[Congressional Record (Bound Edition), Volume 157 (2011), Part 1]
[Senate]
[Pages 1048-1077]
[From the U.S. Government Publishing Office, www.gpo.gov]




    FAA AIR TRANSPORTATION MODERNIZATION AND SAFETY IMPROVEMENT ACT

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to the consideration of S. 223, which the clerk will report by 
title.
  The legislative clerk read as follows:

       A bill (S. 223) to modernize the air traffic control 
     system, improve the safety, reliability, and availability of 
     transportation by air in the United States, provide for 
     modernization of the air traffic control system, reauthorize 
     the Federal Aviation Administration, and for other purposes.

  The PRESIDING OFFICER. The Senator from Texas.
  Mrs. HUTCHISON. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant editor of the Daily Digest proceeded to call the roll.
  Mr. ROCKEFELLER. Madam President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER (Ms. Klobuchar). Without objection, it is so 
ordered.
  Mr. ROCKEFELLER. Madam President, I ask unanimous consent that the 
Senate proceed to a period of debate only on the FAA authorization bill 
for the purposes of opening remarks from the chairman--that being me--
and ranking member--that being Senator Hutchison--of the Commerce 
Committee.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ROCKEFELLER. Madam President, I wish to thank the majority leader 
for bringing this bill to the floor so promptly--the first bill of this 
year, the 112th Congress. The Air Transportation Modernization and 
Safety Improvement Act reauthorizes the Federal Aviation 
Administration. It has been postponed 17 times over the last 4 years, 
to the consternation of all of us who care about this subject. There 
are three Commerce Committee members in the Chamber right now, and we 
are all frustrated about getting it done. So it is the first piece of 
legislation.
  The bill which I introduced and which we are considering is the text 
of the FAA reauthorization bill that was approved by the whole Senate 
last year by a vote of 93 to nothing. All of the matters of safety and 
air traffic control systems and all the rest of it that we talk about 
are all incorporated already in this bill. Although the Senate and the 
House of Representatives informally conferenced, it was not productive, 
and we were unable to come to a final resolution, so here we are once 
again. I thought that beginning this year's consideration of the FAA 
reauthorization bill with the legislation that did pass unanimously 
last year would signal a commitment to bringing forward a bill that had 
broad bipartisan support--at least last year. It wasn't that long ago. 
There are some new Members, and some issues still stand out. We didn't 
resolve all of them.
  I wish to say at the beginning that this is a monumentally important 
bill. I would also say that I recognize without rancor that there are a 
lot of Members of the Congress who don't really keep up with aviation 
because they kind of take it for granted. It is highly technical and 
not always interesting but always important--always important. It 
employs 11 million people, just for a start. It is a vastly important 
bill, and we are vastly behind where we should be, and this bill will 
help us move forward.
  I wish to thank particularly Senator Hutchison, the ranking member of 
the Commerce Committee and my able partner, for her efforts on this 
bill last year. I look forward to working with her again this year in 
passing this bill, as I know she wants to have it happen, and get it 
enacted into law. She and I can't sign it into law, but we want to have 
a good bill signed into law. I believe this bill reflects a shared 
vision and our mutual goal of making sure the United States continues 
to have

[[Page 1049]]

