senate floor and warned 
of the negative impact this regulation would have on small businesses. 
This new regulation appears to ignore the impact it will have in the 
real world. It will drive up costs and reduce the number of people who 
have insurance.
  I recently heard from Jim, an insurance agent in Illinois, who wrote 
to me and said:

       My experience in the last few months is--maintaining 
     grandfather status to my group plans is all but impossible. 
     All my clients' renewal rates in September and October are in 
     excess of thirty percent. To keep grandfather status, the 
     group is limited in deductible changes and contribution 
     levels. The only option is for the employer to accept the 
     premium increase at the worst economic time in forty years. 
     They can't afford to keep the grandfather status and soon 
     won't be able to afford insurance at all. In my opinion, the 
     legislative goal was to make

[[Page 17182]]

     maintaining grandfather status so restrictive, companies are 
     forced out. It's working.

  I have a whole slew of similar stories and I ask unanimous consent to 
have some of them printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 How the Grandfathered Health Plan Regulation Is Impacting Americans--
        Real Life Stories From America's Health Insurance Agents

       I recently helped a couple in their 50's who each had their 
     own individual policy. I signed them up with their policies 
     about a year ago and they gave me a call when their annual 
     rates increased the usual 15%. They wanted to look for 
     something more affordable even if it was a higher deductible 
     plan. They settled on a plan. I went to meet with them and 
     began to explain grandfathering and that if they do choose 
     the new plan, they will lose the chance to keep their 
     grandfathered status and either way will have to pay more. 
     They decided to stay with their ``grandfathered plan'' 
     because the benefits are ``better'' than what they would have 
     been if they went to a new plan where they would have more 
     out of pocket costs.
       Really, either way, it's a lose-lose. At least if things 
     would've remained the same, the benefits would be better. 
     But, now we have to tell our clients and prospects that 
     prices are still going to go up, and benefits are still going 
     to go down, but just at a faster pace. It's been kicked into 
     high gear with ObamaCare. So, kudos to the people that are 
     making these drastic decisions. I'm glad I'm just the 
     messenger, because I wouldn't want to be responsible for 
     killing our healthcare.

                                                  Tressa Girt,

                                           Health Insurance Agent,
     Milwaukie, OR.
                                  ____

       Several of the insurance companies doing business in Utah 
     have announced that they will not allow ``grandfathering'' 
     plans for groups under 50 lives because of the expense to 
     them to maintaining multiple plans on their books. This 
     basically leaves those who had coverage with these carriers 
     without any possibility of grandfathering and thus avoiding 
     the expense of new mandates.

                                               Charles Cowley,

                              Charles H. Cowley Employee Benefits,
     Salt Lake City, UT.
                                  ____

       I am an agent in Lafayette, IN. My specialty is small group 
     health insurance. I work with many farmers and builders. 
     These are hardworking, honest Americans just trying to make a 
     decent living. Many of my clients struggle to make ends meet 
     and desperately want to continue providing health insurance 
     to their employees. With the healthcare reform, they are 
     extremely confused and disappointed when it comes to being 
     able to grandfather their plans. In particular, I insure a 
     local builder. He has ensured throughout the years that his 
     employees have good health coverage. He has absorbed many of 
     the renewal increases in the past few years. With the 
     downturn in new home sales, his business has struggled. His 
     group health plan renewed Sept 1, 2010. He received a 15% 
     increase. In years past, he was able to absorb the increase 
     and keep the health plan ``as is.'' Financially, this year, 
     that wasn't an option. He had to increase his deductible 
     amount or risk being unable to offer health insurance at all. 
     I explained that this small change would in fact cause his 
     group to lose their grandfathering status. He was upset and 
     concerned about the loss. He didn't want to make the change 
     but it was either that or offer no coverage at all. I believe 
     that a group should be able to retain their grandfathered 
     status when making changes in deductibles such as raising by 
     $500 or adjusting contribution levels. It is unrealistic to 
     believe a small group can absorb 15+% increases for the next 
     4 yrs to maintain their grandfathered status.
                                  ____

       My client is a 22-life group in Ft. Lauderdale, FL. 
     Currently with Aetna. They received a large increase which is 
     driving all my clients--not just them--out of a grandfathered 
     plan! They feel forced to get a new plan because they made 
     their current plan so expensive. Now, the new plans have much 
     higher deductibles, more out-of-pocket and the affordable 
     plans only offer to pay 50% coinsurance! The options are very 
     limited.
                                               Jennifer L. Eisler.

  Mr. ENZI. Folks all over the country are just like Jim. Insurance 
agents are explaining to small businesses that they will be forced to 
choose either to absorb premium increases in excess of 15 percent or 
lose their grandfathered health plan status. By the administration's 
own estimate, up to 80 percent of small businesses will lose the right 
to keep what they have. Lots of companies pay 90 percent of the cost of 
their employees' and families' insurance. They were hoping to be 
grandfathered at least until 2014, to see exactly how damaging the 
whole bill would be. But we are experiencing 2014 now, with no help in 
cost cutting.
  The Small Business and Entrepreneurship Council says it pretty 
succinctly. In a letter they wrote to me supporting S.J. Res. 39, they 
write:

       Rather than helping small business owners and their 
     workforce keep their plans, it appears the rule has been 
     rigged to force most small businesses and their employers out 
     of grandfathered status.

  The letter also reads:

       The rule, as written, is in clear violation of President 
     Obama's promise that Americans would be able to keep the 
     health plans they currently have upon passage of the Patient 
     Protection and Affordable Care Act.

  As the Chamber of Commerce, the National Association of 
Manufacturers, the National Retail Federation, and other business 
groups supporting this resolution have said: This rule will make it 
harder for employers to make changes that will hold down their health 
care costs. Large and small businesses will have few options for both 
keeping costs in check and maintaining the grandfathered status.
  If employers do almost anything to help slow the growth in their 
health insurance costs, they will lose the limited protections against 
the expensive new mandates in the bill. It is worth noting that two 
pages in the law that create the grandfathered plans give infinite 
leeway to the bureaucrats who are writing the rule, and they took it. 
The law doesn't say anything about cost-sharing requirements or 
coinsurance rates. The administration made up all of these provisions 
and requirements. They didn't have to write these rules in a way that 
precludes half of Americans from keeping what they have.
  Our economy is already struggling. It doesn't need more job killing. 
It doesn't need cost increasing government mandates. We are hearing 
from small businesses across the country which are already being forced 
to swallow large premium increases that will prevent them from hiring 
more workers. It is about the jobs. We need to create more jobs, not 
write more regulations that lead to less jobs. This bill was sold as 
letting people keep what they have. But the devil is in the details. Do 
a little digging and it is clear; Americans would not be able to keep 
what they have.
  The simple truth is, because this new rule will drastically tie the 
hands of employers, few employers are expected to be able to pursue 
grandfathered status. I even have letters from people who have 
individual situations, and they are concerned as well. That means more 
than half of Americans who like what they have would not be able to 
keep it.
  The final result of the new regulation will be that all Americans 
will eventually be forced to buy the kind of health insurance the 
Federal Government thinks they should have. Never mind they can't 
afford it. Never mind that employers will be less likely to hire new 
workers and probably even lay off workers. Simply put, this rule 
states: Washington knows best.
  This new rule is pretty clear. If you like what you have, you can't 
keep it.
  Later today, the Senate will have the opportunity to vote on the 
resolution that will help small businesses actually keep what they 
have. I urge my colleagues to support this resolution and keep the 
promise that if Americans like the insurance they have, then they can 
keep it. That should be the bare minimum until at least 2014, so 
businesses and employers can assess the damage from all the regulations 
combined--and there is a pile of them coming. Help is not in the bill 
until 2014, but the rule is for now. The big question is, Why weren't 
the cost-cutting measures included in the regulation?
  I yield the floor and reserve the remainder of my time.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, what is the parliamentary situation?
  The PRESIDING OFFICER. The Senate is considering the motion to 
proceed to S.J. Res. 39.
  The Senator from Iowa.
  Mr. HARKIN. Mr. President, I have 1 hour?
  The PRESIDING OFFICER. That is right.
  Mr. HARKIN. I know the Senator from Montana wants to speak. If he 
could just withhold for a few moments

[[Page 17183]]

for my opening comment, and then I will yield to him.
  Mr. BAUCUS. Sure.
  Mr. HARKIN. Mr. President, I listened to the statement made by my 
good friend--and he is my good friend--Senator Enzi from Wyoming. We 
are in the seventh month since the Affordable Care Act became law. Ever 
since the day President Obama signed the bill into law, my friends on 
the Republican side have made it clear they intend to use every 
conceivable opportunity they have to repeal it. This resolution, 
regrettably, is another attempt to make good on that pledge by undoing 
some of the law's most critically important patient protections.
  The resolution offered by Senator Enzi claims to protect small 
businesses by repealing the grandfather regulation, which defines which 
insurance plans and businesses have to comply with certain consumer 
protection provisions of the Affordable Care Act. However, if passed, 
the businesses and Americans could be in the worst of all worlds, 
losing the clear rules that allow them to keep the plans they have 
while not gaining additional consumer protections that apply when their 
plan changes.
  I have a letter from the Main Street Alliance, which strongly opposes 
this resolution. This is an alliance of small businesses. Let me read 
an excerpt from that letter. They say:

       Opponents of the health law's insurance market reforms 
     continue to hide behind business arguments and claims about 
     increasing costs. But independent analyses show that all the 
     new protections in the law should contribute a mere one to 
     two percent increase to costs next year, a number easily 
     offset by provisions like the small business tax credits--

  That we have given small businesses--

     in the short term and savings from increased bargaining power 
     and investing in prevention in the longer term. Let's be 
     clear: those who seek to block implementation of the new 
     grandfather regulations are acting in the best interests of 
     the insurance industry, not Main Street small businesses.

  Mr. President, I ask unanimous consent that letter be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                     The Main Street Alliance,

                                  Seattle, WA, September 28, 2010.
     Re Small business opposition to S.J. Res. 39, attempting to 
         block implementation of health law's grandfathering 
         rules.

       Honorable Senators: On behalf of the Main Street Alliance, 
     a national network of small business coalitions that brought 
     the voices of real small business owners to the national 
     dialogue over health reform, we write to urge your opposition 
     to S.J. Res. 39, filed in the Senate on September 21. This 
     resolution of disapproval would prevent the implementation of 
     the grandfathering regulations that are critical to fostering 
     an orderly transition to a reformed insurance market under 
     the Patient Protection & Affordable Care Act.
       Some of the health care law's new protections apply to all 
     health plans, regardless of grandfathered status, including 
     the prohibition of rescissions, ban on lifetime coverage 
     limits, and end to exclusion of children based on pre-
     existing conditions. Still, other market reforms that are 
     impacted by the grandfather provision are among the new 
     protections most important to small businesses.
       Small business owners want their health plans to cover 
     basic preventive care at no cost so they can maintain a 
     healthy workforce. We want an end to premium discrimination 
     based on our employees' health status. And we want stronger 
     review of premium increases and a meaningful third-party 
     appeals process to make sure we get a fair shake. What we 
     don't want is to be stuck indefinitely with plans that, 
     because of their grandfathered status, allow insurers to 
     continue ``business as usual'' without fulfilling new 
     protections or submitting their rate increases for meaningful 
     review--that would not be reform.
       Opponents of the health law's insurance market reforms 
     continue to hide behind business arguments and claims about 
     increasing costs. But independent analyses show that all the 
     new protections in the law should contribute a mere one to 
     two percent increase to costs next year, a number easily 
     offset by provisions like the small business tax credits in 
     the short term and savings from increased bargaining power 
     and investing in prevention in the longer term.
       Let's be clear: those who seek to block implementation of 
     the new grandfather regulations are acting in the best 
     interests of the insurance industry, not Main Street small 
     businesses.
       Health reform needs to lower costs for small businesses. It 
     also needs to end the slide toward junk health insurance. The 
     regulations drafted by the Administration to implement the 
     grandfather provision create a reasonable transition to a 
     reformed insurance market. We urge your opposition to S.J. 
     Res. 39.
       Sincerely, on behalf of the Main Street Alliance,
     J. Kelly Conklin,
       Foley-Waite Associates, Inc., Bloomfield, NJ.
     Leanne Clarke,
       Haleyanne Jewelry, Seattle, WA.
     David Borris,
       Hel's Kitchen Catering, Northbrook, IL.

  Mr. HARKIN. One of the things we put in the health care bill when we 
designed it was the protection for consumers to keep the plan they have 
if they like it; thus, the term ``grandfathered plans.'' If you have a 
plan you like--existing policies--you can keep them. Well, then we left 
it to the Department of Health and Human Services to craft regulations 
to define exactly what a grandfathered plan is.
  On the one hand, you want to give some flexibility to plans to be 
able to make reasonable changes. For example, if costs go up, they can 
increase their premiums somewhat. They can do certain things. But they 
cannot change the fundamental kind of nature of the plan and still call 
it a grandfathered plan. You want to protect consumers to make sure 
that what plan they signed up for is the grandfathered plan and not 
something else.
  For instance, if the regulations are overturned, which is what the 
Senator from Wyoming wants, insurance plans could change immensely. Yet 
that is not what you signed up for; for example, the grandfathering 
rule that says the insurer cannot significantly cut your benefits. 
Let's say your insurer decides to cut from your plan conditions such as 
cancer or diabetes or heart disease. Let's say they cut that out of 
your plan. Well, that plan would no longer be considered grandfathered 
because that is not what you signed up for.
  The second one says they cannot raise your coinsurance charges. For 
instance, if you are required to pay 20 percent of the cost for all 
hospital visits, your insurer cannot raise that to 50 percent because 
that is not what you signed up for.
  They cannot significantly raise copayments. If your plan is 
grandfathered, you are protected from drastic increases in copays. 
Copays would be allowed to rise nominally each year, but if they 
changed significantly, that is not what you signed up for.
  Grandfathered plans cannot significantly raise deductibles. Let's say 
your plan is grandfathered. You are protected from large increases to 
your deductible. That keeps your insurance company from shifting more 
cost to you because that is not what you signed up for.
  Grandfathered plans cannot significantly increase your premiums. 
Well, for example, if 20 percent of your insurance costs are currently 
deducted from your paycheck, and your employer pays the other 80 
percent, under the rule that cannot be changed by more than 5 
percentage points a year. Well, what if a company came in and said: You 
were paying 20 percent; now you have to pay 40 percent? If they did 
that, that is not what you signed up for, so that should not be a 
grandfathered plan.
  Also, grandfathered plans cannot add or tighten an annual limit on 
benefits. If your plan is grandfathered, your insurer cannot add a new 
cap on the amount they will pay for covered services each year. Why? 
Because that is not what you signed up for.
  Grandfathered plans cannot change insurance companies. If your plan 
is grandfathered, you get to keep your plan. This means you will keep 
your insurance company and with it your network of doctors. Because if 
that is changed on you, that is not what you signed up for.
  So basically the rule my friend from Wyoming is seeking to overturn 
protects you, the consumer. It protects you in keeping the plan you 
like; we said, if you like a plan, you get to keep it, and you can 
grandfather it in. What

[[Page 17184]]