the safest, most efficient, and most modern aviation system possible.
  Given the importance of the airline industry to our Nation's 
economy--again, many people take this for granted, but it is a vast 
industry--I can't think of a more important piece of legislation to our 
Nation's long-term economic competitiveness. It is the right bill to 
start with. We know this legislation will create and support good-
paying American jobs. It already does--11 million is a lot of jobs. 
That is slightly more than the population of West Virginia. The bill 
improves the safety and efficiency of our Nation's aviation system by 
preventing something called runway incursions, which people often 
aren't aware of unless their plane runs into another on the tarmac, 
which happens infrequently but does happen. People would be shocked to 
know how often and how many times incursions are just about to happen 
until they are rescued by an understaffed control tower which says: 
Hey, head right, head left, stop--whatever. It also modernizes our air 
traffic control system. That is an easy phrase--``modernizes our air 
traffic control system.'' It is a vast, new concept. We are living in 
an age when everybody else is GPS and digitalized, and I include 
Mongolia. I would like to include Mongolia because it does have a GPS 
system, and the thought of Mongolia being ahead of us is deeply 
disturbing to me, and it is a way of making a point, I think one would 
agree. I wish to reduce delays that frustrate fliers, and we do that. 
It opens the door to better economic development, especially in rural 
and underserved areas. It makes a very big point of that, with 
essential air service, airport improvement programs, and other 
programs.
  Simply put, this bill helps protect our position as the global leader 
in aviation. Now, I said ``global leader.'' We are. We are. The 
aviation needs and goals of Texas and West Virginia are the same. 
People might not believe it, but they are. My good friend Senator 
Hutchison represents some of the largest airports in the country. I 
represent some of the finest smaller airports in the Nation. All of our 
airports are critical economic engines to their respective communities. 
Senator Hutchison may have more flights in and out of Texas than we 
have in West Virginia--in fact, I guarantee she does--but we both know 
the importance of air service to economic growth and global 
competitiveness.
  Every one of our constituents wants the safest aviation system 
possible. Before assuming our current roles, Senator Hutchison and I 
rotated being chairman and ranking member of the aviation subcommittee. 
We did that for 10 years, so we are pretty heavily into the subject, 
and we agree on virtually everything--virtually everything. But we 
share a passion for aviation because we know how critical this industry 
is to our economy, to the comfort and mobility of our people, and to 
our Nation's future. We both share a strong desire to get this 
legislation enacted into law. I have already said that. It has been far 
too long--4 years--since the last FAA reauthorization bill was enacted. 
Our Nation cannot afford to wait one second longer.
  Sadly, when many people think of flying, their first reaction is 
often negative, and that is usually what we hear--people complaining 
about TSA lines, about delays, about weather; airlines are meant to 
control weather. Actually, they don't, statutorily or otherwise. But 
people are not happy, so there is sort of a grumpiness about this 
subject, which we don't address, but we try to take away the causes of 
grumpiness.
  I will be the first to admit from my own point of view that travel is 
not always enjoyable. That is a symptom of a number of expectations we 
have somehow developed over the years. Air travel has changed with 
deregulation. Oh, how well I remember regulation. American Airlines, 
big jets in Charleston, WV; United Airlines, big jets in Charleston, 
WV; Eastern Airlines, big jets in Charleston, WV; deregulation, and one 
month later, no more jets, and we now subsist basically on prop planes 
with two propellers. If you are my height, it takes an hour or so to 
restore your blood flow after you get out of one of those--if you are 