if they change the caps on certain annual limits? What if they raise 
your copays? What if they raise your deductibles? What if they sell out 
to another insurance company that has a different kind of a policy? Why 
should that be grandfathered? Because that is not what you signed up 
for.
  We want to make sure if you signed up for a plan and you like that 
plan, it can be grandfathered. What cannot be grandfathered is 
something drastically different, which puts you at a disadvantage.
  So it is clearcut on this issue before us: You either stand with 
consumers and you stand with Main Street businesses--which I just read 
a letter from, which recognizes that if they want grandfathered plans, 
they also want to be protected, they want some certainty out there to 
know what those plans are going to be; and that is what these rules 
provide. On the other hand, if you vote to overrule this rule, you are 
obviously standing with the insurance companies one more time, letting 
them continue what we closed the door on, some of these terrible abuses 
of cutting people off, putting caps on what you can get, changing your 
policies midstream.
  Well, the rule says: Yes, insurance company, you can do that, but you 
are no longer a grandfathered plan. That is exactly what this rule is 
about, to protect consumers and to provide certainty out in the 
marketplace for small businesses so they know what the grandfathered 
plans are and what they are not. Without this, if you do not have a 
rule, who knows what a grandfathered plan is. It is up in the air.
  So with that, I yield 15 minutes to my friend from Montana who did 
such a great job as chairman of the Finance Committee in shepherding 
the health care reform bill through. He is one of our great experts in 
this area, and I know he feels strongly about these grandfathered plans 
too. So I yield 15 minutes to my friend from Montana.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I thank my friend from Iowa, the chairman 
of the HELP Committee, for his excellent service.
  A weather vane shows when the wind is blowing and in what direction 
it is blowing and a resolution such as this shows when it is election 
season.
  This resolution is a political stunt. It is an election-season effort 
to take potshots at the new health care reform law. Before the Senate 
now is a joint resolution of disapproval under the Congressional Review 
Act of 1996. Colleagues will recall that the Congressional Review Act 
is part of what some folks called the Contract with America.
  This particular resolution would nullify a regulation that is 
essential to implementing the new health reform law. The resolution is, 
thus, a transparent effort to undermine the new law. I urge my 
colleagues to oppose the resolution.
  From the beginning, the new health care reform law has been about 
ending the worst insurance company abuses. That is why the new law 
requires insurance companies to end lifetime limits on coverage. That 
is why the new law prevents insurance companies from canceling coverage 
when you get sick. That is why the new law requires insurance companies 
to allow parents to put their children up to age 26 on their insurance 
policy, and that is why the new law prevents most insurance companies 
from discriminating against kids with preexisting conditions.
  These important new protections took effect just last week. From the 
beginning, the law has been about preserving what is good about 
American health care. That is why one of the central promises of health 
care reform has been and is: If you like what you have, you can keep 
it. That is critically important. If a person has a plan, and he or she 
likes it, he or she can keep it.
  Now some on the other side of the aisle have tried to pick apart that 
promise. They have tried to find some rare example to the contrary. But 
despite what some folks might say, we stuck to that promise. If you 
like your health care plan, you can pretty much keep it.
  Then the question becomes: How can we be sure that what you have is 
still the same health care plan? What changes can the insurance plan 
make and still remain the same plan? That is what this new regulation 
is all about.
  The Departments of Health and Human Services, Labor, and Treasury 
promulgated this regulation on June 17. The regulation defines what 
changes an existing health care plan can and cannot make in order to 
retain what is called the ``grandfathered'' status.
  The new health care reform law gives grandfathered plans special 
treatment. This treatment ensures that satisfied consumers can continue 
to get their current health care plans, and this treatment ensures that 
dissatisfied consumers can get access to a fairer marketplace.
  Plans with grandfathered status get more time to incorporate some of 
the consumer protections guaranteed in the new health care reform law. 
Grandfathered status is valuable to the health insurance plans. In some 
cases, it exempts plans from having to make particular changes until 
the year 2014.
  Some fundamental consumer protections, however, are so important that 
all plans have to comply with them right away. Many of those 
protections are the ones that became effective just last week. The new 
regulation strikes a careful balance. It protects consumers from some 
of the insurance companies' most egregious abuses. At the same time, it 
recognizes the realities of what insurers are able to do. That balance 
is important to maximizing consumer choice, and that balance is 
important to minimizing insurance market disruption.
  The new regulation spells out coverage changes that would cause 
insurance plans to lose this special grandfathered status. For example, 
plans cannot significantly reduce benefits and still retain their 
grandfathered status. It makes perfect sense to require plans to 
maintain their benefits as a condition of their preferred status. After 
all, if a plan significantly reduces its benefits, it is not the same 
plan anymore. If a plan significantly reduces its benefits, the plan is 
not truly letting you keep what you have.
  Another example under the new regulation is that plans cannot 
significantly increase cost sharing and retain their grandfathered 
status. In other words, plans cannot significantly increase 
deductibles, copays or coinsurance that are more than nominal.
  Once again, the new regulation is only fair because plans should not 
be increasing the financial burden on consumers and still qualify for 
this special status. If a plan significantly increases the financial 
burden on consumers, it is not the same plan. If a plan significantly 
increases the financial burden on consumers, the plan is not letting 
you keep what you have.
  A third example under the regulation is that plans cannot add new or 
more restrictive limits on coverage and remain grandfathered. This, 
too, makes sense, because imposing or lowering annual limits has the 
same effect as reducing benefits, and that is not something for which 
plans should be rewarded.
  Once again, if a plan adds new or more restrictive annual limits on 
coverage, it is not the same plan and the plan is not letting you keep 
what you have. These examples demonstrate how reasonable the new rules 
for grandfathered status are. Plans basically have to offer the same 
coverage. They have to offer the same cost sharing and annual limits as 
they do today.
  The resolution before us would allow health insurance plans to leave 
the path to full compliance with new, commonsense consumer protections. 
The resolution would leave consumers relying on the kindness of the 
insurance industry, and we have seen how well that works. That is the 
effect of the resolution before us.
  The resolution before us would strike down disincentives for plans to 
cut benefits, increase consumers' out-of-pocket costs, or reduce how 
much health care a consumer may use in a year. The resolution before us 
would thus free the health insurance companies to cut benefits, to 
increase out-of-

[[Page 17185]]

pocket costs, and to reduce annual limits.
  The new health care reform law aims to eradicate these abusive 
practices, and the grandfathering regulation ensures a successful 
transition to a fully reformed insurance market.
  The new health reform law puts consumers and their doctors--not 
insurance companies--in charge of their health care.
  This resolution would put consumers at risk. It would put consumers 
at risk of paying more and getting less. This resolution is the exact 
opposite of health care reform.
  This resolution is a political stunt. It is about repealing health 
care reform in an election season. This resolution is an attempt by the 
other side to dismantle the new health care reform law piece by piece. 
This time, they are sending a message to their friends in the insurance 
industry. This resolution invites the insurance companies to continue 
to put profits before patients. So I ask: What is next?
  The other side says they want to repeal and replace the new health 
care law, but we saw what happened before health care reform. Before 
health care reform, insurance companies could discriminate against kids 
with a preexisting health condition. Before health care reform, health 
insurance companies did not have to let adults under 26 stay part of 
their parents' health insurance plans. Before health care reform, 
health insurance companies could kick people off their rolls when they 
were sick and needed coverage the most. That is what the law was before 
the new health care reform law. Is that what the other side wants to go 
back to?
  The bottom line is this resolution would take away consumer 
protections that the new health care reform law guarantees.
  I urge my colleagues to reject the proposition that insurance 
companies know best. They don't know best. I urge my colleagues to 
maintain the commonsense consumer protections that have just come into 
effect, and I urge my colleagues to reject this election season 
resolution.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I appreciate the comments by both of the 
leaders on health care from the other side, but you can't have your own 
facts. You can't show significant changes as being the only thing that 
eliminates grandfathering.
  If you look at the Federal Register, page 34,568, the last few 
paragraphs say: Any increase in a percentage cost-sharing requirement 
causes a group health plan or health insurance to cease to be a 
grandfathered health plan.
  Another part says: Any increase in a fixed-amount, cost-sharing 
requirement other than a copayment--any increase in a fixed amount 
copayment. It doesn't say significant changes, it says any change.
  I yield up to 10 minutes to my friend, the Senator from Wyoming, 
Senator Barrasso.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Thank you, Mr. President. As my colleagues know, I have 
come to the floor week after week after this bill was signed into law 
with a doctor's second opinion based on my nearly quarter of a century 
practice in Wyoming, taking care of families there. I go home every 
weekend and talk to people.
  The people of Wyoming remember when the President of the United 
States spoke to a joint session of Congress and he told the American 
people about the plan that was later signed into law. During that 
speech the President said:

       . . . if you are among the hundreds of millions of 
     Americans who already have health insurance through your job, 
     or Medicare, or Medicaid, or the VA, nothing in this plan 
     will require you or your employer to change the coverage or 
     the doctor you have.

  Let me repeat:

       Nothing in our plan requires you to change what you have.

  I think I heard the chairman of the Finance Committee say that if you 
like your plan, you can pretty much keep it. That is not what the 
President said. Pretty much keep it? With those words, the President--
and congressional Democrats--made a vow to 170 million people who get 
health coverage through their employer. The President and congressional 
Democrats promised that if you like what you have, then the health care 
law would let you keep it. What a difference a year makes.
  On June 14 of this year, the Obama administration released a 121-page 
``grandfathered health plan'' rule. It is a rule that clearly 
violates--clearly violates--the President's promise.
  Let me explain how. ObamaCare included a provision allowing existing 
insurance plans to be ``grandfathered'' under the new law. 
Theoretically, that means that employers and individuals would not have 
to give up the coverage they have and they like to comply with onerous 
government rules and mandates.
  So you have to make sure, though, that you read the fine print. Look 
at the chart. The chart in the new administration rules estimates 
between 39 and 69 percent of businesses will lose their grandfathered 
health plan status.
  The picture is even worse for small businesses in America, and it is 
small businesses that are the engines that drive this economy. The same 
chart in this report estimates that by the year 2013, up to 80 
percent--80 percent--of small businesses will lose their grandfathered 
status. This means American businesses will not be able to keep their 
current insurance plans. That is what this means. They will be required 
by the Federal Government to comply with all the new mandates which are 
very expensive and are contained in the new health care law. This only 
serves to drive employer health care costs up, making it even more 
difficult for them to offer health insurance to their workers.
  I am sorry. Maybe the American people are confused. The American 
people believed the goal of reform was to lower health care costs. 
America's small businesses struggle each and every day to find a way to 
provide health insurance to their employees. The government should be 
making it easier for businesses to keep providing the coverage. 
Instead, this bureaucratic regulation drives prices up. This is going 
to increase the odds that employers are going to simply choose to stop 
offering health care insurance coverage completely.
  Additionally, this so-called grandfather regulation makes it much 
harder for employers to make health insurance changes that would 
actually help to keep down the cost of care, to keep down the cost of 
coverage. Today, businesses have very few options if they want to keep 
costs in check, as well as keep their grandfathered status. Businesses 
that lose their grandfathered status are then forced to comply with all 
the new rules, all the mandates in the health care law, and now, even 
by the White House's own admission, we are talking about up to 80 
percent of the small businesses in this country.
  Subjecting employers to these mandates forces them to change and to 
expand their insurance plans. What does that mean? Well, it means costs 
are going to go up. No surprise. It is obvious this administration 
doesn't want the American people to be able to keep what they have if 
they like it. The law wasn't written that way, and certainly the 
regulations were written in a way that violates--and this is the White 
House--the White House regulations were written in a way that violates 
the pledge the President made to the American people.
  President Obama and congressional Democrats certainly like using 
their talking points, but the American people know it is just spin. 
That is why this bill was unpopular when it was signed into law and 
now, 6 months later, it is even more unpopular, with 61 percent of the 
American people wanting this bill and this law repealed and replaced.
  That is why I come to the floor today to support the efforts of my 
friend, the senior Senator from Wyoming, the ranking member of the 
Health, Education, Labor and Pensions Committee, who has introduced 
Senate Joint Resolution 39, a resolution of disapproval that would 
overturn the administration's so-called grandfather rule. It is

[[Page 17186]]

an honor to stand with Senator Enzi and fight against this job-killing 
Washington mandate. I appreciate his leadership but, more importantly, 
his dedication to make sure the President keeps his promise--a promise 
that if you like the health insurance you had before the new health 
care law was passed, then you can actually keep it.
  That is my second opinion. That is why we need to repeal and replace 
this health care law.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The minority leader.
  Mr. McCONNELL. Mr. President, I wish to proceed under my leader time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCONNELL. Mr. President, first, I had an opportunity to hear the 
remarks of Dr. Barrasso, the Senator from Wyoming, about health care, 
and I wish to thank him for the ongoing contribution he has made in 
this very important debate. This is an issue that is not over and we 
will keep on revisiting the flaws in the coming years. So I thank the 
Senator from Wyoming for his important contribution.
  I also thank the other Senator from Wyoming who is sitting to my 
left, who is the author of this measure we will be voting on--a 
necessary step. I thank the Senator from Wyoming for his important 
contribution as well.


                           Voices Grow Louder

  Mr. President, for the past year and a half, Americans have witnessed 
something truly remarkable here in Washington. They have watched a 
governing party that was more or less completely uninterested in what 
the governed had to say about the direction of the country. In a nation 
where the government's power is derived from the consent of the 
governed, that is a pretty risky governing philosophy. That is why the 
voices of the American people have grown louder and louder.
  Republicans have listened to those voices. We heard the concerns 
Americans had with the stimulus bill that was based on the discredited 
premise that having bureaucrats and Democratic lawmakers spend $1 
trillion on their favorite programs would revive the economy, and we 
opposed it. We heard the concerns Americans had about a health spending 
bill that was built on the discredited premise that spending more money 
and growing the Federal bureaucracy would make health care less 
expensive, and we opposed it. We heard the concerns Americans had about 
a financial regulatory bill that was built on the discredited premise 
that hiring more of the same kind of bureaucrats who missed the last 
crisis was a good formula for preventing the next one, and we opposed 
it.
  Again and again, Democrats were faced with a problem, and their 
solution was to ram through some costly, big government solution 
Americans did not want, but that they are now expected to pay for. And 
they are still not finished.
  In order to fund even more programs, more government, our friends on 
the other side now want to raise taxes. Nearly 15 million Americans are 
looking for work and can't find it. Another 11 million are 
underemployed, meaning they have settled for part-time work instead of 
a full-time job. Household income is down for the second year in a row, 
and Democrats want to take more money out of people's pockets.
  Just yesterday, the nonpartisan Congressional Budget Office said 
these tax hikes will hurt the economy and slow the recovery. So what 
did we do here over the past week in the Senate? An ill-conceived bill 
the chairman of the Finance Committee said would put U.S. companies at 
a competitive disadvantage, and a campaign finance bill, the entire 
goal of which was to give Democrats an electoral advantage in the 
upcoming elections by muzzling their opponents.
  If Americans need any further proof that Democrats haven't been 
listening to them, this past week has provided all the evidence they 
need. Americans want us to focus on jobs, and our friends on the other 
side focused on preserving their own jobs and spending more taxpayer 
dollars.
  It has to stop.
  That is why earlier this month I proposed a bill that would prevent a 
massive tax hike from going into effect on anyone at the end of the 
year, and that is why Republicans put forward an appropriations cap 
that would cut $300 billion from the President's budget, even as our 
friends on the other side neglected to bring a single appropriations 
bill to the floor.
  Sometime today or tomorrow, we will be leaving Washington to head 
back to our States and when we do, Democrats will have a lot of 
explaining to do about how they have spent their time here in the last 
year and a half. As for Republicans, we will be able to say we 
listened.


                          Tribute to Larry Cox

  Mr. President, in the reception area of my office in the Russell 
Building, there is a framed copy of a page from my hometown newspaper 
hanging on the wall. It is from section B, the front page, and the date 
reads January 21, 1985, just days after I was first sworn in as 
Kentucky's newest Senator.
  There is a picture of me sitting in my new Senate office, talking on 
the phone, with quite the head of dark hair. Behind me you can see a 
man in a sport coat lifting some boxes. And he looks like he can lift 
them quite easily, too. The caption under that photo reads:
  ``McConnell made a few telephone calls while aide Larry Cox moved 
boxes in on the first day.''
  The first day.
  Now, in too many ways, it feels like an era has reached its final 
days. Because after more than 25 years of Senate service, and nearly 30 
years of setting his own ego aside to help me and my career, on 
September 2 of this year, Larry Cox retired.
  No other single person worked as hard or did as much for Team 
McConnell as Larry has. And because Larry was there from the 
beginning--when on any given day, he could serve as driver, security 
detail, advance man, political operative, caseworker, legislative 
advisor, and my eyes and ears all at once--no other single person 
probably ever will.
  We have heard the phrase ``jack of all trades,'' but Larry is a 
master of all trades--not only because of the many roles he filled in 
my office, but for the fullness of his life outside the office as well.
  As the State director in my office beginning in 1985, Larry was my 
chief representative in Kentucky. He oversaw an 18-member field staff, 
spread out amongst six offices in the State, and led my efforts in 
constituent casework, project development, and outreach.
  Beyond that, however, Larry was the picture of the perfect Senate 
staffer. Content to stay in the background, for years he happily worked 
without seeking credit. He is a man of fairly strong opinions, and was 
somewhat our resident keeper of the ideological flame--but he would 
never force his opinion on you if you didn't ask for it.
  Most of all, for the hundreds of staffers that have been through my 
offices, he served as a role model, an example of good character, and a 
true friend.
  Larry and I have more in common than just our Senate service. We were 
both born in Alabama, just a year apart, and after a little traveling, 
we both ended up about as Bluegrass as one can get. Additionally, both 
Larry's father and mine served in World War II.
  After the war, Larry's father, Lawrence E. Cox, Jr., worked for Gulf 
Oil, and that job took him and his family all across the southern 
United States. Larry spent time growing up in Louisiana, Arkansas, and 
Tennessee.
  He attended George Peabody College of Vanderbilt University, and 
earned his master's at the University of Tennessee. A city planner by 
trade, he finally moved home--that is to say, to Louisville--in 1972.
  My friendship with Larry began in 1981, when Larry began working for 
county government as the deputy secretary for community development. I 
was the county judge/executive, and I successfully lured Larry away 
from his old job. By 1984, he was with me as I made by first run for 
the Senate.
  I can't talk much longer about Larry without mentioning his lovely 
wife Joanie. Larry came to start working

[[Page 17187]]

for me just 3 months after he and Joanie got married. It is lucky for 
me it wasn't 3 months before. Joanie didn't know just how much I would 
take her husband away from her over the years.
  Elaine and I have to thank Joanie for sharing Larry with us, because 
as we all know, sometimes Larry's work obligations have gotten the 
lion's share.
  Sometimes Larry served as a one-man security detail. It was like 
being staffed by Clint Eastwood. You could call him ``Dirty Larry,'' 
and he was just waiting for someone to make his day.
  Larry is not a guy you want to make mad, even though those of us who 
know him know that under that tough exterior is a very kind and caring 
man. I am probably going to get in trouble with him for saying that out 
loud.
  In the old days, Larry and I crisscrossed every county in the State, 
in a car that Larry faithfully had service every 3,000 miles. Every 
event, he had planned precisely down to the minute. Executing Larry's 
plans was like executing a military maneuver.
  This was also when I first learned about Larry's honest-to-gosh 
superpower. He is a walking, talking human GPS. Ask him how to get 
anywhere, and he can give you landmarks, travel time, distance and 
cardinal direction.
  Naturally, a fellow like that became one of my very first Senate 
staffers after we were victorious in the 1984 election. And he was the 
perfect choice to be my State director.
  In that job, he has been to every town parade and county festival. I 
believe he could name the sitting judge/executive in all 120 Kentucky 
counties, or tell you which counties towns like Eighty Eight or Grab 
are in. Since 1985, there have been 14 commanding generals at the Fort 
Knox Armor Center, and he has known and worked with every one of them.
  And in the hundreds of thousands of hours I have spent with Larry, if 
he ever had a bad day, he did it pretty well.
  Maybe that is because Larry never got bored. I have already described 
how he did everything in my office, no job too big or too small. And 
the rich and complete life he leads has given him plenty else to do as 
well.
  Larry knows a lot about a lot of things. If you are on the road with 
him, and you point out a nice looking Corvette, he will be able to tell 
you it's a ZR1 with 638 horsepower and over 600 pounds of torque that 
can pull one `G' in a turn and goes zero to 60 in 3.5 seconds.
  Larry once stopped me from boarding a plan because he could smell 
that it had been filled with the wrong kind of fuel. Despite the so-
called experts telling him otherwise, he insisted they double check. 
Turned out he was right. Larry's nose saved some lives that day.
  Larry's favored method of transportation, however, is not by air, but 
by land--specifically, by motorcycle. You can catch him driving across 
Kentucky on his Suzuki Bandit 1250, and he is usually with friends. In 
fact, Larry's got so many friends in the biker community that I have 
benefited from having a fleet of motorcycles roll in to many of my 
events. Larry's also a strong supporter of the second amendment. He 
believes in gun control--gun control being a firm hand and a steady 
grip.
  I don't know how many guns Larry has, he may not even know, but I 
believe the number is somewhere north of 50. Years ago, Larry used to 
shoot skeet competitively.
  You could even say Larry is one of those ``bitter'' people, the type 
who clings to his guns and his religion. He is a devout Christian who 
has been attending St. Matthew's United Methodist Church in Louisville 
since 1978.
  He has faithfully volunteered countless hours over the years, 
including time spent at Susannah House, a daycare center run by the 
church. He has held every church leadership position, including serving 
on the board of trustees.
  In what is becoming a recurring theme for Larry, he is always willing 
to do whatever is asked, and whatever it takes. On top of his church, 
he gives his time generously to the Kiwanis, and to the State 
Republican Party.
  Larry is a great lover of the outdoors. He and Joanie have a farm in 
Hart County, KY, that is just shy of 100 acres. Now that Larry is 
leaving us I know he will be spending a lot more time there.
  Larry generously opens up his farm to the McConnell Scholars, 
students at the University of Louisville who are part of a scholarship 
program for kids that I helped establish in 1991. He has held retreats 
for them there, mentored the students, and helped bring in speakers for 
other McConnell Center events. His contribution is so great that Dr. 
Gary Gregg, the center's director, puts it this way: ``Simply put . . . 
we would be impoverished without Larry.''
  Dr. Gregg has a 15-year-old son, and Larry has helped encourage his 
interest in deer hunting, by letting him use his farm and his fields 
and educating him about shooting and gun safety. Whenever he has a 
chance to share his love of nature and the outdoors, Larry shines.
  Anyone who thinks Republicans can't be conservationists, I want them 
to meet Larry and go visit his farm. The Green River runs through it, 
and Larry participates in the CREP program--a Kentucky conservationist 
effort to preserve and protect the river.
  A third of the farm is planted with warm-season native grasses, to 
prevent soil erosion into the river and enhance the local wildlife. A 
third of the property is in timber, and a third in hayfields. You may 
have noticed what's missing on this farm--Larry has to abide by 
Joanie's rule, ``No crops, no critters.''
  Larry is so well known throughout the State for his conservation 
efforts, he was honored this year as the Kentucky Association of 
Conservation Districts Person of the Year. He is also the first person 
to receive the Award for Distinguished Service from the Natural 
Resources Conservation Service.
  My wife Elaine is also close to Larry and Joanie, and I know she is 
going to miss them a lot. Larry was one of the first Kentuckians she 
met when she came to the State, and he was so knowledgeable and 
friendly he made her feel just at home. She liked going to Larry and 
Joanie's home, where she knew she would always find good food and good 
company.
  During my 1996 campaign, Elaine's sister Angela came to Louisville to 
volunteer, and Larry and Joanie generously put her up in their home. 
They have done that many times for other volunteers and staffers 
through the years. The McConnell Team has always been grateful to stay 
at their home.
  I have wondered often over the years how a man as unique and special 
as Larry Cox came to be, and how I was lucky enough to find him.
  To the second question, I can only credit providence. But the first 
question, that I can take a stab at answering.
  I know Larry learned a lot about living from his mother. So did I. So 
did everyone lucky to know her. Beryl O. Cox was a spirited, 
adventuresome woman--in other words, she was a lot like Larry.
  She raised three boys, and she was like one of the boys. She knew her 
priorities: She loved her family, her church, her motorcycles, and her 
bourbon--not necessarily in that order.
  She and Larry would go riding together. She had her own motorcycle, a 
Honda Valkyrie. She didn't drive it--Larry would drive, and she would 
sit on the back.
  Beryl was a delightful woman--``a real kick,'' according to Joanie. 
And may I say she was a close friend of mine as well. I remember how 
much she volunteered on many of my campaigns.
  She was about the same age as my own mother. She lived a full and 
robust life, until her passing at the age of 95 in 2007.
  A full and robust life, well lived. Larry obviously learned that from 
his mother as well. And just like her, he has made countless friends 
along the way.
  Those friends will get to see a lot more of Larry now. So will his 
family. Whether it is time spent on the farm or on the back seat of his 
motorcycle, if it

[[Page 17188]]

is time spent with Larry, I am sure they are grateful.
  The Cox family includes Larry's wife Joanie; his daughter and son-in-
law Lisa C. and Steve Pieragowski; his son and daughter-in-law J. 
Randall and Kristen A. Cox; his grandchildren Alexa Brooke Pieragowski, 
Erin Phoebe Pieragowski, Hayden Lawrence Cox, and Hadley Marie Cox; his 
brother and sister-in-law Alvin J. and Cammie Cox; his brother and 
sister-in-law Davis S. and Lynn C. Cox; his nieces and nephews 
Christopher L. Cox, Carter Cox, Lindsay F. Cox, and Stephen Cox; and 
many more beloved friends and family members.
  Larry, your family's gain will certainly be our loss. It is a loss 
for my office, and a loss for the entire State of Kentucky that you 
have faithfully served for so many years.
  As for me, I am going to miss my old friend.
  After 30 years, there is too much to be said, so I simply say, thank 
you, Larry. For your dedication, your service, and your friendship, I 
don't think you can ever be thanked enough.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. HARKIN. Mr. President, before I yield to the Senator from 
Connecticut, I listened to my friend from Wyoming before the minority 
leader spoke. He was reading from the Federal Register, if I am not 
mistaken, saying that any change--and he kept repeating ``any change,'' 
``any change,'' any increase because we have been talking about there 
had to be significant increases and changes. My friend from Wyoming was 
reading from the Federal Register and said ``any increase.''
  After reading through this, it reminds me of an example I have often 
used about not taking things out of context. It comes from Psalm 14 in 
the Bible. There is a sentence in the Bible that says, ``There is no 
God.'' I say to a lot of people, it cannot be true. Yes, there is a 
sentence in Psalm 14. It is right there. The problem is the sentence 
before that says: ``The fool in his heart says there is no God.'' You 
can take things out of context. I started reading this and saw how this 
was taken out of context.
  First of all, my friend from Wyoming said ``any increase in fixed 
amount cost sharing requirement.'' But, it says--he did not read on--
``if the total percentage increase exceeds the maximum percentage 
increase,'' as defined in another paragraph over here, which is 
basically expressed as a percentage of inflation plus 15 points. So it 
is not any increase, it is any increase based on whether it is 
inflation plus 15 points.
  Then my friend said: ``Any increase in fixed amount copayment.'' But 
you have to read on because it says ``determined as of the effective 
date if the total increase in the copayment exceeds the greater of an 
amount equal to $5 or the maximum percentage increase,'' as I mentioned 
before, which is medical inflation plus 15 percentage points.
  I ask unanimous consent to have printed in the Record this chart to 
show that it is not any changes, as my friend was saying.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

         CHANGES THAT DISQUALIFY PLANS FROM GRANDFATHERED STATUS
------------------------------------------------------------------------
               Plan Element                     Disqualifying Change*
------------------------------------------------------------------------
Copayment.................................  The greater of an increase
                                             of more than $5 (adjusted
                                             for medical inflation since
                                             March 23, 2010) or an
                                             increase above medical
                                             inflation plus 15
                                             percentage points.
Deductible................................  An increase above medical
                                             inflation (since March 23,
                                             2010) plus 15 percentage
                                             points.
Out-of-Pocket Limit.......................  An increase above medical
                                             inflation (since March 23,
                                             2010) plus 15 percentage
                                             points.
Co-Insurance..............................  Any increse in the co-
                                             insurance rate after March
                                             23, 2010
Annual Limit..............................  Any decrease of an annual
                                             limit that was in place on
                                             March 23, 2010,
                                             disqualifies a plan.
                                             Adoption of a new annual
                                             limit for plans that did
                                             not have one on March 23,
                                             2010, also disqualifies a
                                             plan.**
Employer Premium Contribution Rate (in      A decrease of more than 5
 group plans).                               percentage points below the
                                             existing employer
                                             contribution rate as of
                                             March 23, 2010
Benefits Package..........................  The elimination of all or
                                             substantially all covered
                                             benefits to diagnose or
                                             treat a particular
                                             condition after March 23,
                                             2010.
------------------------------------------------------------------------
*See the interim final rule on grandfathered plans, listed under
  ``Additional Resources,'' for information regarding exceptions to the
  March 23, 2010 date. Exceptions may apply to plans that had already
  filed pending changes at the time that health reform was enacted.
**If a plan had a lifetime limit but no annual limit on March 23, 2010,
  it may replace its lifetime limit with an annual limit while
  maintaining its grandfathered status, as long as annual limit has a
  dollar value that is equal to or greater than the previous lifetime
  limit.

  Mr. HARKIN. Mr. President, you have to read the whole paragraph. 
There is one where there is any change at all would disqualify a 
grandfather plan, and that is any increase in the percentage cost 
sharing. You can understand that. If you have a percentage cost 
sharing, let's say it is 20 percent, if the cost of the plan goes up, 
medical inflation goes up, then your total cost will go up because 20 
percent of $100 is $20; 20 percent of $120 is $24. Your out-of-pocket 
will go up.
  The only thing that would deny a plan from being grandfathered is if 
they changed the percentage of your copay. But if they have a fixed 
amount of copay, say $20, they can go above that by the maximum 
percentage increase of inflation plus 15 points.
  I wanted to try to clear that up, that there is only one case in 
which any change at all denies grandfathering, and that is if, in fact, 
the plan changes your percentage of what you have to pay in. I wanted 
to make that clear.
  Now I yield to my good friend, Senator Dodd, who was the leader on 
our committee in getting the Affordable Care Act through and who knows 
the importance of making sure we keep these protections, not only for 
consumers but for small businesses.
  I yield whatever time he wants.
  The PRESIDING OFFICER. The Senator from Connecticut is recognized.
  Mr. DODD. Mr. President, I express my gratitude to my friend and 
colleague from Iowa and his terrific work. He, along with so many 
others, brought us to the point that has defied administrations and 
Congresses for more than half a century. Together, we were finally able 
to expand access, try to stabilize costs, and increase the quality of 
health care. It is no easy task. These efforts, obviously, consumed a 
great amount of this Congress's time and attention.
  Despite the rigid opposition of those opposed to these changes, 
without an alternative ever being offered, for the first time the 
American people can look forward in the years to come to having 
increased access to health care, improved quality, in my view, but also 
stabilizing costs. Without these changes, we would put our great 
economy in this country at significant risk, beyond the other problems 
we are grappling with today.
  I say respectfully--because my friend from Wyoming knows he and I 
have worked together on many issues over my tenure and his--it is with 
a deep sense of respect for him that I rise today in opposition to what 
his resolution would attempt to achieve and to associate myself with 
the remarks of Senator Harkin, Senator Baucus, and others who worked 
day to day, along with their staffs, to achieve this health care reform 
package.
  We are told health reform is not popular. I listened to one of my 
colleagues give a presentation that this is not terribly popular in the 
polls, as if somehow that is going to determine whether what we are 
doing is right or wrong.
  I recall 1948, the Marshall Plan. If popularity in the polls had been 
the deciding factor as to whether we passed the Marshall Plan, it would 
have failed miserably. About 17 percent of Americans thought we should 
rebuild Europe. The Civil Rights Act and the Voting Rights Act--I can 
guarantee to this day there were those who said this was not a terribly 
popular idea. I am not sure how it would fare in certain quarters. I do 
not think anybody in this Chamber would disagree we are a better 
country today because of what we did in the Marshall Plan, what we did 
with the Voting Rights Act, the Civil Rights Act, and others.
  I think it is disturbing that we ought to determine the outcome of 
trying to make America achieve its great potential by the results of 
polling data. I know that has become the standard some people use. It 
ought not be the standard by which the Senate determines its course of 
action.
  Health reform is the culmination of more than a half century--in 
fact, arguably going back to Teddy Roosevelt's day, almost a century 
ago--a struggle by Democrats, Republicans, and Congresses to try and 
get to a point where we can get our arms around this very important 
issue. At long last, we set ourselves on a course to manage this issue.

[[Page 17189]]

  At the center of that struggle was the question: Who would control a 
person's health care? On this issue there seems to be unanimity. I 
think all of us would like individuals and their health care providers 
to be in control when it comes to deciding what a person's health care 
coverage would be, and not the insurance industry that has a history of 
abusing those who fall ill and need coverage.
  Just 6 months ago, we answered this question definitively. Americans 
should be able to control their own health care, and the insurance 
industry should not. This resolution before us today would take us 
backwards once again on that fundamental, underlying question at the 
heart of the long debate that consumed this Congress: Who would control 
whether a person had good health care, the insurance industry or the 
individual, their family, and their providers?
  The law we passed phases in many new protections over several years 
protecting Americans' rights while ensuring stability of the health 
care system. Just last Thursday on the 6-month anniversary of the 
passage of the health care reform bill, many consumer protections came 
into effect making up what we call the Patients' Bill of Rights.
  This Patients' Bill of Rights, which my colleagues and I fought so 
very hard to include in our final bill, provides that sense of security 
to people across the Nation and in each of our respective States by 
prohibiting the worst of the insurance companies' abuses and practices. 
These abuses went on year in and year out, disadvantaging average 
citizens in our country. As a result of that bill of rights we adopted 
in our health care reform bill and as a result of last Thursday, the 
following rights became the law of this land:
  All insurance plans must end lifetime limits on coverage. How long 
have we heard that debate and how important is it today that protection 
exists?
  All insurance plans must stop canceling coverage when you get sick. 
How many of my colleagues at townhall meetings heard the frustrations 
expressed by our constituents that just when they needed the coverage 
the most, they would be dropped by the insurance industry?
  And, today, parents who have adult children but under the age of 26 
know they can carry those kids on their plan. How many families, 
because of the economy we are in with high unemployment, particularly 
among younger people, go through sleepless nights worrying about their 
children who have been dropped from their plans, knowing they are 
struggling to get on their feet? The law today protects those families 
and those young adults.
  New insurance plans must offer additional benefits and protections to 
consumers under our bill such as preventive services--which Senator 
Harkin championed day in and day out to be included as part of this 
bill--covered with no cost sharing, an increased choice of providers, 
and no prior authorization requirement for emergency care. Those 
protections benefit millions of people across this country.
  If they knew what was at stake with this kind of a resolution, which 
can throw these back and change these plans in such a way, I suspect 
those using polling numbers to identify a reason for being for this 
resolution or against the health care bill might have second thoughts. 
When we began to debate the health care reform bill, the President of 
the United States made clear that part of having control of one's 
health care was having the right to keep what you have. We enshrined 
that in the bill during the HELP Committee markup, the Finance 
Committee markup, and the Senate debate on this bill.
  No matter how important we thought those protections were, we said 
you can keep what you have, if that is what you want. But this was not 
carte blanche for the insurance industry to ignore the new law and 
continue abusive practices that have been in place for too long. They 
can continue their old plans as long as they did not dramatically 
increase the cost to their customers.
  It made no significant negative changes to the coverage consumers 
were paying for. In other words, you can keep what you have. But if the 
insurance companies try to take away what you have, the law will 
protect you. In the parlance of Washington, this is called 
grandfathering.
  To clarify to businesses, insurers, and all Americans what this meant 
in practice, the administration released a regulation on June 17. This 
regulation strikes an important balance of keeping our businesses 
strong while ensuring that employees and their families are able to 
weather difficult economic times, such as the ones we are in.
  Under the regulation adopted on June 17, grandfathered plans are not 
required to offer the additional benefits included in the Patients' 
Bill of Rights. I wish they were, but they are not. The grandfather 
regulation provides insurers and businesses flexibility to continue to 
innovate and to grow and still maintain their status.
  Businesses' health plans will not lose their grandfather status 
unless significant changes are made to policies which unduly burden 
employees and average American families.
  For example, if a health plan increases co-payment charges for a 
working mother in Hartford, CT, as has been pointed out by Senator 
Harkin, by more than 15 percentage points, it will lose the grandfather 
status. Or if a health care plan significantly reduces benefits for a 
family in New Haven, CT, it loses its grandfather status, as it should.
  These are not unreasonable requirements as we strive to protect 
average families in our country.
  My colleague from Wyoming and I disagree about this new law. We sat 
together day in and day out during those long markup periods. He is a 
good man, a good Senator, and a good friend. But I disagree with him 
strongly on this resolution. In my view, he wrongly claims this repeal 
would benefit small businesses. I say today that adopting this 
resolution would not only hurt small businesses but also roll back the 
important consumer protections that ended some of the worst insurance 
industry abuses across our country.
  If we repeal the grandfather regulations, we will harm small 
businesses and their employees because nothing would protect them from 
the insurance companies raising premiums by double digits each year, 
without offering any new and better benefits to the very people who 
would suffer.
  Nothing would protect them from insurance companies deciding to drop 
benefits or price them out of reach for these very employees.
  This resolution would not guarantee the right to keep what you have. 
What this resolution does guarantee is that the insurance industry can 
decide what you are going to get from them--not what you want. That is 
the fundamental difference if we adopt this resolution.
  Health reform changed that by handing control, as we all agreed on, 
back to you and your family. If we adopt this resolution we 
fundamentally shift that equation once again. In order to help small 
businesses more easily provide coverage to their workers and make 
premiums more affordable, the law provides tax credits for that 
coverage. In Connecticut alone, there are 54,000 small businesses that 
will benefit from these tax credits. This is just the first step toward 
bringing health care costs down, as we all want, and ensuring quality 
care, as we all want as well, for coverage of average Americans and 
their providers.
  This resolution is not about small businesses and harming them. This 
is another effort to dismantle health reform, and I believe it is 
fundamentally wrong for thousands of small businesses and employees 
across the country. It is a gift to the insurance industry, which all 
of us agree should no longer be the ones to decide what you get based 
on what they want to charge you, but whether you have insurance and 
confidence you are going to get for your family what you need not what 
they decide you get.
  For those reasons, I strongly oppose this resolution and hope my 
colleagues will join us in that effort.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized.