lucky enough to get an exit seat. If you are not, it may take 2 or 3 
hours. Anyway, some of the changes with deregulation have been for the 
better. Not all of those changes have been for the best. There have 
been frustrating changes for travelers as the industry has adapted to 
this new reality. There have been many other benefits, primarily 
cheaper tickets to more places for the average flier.
  We must also remember that aviation is more than just a commercial 
air travel service. Aviation accounts for $1 trillion-plus worth of 
economic activity for the country and, again, supports more than 11 
million jobs. It is a critical sector of our economy. Boeing is the 
Nation's largest exporter, and aerospace sales from large and small 
producers provide billions of dollars toward balanced trade for the 
United States with international buyers. This is a great success story, 
but we haven't been tending to it. That is why we are doing this bill 
now.
  In 2010, the United States did not have a single commercial aviation 
fatality. That is a truly remarkable statistic. It is one we should not 
only be thankful for but very proud of. Safety is the No. 1 priority of 
the Federal Aviation Administration, the airline industry, and the 
people who work for both, and it is the No. 1 priority of Senator 
Hutchison and myself, and well as the Commerce Committee as a whole. It 
always is and has to be. It is through the hard and dedicated work of 
the thousands of FAA and airline industry employees that we do, in 
fact, have the safest aviation system in the world. Improving the 
safety of our aviation system has been a huge priority for all of us. 
You can't rest on your laurels in aviation in any respect. The industry 
is always shaky. The public is always a little bit shaky. Times are 
shaky--bad times, fewer passengers; better times, more passengers. That 
sounds like good news--more passengers--but I am copping to that. It 
isn't necessarily good news that there will be more passengers in the 
future.
  I strongly believe this bill is fundamentally about the future of 
aviation, and it is vastly important. This bill is about making sure we 
have the most technologically advanced satellite-based air traffic 
control system in the world. This bill is about catapulting our air 
traffic control system out of the 19th century and into the 21st 
century with every other industrialized country in the world. We do not 
share that with them now. More people drive rented cars with GPS 
systems than airplanes have. It sort of doesn't make sense, but that is 
a fact. Today, as I said, we are behind Europe and even Mongolia. We 
have to remedy that fact, and we have to do it quickly.
  This bill is about making sure we continue to have the most dynamic 
aviation industry in the world. I will say it again. The U.S. civil 
aviation sector generates $1 trillion a year in economic activity and 
employs 11 million people. All of that activity creates jobs in every 
sector of our economy, including airport construction jobs and building 
airplanes, from the smallest general aviation planes to Boeing's state-
of-the-art 787 Dreamliner. All this activity creates jobs--jobs in 
airlines, jobs in general aviation, such as the small airports that dot 
both Senator Hutchison's State and mine, the rural parts thereof, as 
well as the Presiding Officer's. Airports and the aviation industry 
support millions of indirect jobs. That makes sense. One need only 
look--and this is sort of the most obvious presentation of it--at the 
growth around Dulles, Dallas/Fort Worth, and Denver International. 
Denver International was built out in the middle of the desert. Not 
anymore. I don't think Dallas/Fort Worth was ever out in the middle of 
the desert, but the growth is extraordinary. It attracts jobs. People 
don't want to bicycle to Dallas or Charleston or anywhere else; they 
want to go by air. Business decisions are made by air. So that point 
speaks for itself.
  In Beckley, WV, which is not huge but has a wonderful airport, what 
is interesting is that it also has an enormously successful business 
park at that facility. Our major airports in Charleston and Huntington 
have direct