[[Page 17190]]


  Mr. ENZI. I yield up to 10 minutes to the Senator from Iowa.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, Congress meets in the District of 
Columbia. The District of Columbia is an island surrounded by reality. 
Only in the District of Columbia could you get away with telling the 
people if you like what you have you can keep it, and then pass 
regulations 6 months later that do just the opposite and figure that 
people are going to ignore it. But common sense is eventually going to 
prevail in this town and common sense is going to have to prevail on 
this piece of legislation as well. I support the resolution of Senator 
Enzi, disapproving the regulation on grandfathered health plans.
  The partisan health care overhaul enacted last March and subsequent 
implementation represents so many broken promises that I hardly know 
where to begin. But the resolution of Senator Enzi certainly sheds some 
light on one of the most glaring broken promises we have seen so far, 
and is as good a place as any for us to start.
  Time and again throughout the health care debate, supporters of the 
health care overhaul assured voters that even after their proposal 
became law, ``If you like what your current health plan is, you will be 
able to keep it.''
  The administration's own regulations prove this is not the case. 
Under the grandfathering regulation, according to the White House's own 
economic impact analysis, as many as 69 percent of businesses will lose 
their grandfathered status by 2013 and be forced to buy government-
approved plans.
  The estimates are even more troubling if you are a small business. 
Again, according to the administration's own estimates in the 
regulation, as many as 80 percent of small employers will be forced out 
of their current plan and into a more expensive government-approved 
plan. It is no wonder that the grandfathering regulation is opposed by 
pretty much every employer organization in the country. The National 
Federation of Independent Businesses, the Chamber of Commerce, the 
National Association of Manufacturers, and the National Retail 
Federation have all weighed in against this burdensome and disruptive 
policy. In every one of those cases, businesses that are members of 
those organizations want to provide health insurance and have been 
providing health insurance for their employees, and they want to keep 
it. They were believing Congress when they said if you have what you 
like you can keep it, and now they are finding out otherwise.
  It is true our economy is in a fragile place right now. Yet the 
implementation of the new health care law is creating more uncertainty 
and higher costs for American businesses. How can we ask them to go out 
and create jobs and hire new people when each new health care 
regulation adds another layer of bureaucracy and uncertainty? The White 
House should be making it easier to do business in this country, not 
harder.
  This is not just about confusion, it is also about costs. When 
employers and individuals make even modest changes to their benefits 
and lose grandfathered status, they are forced to buy a new government-
approved health care plan that in most cases will cost more than their 
current plan. That means the government will tell employers what 
benefits they have to cover, to whom they have to offer coverage, and 
how much they are going to have to contribute.
  We have already seen data from health plans saying that the 
requirement in the new law could drive up premiums by about 9 percent. 
This is in line with the Congressional Budget Office's estimate that 
the overall increase in premiums could be as much as 10 percent to 13 
percent. When you factor in medical inflation, some people are still 
seeing premium increases of 20 percent or more after the passage of the 
health care law.
  What happened, then, to President Obama's promise about lowering 
premiums by $2,500? Are we supposed to add that to the list as another 
broken promise? Each day it seems as if another news story comes out 
that shows why the partisan health care overhaul was the wrong 
approach. Health plans are being forced out of the child-only market. 
Some have stopped selling in individual markets entirely. Premiums 
continue to go up at twice the rate of inflation.
  The White House's own actuary is telling us that health care 
inflation will be worse now than it was before the health care reform 
bill became law. Over 1 million seniors are being forced out of their 
current national Medicare Advantage or Medicare prescription drug 
plans, and this is only going to get worse. Businesses are considering 
dropping retiree health care benefits and possibly dropping health care 
coverage altogether.
  With these kinds of stories coming out on a daily basis, it is no 
wonder that polls are showing close to 60 percent of the American 
people opposed to this new law. I support the efforts of Senator Enzi 
and appreciate that he is willing to shed some light on this issue. 
There is a lot of misinformation out there and people need to 
understand what this health care overhaul means for them.
  The grandfathering regulation is a clear violation of the promises 
made by supporters of the health care law that, if you like what you 
have, you are able to keep it. We owe it to our constituents to fix 
that misrepresentation.
  I urge my colleagues to support the resolution.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized.
  Mr. ENZI. Mr. President, I yield up to 10 minutes to the Senator from 
Nevada, Senator Ensign.
  The PRESIDING OFFICER. The Senator from Nevada is recognized.
  Mr. ENSIGN. Mr. President, many Americans may be wondering what this 
huge stack of paper is that I have on my desk. Over 2,000 pages of this 
stack of paper represent the actual health care bill. The rest of the 
stack consists of the regulations that have been written to this point.
  From what we understand, once the whole health care bill and 
regulations are written, this stack of paper will grow much higher; 
estimates are as much as 20,000 pages total. The complexity of the 
health care law is incredible. The resolution we have before us today 
concerns grandfathered health plan status. This regulation is one of 
those regulations that many of us believe is going to do damage to our 
health care system. I want to talk a little bit about the regulations 
under discussion today.
  Over the last couple of months, I have gone around to many businesses 
in my home State of Nevada, to talk about many of these regulations as 
well as the health care bill. Let me tell you, many small business 
owners in my State are very concerned about what this health reform 
bill is going to do to their businesses. A lot of small businesses 
struggle to do the right thing by giving their employees health care. A 
lot of them cannot afford the Cadillac plans that a lot of big 
businesses have, but they are trying to do the right thing. Some 
businesses cover half of what their employees pay. Some businesses have 
slimmed-down plans. The vast majority of the health plans that small 
businesses offer would not meet the minimum standards that this health 
care bill is going to require.
  Why is that important? The President said during the health care 
debate that if you like your plan you can keep it. If you like your 
doctor, if you like your plan, you will absolutely be able to keep it. 
There is a small detail he left out. The detail is this: If you change 
your health plan--and it does not have to be in a significant way--or 
if you change your copays--you could lose your grandfathered status. If 
you lose your grandfathered status you now have to comply with the 
minimum standards in the Federal law. That is a problem because, for 
most small businesses, these standards will dramatically increase the 
cost of their health insurance for their employees and a lot of them 
are barely keeping their doors open today. A lot of small businesses I 
talk to are actually putting pencil to paper and figuring out whether 
they

[[Page 17191]]

are even going to be able to keep the plans they have today.
  The advocates will say: Well, don't change your plan. The reality is 
that every single year, businesses look at the health care plans that 
they offer and almost every year they make changes to those health care 
plans. Under this regulation, if you make changes to your health care 
plan you could lose the grandfather status. That is a major problem.
  According to the government's own statistics, by 2013 as many as 
almost 70 percent of all employer plans and 80 percent of small 
business plans will relinquish their grandfathered status. Those are 
the government's own estimates. Based on these numbers, it doesn't 
sound like everybody is going to be able to keep their plan, as the 
President talked about in his promises about this health care 
legislation.
  In my view--and I think this view is shared by a lot of experts who 
are studying this health care plan, this bill is going to raise costs 
for those who currently have insurance. Think about it; if you are 
going to cover 30 million people there will be costs associated with 
that coverage. There was a $500 billion cut in Medicare and there was 
an increase in taxes. We know that a lot of different taxes were 
increased to pay for this bill. But the other pay-for in this bill, 
that was not officially scored as a pay-for, is that for people who 
have insurance--it is going to become more expensive for them because 
of a lot of the mandates in the bill.
  We have seen recently, insurance company after insurance company, 
when they are going to their State commissions bringing forward fairly 
large increases.
  I was talking to a small business owner the other day in Nevada. He 
told me his plan is going up 38 percent. That was the lowest bid he 
could get; a 38-percent increase for this year. The insurance companies 
told him it is because of this health care bill.
  I was on a telephone call yesterday. I did a telephone townhall 
meeting back in my State. A senior citizen was on the phone. He was 
telling me about his Medicare supplemental insurance that is covered by 
his union. The copays and the premiums for that were going up 
dramatically. He was wondering how he was going to be able to pay his 
rent. He has virtually no discretionary income, so any premium increase 
is going to make it tough for him. He is actually figuring out how he 
is going to be able to make his rent payments. Those are some of the 
unintended consequences with this bill and the regulations that are 
being written.
  I think we need to take a second look at health reform. First of all, 
obviously I wish to see the health reform bill repealed and replaced 
with real health insurance reform that makes insurance more affordable. 
I support things such as buying insurance across State lines--similar 
to how we buy car insurance across State lines. I also wish to see us 
enact real medical liability reform that would lower the costs of 
health care in this country. All of these things would be good to make 
health care more affordable and accessible for more Americans as 
opposed to what we have today. But let's at least start this process by 
rejecting the regulations that are going to hurt the grandfathered-in 
status of a lot of these plans. If you take away grandfathered status 
from a lot of plans, a lot of small business owners are going to be 
hurt and a lot of people who work for small businesses are going to 
lose their health insurance. This is because the small businesses will 
not be able to afford to comply with this health care bill and the 
regulations that are associated with it.
  I urge support of this resolution of disapproval. I appreciate 
Senator Enzi for bringing this resolution of disapproval of these 
regulations forward. I think this resolution is something the Senate 
should support and support in a bipartisan way.
  I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, I yield up to 8 minutes to the Senator from 
Kansas.
  The PRESIDING OFFICER. The Senator from Kansas is recognized.
  Mr. ROBERTS. Mr. President, I rise in support of Senator Enzi's 
resolution of disapproval and thank him for that. It seems every day a 
new story comes out about the negative consequences of the health care 
reform law, and I cannot keep up with them. I know people involved in 
the health care industry are having a very difficult time also.
  Do you remember the campaign pledge that health care reform would 
immediately reduce family's premiums by $2,500? Well, last week a slew, 
a slew of new mandates on health insurers, including coverage of 
preventative services without any cost sharing, restrictions on annual 
limits on coverage, and coverage of children up to age 26--I guess a 
child 25 is a child--took effect.
  Many of them, in fact, may be beneficial to some Americans, but they 
will not come free. Health insurers have begun alerting their customers 
to the fact that these new mandates cost money, money that has to be 
charged in additional premiums. I think most Americans understand you 
cannot get something for nothing.
  But instead of admitting that their policies are causing health 
insurers to raise their rates, the Obama administration has unleashed 
Health and Human Services Secretary Kathleen Sebelius to silence its 
critics by intimidation.
  In a letter to America's health insurance plans, the Secretary 
explicitly threatens health insurers that do not toe the line on 
ObamaCare with exclusion from the State health insurance exchanges, 
which start in 2014. ``There will be zero tolerance for this type of 
misinformation and unjustified rate increases,'' she has warned. ``We 
will also keep track of insurers with a record of unjustified rate 
increases: those plans may be excluded from health care exchanges in 
2014.''
  Well, let's be clear about what the Secretary, on behalf of the 
President, is saying. She is threatening to shut down private companies 
for exercising their first amendment right to free speech, and she is 
keeping a list. Some have called this gangster government in the press. 
As a former newspaper man, I am shocked. I am stunned by my former 
Governor's actions. First, it was the gag order on Humana Insurance for 
daring to describe the consequences of slashing more than $100 billion 
from Medicare Advantage to the customers, now this.
  This administration says it wants transparency. Well, transparency is 
a two-way street. It does not mean muzzling dissenting opinions or 
inconvenient facts because they are not advantageous to the 
administration. As the Wall Street Journal opinioned: ``They're more 
subtle than this in Caracas, Venezuela.''
  Not only are the actions of the Obama administration 
unconstitutional, they are also extremely hypocritical in light of 
their own highly misleading rhetoric. For example, the President and 
Secretary Sebelius have been touting the recent decision of health 
insurer Blue Cross Blue Shield in North Carolina to issue rebates to 
its customers in the individual market as a supposed ObamaCare victory.
  President Obama claimed this victory at a recent campaign stop in 
Virginia, saying that the insurance commissioners are newly empowered 
to look after consumers, that we are already seeing ObamaCare's new 
levels of accountability pay off.
  Well, aside from the fact that most State insurance commissioners 
have had the ability to review rate increases for years, a fact that 
Secretary Sebelius, as a former Kansas insurance commissioner, knows 
all too well, they are leaving out another very important fact, the 
rest of the story.
  What they are not telling you is, the reason why the insurer is 
paying out rebates is, because of ObamaCare, their plans in the 
individual insurance market will cease to exist in 2014. This means the 
reserves they have stored to protect their solvency are no longer 
necessary.
  That is where the rebates are coming from, not some well of hidden 
profits. The insurer is paying the rebates out of their reserves 
because the plans will no longer exist. This is hardly a victory for 
the thousands of people enrolled in

[[Page 17192]]

those plans. If that is not misleading, I do not know what is.
  What about the Secretary's taxpayer-financed mailer regarding 
Medicare Advantage that was recently sent to seniors all across the 
country? This mailer misleadingly claims that Medicare Advantage 
enrollees will not see any changes to their benefits under ObamaCare. 
That is a claim that is demonstrably false.
  Already we are seeing insurers such as Harvard Pilgrim drop their 
Medicare Advantage plans altogether as a result of these huge cuts. So 
actually thousands of seniors will see changes in their benefits. They 
will not have any. I urge the President and the Secretary to reconsider 
their use of these tactics which only serve to further erode the 
government's credibility with the American people and to insult their 
elected representatives.
  In the United States of America, private citizens are not only 
allowed to disagree with the government, it is a cornerstone of our 
democracy. So I say to the Department of Health and Human Services and 
the administration, stop the gag orders and the intimidation. To HHS, 
do not tread on the first amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, while I am waiting for another speaker to 
come, I will make some additional comments.
  Mr. HARKIN. Mr. President, can I ask how much time is remaining?
  The PRESIDING OFFICER. There is 27 minutes on the Senator's side and 
21 minutes on the other side.
  Mr. ENZI. Mr. President, I just wish to get a few things read into 
the Record. I have a list of 54 organizations that are supporting my 
resolution. They include the Latino Coalition, the Chamber of Commerce, 
the Coalition of Affordable Health Coverage, the Health Care Leadership 
Council, the National Federation of Independent Business, the National 
Restaurant Association, the Small Business and Entrepreneurship 
Council, to name just a few of the 54.
  I ask unanimous consent to have printed letters of support from the 
Chamber of Commerce, the National Association of Health Underwriters, 
the National Association of Manufacturers, the National Federation of 
Independent Business, the National Retail Federation, the Small 
Business Entrepreneurship Council, and the Associated Builders and 
Contractors, all of which are in support of this and I suspect will be 
key voting this particular resolution.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1).
  Mr. ENZI. The Chamber of Commerce, for instance, says:

       The administration released an extremely complex regulation 
     that makes it virtually impossible for plans to maintain 
     grandfathered status, instead subjecting them to many 
     expenses and burdensome new requirements. In our view, this 
     regulation violates Congressional intent, and does not live 
     up to the promises of proponents of the new law.

  NFIB, a small part of their letter says:

       If required to comply with the administration's interim 
     final rule, millions of small businesses will be forced out 
     of the plans they know and like--

  Which means their employees lose the plans they know and like.
  The Associated Builders and Contractors say:

       The grandfathered rule demonstrates a fundamental failure 
     of the Federal Government to understand the needs of small 
     businesses. With the current unemployment rate of 17 percent, 
     the construction industry cannot endure another cost increase 
     at the hands of the Federal Government. It is unfortunate 
     that the Federal Government continues to fail to provide 
     employers and their employees with health care solutions that 
     are practical or affordable.

  Earlier, there were some mainstays of health care that--I think there 
was an aspersion I was getting rid of with my resolution. I want you to 
know that if the resolution passes, businesses will still be prohibited 
from discriminating against someone with preexisting conditions, 
businesses will still be prohibited from imposing annual limits on 
benefits, all plans will still be prohibited from imposing lifetime 
limits on benefits, all plans will still have to cover kids under the 
age of 26 on their parents' plan, all plans will still be prohibited 
from canceling coverage because of a paperwork error.
  All those things will exist when this resolution passes, and this 
resolution needs to pass. All those things that I mentioned, 
preexisting conditions, annual limits, lifetime limits, children under 
the age of 26, and canceling coverage for paperwork errors, all those 
cost money. That is why the price is going up at the present time.
  The price is going up at the present time. This was supposed to be 
cutting costs. Help does not arrive until 2014. But small businesses, 
particularly small businesses, are going to be required to meet this 
grandfathering rule now. They cannot afford the grandfathering rule 
now. Another thing I am objecting to is watching television and seeing 
an old favorite of mine, Andy Griffith, getting paid, at taxpayer 
expense, to tell us that this whole deal is excellent.
  You saw the stack of regulations over there. They estimate there will 
be 100 pages of regulation for each page of that bill. There are 2,700 
pages in the bill. That means there are going to be 270,000 pages of 
regulations. We do not legislate that way. We try and fill in those 
blanks. You do not even know what those blanks are going to hold yet, 
neither does small business.
  They already know these are things that are going to drive up cost in 
the beginning, with no cost-cutting opportunity, and then the 
grandfathering rule kicking in right away, which means for 3 years, 
before they even know what some of those regulations are going to be, 
they are going to have to constrain everything in their organization 
within 15 points, as is pointed out, and we can expect the first year's 
increases to be even greater than the 15 points.
  But they will try and stay with that grandfathered plan because it is 
what they can afford and it is what their employees like. So we are 
trying to keep people in the insurance they like. It is an employee 
request. I also noticed one of the Senators mentioned the Marshall Plan 
that was not liked when it was first passed; and the Civil Rights Act 
that was not liked when it was first passed.
  I would like to point out those were both very bipartisan acts that 
were passed--bipartisan. It was not a partisan bill. You would have to 
notice that a lot of these people have been mentioning this was all 
passed by one side of the aisle, and there was a lot of warning before 
that if you do things in a hurry and you do it just partisan, that you 
do not devote the time that is necessary or put it in a small enough 
package that people can understand it.
  There are vast parts of this that people did not get to read before 
they passed it. It is particularly noted on the House side. That leads 
to the kinds of difficulties we have now. We also turn over to 
bureaucrats writing the rules, and this is one of the examples, and we 
have a chance to overturn that at this point. They can go back and 
rewrite it again.
  But, at this point, we can say: No, enough is enough. You cannot put 
all these things into place. You cannot kick people out of their 
insurance and let's see what happens in 2014 when we have all the 
regulation. So I think we have put a lot onto businesses that does 
increase cost. Because we do--even when this passes, we will still 
prohibit discriminating against someone with a preexisting condition, 
we will still prohibit imposing annual limits on benefits, we will 
still prohibit imposing lifetime limits on benefits. All plans will 
still have to cover kids under the age of 26. Although, I have noticed 
a whole bunch of the companies now are not going to write some of the 
plans that would do this, and they are getting out of the business. But 
all plans will still be prohibited from canceling coverage because of a 
paperwork error. Those drive up costs.
  Relief is not in sight until 2014.
  I yield the floor and reserve the remainder of my time.

[[Page 17193]]



                               Exhibit 1

            List of 54 Organizations Supporting S.J. Res 39

       Aetna; American Council of Engineering Companies; American 
     Osteopathic Association; American Rental Association; 
     American Road & Transportation Builders Association; AMT--The 
     Association For Manufacturing Technology; Associated Builders 
     and Contractors; Association of Clinical Research 
     Organizations; Assurant Health; Automotive Recyclers 
     Association; Chamber of Commerce; Cigna; Coalition for 
     Affordable Health Coverage; Communicating for America; 
     Furniture Dealers Association; Health Equity; Healthcare 
     Leadership Council; Independent Electrical Contractors; Inc; 
     International Franchise Association; International 
     Foodservice Distributors Association.
       International Housewares Association; Manufacturers' Agents 
     Association for the Foodservice Industry; National 
     Association for Printing Leadership; National Association of 
     Health Underwriters; National Association of Insurance and 
     Financial Advisories; National Association of Manufacturers; 
     National Association of Mortgage Brokers; National 
     Association for the Self-Employed; National Association of 
     Wholesaler-Distributors; National Club Association; National 
     Federation of Independent Business; National Office Products 
     Alliance; National Restaurants Association; National Retail 
     Federation; National Roofing Contractors Association; 
     National Tooling and Machining Association; Northeastern 
     Retail Lumber Association; NPES The Association for Suppliers 
     of Printing, Publishing and Converting Technologies; Office 
     Furniture Dealers Alliance; Pediatrix.
       Pharmeceutical Research & Manufacturers Association; 
     Plumbing-Heating-Cooling Contractors--National Association; 
     Precision Machined Products Association; Precision 
     Metalforming Association; Printing Industries of America; 
     Self-Insurance Institute of America; Service Station Dealers 
     of America; Small Business & Entrepreneurship Council; Small 
     Business Coalition for Affordable Health Care; Specialty 
     Equipment Market Association; Textile Care Allied Trades 
     Association; Tire Industry Association; Turfgrass Producers 
     International; The Latino Coalition.
                                  ____

                                         The Spirit of Enterprise,


                                     U.S. Chamber of Commerce,

                                Washington, DC September 27, 2010.
       To the Members of the United States Senate: The U.S. 
     Chamber of Commerce, the world's largest business federation 
     representing the interests of more than three million 
     businesses and organizations of every size, sector, and 
     region, urges you to support S.J. Res. 39, a resolution of 
     disapproval that would repeal the onerous grandfathering 
     regulations promulgated pursuant to the Patient Protection 
     and Affordable Care Act.
       The President and many other proponents of the new health 
     care law repeatedly promised, ``if you like the plan you 
     have, you can keep it,'' and the grandfathering provision was 
     meant to ensure this promise. The statute contained a few 
     short paragraphs specifying that a plan operating when the 
     bill was enacted could continue to operate as before; new 
     employees and dependents of employees could also be added to 
     the plan. The provisions demonstrate Congress clearly 
     intended to preserve maximum flexibility for employer plans 
     and those currently in operation.
       However, the Administration released an extremely complex 
     regulation that makes it virtually impossible for plans to 
     maintain grandfathered status, instead subjecting them to 
     many expensive and burdensome new requirements. Rather than 
     allowing plans to continue operating in the manner they are 
     accustomed to, the regulation specifies numerous ways by 
     which such plans would lose grandfathered status. Thus, many 
     existing plans would be forced to change in order to comply 
     with an array of new mandates. In our view, this regulation 
     violates Congressional intent, and does not live up to the 
     promises of proponents of the new law.
       Due to the critical importance of this issue to the 
     business community, the Chamber strongly urges you to support 
     S.J. Res. 39. The Chamber may consider votes on, or in 
     relation to, this issue in our annual How They Voted 
     scorecard.
           Sincerely,
     R. Bruce Josten.
                                  ____

                                              National Association


                                       of Health Underwriters,

                                Arlington, VA, September 28, 2010.
     Hon. Michael B. Enzi,
     Ranking Member, Committee on Health, Education, Labor and 
         Pensions, U.S. Senate, Hart Office Building, Washington, 
         DC.
       Dear Senator Enzi: On behalf of the National Association of 
     Health Underwriters (NAHU), which represents more than 
     100,000 health insurance agents, brokers and employee benefit 
     specialists involved on a daily basis in the sale and service 
     of private health plans, I am writing to convey our support 
     for your resolution of disapproval (S.J. Res. 39) to overturn 
     the so-called grandfather rule in the Patient Protection and 
     Affordable Care Act (PPACA).
       As you know, throughout the legislative debate on health 
     system reform, President Obama and congressional leaders 
     repeatedly stated that ``if you like the coverage you have, 
     you can keep it.'' Unfortunately, the proposed interim final 
     rule (IFR) on grandfathering issued this past June follows a 
     rigid path in defining the requirements for ``keeping what 
     you have,'' which our professional benefit specialist members 
     conclude will have a negative impact on employers large and 
     small, their employees and their families. The complex and 
     inflexible requirements could ultimately undermine the 
     ability of employers to continue to provide existing health 
     coverage for their employees.
       The current grandfather IFR has not provided adequate 
     guidance on various scenarios employers and consumers may 
     encounter and, as such, there are many questions about the 
     allowable changes that may be made to employer plans and the 
     risk of losing grandfathered status. Once grandfathered 
     status is lost, employers will be forced to follow a number 
     of expensive new insurance rules, which will increase costs 
     for employers and employees, threatening the coverage 
     Americans currently have.
       The Departments of Treasury, Labor and Health and Human 
     Services own estimates indicate that the complex and 
     restrictive IFR regime would effectively make grandfathering 
     temporary: More than half of all employers, and two-thirds of 
     all small employers, will relinquish their grandfathered 
     health plans by the end of 2013.
       Barring employers from changing insurance carriers or 
     increasing cost sharing percentages of any level, for 
     example, severely limits the ability of employers to maintain 
     their grandfathered status. Other requirements to maintain 
     grandfathered status, such as limits on the increases for 
     fixed-amount cost sharing, are simply out of touch with the 
     individual and small-group insurance markets since most 
     employers have little control over the plan designs offered 
     in the small-group and individual market.
       In addition, the current grandfather rules do not afford 
     protections for individuals and employers who lose their 
     grandfathered status through no fault of their own. For 
     example, if an individual or employer's health insurance 
     carrier pulls out of a state marketplace, the only option the 
     consumer has is to buy a new non-grandfathered policy or 
     cease to be covered altogether. Unfortunately, our members 
     report that a number of carriers are vacating many health 
     insurance markets as a result of PPACA provisions, 
     particularly in the individual and limited benefit plan 
     markets, and that millions of their clients will be affected.
       Our members also report that many large health insurance 
     carriers are reorganizing all of their policy offerings as a 
     means of streamlining administrative expenses. So while an 
     individual or employer may be offered identical benefits 
     through the carrier, their contractual dates may shift and 
     they may technically be sold a new policy offering. Such 
     administrative simplification moves may inadvertently cause 
     millions to relinquish their grandfathered status.
       We are very concerned that a great number of individuals 
     and employers will be left with even less choice and 
     flexibility and will be faced with the difficult choice of 
     paying more to maintain grandfathered coverage, shopping for 
     a new (and more expensive) plan or possibly dropping it 
     entirely.
       A workable and sustainable grandfathering protection 
     framework should be aimed at achieving a number of important 
     health reform objectives: (1) to promote stability during the 
     transition to full health care reform by ensuring that 
     Americans have a choice of keeping their current coverages; 
     (2) to allow individuals to better control their health care 
     costs; (3) to preserve affordable coverage options and limit 
     disruption of coverage for currently insured individuals; and 
     (4) to lessen the potential for regulatory uncertainty.
       Unfortunately, the current grandfather rules fall short of 
     these objectives on a number of levels. As such, we very much 
     support your resolution of disapproval of the current 
     grandfather rules, and hope that Congress and the 
     Administration can work together toward a more sensible and 
     sustainable policy moving forward.
           Sincerely,
                                                  Janet Trautwein,
     Executive Vice President and CEO.
                                  ____

                                              National Association


                                             of Manufacturers,

                               Washington, DC, September 23, 2010.
     Hon. Michael Enzi,
     Ranking Member, Committee on Health, Education, Labor and 
         Pensions, U.S. Senate, Washington, DC.
       Dear Ranking Member Enzi: The National Association of 
     Manufacturers (NAM)--the nation's largest industrial trade 
     association--urges you to support S.J. RES. 39, a 
     ``resolution of disapproval'' to prevent implementation of 
     the Interim Final Rule defining grandfathered health plans 
     under the Patient Protection and Affordable Care Act.
       The grandfather rule, as currently drafted, does not meet 
     the standard on which the push for reform was predicated--
     insure the uninsured and allow those with coverage to keep an 
     existing plan. The Department of Health and Human Services' 
     own analysis determined that up to 80 percent of existing

[[Page 17194]]

     small plans will lose their grandfathered status. Employers 
     are proud to offer their employees health insurance, and 
     freezing this benefit limits employers' ability to provide 
     quality coverage.
       Currently, 170 million people receive insurance from their 
     employers. Under the new law, the health plans covering these 
     employees were to have grandfathered status and were not to 
     be subjected to the broad insurance market reforms necessary 
     for newer plans. This exemption was intended to allow 
     employees to keep the coverage they currently have and with 
     which they are most comfortable. However, the Interim Final 
     Rule limits the ability of these plans to make routine 
     modifications that will control the rising health care costs 
     crippling many manufacturers.
       The rule also removes grandfathered status from those who 
     are fully insured if they change issuers. This eliminates the 
     ability of many smaller businesses to negotiate with insurers 
     to obtain lower rates. Those that are fully insured should be 
     able to negotiate with competing issuers and maintain 
     grandfathered status if they change issuers. This would allow 
     for a competitive marketplace, keep costs down and create 
     parity for smaller businesses that, without a large pool of 
     insured to manage costs like most self-insured plans, use the 
     competition of an open market to lower costs. As a result, 
     the current rule places small businesses at a significant 
     disadvantage.
       Ninety-seven percent of NAM members provide health 
     insurance to their employees. Manufacturers are proud to 
     provide health care to their employees and would like to 
     continue that benefit. The rule, as it stands, will decrease 
     competition and create a stagnant, uncompetitive and more 
     expensive insurance market.
       The Senate should disapprove this rule because it will 
     unnecessarily disrupt the current employer-based system, 
     which provides coverage to millions of Americans. As 
     manufacturers face tremendous uncertainty in these 
     challenging economic times, Congress should not allow a 
     federal agency to issue regulations that harm manufacturers' 
     ability to create and retain jobs.
       On behalf of manufacturers, we urge your support for S.J. 
     RES.39 and look forward to working with you on our shared 
     goals for a strong economy and job creation.
           Sincerely,

                                                  Joe Trauger,

                                                   Vice President,
     Human Resources Policy.
                                  ____

                                               September 28, 2010.
     Hon. Mike Enzi,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Enzi: On behalf of the National Federation of 
     Independent Business (NFIB), the nation's leading small 
     business advocacy organization, I am writing in support of 
     S.J. Res 39, the Enzi disapproval resolution regarding the 
     Interim Final Rule on grandfathered plans under the Patient 
     Protection and Affordable Care Act (PPACA). The vote in 
     support of the motion to proceed to S.J. Res 39 will be 
     considered an NFIB Key Vote for the 111th Congress.
       NFIB believes the Administration has overstepped its legal 
     authority under PPACA in writing regulations that go beyond 
     the legislative authority embedded in the statute. A strict 
     reading of Section 1251 in the Act clearly outlines what 
     defines a grandfathered plan. However, through its Interim 
     Final Rule the government inappropriately reinterprets the 
     intent of Congress by narrowing the scope of how plans 
     qualify to retain grandfathered status.
       The Interim Final Rule appears to be based on an assumption 
     that coverage choices should be narrowed in the run up to 
     2014. Nothing in the statutory language of the PPACA supports 
     this assumption. In fact, interpreting the PPACA so that it 
     narrows the range of coverage choices is inconsistent with 
     the spirit of the Act, as well as the letter of the law.
       If Congress is unable to overturn the Interim Final Rule, 
     NFIB remains deeply concerned that the new regulations will 
     most heavily impact small, rather than large businesses. As 
     written, the Interim Final Rule is so restrictive that the 
     rule provides small businesses with little to no flexibility 
     to keep their plan.
       The precedent set forth by this Interim Final Rule is 
     especially detrimental for the men and women who currently 
     have coverage through small businesses. Millions of Americans 
     rely on small business plans for their health coverage, and 
     must continue to rely on those plans until at least 2014 when 
     new purchasing options become available. However, if the 
     Interim Final Rule is not overturned, the government's own 
     analysis confirms what many small businesses fear most--that 
     upwards of 80 percent of small employers could lose the plan 
     they have today by 2013.
       NFIB strongly supports the Enzi resolution of disapproval. 
     As the 111th Congress comes to a close, Congress must restore 
     the true meaning of ``if you like what you have today, you 
     can keep it.'' If required to comply with the 
     Administration's Interim Final Rule, millions of small 
     businesses will be forced out of the plans they know and 
     like. Thank you for your hard work on behalf of small 
     business, and NFIB looks forward to working with you to 
     address this critical issue.
           Sincerely,
                                                    Susan Eckerly,
     Senior Vice President, Public Policy.
                                  ____

                                               September 27, 2010.
     Hon. Mike Enzi,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Enzi: I write to lend the support of the 
     National Retail Federation (NRF) to the resolution of 
     congressional disapproval (S.J. Res. 39) you have recently 
     introduced to block the ``grandfathered plan'' regulations. 
     We strongly support and endorse your effort and urge that the 
     resolution be promptly adopted.
       We are also concerned that regulators have taken too narrow 
     a view of the grandfathered plan regulation. NRF's formal 
     comments (submitted on August 16, 2010) noted in part that: 
     ``[o]ur concern is that the [interim final regulation's] 
     rigid, trip-wire rules make it entirely too possible (if not 
     probable) that a plan that elects grandfathered plan status 
     will not be able to maintain that status for long. Many plans 
     may not even bother to elect grandfathered plan status.'' Our 
     letter recommended several specific steps to improve the 
     grandfathered plan regulation:
       1. Allow employers to change insurance carriers without 
     losing grandfathered status provided that: The coverage is 
     actuarially equivalent or better, and that provider networks 
     are substantially equivalent; prohibiting a change in 
     carriers will needlessly inhibit competition bases on price 
     and quality of service.
       2. Allow for improvements in prescription drug formularies 
     and provider networks without jeopardizing grandfathered plan 
     status. New drugs come onto the market with great regularity 
     and medical practice changes quickly. Formulary changes in 
     the interest of plan beneficiaries are appropriate and 
     necessary. Provider networks require regular maintenance to 
     allow for retirements, addition of new providers and to 
     maintain network quality. Reasonable changes that do not 
     compromise ongoing treatment should be allowed.
       3. Provide greater flexibility to manage future medical 
     inflation. Changes in fixed dollar cost sharing should be 
     made on a year-to-year basis rather than be based on March 
     23, 2010 and percentage increases from that.
       We strongly concur with your view that a formal resolution 
     of congressional disapproval is the appropriate next step 
     under existing law. We urge its prompt adoption. Again, NRF 
     commends you for introducing this legislation.
           Sincerely,
                                                    Steve Pfister,
     Senior Vice President, Government Relations.
                                  ____