[[Page 1050]]

flights to the major headquarters of chemical and energy companies that 
allow businesses to grow in West Virginia.
  I believe the future of the U.S. aviation system has unlimited 
potential. We face serious challenges in making sure we reach that 
potential, but I know we are up to it. To make it work, we have to 
upgrade our 1950s-era, antiquated air traffic control system. Investing 
in technology and infrastructure is a very good place to start. It is 
embarrassing that some of our newer cars have more sophisticated global 
positioning systems than many of our aircraft in the skies. That has to 
change, and it costs money. It has everything to do with lives and 
safety. It is going to get much bigger, with many more passengers. We 
have about 750 million people flying every year now. In another decade 
it will be nearly 1 billion. So it is almost like a 50-percent increase 
in the number of people flying. Everything gets more complicated and 
crowded.
  It is eye-opening to see the speed with which China and other 
developing nations are investing in their air traffic control systems 
and their airports. They know what they are doing. They take nothing 
for granted. Growth is on their minds. Again, we have to make the 
effort to get ahead or we will be left far behind. I am sorry, but that 
is the way it works. It is not a sentimental industry. It is one that 
needs to be treated well, nurtured, and supported.
  If we don't act quickly, we are at risk for falling behind our global 
competitors. We will lose the cargo hubs, the aircraft manufacturing 
plants, and the economic development that aviation causes. I cannot 
understate the importance of a vibrant and strong aviation system. I 
have made no attempt to be shy on that account. I cannot be. It is 
fundamental to our Nation's long-term economic growth and to my State's 
ability to attract new investment.
  When choosing to invest in an area, the quality of air service is the 
prime consideration. I say ``the''; you could say ``a.'' You can have a 
great quality of life, but it doesn't give you a factory. Quality of 
life is good, but it isn't preemptive. The ability to fly from West 
Virginia to almost any corner of the world, which we now have, is 
critical for our ability to attract new businesses and jobs.
  Why do we have 20 Japanese companies in West Virginia? That is 
actually a cerebrally interesting question. The reason is, because we 
have good air service and good workers. But if we had good workers and 
no particularly good air service, we would not have them. You have a 
lot more of that in Texas, but for West Virginia that is a phenomenal 
statistic. All of our futures are tied to modern aviation systems.
  Over the last several years, we have focused more on the 
inconveniences of air travel, rather than trying to solve the 
underlying problems that make air travel so challenging.
  Most Americans do not understand how fragile our air transportation 
system is. The economic downturn of the last several years masked this 
fragility because fewer people flew, so there was less pressure on the 
system.
  As our economy recovers, I am afraid the inherent weakness of our 
system will loom larger than ever in years to come as we get to 1 
billion passengers a year.
  The possibility of a meltdown of the air traffic control system may 
become reality, unless we modernize it. This will create more than 
inconvenience; it will put passenger safety at a very substantial and 
unnecessary risk.
  These are not the only troubling signs, as I noted. There were no 
commercial aviation fatalities in 2010, but that doesn't mean the 
system is working to perfection. We were lucky and people worked hard. 
Over the last few years, the FAA and the industry have faced serious 
questions over their commitment to safety. That commitment has been 
called into question.
  The grounding of thousands of aircraft throughout the system in 2008 
raised questions about the quality of airline maintenance practices and 
the FAA's ability to provide sufficient oversight of air carriers and 
their maintenance, not just domestic but also overseas, which is 
another subject.
  The tragic accident, the downing of flight 3407 on that snowy night 
in Buffalo, exposed problems with pilot training, flight crew fatigue, 
particularly pilot fatigue, and the ability of the industry to assure 
the traveling public that there is one level of safety throughout the 
entire system. This bill addresses that through a number of 
stipulations, but we are making it a rule. We have to get this into 
law. The FAA is putting some of this into practice, but we have to make 
it into law. People have to get enough sleep. Above 10,000 feet, they 
can talk about something other than aviation, but below 10,000 feet, 
where the crowd gathers and aviation is being scrutinized by air-
traffic control folks, you have to have what is called a sterile 
cockpit, where nobody talks about anything but landing. So I am deeply 
proud of the reforms we have put into place in the area of safety, and 
they offer even more incentive to pass the bill quickly.
  Before I close, I wish to recognize the efforts of former Senator 
Byron Dorgan and I think Senator Hutchison would join me in saying 
this--for his hard work on behalf of the safety issue. I am pleased to 
say the FAA is currently working on implementing the two dozen 
provisions of the law that he helped, with others, to create.
  I feel very strongly that improving our aviation system is a national 
priority. My passion comes from a deep belief that our future is tied 
to a healthy aviation industry. America is the cradle of aviation. I 
don't want to see that change.
  Since 1988, I have worked diligently, as the chairman of the Aviation 
Subcommittee and now as chairman of the Commerce Committee, to support 
our aviation system and to address its challenges; to wit, inadequate 
funding for the FAA, a chronically unprofitable commercial aviation 
industry, and minimal investment in aerospace research.
  Nobody moves forward in industry without doing research, and we will 
not pay for it. So a lot of it is not done.
  In some areas, we have made progress. We have increased our 
investment in airport infrastructure, we have opened new markets for 
U.S. air carriers and, thanks to the Obama administration, we have 
finally begun to make serious investments in modernizing our air 
traffic control system. It is a multi-year process, highly expensive.
  I know many of my colleagues will say we cannot afford to make those 
investments in aviation at this time. But now, it seems to me, it is 
the precise time to make them.
  The recession has prevented widespread delays from occurring. So we 
were lulled into thinking everything was going well. Over the last 
decade, airlines dramatically cut capacity and parked hundreds of 
planes in the desert. We don't have them in West Virginia, and I don't 
know where they are parked--somewhere in the desert. They were taken 
offline because of a lack of passenger demand. Anyway, we cannot make 
shortsighted budget decisions. The cost of inaction will be far 
greater.
  I ask my colleague from Texas, I am proceeding well, but I am not 
finished; is that acceptable?
  Mrs. HUTCHISON. Yes.
  Mr. ROCKEFELLER. I thank the Senator. Our economy has begun to slowly 
turn around, and the demand for air travel has slowly begun to grow. 
Airlines have cautiously increased capacity. If we act now, we can be 
prepared to meet the challenges of adding millions of passengers to the 
system in the next decade. If we fail to act, congestion will plague 
the system again, delays will be a fact of life, and today will look 
like the golden age of travel.
  The benefits of investing in air traffic control modernization extend 
far beyond the ability to handle more passengers. Most important, the 
Next Generation Air Transportation System, what we call NextGen, will 
dramatically improve the safety of our air transportation system by 
providing pilots and air traffic controllers with better situational 
awareness. Now you can't tell if there is a mountain in front of you, 
you can't tell about the ground situation, and you can't tell