                                                  Small Business &


                                     Entrepreneurship Council,

                                   Oakton, VA, September 23, 2010.
     Hon. Mike Enzi,
     Ranking Member, Health, Education, Labor and Pensions 
         Committee, Senate Russell Office Building, Washington, 
         DC.
       Dear Senator Enzi: On behalf of the Small Business & 
     Entrepreneurship Council (SBE Council), I am writing to 
     applaud you for introducing a Resolution of Disapproval (S.J. 
     Res. 39) relating to the rule on ``grandfathered plans'' 
     issued by the U.S. Department of Health and Human Services 
     (HHS). The rule, as written, is in clear violation of 
     President Obama's promise that Americans would be able to 
     keep the health plans they currently have upon passage of the 
     Patient Protection and Affordable Care Act (PPACA). In 
     addition, we believe that HHS has taken creative license in 
     its interpretation of PPACA, bringing an ideological bent 
     that is not supported by the statutory language.
       SBE Council strongly supports your Resolution. Without its 
     successful passage most small business owners and their 
     employees will lose the health coverage they currently enjoy.
       Small business owners and the self-employed were promised 
     by President Obama and supporters of PPACA that they could 
     keep the plans they currently have under the legislation. 
     However, this promise has turned out to be false and small 
     business owners feel betrayed by what transpired during the 
     rule-making process, as well as what is occurring in the 
     insurance marketplace. In order to qualify for grandfathered 
     status, small business owners must stay with their current 
     carrier and not significantly alter their current health plan 
     or coverage. If their current carrier significantly raises 
     their premiums, small business owners cannot shop around for 
     more affordable plans or they will risk losing grandfathered 
     status. The alternative is to move to another carrier and 
     face more costly coverage mandated by the new health care 
     law. In sum, small business owners are rendered helpless by 
     this catch-22 rule.
       Rather than helping small business owners and their 
     workforce keep their plans, it appears the rule has been 
     rigged to force most small businesses and their employees out 
     of grandfathered status. We are aware that

[[Page 17195]]

     HHS estimates, worst case, 80 percent of small business 
     owners will lose their current health plans. SBE Council 
     believes 80 percent is the likely scenario, if not a 
     conservative figure.
       The consequence of the rule is obvious--more small business 
     owners will drop coverage. Hiring will remain weak and jobs 
     will be lost. This was not the promised outcome of PPACA.
       Senator Enzi, SBE Council shares your desire to overturn 
     this unjust rule. We applaud your leadership, and will do 
     what it takes to see that S.J. Res. 39 advances into law.
           Sincerely,
                                                   Karen Kerrigan,
     President & CEO.
                                  ____

                                               Associated Builders


                                        and Contractors, Inc.,

                                Arlington, VA, September 28, 2010.
     Hon. Mike Enzi,
     United States Senate.
       Dear Senator Enzi: On behalf of Associated Builders and 
     Contractors (ABC), a national association with 77 chapters 
     representing 25,000 merit shop construction and construction-
     related firms with 2 million employees, we are writing to 
     express our strong support for S.J. Res. 39, which would 
     overturn the recently issued rule relating to status as a 
     grandfathered health plan under the Patient Protection and 
     Affordable Care Act (PPACA).
       Throughout the health care reform debate, ABC advocated for 
     policies that reduce the cost of health care for employers 
     and their employees. ABC called on Congress to advance 
     commonsense proposals that would address the skyrocketing 
     costs of health insurance, especially for employer-sponsored 
     plans, and the rapidly rising number of uninsured Americans. 
     ABC believes true reform should provide greater choice and 
     affordability and allow private insurers to compete for 
     business.
       Unfortunately, the new health care law will do nothing to 
     reduce the cost curve; instead it simply will enroll more 
     Americans into a broken and unsustainable health care system. 
     Specifically, the recently issued grandfather rule will 
     increase, rather than decrease, costs for small businesses.
       On June 17, the Departments of Health and Human Services, 
     Labor and Treasury issued an interim final rule relating to a 
     plan's status as a ``grandfathered health plan'' under PPACA. 
     As part of the Small Business Coalition for Affordable 
     HealthCare, ABC and several other organizations filed 
     comments expressing concern that the grandfather rule is 
     overly restrictive and could make it even more likely that 
     small businesses will choose to drop their plans prior to 
     2014 as they are faced with unsustainable premium increases. 
     Instead of lowering the number of uninsured Americans, the 
     rule could actually increase the number of uninsured before 
     the health care law is fully enacted.
       The coalition also pointed out that neither PPACA nor the 
     grandfather rule address the core problem facing small 
     businesses: the rising costs of health care. Instead, the 
     rule strips small employers of the ability to exercise 
     flexibility in adjusting to cost increases in order to 
     maintain their current plan.
       The grandfather rule demonstrates a fundamental failure of 
     the federal government to understand the needs of small 
     businesses. With a current unemployment rate of 17 percent, 
     the construction industry cannot endure another cost increase 
     at the hands of the federal government. It is unfortunate 
     that the federal government continues to fail to provide 
     employers and their employees with health care solutions that 
     are practical or affordable.
       Once again, ABC strongly supports S.J. Res. 39 and we 
     commend you for introducing a resolution that is intended to 
     reduce health care costs for a struggling sector of our 
     economy: small businesses. We look forward to working with 
     you in the future on commonsense health care initiatives.
           Sincerely,
                                                Brewster B. Bevis,
                              Senior Director, Legislative Affairs

  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. Mr. President, I yield myself such time as I may consume.
  I have to say to my friend from Wyoming: Where did that come from--
100 pages of regulations for every page that is in the bill? That is 
going to be 200,000 pages of regulations. Where did that come from? It 
sounds like it came from the health insurance industry to me. Boy, I 
tell you, that is quite a figure. Well, obviously, it is a bogus 
number, and I do not know where that figure came from. I would like to 
ask my friend where that did come from.
  But I say to my friend from Wyoming, the Senator just said there is 
no help--I wrote it down here as fast as I could--no help for small 
businesses until 2014.
  Wait a minute. Wait a minute. In the Affordable Care Act, we 
attached--in the tax bill that Senator Baucus got through the Finance 
Committee, small businesses, beginning this year, 2010, will receive a 
tax credit--a tax credit, not deduction, a tax credit--of up to 35 
percent of the cost of an employee's health insurance.
  So you have a small business, prior to this year, that did not get a 
tax credit, I say to my friend from Wyoming. I mean, the Republicans 
ran this place for 8 years under George Bush--8 years. They had a 
Republican President, Republican Senate, Republican House. They did not 
give small businesses any tax breaks for health insurance. We did. It 
is in the bill, a 35-percent tax credit this year for small businesses. 
That would cover 83.7 percent of all small businesses in the country. 
That is quite a bit of help for small business.
  I have heard from small businesses in my State that can get that tax 
credit this year that they have never had before. A lot of these small 
businesses are small businesses that employ just a few people--10, 12. 
They know their employees. They go to the same churches, schools. They 
are neighbors. I can't tell my colleagues how many small business 
owners in Iowa have told me: I feel so bad. Because of the increasing 
costs of health insurance, whether they are increased copays or 
deductibles, cutting out benefits, I have had to increase the cost of 
health insurance to my employees to the point that it is almost not 
worth it anymore because of high deductibles.
  They feel badly about it because these are their friends, neighbors. 
They are related a lot of times. I have had them come to me and say: 
Finally, this year I can get a tax credit, up to 35 percent.
  Quite frankly, in my State, 90.8 percent of small businesses will get 
the maximum 35 percent tax credit. Small businesses don't have to wait 
until 2014 to get help; they are getting that help right now.
  Mr. DURBIN. Will the Senator yield for a question?
  Mr. HARKIN. I am delighted to yield to my friend from Illinois.
  Mr. DURBIN. I would like to ask the Senator from Iowa, if the Senator 
from Wyoming prevails in what he is seeking to do this morning, it is 
my understanding that almost half the people in America who currently 
have health insurance through their employers, people who are so-called 
grandfathered in under this bill, would not get the new protections 
that are coming in the law, protections that say that under their 
health insurance, they will not be subject to a lifetime limit. For 
example, if someone gets into long-term cancer therapy that is going to 
be very expensive over a long period and the insurance company decides 
halfway through they will cut them off, we now protect people so that 
they can continue to get the care they need. They can't be limited.
  Isn't it also true that the effort of the Senator from Wyoming would 
protect the right of the insurance companies to literally cancel one's 
policy because of an error made in the application for the policy, to 
rescind the policy?
  I might add, it is my understanding that this rescission is abused in 
my State more than any other in the Nation. The rescission rate on 
health insurance in Illinois is three times the national average. We 
have had over 5,000 people who have had their health insurance 
canceled. When they went to the company and said: I am facing surgery, 
I am facing cancer therapy, and I need coverage and want to make sure I 
have it, they ended up getting their policies canceled.
  I ask the Senator, would the effort by the Senator from Wyoming take 
away these protections we are now building into the law to make sure 
health insurance is there when people need it the most?
  Mr. HARKIN. Mr. President, we have two things here. We have the 
Patients' Bill of Rights which just went into effect. That covers 
everybody. That covers all plans. That covers grandfathered plans. They 
can't escape that. However, if a plan wanted to be grandfathered, we 
left it up to the Department to write rules and regulations as to what 
grandfathered means. For example, let's say the Senator from Illinois 
and I have a contract. We both

[[Page 17196]]

have agreed to it. We say we are going to let that contract go into the 
future. After a certain date, you are grandfathered in that contract.
  What the Senator from Wyoming would say is that if you are the 
insurance company and I am the individual covered, we will grandfather 
it, but you can change it any way you want. You can raise my copay. You 
can raise my deductible. You can reduce the annual limit on claims you 
will pay. You can eliminate benefits, such as the Senator just pointed 
out, for cancer or diabetes. And guess what. You would still be 
considered grandfathered. But I am stuck with that. That is what is so 
important here. That is what people have to understand about what the 
Senator from Wyoming is trying to do. He is saying that basically we 
will grandfather it in, but the insurance companies can change it 
however they want, and you are stuck with it.
  Mr. DURBIN. So if the Senator from Wyoming prevails and I am one of 
the grandfathered plans--in other words, I have my health insurance 
plan that I like through my employer--my health insurance company on my 
grandfathered plan can literally cut me off when I need health 
insurance the most, can literally put a limit on the amount they are 
going to pay on an annual basis?
  Mr. HARKIN. That is right.
  Mr. DURBIN. Can really take away my health insurance protection.
  I ask the Senator from Iowa, hasn't he heard, as I have from people 
in my State, how vulnerable they are when you empower health insurance 
companies to bail out when you need them the most? If we voted with the 
Senator from Wyoming, we would empower the health insurance companies 
at the expense of vulnerable people who may face an accident or a 
diagnosis tomorrow that changes their lives. Isn't that what this gets 
down to in its most basic form? Do we want to give power to the people 
who are insured or power to the health insurance companies? As I 
understand the Senator from Wyoming, he thinks the health insurance 
companies should have the power and we should not be providing 
protection to the people who need it most.
  Mr. HARKIN. That is the way I see it. It just seems that we have 
rules and regulations. What the Department has said is that, OK, to be 
a grandfathered plan, you have to fall under these items: You can only 
raise your copayment a certain amount. By the way, it is quite a bit. 
You can raise your copayment either the greater of 5 bucks or medical 
inflation plus 15 percent. That is pretty good. It says you can change 
different things but within certain limits. They can't, for example, 
raise your coinsurance charges--that is, if you have a percentage. For 
example, if it is 20/80, they can't just raise that. It has to stay the 
same percentage. They could raise the copayment if it is a dollar 
amount.
  That is why the Senator from Illinois is so right. If this resolution 
passes, all of the protections for consumers are wiped out.
  Mr. ENZI. Will the Senator yield for a question?
  Mr. HARKIN. On whose time?
  Mr. ENZI. I am about out of time.
  Mr. HARKIN. How much time remains?
  The PRESIDING OFFICER. The Senator from Iowa has 17 minutes, and the 
Senator from Wyoming has 13\1/2\ minutes remaining.
  Mr. HARKIN. Mr. President, I will be glad to yield time if he will 
yield me time if I have a question.
  Mr. ENZI. Certainly.
  The Senator from Iowa is not answering the same question the Senator 
from Illinois is asking. I did say that when the resolution passes, 
they would not be able to discriminate on preexisting, they would not 
be able to impose annual limits. They will not be imposing lifetime 
limits. They will have to keep people until age 26, and they will not 
be able to cancel it for paperwork error. I think that is the question 
the Senator from Illinois was asking, not the copays and those things.
  Mr. HARKIN. I did respond that the bill of rights applies to all 
plans.
  Mr. ENZI. All plans, even if the grandfathering clause is taken out?
  Mr. HARKIN. Absolutely. I made that very clear. The bill of rights 
that came into effect stays for everything. But what I am saying is 
that the Senator is right, and I responded that way concerning the bill 
of rights. But what doesn't apply to grandfathered plans are preventive 
services that are covered with no cost. That is not covered. The right 
to an appeal to a third party is not covered. Restrictions on annual 
limits is not applied. They can put annual limits on coverage under 
these grandfathered plans. Direct access to OB/GYNs without a referral 
is not part of the Patients' Bill of Rights. No higher cost sharing for 
out-of-network emergency services, no prior authorization requirement 
for emergency care--none of that is in the bill of rights. So all of 
that is wiped out by the resolution of the Senator from Wyoming.
  Again, for emphasis, you have a contract. You work for an employer. 
They have a plan. You are part of that plan. If you like that plan, you 
can stay with it. My friend from Wyoming said: Only in Washington, DC, 
could they say, if you like your plan, you can stay with it, and then 
they change it. No. Only in the health insurance industry, perhaps in 
the Republican philosophy, would you say that you can grandfather a 
plan, but you the consumer are stuck if the insurer wants to change it 
any way he wants to change it, with the exception of the bill of 
rights. They could raise your copayment, they could take away your 
right of access to an OB/GYN without referral, and all the other things 
I mentioned.
  If your insurer dramatically raises your copayment, that is not what 
you signed up for. That was not the plan you signed up for. If your 
insurer dramatically raises your deductible, that is not what you 
signed up for. If your insurer reduces the annual limit on claims they 
will pay, that is not what you signed up for. If your insurer 
eliminates covered benefits, such as cancer or diabetes, that is not 
what you signed up for.
  We are saying: You have a plan here. You signed up for it. You like 
it. You can keep it.
  But what if your insurer comes along and says: Guess what. We are not 
going to cover it if you get diabetes, and we are going to put an 
annual limit on claims we will pay, and we are going to raise your 
deductible by a huge amount. Is that the plan you signed up for? No. So 
why should you be stuck with that? Why should that be a grandfathered 
plan?
  A grandfathered plan means a plan that was in existence before April 
of this year that you like but which is not changed dramatically on you 
by your insurer. So if you have a grandfathered plan, you are fine. 
What the Department did is that they issued regulations to define what 
that is. Quite frankly, I thought they were very lenient. For crying 
out loud, they can raise your copayment by the greater of $5 or medical 
inflation plus 15 percent. Fifteen percent of medical inflation sounds 
like a lot to me. That is quite lenient.
  Again, my friend had a lot of letters he included for the Record. I 
would like to insert letters in opposition from the Small Business 
Majority, from the Center for Budget and Policy Priorities. Here is a 
letter signed by the American Cancer Society Cancer Action Network, the 
American Diabetes Association, the American Heart Association, Families 
USA, the National Partnership for Women and Families, National Women's 
Law Center, SCIU, and U.S. PIRG. I also have letters from Health Care 
for America Now, Service Employees International Union, the AARP, and 
Trust for America's Health. I ask unanimous consent to have these 
letters printed in the Record.
  All are in opposition to the Enzi resolution.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


[[Page 17197]]




                                      Small Business Majority,

                                Sausalito, CA, September 28, 2010.
     Hon. Tom Harkin,
     Chair, Senate Committee on Health, Education, Labor and 
         Pensions, Senate Dirksen Office Bldg., Washington, DC.
     Hon. Mike Enzi,
     Senate Russell Office Bldg.,
     Washington, DC.
       Dear Senators: Small Business Majority strongly opposes 
     S.J. Res. 39--a resolution of disapproval that would prevent 
     implementation of the grandfathering regulations under the 
     Patient Protection and Affordable Care Act. This unnecessary 
     resolution would impede the orderly and responsible 
     implementation of comprehensive reform--which would deny 
     small businesses and their employees the protections reform 
     provides, and make it more difficult for them to access 
     affordable care.
       The passage of healthcare reform was a huge victory for 
     small businesses, many of whom are being crushed under high 
     healthcare costs and were looking to reform to give them some 
     relief. However, there are small businesses that like their 
     existing plans and want to keep them. The legislation allows 
     them to do so. But these plans must continue to resemble 
     their current form and also must work in the context of 
     overall reform.
       The regulations issued by Health and Human Services on June 
     15 strike the right balance. They require that the existing 
     plans don't increase costs more than 15% above medical 
     inflation and that they don't disturb reforms that will be 
     put in place in 2014--such as prohibiting insurance companies 
     from denying coverage due to preexisting conditions. We found 
     from extensive opinion polling that these requirements 
     address small business owners' biggest concerns: controlling 
     costs and the elimination of preexisting condition rules. 
     While we believe the regulations make sense, they aren't set 
     in stone; HHS is open to making additional changes based on 
     small business input.
       Small Business Majority continues to support healthcare 
     reform. Small businesses are the lifeblood of our nation's 
     economy and shouldn't be denied the benefits reform provides, 
     which is why we urge you to vote against this 
     counterproductive resolution.
           Sincerely,
                                                  John Arensmeyer,
     Founder & CEO.
                                  ____


[From Off the Charts, Center on Budget and Policy Priorities, Sept. 29, 
                                 2010]

   Enzi Proposal Would Threaten Market Reforms in Affordable Care Act

       The Senate is expected to vote today on a proposal from 
     Senator Mike Enzi (R-WY) to overturn federal regulations 
     related to some of the Affordable Care Act's key health 
     insurance market reforms that took effect last week.
       The regulations define ``grandfathered plans.'' Here's why 
     this definition matters. Among other things, the new health 
     reform law would require health plans to cover preventive 
     care without cost-sharing, undergo reviews to see if their 
     premium rate increases are unreasonable, and offer enrollees 
     the choice of their primary care provider. But plans that 
     existed when the law was enacted on March 23, 2010--known as 
     ``grandfathered'' plans--aren't required to comply with these 
     reforms.
       The regulations define how much a grandfathered plan can 
     change before it is considered a new plan that must abide by 
     these new reforms and consumer protections. As we explained 
     in a recent fact sheet, they strike a good balance for 
     consumers, allowing people to keep the plans they have while 
     ensuring that consumer protections kick in if an insurance 
     company reduces a plan's benefits or raises consumers' out-
     of-pocket costs significantly.
       Repealing the regulations, as Senator Enzi is proposing, 
     would confuse consumers, employers, and insurers about which 
     plans are grandfathered and which plans have to comply with 
     market reforms. As a result, it would threaten the 
     implementation of the immediate market reforms, thus making 
     the insurance market less stable and would likely leave many 
     consumers without access to critical protections the 
     Affordable Care Act provides.
       In short, the Enzi proposal--which would require just 51 
     votes to pass--would be a significant step backward.
                                  ____

                                               September 29, 2010.
       Dear Senator: The undersigned organizations write to you to 
     express opposition to Senate Joint Resolution 39, Disapproval 
     of Grandfathered Health Plans, filed by Senator Mike Enzi. 
     The resolution would block key insurance reforms included in 
     the Affordable Care Act that protect consumers and ensure 
     high quality, affordable care.
       Specifically, the resolution would eliminate an interim 
     final rule issued by the Departments of Health and Human 
     Services, Labor and Treasury in June that clarified important 
     consumer protections. Many provisions in the Affordable Care 
     Act apply to all plans, new and existing. However, some 
     provisions only apply to new plans. The rule outlines how 
     health insurance plans could maintain or lose their 
     ``grandfathered'' status.
       The rule, issued by the Administration, strikes the right 
     balance between protecting consumers and providing stability 
     and flexibility for employers. Specifically, the rule 
     prohibits plans from significantly cutting or reducing 
     benefits, increasing copays by an excessive amount, 
     dramatically raising deductibles or decreasing employer 
     contributions that result in an increase in workers' share of 
     premiums. If plans significantly raise out-of-pocket costs 
     for consumers, they lose their ``grandfathered'' status and 
     would be considered a new plan, subject to further 
     requirements in the law. Senator Enzi's resolution would 
     completely eliminate the rule, making it impossible to 
     enforce important consumer protections against potential 
     insurance company abuses. If enacted, the resolution would 
     put consumers' rights in jeopardy.
       We strongly urge you to stand up for American families and 
     vote ``no'' on SJ Resolution 39.
           Sincerely,
       American Cancer Society Cancer Action Network.
       American Diabetes Association.
       American Heart Association.
       Families USA.
       National Partnership for Women and Families.
       National Women's Law Center.
       SEIU.
       U.S. PIRG.
                                  ____

                                                       Health Care


                                             for America NOW!,

                               Washington, DC, September 28, 2010.
       Dear Senator: On behalf of Health Care for America Now, we 
     urge you to oppose the Joint Resolution of Disapproval of the 
     ``grandfathering rules'' filed by Senator Enzi. We understand 
     this could come up for a vote as early as Wednesday, 
     September 29. The Enzi resolution would nullify the interim 
     final rule defining grandfathered plans. In striking the 
     rule, Senator Enzi's resolution potentially allows any health 
     plan to be grandfathered--shielding plans indefinitely from 
     complying with important new consumer protections that 
     benefit millions of Americans.
       Like the Affordable Care Act (ACA) itself, the interim 
     final rule issued by the Departments of HHS, Labor and 
     Treasury sought to strike a balance that allows consumers to 
     keep current plans they like, while also ensuring that plans 
     evolve to incorporate new consumer protections. To do this, 
     the rule laid out the circumstances under which a health plan 
     loses grandfathered status, and therefore must comply with 
     certain new consumer protections. Factors that result in a 
     plan losing grandfathered status include significant benefit 
     cuts, cost-sharing hikes, lower employer contributions, a new 
     or tightened annual limit, or switching insurance carriers.
       The Enzi resolution wipes away the rules that define 
     grandfathered plans, potentially allowing any plan to assert 
     its permanent non-compliance with consumer protections. This 
     would invalidate many benefits of the ACA for people that 
     currently have insurance and indefinitely lock them into 
     plans that fail to meet basic consumer protections. Though 
     claiming to help small business, the resolution will plunge 
     many small business health plans into a maze of litigation. 
     This resolution is a transparent attempt to gut some of the 
     most important provisions of insurance reform.
       Consumers lose under the Enzi resolution. Plans would not 
     have to cover preventive services at no cost. The right to 
     internal and external appeals could be stripped. A trip to 
     the emergency room could again require prior authorization 
     and result in enormous out-of-network costs. These 
     protections are so basic, popular and bipartisan that there 
     can be no explanation for this resolution other than 
     pandering to an insurance industry that lost the battle but 
     is still gunning to win the war against consumers on health 
     reform.
       On September 23, people all around the country celebrated 
     the arrival of key consumer protections. Advocates hosted 
     hundreds of events nationwide, including 87 sponsored by 
     Health Care for America Now and the Main Street Alliance. 
     This spiteful resolution threatens to rip away those hard-won 
     consumer benefits. We urge Senators to vote no on the motion 
     to proceed and no on the resolution.
           Sincerely,
                                                       Ethan Rome,
     Executive Director.
                                  ____

                                                 Service Employees


                                          International Union.

       On behalf of the more than 2.2 million members of the 
     Service Employees International Union (SEIU), I urge your 
     boss to oppose S.J. Res. 39 filed by Senator Enzi. This 
     resolution of disapproval would strike the interim final rule 
     submitted by the Departments of Health and Human Services, 
     Labor and Treasury on the grandfathered health plans under 
     the Affordable Care Act (ACA).
       Many of the new protections under the ACA apply to all 
     health plans, both those in existence known as grandfathered 
     plans and new health plans or non-grandfathered plans. Those 
     provisions covering all health plans

[[Page 17198]]

     include a prohibition of rescissions, a ban on annual 
     lifetime coverage limits, coverage of children until age 26, 
     and an end to exclusion of children based on pre-existing 
     conditions. There are certain provisions that do not apply to 
     grandfathered plans, including the requirement to provide 
     preventive health services with no cost sharing and the new 
     internal appeals and external review process. Senator Enzi's 
     resolution seeks to disapprove the interim final rule which 
     states that health plans would cease to be the same plan that 
     was in effect on March 23, 2010 and therefore no longer 
     maintain grandfathered status if they significantly cut 
     benefits, raise deductibles or co-pays or lower employer 
     contributions.
       This resolution would give insurance companies free reign 
     to change the structure of a health plan such as increasing 
     co-pays and deductibles and not be required to provide 
     stronger consumer protections/benefits enacted under health 
     care reform designed to increase access and affordability. In 
     short, S.J. Res 39 is a blatant attempt to erode the 
     protections provided to consumers under health care reform.
       SEIU strongly urges you to oppose S.J. Res. 39. SEIU will 
     add votes related to this issue to our Congressional Score 
     Card located on our Web site at www.seiu.org. Should you have 
     any questions or concerns, contact Desiree Hoffman, Assistant 
     Director of Legislation, at desiree.hoffmanaseiu.org.
                                  ____

                                               September 29, 2010.

   AARP: Senate Resolution Would Weaken New Health Insurance Patient 
                              Protections


           Association Urges Senators to Oppose S.J. Res. 39.

       Washington.--AARP Legislative Director David Certner 
     released a statement in advance of today's expected vote on 
     S.J. Res. 39, a Senate resolution of disapproval that would 
     weaken the patient protections put in place under the health 
     care law. Certner's statement follows:
       ``The rules created earlier this year strike a good balance 
     between preserving the rights of individuals to keep their 
     existing coverage, while also honoring the purpose of the 
     Affordable Care Act in providing for patient protections and 
     important insurance reforms that safeguard individuals from 
     practices that lead to denials of coverage or to 
     underinsurance in the event of serious illness or accident.
       ``As I stated in AARP's letter regarding the Interim Final 
     Rule (IFR) to implement the grandfather status rules, `AARP 
     supports the general thrust of the IFR that plans not lose 
     their grandfather status for changes that are modest in 
     nature. This is consistent with the need to balance the 
     objectives in the ACA of preserving the right of individuals 
     to keep their existing coverage with the goal of ensuring 
     access to affordable essential coverage and improving the 
     quality of that coverage.' AARP agrees with the IFR's 
     determination of what would cause plans to lose their 
     grandfather status (e.g., cannot significantly cut or reduce 
     benefits, cannot significantly raise co-payment charges, 
     cannot significantly lower employer contributions) as 
     important consumer protections and consistent with the 
     statute.
       ``As a result, AARP urges Senators to oppose this 
     resolution to ensure critical new protections and rules 
     remain in place so that the vast majority of Americans who 
     get their health insurance through employers will have clear 
     guidelines on how their plans comply with the new law.''
       AARP is a nonprofit, nonpartisan social welfare 
     organization with a membership that helps people 50+ have 
     independence, choice and control in ways that are beneficial 
     and affordable to them and society as a whole. AARP does not 
     endorse candidates for public office or make contributions to 
     either political campaigns or candidates. We produce AARP The 
     Magazine, the definitive voice for 50+ Americans and the 
     world's largest-circulation magazine with over 35.1 million 
     readers; AARP Bulletin, the go-to news source for AARP's 
     millions of members and Americans 50+; AARP VIVA, the only 
     bilingual U.S. publication dedicated exclusively to the 50+ 
     Hispanic community; and our website, AARP.org. AARP 
     Foundation is an affiliated charity that provides security, 
     protection, and empowerment to older persons in need with 
     support from thousands of volunteers, donors, and sponsors. 
     We have staffed offices in all 50 states, the District of 
     Columbia, Puerto Rico, and the U.S. Virgin Islands.
                                  ____



                                   Trust for America's Health,

                               Washington, DC, September 29, 2010.
     U.S. Senate,
     Washington, DC.
       Dear Senator: The Trust for America's Health urges you to 
     oppose S.J.Res 39, a resolution of disapproval of the interim 
     final rule that stipulates what actions health plans are 
     precluded from taking if they wish to be considered a 
     ``grandfathered'' health plan under the Patient Protection 
     and Affordable Care Act (ACA).
       Among the many benefits of this critical law enacted 
     earlier this year is the renewed focus of the law on the 
     importance of prevention. As a result of ACA, patients and 
     consumers who enroll in new health insurance plans will have 
     access to recommended preventive clinical services for little 
     to no cost. This represents a tremendous opportunity to 
     encourage Americans to seek out and receive recommended 
     preventive services, which will have a real impact on 
     improving health outcomes. Furthermore, guaranteed coverage 
     of preventive services is a critical component of 
     establishing a national culture of prevention and wellness.
       While we hope that one day all Americans will be guaranteed 
     this access, a certain category of ``grandfathered'' health 
     plans are exempt from this requirement. As released in June, 
     the rule requires that health plans not make significant 
     changes to plan benefits, premiums, or cost-sharing 
     requirements should they wish to maintain their 
     ``grandfathered'' status.
       Enactment of this resolution would block the Department of 
     Health and Human Services from implementing this rule and 
     effectively permit any existing health plan to avoid the 
     important affordability and benefit protections created under 
     health reform, including coverage of preventive health 
     services.
       Once again, we urge you to vote against this resolution to 
     ensure that ``grandfathered'' status does not become a route 
     to curtailing the important prevention components of health 
     insurance reform. We hope you will stand on the side of 
     ensuring that patients have access to clinical preventive 
     services and other important insurance reforms contained 
     within ACA.
           Sincerely,
                                                     Jeffrey Levi,
                                               Executive Director.

  I yield the floor and reserve the remainder of my time.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized.
  Mr. ENZI. Mr. President, I yield up to 10 minutes to the Senator from 
Arizona, Mr. McCain.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.
  Mr. McCAIN. Mr. President, I ask unanimous consent to engage in a 
colloquy with the Senator from Wyoming.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCAIN. I would say to my friend from Wyoming, this seems like 
old times--what we tried to stop for over a year, and now our 
predictions came true, beginning with they turned 2 pages of this 
2,733-page bill--2 pages--into 121 pages of regulation. Is that 
correct, I would ask my colleague from Wyoming?
  Mr. ENZI. In one of the instances, that is correct.
  Mr. McCAIN. So in a 2,733-page bill, if we have 121 pages of 
regulation for every 2 pages, that is going to be pretty interesting, 
isn't it? And the fun has just begun. The fun has just begun.
  If the Senator might recall, I ask my friend from Wyoming, President 
Obama--quote after quote, time after time:

       And if you do have health insurance, we'll make sure that 
     your insurance is more affordable and more secure.

  We know that is not true from every estimate. It is neither 
affordable nor secure.

       If you like your health care plan, you can keep your health 
     care plan. This is not some government takeover. . . . I 
     don't want government bureaucrats meddling in your health 
     care. . . . That's what reform is about.

  I quote from the President of the United States.
  So now they have taken 2 pages of a 2,733-page bill, and that is 121 
pages of regulation.
  Now, isn't it true, I would ask my colleague from Wyoming, who knows 
as much or more about this than anyone, that it will result in 50 
percent of all employees being in plans ineligible for grandfathered 
status? Is that a correct statement?
  Mr. ENZI. That is not only a correct statement, the estimate is a 
little low, according to the administration.
  Mr. McCAIN. According to the administration.
  Mr. ENZI. According to the administration, in small businesses, 80 
percent of the people--unless this is passed--will lose the insurance 
they have and like, and in all businesses 69 percent will. Those are 
not my numbers; those are the administration's numbers.
  Mr. McCAIN. But isn't it also true that is the case for small 
business and people and entrepreneurs all over America except the 
unions? Isn't that true? Isn't this a carve-out again, part of this 
sleaze that went into putting this bill together, part of the 
``Cornhusker kickback,'' the ``Louisiana purchase,'' the buying of

[[Page 17199]]

PhRMA--all that went into this--the ``negotiations'' that were going to 
take place on C-SPAN that the President said during the Presidential 
campaign that went from one sweetheart deal cut to another. Part of one 
of those sweetheart deals was the unions are exempt; is that correct?
  Mr. ENZI. That is correct. And so were the other parts that were done 
in order to buy the bill in a bipartisan way.
  Mr. McCAIN. So what you are saying is that unless a health care 
policy provided by an employer is absolutely unchanged totally for an 
unspecified period of time, then that health insurance policy can be 
declared invalid by the Department of Health and Human Services, and 
they will have to go to a government-mandated health insurance policy 
or pay a fine. Is that a correct assessment?
  Mr. ENZI. It is a correct assessment in most of the parts. They will 
have to give up the insurance they have now, even if they like it, 
which the President did mention 47 times in public speeches. And there 
are some requirements on how much of a change there can be.
  But I have been talking to small businessmen traveling across 
Wyoming, talking to them and visiting them, because Congress thinks 
``profit'' is a bad word, and a lot in Congress think every business is 
simple to run. But they have never been out there and scratched the 
surface a little bit to see just how tough it is.
  I have had businessman after businessman whom I have visited and ones 
who have come to Washington because they have been so concerned who 
have said: I am going to do everything I can to keep my plan just 
exactly the same because this regulation is so difficult to understand, 
and I am pretty busy anyway, so I don't think I dare make any changes.
  That is not true. They could make a few changes, but if they do, they 
will lose their status, and they will have to pay more.
  Mr. McCAIN. So an employer, a small businessperson provides health 
insurance for their employees. That employer sees health care costs go 
up,--as everybody knows, and that is every objective estimate--so that 
employer says to its 10, 50, 60, whatever, employees: Look, we are 
going to have to increase your copay. We are going to have to increase 
your copay because, simply, the costs are prohibitive, and we would 
like to sit down, and I think you would probably agree to it given the 
overall situation across health care. And the employees agree with that 
and they change the copay, and then automatically they are finished. Is 
that correct?
  Mr. ENZI. Yes, that is correct. That is correct. If they change the 
copay, they are no longer grandfathered.
  Mr. McCAIN. So even though it is obvious that the cost of health care 
is going up, continues up dramatically--that is estimates of OMB, of 
literally every objective observer; the curve has not been bent down--
that unless employers keep exactly, with very little wiggle room, 
basically the same health insurance policy for their employees, then 
they will then have to comply with a government-mandated health 
insurance policy. Is that correct?
  Mr. ENZI. That is correct. The Federal bureaucrats have figured out 
what the minimum amount of insurance is that you ought to have and 
everybody else in America ought to have, and even if you like what you 
have, you are going to have to go to that if there are certain changes 
in your policy.
  The small businessmen are worried about any changes. Because this 
thing is so complicated, they do not even know what the rest of the 
rules are going to be. They have talked about this tax credit, but a 
number of them have looked at the requirements on the tax credit and 
said: How in the heck do I ever comply with that? So they are a little 
worried about being able to get that too.
  Mr. McCAIN. So I guess it was one of our colleagues and the President 
who intimated: Well, the American people really don't pay attention. 
The American people don't really--they are deceived by FOX News, et 
cetera.
  The American people knew this was a bad deal then, and they know it 
is a bad deal now. The majority of the American people want it 
repealed. And all of this is suspicions confirmed when you take 2 pages 
of legislation and turn it into 121 pages of regulation--a 2,733-page 
bill.
  Mr. ENZI. Yes, it will be dramatic. We have not begun to touch all of 
the regulations that have to be written on this yet. We looked at the 
Medicare bill and how many pages of regulations came out of that, and 
it was 100 per page, which would be 270,000 pages on this one. That is 
where that number came from.
  Mr. McCAIN. So here we are with an economy that the administration, 
the President, and his crack economic team said that if you pass this 
stimulus bill, maximum unemployment will be 8 percent. What is the 
problem with investment and hiring and economic growth in America 
today? The total uncertainty. We have just punted on the extension of 
the tax cuts or an Obama tax increase. We have just punted on a number 
of issues, and the American people now are going to have to--this small 
businessperson the NFIB represents is going to have to thumb through 
121 pages of new regulations in order to understand. Big businesses and 
small businesses are going to say: What are the next 121 pages of 
regulations that are coming down for 2 pages of the bill? I guess the 
title page probably would not have regulations associated with it, but 
the other 2,732 would.
  Mr. ENZI. And the Senator from Arizona has not even mentioned the 
1099 problem that is supposed to help pay for part of this bill.
  Mr. McCAIN. Yes, which our colleagues just voted down. They voted 
down a resolution by the Senator from Nebraska that would allow them 
not to have to report every single transaction of $600 or more. No 
wonder small and large businesses in America are reluctant to invest 
and hire with this kind of foolishness going on.
  Mr. ENZI. Right.
  Mr. McCAIN. The CPAs come to me in Arizona and say: I can't advise my 
clients. I don't know what the tax structure will be.
  So here we are with a new 121 pages of regulation which obviously 
will affect 50, 60, 80 percent--let's say it only affects 50 percent of 
businesses in America--and we are going to vote down, probably, with 
the big-government majority here, this effort to not have this 
regulation implemented.
  All I can say to my colleague from Wyoming is, thank you for your 
leadership. Thank you for your thoughtful dissertation on this issue. 
And I guarantee you, maybe next January, we can take this up again.
  Mr. President, I yield the floor.
  Mr. KYL. Mr. President, last June, President Obama promised on 
national television that ``Government is not going to make you change 
plans under health reform.''
  In his September 2009 address to Congress he told Americans, ``If you 
have health insurance through your job, nothing in our plan requires 
you to change what you have.''
  Many Americans doubted this would be the case, and they have been 
proven right.
  In the months after the health care law was passed, the 
administration wrote the regulations for plans with grandfathered 
status. Grandfathered status was supposed to allow employers to 
continue offering current health plans, even if those plans don't meet 
all of the government's new cost-increasing mandates and requirements. 
And we were told it was intended to help protect Americans enrolled in 
these plans from ``rate shock,'' or significant premium increases, as a 
result of the new government mandates.
  The consulting firm Mercer has bad news for people hoping to keep 
what they currently have. It released a new survey of employers on the 
impact of the health care law. One-quarter of employers surveyed 
estimate that the law would raise premiums by at least 3 percent. That 
increase is beyond this year's normal rise in costs due to medical 
inflation.
  A majority of respondents--57 percent--said they will ask employees 
to pay a greater share of the cost of coverage in 2011, meaning higher 
deductibles and copays.