[[Page 1051]]

very well about separation. It is inefficient. Planes land, but they 
could land more quickly. You cannot read the distance and altitude 
between one plane flying in for a landing or one taking off. It is 
inefficient--dangerous, in fact. So we have to do this. We have to be 
able to see other aircraft and detailed weather maps in real time and 
to be able to go from one place to another in a straight shot. That is 
what NextGen will do for us. Now planes are going all over the place, 
avoiding this and that, as they go from one TRACON to another TRACON, a 
weather system or an unexpected flight. GPS NextGen will allow for 
straight flights. That saves a lot of fuel and a lot of time, and 
delays cost the American economy over $30 billion a year.
  So, again, we have to provide our pilots and air traffic controllers 
with better situational awareness. They will be able to see other 
aircraft and detailed weather maps, and that becomes important.
  A new satellite-based ATC system will allow airplanes to move more 
efficiently by taking more direct routes, which saves our economy 
billions of dollars on an annual basis.
  Greater operational efficiency will also create substantial 
environmental benefits. Drastic reductions in fuel consumption means 
not only that we will achieve lower carbon emissions--less of them will 
be spewed out--but almost every community near an airport will benefit 
greatly from this effort. Also, planes are becoming quieter. In all 
ways they are getting better. We still have to guide them correctly.
  As I noted, the President clearly recognizes the value of investing 
in our air transportation system, and this was reflected in his budget 
request. The administration proposed a total of over $1 billion in 
fiscal year 2011 for NextGen programs, which is more than a 30-percent 
increase from the fiscal year 2010 budget. Is that bad in this time and 
age of skepticism about budgets? I hope we can continue this level of 
budget, even in lean budget years.
  Modernizing the ATC system will require a sustained focus and 
substantial resources. This legislation takes concrete steps to make 
sure the FAA accelerates and achieves key NextGen programs and that the 
agency implements modernization efforts in an effective and efficient 
manner in the long run. How many airports can be done by 2014 and by 
2018? It is laid out in the bill.
  Let me discuss a few key measures in S. 223 that further address 
modernization. To improve accountability, this bill establishes an air 
traffic modernization board, and it designates a chief NextGen officer 
to provide specific oversight of the FAA's modernization activities. 
Oversight is what Congress is for, and we don't do it well enough 
because we are all on too many committees and have too much work to do. 
Putting somebody in who is responsible for overseeing NextGen within 
the FAA is a good idea, not a silly one.
  The bill also establishes specific deadlines for the implementation 
of the key NextGen programs. It has fancy names for them. Area 
Navigation, or RNAV, and Required Navigation Performance, or RNP, 
procedures must be developed at the Nation's largest 30 airports by 
2014. Where these technologies are already in place, we are seeing 
dramatic benefits in reduced fuel consumption and many other benefits.
  All aircraft are required to be equipped with Automatic Dependent 
Surveillance-Broadcast. I will not bore you with what that is about. It 
is called ADS-B, and it is the cornerstone of the FAA's traffic control 
modernization effort. It provides controllers and pilots with an 
aircraft's immediate position. Pilots will be able to see the real-time 
position of other aircraft in their vicinity and receive the same 
information the controllers are seeing in their towers. They will see 
them in their cockpit.
  The FAA estimates that NextGen will cost probably about $20 billion 
through 2025 and the airlines another $20 billion in aircraft equipage. 
In other words, they have to match--the airlines--to a certain extent 
what the Federal Government is doing. They will do that. Again, some 
will argue we cannot afford this investment. I say it is the other way 