[[Page 17200]]

  As the Mercer study notes, ``The rules for maintaining grandfathered 
status were tougher than many employers expected. As they start to get 
a clearer picture of projected costs for 2011, many are finding they 
need more flexibility to get their cost increases down to a level they 
can handle.''
  Yet the administration's regulations expose employers and employees 
to extensive bureaucratic redtape just so they can keep their current 
plans.
  In fact, the administration's own experts at the Department of Health 
and Human Services estimate that between 39 and 69 percent of 
businesses won't be able to keep the health plans they have now.
  Small businesses will fare even worse. By 2013, up to 80 percent of 
small businesses could lose their grandfathered status. All of this 
means that few health plans will qualify for grandfathered status, so 
many Americans will not get to keep what they have.
  Employers that lose grandfathered status for their health plans will 
be forced to comply with all of the new mandates included in the health 
care law and all of the administration's regulations.
  Subjecting employers' health plans to these mandates will either 
force them to change their plans and increase their costs of insurance 
or pay a fine and dump their employees into the Federal Government's 
new insurance exchange.
  I do not support the health care law at all, but I believe Americans 
should get to keep what they have, as promised, so I support the Enzi 
resolution of disapproval. The resolution would nullify these 
regulations and direct the administration to develop true 
grandfathering protections that allow Americans to keep their current 
coverage.
  These latest developments are consistent with the pattern that has 
emerged ever since this bill passed and was signed into law--one of 
broken promises. Americans never liked or wanted this bill, and we are 
continually reminded why they opposed it in the first place.
  Mr. WARNER. Mr. President, I ask unanimous consent to have printed in 
the Record, the following letter to Secretary Sebelius which discusses 
my thoughts on the interim final rule, ``Rule'', regarding 
grandfathered plans--75 Fed. Reg. 34538--as part of the Affordable Care 
Act. While I will vote against the motion to proceed on Senator Enzi's 
joint resolution of disapproval, S.J. Res. 39, I do have concerns that 
the rule itself is overly restrictive. I look forward to working with 
the administration and my fellow colleagues on continuing to develop 
guidance on this issue.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                  U.S. Senate,

                               Washington, DC, September 29, 2010.
     Hon. Kathleen Sebelius,
     Secretary, U.S. Department of Health and Human Services, 
         Washington, DC.
       Dear Secretary Sebelius I write regarding the Interim Final 
     Rule (``Rule'') regarding grandfathered plans (75 Fed. Reg. 
     34538).
       While I understand that the Rule seeks to balance consumer 
     protections while still allowing consumers to keep their 
     existing plans, I am concerned that as currently written, the 
     Rule is overly restrictive. In some places the Rule places 
     significant restraints on the ability of employers and health 
     plans to make adjustments to their existing plans that 
     contain costs while maintaining the overall benefit structure 
     and value for plan participants.
       As a starting point for more flexibility, I urge you to 
     reconsider the provision that automatically revokes 
     grandfathered health plan status if an employer-sponsored 
     health plan changes insurance carriers. This provision, as 
     written, is overly restrictive and unfairly locks in 
     employers to a specific carrier. For instance, changing 
     carriers should not trigger a loss of grandfathered status if 
     the benefit coverage under a different insurer remains the 
     same. In fact, many new carriers have shown that they can 
     offer lower cost-sharing to employees due to a better rate.
       I hope to work with you to refine and adjust this and other 
     aspects of the regulation as we further define grandfathered 
     plans to ensure appropriate stability in the marketplace. I 
     appreciate the opportunity to assist the Agencies in 
     continuing to develop guidance on this important issue.
           Sincerely,
                                                   Mark R. Warner,
                                            United States Senator.

  Mr. HARKIN. Mr. President, how much time do we have?
  The PRESIDING OFFICER. Eleven minutes 12 seconds.
  Mr. HARKIN. How much time does the other side have?
  The PRESIDING OFFICER. Three and a half minutes.
  Mr. HARKIN. Mr. President, I yield 4, 5 minutes to the Senator from 
Illinois.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Illinois.
  Mr. DURBIN. Mr. President, I just listened to the Senator from 
Arizona, who is my friend and whom I respect. I cannot remember how 
many pages were in the McCain-Feingold bill. I voted for it. I believed 
in it. I did not count the pages. I thought he was on the right track 
to change campaign financing in America. It was a bipartisan bill, and 
I supported it.
  Has that now become the measure in the Senate--we will count the 
pages, and if it goes over 1,000 pages, we are not going to pass the 
bill? I hope not because this bill, the underlying bill on health care 
reform, to make it more affordable and more accountable, took on one of 
the major industries in America, where the cost of health insurance has 
gone up 10, 15, 20 percent a year.
  We know the health insurance industry and the companies behind it are 
not going to go down without a fight. They are going to hire the 
lawyers and the lobbyists--and they did--to fight the passage of the 
bill and to fight its implementation in court and everyplace you turn 
because what is at stake is their money, their profit. What is at stake 
is the way they do business, and they know it. So when this 
administration writes the rules and regulations to make sure that when 
we are challenged in court, this is going to stand up under the law, it 
is the reasonable thing to do, and I think even the Senator from 
Arizona would acknowledge it.
  Now, I know the Senator from Wyoming does not feel this way because 
he told me personally this morning that he does not favor repeal of the 
bill. I do not know what the position of the Senator from Arizona is. 
But I would say to those who want to repeal the health care bill that 
the President signed into law, this is what they want to repeal. They 
want to repeal the consumer protections which we have finally put into 
the law which say the health insurance companies cannot cancel your 
coverage when you need it the most. They cannot deny you coverage 
because of a preexisting condition. They cannot deny to children under 
the age of 18 coverage under health insurance for a preexisting 
condition. They cannot deny to you the right to keep your kids under 
your health insurance policy, your family's policy, until they reach 
the age of 26.
  In that bill was also a new deduction for the cost of health 
insurance for small businesses so they can afford to find health 
insurance for the owners and the employees of the businesses. In this 
bill was closing the doughnut hole on the Medicare prescription Part D, 
sending a $250 check to the seniors who needed it this year and 
increasing that amount over the year and still not adding to the 
deficit overall with this bill. That is what they want to repeal.
  Well, I am not going to stand before you and tell you that the bill 
we voted for was a perfect law. The only perfect law I am aware of was 
carved in stone tablets and carried down a mountain by Senator Moses. 
All the other bills that have been passed are going to need some 
changes over the years. But the change the Senator from Wyoming brings 
to the floor is a bad change--a bad change--because what he wants to do 
is empower the health insurance companies to increase the amount of 
money Americans pay for their coverage. That is it. Give them more 
protection so they can raise costs.
  The Senator from Wyoming said we should not be embarrassed to say 
these companies are in business for a profit. I understand that. But 
this underlying bill limits the profits of the company and says that 80 
percent of the premiums they collect need to be spent on health care. 
That leaves them 20 percent for their bonuses, for their salaries, 
whatever they want. But we want

[[Page 17201]]

to make sure people across America have a fighting chance to have 
health insurance protection when they absolutely need it the most.
  I see my colleague on the floor, the Senator from South Dakota. He 
and I had an unexpected experience in the month of August. We were both 
in a hospital for surgery. Lucky for us, Senator Johnson and Senator 
Durbin--and also the Senators on the other side of the aisle--are 
protected by the best health insurance in America. Shouldn't the people 
of this country have that same kind of peace of mind so that when they 
need medical care, even expensive medical care, their health insurance 
is there to protect them?
  All of the people standing on the floor railing against government-
administered health care are covered by government-administered health 
care. Our health insurance plans in Congress are administered by the 
Federal Government, and not a single Senator on the other side of the 
aisle has said: In principle, I am going to give up my health insurance 
to show you how much I hate government-administered health care. They 
have not done it because the plans are too darn good. We want to give 
every American the same peace of mind Members of Congress have.
  We have to defeat the Enzi approach today. It empowers health 
insurance companies at the expense of people who need health insurance 
when they face a diagnosis, a surgery, a cancer treatment that could 
literally bankrupt their family unless they have health insurance 
protection. I urge my colleagues to oppose Senator Enzi's effort on the 
Senate floor today.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. Mr. President, how much time do we have remaining?
  The PRESIDING OFFICER. The Senator has 6 minutes remaining.
  Mr. HARKIN. Mr. President, again, I don't know where all of these 
figures come from, how many pages of regulations per page on the bill, 
and all that kind of stuff.
  I have in front of me the Federal Register of Thursday, June 17, 
2010. What we are dealing with today are grandfathered plans, right? 
The resolution offered by the Senator from Wyoming has to do with what 
is a grandfathered plan and the regulation of the grandfathered plan.
  Well, I looked at the rules in the Register. It is one page and not 
even a half, about a page and one-third--well, not actually even a page 
and a third, a little over a page, a page and a third. I have it right 
here. Page 34,568 and page 34,569: Maintenance of Grandfather Status. 
That is what it is, and that takes into account all of the things to 
which the Senator from Wyoming referred.
  It is a page and a quarter, right there. There is a bunch of other 
stuff in this regulation that comes through there, including accounting 
tables and all kinds of things, but the actually rule, regulation, is a 
page and a third. I don't know what all this other stuff is in here. It 
is probably make work for somebody, I don't know. But it is a page and 
a third.
  But getting to the crux of it, we provided in the health reform bill, 
which is now law, that if you had a plan you liked, you could keep it. 
If that plan was in effect prior to April of this year, you can keep 
it. It is called grandfathering. Many of the things we provided for new 
plans don't apply to those grandfathered plans, things such as 
preventive services. As my colleagues know, all new plans now must 
cover certain preventive services without any copays or deductibles, 
that type of thing. All new plans have a right to an external appeal to 
a third party, if you want. There are restrictions on annual limits and 
coverage in the individual market. There is direct access to OB/GYNs 
without a referral. You can't charge a higher cost sharing for out-of-
service emergency services. You don't need a prior authorization 
requirement for emergency care. Those are just some of the elements 
that apply to new plans that will not apply to a grandfathered plan.
  So then you have to ask, well, what is a grandfathered plan? A 
grandfathered plan is a plan that was in existence prior to April of 
this year on which the insurer and the insured agreed, like a contract.
  What if that grandfathered plan--what if that insurer then says: 
Well, we agreed on a certain coinsurance charge. It was 20 percent. But 
now we are going to raise it to 40 percent. Well, that is not what you 
agreed to. That is not what you signed up for.
  Let's say they want to raise deductibles. Let's say your deductible 
was $1,000, and they say now they are going to raise your deductible to 
$2,500. That is not what you agreed to. That is not the plan you liked 
or you signed up for. Or let's say the plan wants to significantly 
increase your premiums or they want to tighten down on your annual 
limits. That is not what you signed up for.
  So the rules and regulations say: Look, there are certain limits. You 
can raise your copayment, but not more than $5 or 15 percentage points 
above medical inflation. So there are certain restrictions put on what 
an insurer can do and still claim to have a grandfathered plan. That 
seems to me to make infinitely good sense because they leave the 
consumer with nothing. They are at the whims of the insurance company. 
That is what it was like before we passed the health care reform bill. 
That is what my friends on this side of the aisle want to go back to: 
Giving the insurance companies the wherewithal to define everything and 
tell the consumer what it is that a consumer has to have. They call the 
shots.
  Well, quite frankly, what this regulation does is it gives more 
empowerment to consumers. It says to an insurer: You can't just willy-
nilly change your plans that you had prior to April and call it a 
grandfathered plan. If you change it, if you make all of these big 
changes, guess what. You are going to have to cover preventive services 
without copays and deductibles. If you do all of these big changes, 
well, your insurer is going to have the right to appeal that. Quite 
frankly, I think that has a lot to do with this. We said for any new 
plans, the insurer has the right to appeal to a third party--not the 
grandfathered plans but the new plans. That is why a lot of the old 
plans don't want to become new plans. They don't want to give you that 
right of appeal.
  There are restrictions on annual limits, which I mentioned before, in 
the individual market.
  So, again, if you want to have a grandfathered plan, fine, but you 
can't just change it dramatically. I say again to my friend from 
Wyoming, read it in full. It doesn't say any changes; it says any 
changes based upon certain things.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. HARKIN. So I say to my friends, we should vote this down and move 
ahead with health care reform and protect the consumers of America.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, when we talk about 121 pages, we are talking 
about what the small businessman has to access. He has to go on the 
Internet and print out the pages. There are 121 pages. Yes, if he could 
get it in the format of the Federal Register, he would have 34 pages. 
But you can't ignore everything but 1\1/2\ pages. You have to do the 
whole thing.
  Small business is upset about this. That is why I listed the 54 
different organizations that are opposing this bill. I have gotten, and 
I am sure everybody has gotten--even though I only brought this 
resolution up last week, there are hundreds of letters coming in with 
examples of what this will do to them.
  From Fort Lauderdale, FL: They received such a large increase of 
people being grandfathered out of the plan, they will be forced to get 
a new plan because they made their current plan so expensive. Now the 
new plans have much higher deductibles, more out-of-pocket costs, and 
more affordable plans only offer to pay 50 percent coinsurance. So the 
options are limited.
  The options are limited to all of the businesses. I have letter after 
letter that shows how it isn't just the business that has to absorb 
these costs. The individuals who have the insurance who have been 
pleased with their insurance are going to have to go out on the

[[Page 17202]]

open market because the company is going to say it can't afford to do 
it anymore. They are trying to keep the insurance, but that has been 
the problem for small businesses all along.
  Our economy is already struggling. It doesn't need more job-killing, 
cost-increasing government mandates. We are hearing from small 
businesses across the country which are already being forced to swallow 
large premium increases that will prevent them from hiring more 
workers. That is jobs. We need to create more jobs, not write 
regulations that lead to less jobs.
  The bill was sold as letting people keep what they have, but the 
devil is in the details. Do a little digging. It is clear. Americans 
would not be able to keep what they have. The simple truth is, because 
this new rule will drastically tie the hands of employers, few 
employers are expected to be able to pursue grandfathered status.
  The Enzi resolution is about protecting small business and the people 
who work there. Anytime an individual doesn't like what they are 
getting, they can go out on the open market and get something, but most 
of the help on getting that doesn't arrive until 2014.
  Where is the cost cutting they were promised in the bill? Now we are 
going to add this regulation to it, and small businesses are telling me 
they can't afford it. If this becomes the grandfathered thing, 80 
percent of small businesses are going to have to change unless my 
resolution is passed. Sixty-nine percent of all businesses are going to 
change unless my resolution is passed. People out there who like what 
they have--listen to this. Help your small business and help get this 
grandfathered thing passed.
  As I mentioned, there are several organizations that are key voting 
on this one because it is so critical to their members and the people 
who work for them.
  I ask my colleagues to support the resolution.
  I yield the floor.
  Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There appears to 
be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Alaska (Ms. Murkowski).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 40, nays 59, as follows:

                      [Rollcall Vote No. 244 Leg.]

                                YEAS--40

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

                                NAYS--59

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

                             NOT VOTING--1

       
     Murkowski
       
  The motion was rejected.

                          ____________________