around.
  This bill is paid for. It makes a substantial commitment to providing 
the FAA with the resources it needs. I have worked with Senators Inouye 
and Baucus to reach an agreement that moves us in the right direction. 
S. 223 will create a new subaccount with the aviation trust fund to 
fund FAA's modernization efforts. This modernization subaccount will 
dedicate $400 annually to NextGen efforts and to nothing else. So it is 
boxed right in. Our colleagues have worked hard on this issue.
  A word on small community air service. That is another core 
challenge. Every part of my State of West Virginia is basically rural, 
and every State has some rural parts. Everybody thinks of LaGuardia and 
JFK, but try upstate New York, try around the Saranac or west of that 
into Buffalo. They deal with small aircraft. That is where the small 
aircraft crash took place, in Buffalo. The pilot was drowsy.
  The continuing economic crisis has hit the U.S. airline industry very 
hard. Rural communities are at the end of the food chain. If something 
bad happens at the top of the food chain, there will be some suffering. 
But the real suffering takes place at the bottom of the food chain. 
That is where the flights get cut off, that is where they get limited, 
that is where some flights suddenly stop going to places. There is hope 
for better times, but we do not have them yet. We are in crisis.
  The reduction or elimination of air service has a devastating effect 
on the economy of the community nearby. I stipulate that with the 
previous sentence. Having adequate air service is not just a matter of 
convenience but also a matter of economic survival. Without access to 
reliable air service, no business is going to locate their operations 
there. I already talked about that issue. Small airlines and small 
airports are important.
  When Congress deregulated the airline industry in 1978, we made a 
promise to small communities--an official promise--that they would 
continue to have access to the Nation's air transportation system. I 
believe that the Federal Government needs to provide additional 
resources and tools for small communities to help them attract adequate 
air service. This legislation does this by building on existing 
programs.
  Authorized funding for the Essential Air Service program is increased 
to $200 million annually. The EAS program is critical to dozens of 
communities throughout this country. I made that point. It is needed. 
It also provides a lot of flexibility to EAS, and what small airports 
can do with EAS. Someone may be phasing out being a commercial EAS 
airport and headed to being a general aviation airport. This allows 
that transition to move forward.
  I am almost at the end. Consumer protection is key. We are about 
protecting lives, protecting people, protecting passengers. The bill 
strengthens passenger protections by incorporating elements of the 
passenger bill of rights which came right out of the Commerce Committee 
to deal with the most egregious flight delays and cancellations.
  Talk about angry travelers. This is where you run into them. The 
industry would be required to take basic steps to improve the passenger 
experience. To wit, passengers must be provided with information 
regarding on-time arrivals and chronically delayed flights when they 
purchase tickets. Most of them will do that online so the airlines have 
to publish what is their record for on-time takeoffs or on-time 
landings, what is their delay, what is their cancellation. That has to 
be posted so that fliers who want to purchase tickets can compare and 
go elsewhere if they want.
  Air carriers are also required to permit passengers to deplane after 
3 hours have elapsed. We all heard about 9-hour waits on the tarmac. It 
is usually not as dramatic as that. If you are a mother and have three 
children, 3 hours not moving is a long time. Three hours moving is a 
long time, but not moving is a very long time. They would have, after 3 
hours, the right to deplane. It is their right to deplane. Airlines 
cannot stop that unless the pilot has a certain belief that they are 
just about to take

[[Page 1052]]

off. They have to be given water and medical attention, if they need 
it, bathroom facilities, and the rest of it.
  The Department of Transportation has taken steps to improve customer 
protections, and I applaud their actions. But I for one believe 
statutory protections are better than when a government agency decides 
to do it.
  In conclusion, when we began work on this bill, I at least had four 
simple goals: One, take steps to address critical safety concerns; two, 
establish a roadmap for the implementation of NextGen and accelerate 
the FAA's key modernization programs; three, make sure we adequately 
invest in airport infrastructure; and four, continue to improve small 
communities' access to the Nation's aviation system. This bill takes 
those steps.
  I feel very strongly about the bill. The Airport Improvement Program, 
which is part of this bill, is estimated to support 120,000 jobs 
annually. This bill authorizes a total of $8.1 billion for this 
account. Moving forward with NextGen will certainly help us keep our 
position as a global leader. This is the culmination of more than 4 
years of work with Senator Hutchison and myself and the hard-working 
members of the Commerce Committee.
  Again, this language passed 93 to 0 less than 12 months ago. It is an 
important bill--important for the safety of the traveling public, 
important to our ability to create jobs, important to sustaining an 
aerospace industry, important to having healthy airlines, important to 
general aviation's future, and important to our future competitiveness.
  I urge my colleagues to support this bill, and I welcome ideas on how 
we might improve it. I ask my colleagues to join me in our 
determination to complete our work and reauthorize FAA.
  The PRESIDING OFFICER (Mr. Franken). The Senator from Texas.
  Mrs. HUTCHISON. Mr. President, as ranking member of the Committee on 
Commerce, Science and Transportation, I, too, wish to discuss the FAA 
reauthorization bill and agree with the chairman, Senator Rockefeller, 
who has just spoken, that we have worked in a bipartisan way on this 
bill for 4 years.
  I am glad he mentioned Senator Dorgan, who was the chairman of the 
subcommittee, who pushed so hard last year for us to come to a 
conclusion and try to pass a permanent bill.
  The bill that is before us is the bill that passed last year. There 
are many good provisions in this bill. It passed unanimously in the 
Senate, and we were on our way to conference with the House. But the 
House bill was quite different. We never got to the point of being able 
to work out the differences.
  I do think there was one part of the bill, which I will discuss more 
later, where we worked on a compromise to achieve a goal of easing the 
perimeter rule at Washington's Reagan Airport. We were able to come to 
an agreement among the leaders on the committee, but we were not able 
to get the full agreement of the Senate. That was a gentlemen's 
agreement, if you will, that we would work on putting that into the 
conference report, but that never came to pass.
  The perimeter rule around National Airport has slot restrictions and 
mileage restrictions on how far a plane can go directly in and out of 
National Airport. The perimeter rule prohibits flights traveling to or 
from points that are more than 1,250 miles from National Airport unless 
there is an exemption. Many Western States would like more of those 
exemptions, especially given that the airport can now handle additional 
capacity.
  I want to be clear at the onset of this process, I cannot support a 
final bill that does not address this issue. We need to work out either 
a consensus majority or an agreement that addresses the issue rather 
than just leaving it out.
  The FAA has operated under a series of short-term extensions since 
2007; 18 short-term extensions have occurred. That is not providing the 
policy to keep us in the forefront of modernization of our air traffic 
system. We need to have a bipartisan, commonsense, multiyear FAA 
reauthorization to provide the stability that the FAA and its 
stakeholders--the airlines and passengers--need to make sound 
investment decisions for our future aviation system.
  The current short-term extension expires March 31. If we address 
these issues in our Senate bill, I believe we can work with the House 
that has already begun to formulate the basis of its bill and have a 
true multiyear reauthorization bill that would be able to pass on March 
31 instead of yet another short-term extension.
  The House version last year was quite different from our bill. While 
a year now has almost elapsed, many of the bill's provisions need to be 
updated. The one we have before us would modernize the air traffic 
control system, NextGen, which was mentioned by Senator Rockefeller. It 
would improve aviation and it would ensure passengers are treated well, 
especially if they are delayed and stuck in an aircraft for more than 3 
hours. I call it the captive passenger rule that we need to enact.
  First, modernization. Probably the most important area we address in 
this bill is expediting the FAA's air traffic control air modernization 
program, known as NextGen. The FAA operates the largest and safest air 
traffic control system in the world. In fact, the FAA's air traffic 
control system handles almost half of the world's air traffic activity. 
The United States has been a leader in developing and implementing new 
technologies to create a safer and more efficient airspace system.
  However, today's air traffic control system is not much different 
from that which was started in the 1960s. The system is based on radar 
tracking and ground-based infrastructure. NextGen will move much of the 
air traffic infrastructure from ground based to satellite based by 
replacing antiquated, costly ground infrastructure with orbiting 
satellites and onboard automation. By doing this, the FAA will be able 
to make our aviation system more safe and efficient while increasing 
capacity at our Nation's busiest airports.
  Some of the modernization provisions in the bill include establishing 
clear deadlines for the adoption of existing Global Positioning System 
navigation technology. It mandates 100 percent coverage at the top 35 
airports by 2014, with the entire national airspace system to be 
required to be covered by 2018.
  Aviation safety. As a former vice chairman of the National 
Transportation Safety Board, I understand well the critical and 
difficult mission the FAA has in overseeing our Nation's airlines and 
aviation system. Aviation safety and the public trust that goes along 
with it are the bedrock of our national aviation policy, and we simply 
cannot allow any degradation of safety for the flying public. This bill 
goes a long way to advance and promote the air travel system.
  Last August, as part of one of the short-term extensions, several of 
the important safety provisions were enacted into law that were the 
direct result of weaknesses identified from the tragic crash and 
aftermath of Colgan flight 3407 in Buffalo, NY. While those provisions 
were of great importance and will have an impact on creating one level 
of safety through all sectors of aviation, we still have important work 
to do, and in this bill we do it, such as addressing inconsistent 
application of airworthiness directives by improving the voluntary 
disclosure reporting process to ensure adequate actions are taken in 
response to reports; limiting the ability of FAA inspectors to work 
with air carriers over which they had oversight.
  The PRESIDING OFFICER. Will the Senator yield?
  Mrs. HUTCHISON. I will be happy to yield if the leaders allow me to 
come in when they are finished and continue.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. Mr. President, I ask unanimous consent that Senator 
Stabenow be recognized to offer an amendment related to 1099 reporting 
forms; that she give her speech regarding this after Senator McConnell 
offers an amendment relating to health care, and the amendments be 
debated concurrently.

[[Page 1053]]

  Senator McConnell can do whatever he feels appropriate, but he will 
speak before Senator Stabenow. How much more time does the Senator from 
Texas need?
  Mrs. HUTCHISON. Probably about 5 or 6 minutes.
  Mr. REID. So whatever she and Senator McConnell decide on that is 
fine with me.
  Mrs. HUTCHISON. So I will speak after Senator McConnell, and before 
Senator Stabenow.
  Mr. McCONNELL. My statement is pretty brief, if the Senator from 
Texas would not mind. I think Senator Stabenow is willing to let me do 
my statement and lay down my amendment.
  Mr. REID. Then Senator Stabenow will be willing to let the Senator 
from Texas finish her statement.
  I ask unanimous consent that Senator Stabenow be recognized to offer 
her amendment and then Senator McConnell would offer his.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.


                            Amendment No. 9

  Ms. STABENOW. Mr. President, I have an amendment at the desk, 
amendment No. 9, and I ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The assistant legislative clerk read as follows:

       The Senator from Michigan [Ms. Stabenow] proposes an 
     amendment numbered 9.

  Ms. STABENOW. I ask unanimous consent that the reading of the 
amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To repeal the expansion of information reporting requirements 
 for payments of $600 or more to corporations, and for other purposes)

       On page 335, after line 20, insert the following:

  TITLE XI--REPEAL OF EXPANSION OF INFORMATION REPORTING REQUIREMENTS

     SEC. 1101. REPEAL OF EXPANSION OF INFORMATION REPORTING 
                   REQUIREMENTS.

       (a) In General.--Section 9006 of the Patient Protection and 
     Affordable Care Act, and the amendments made thereby, are 
     hereby repealed; and the Internal Revenue Code of 1986 shall 
     be applied as if such section, and amendments, had never been 
     enacted.
       (b) Rescission of Unspent Federal Funds to Offset Loss in 
     Revenues.--
       (1) In general.--Notwithstanding any other provision of 
     law, of all available unobligated funds, $44,000,000,000 in 
     appropriated discretionary funds are hereby rescinded.
       (2) Implementation.--The Director of the Office of 
     Management and Budget shall determine and identify from which 
     appropriation accounts the rescission under paragraph (1) 
     shall apply and the amount of such rescission that shall 
     apply to each such account. Not later than 60 days after the 
     date of the enactment of this Act, the Director of the Office 
     of Management and Budget shall submit a report to the 
     Secretary of the Treasury and Congress of the accounts and 
     amounts determined and identified for rescission under the 
     preceding sentence.
       (3) Exception.--This subsection shall not apply to the 
     unobligated funds of the Department of Defense, the 
     Department of Veterans Affairs, or the Social Security 
     Administration.   


                   Recognition of the Minority Leader

  The PRESIDING OFFICER. The Republican leader is recognized.
  Mr. McCONNELL. Mr. President, I thank the Senator from Texas very 
much for letting me make a brief statement about the amendment I am 
about to offer, and apologize for interrupting her comments.
  What we have today is an opportunity--an opportunity--for the 
majority to reevaluate what it has done on the issue of health care and 
to take another path. It is no secret the American people don't like 
the health care bill that was passed last year. If you have talked with 
doctors or nurses or anybody else involved in health care over the last 
year, most of them will tell you they do not like it either. Employers, 
big and small, have been desperately trying to get the message across 
of how damaging this bill will be to their ability to create jobs. They 
tell us the impact of the bill is severe--higher taxes, penalties for 
hiring workers, new regulations that have already run to more than 
6,000 pages, and mountains of new paperwork all at a time when 
businesses want to create jobs and millions of Americans are looking 
for one.
  Don't take it from me. Here is how the National Federation of 
Independent Business puts it:

       Small business owners everywhere are rightfully concerned 
     that the unconstitutional new mandates, countless rules and 
     new taxes in the health care law will devastate their 
     businesses and their ability to create jobs.

  Yesterday, a Federal court in Florida found the crux of the law to be 
unconstitutional. So we have an opportunity today--an opportunity for 
all those who supported the health law--to reevaluate your vote and to 
listen to your constituents, who are desperately trying to get your 
attention. You can say, perhaps, this was a mistake, we can do this 
better or you can continue to dismiss the majority of the people in 
this country as not knowing what they are talking about.
  It is not every day that you get a second chance on a big decision 
after you know all the facts. Today is one of those days. For all of us 
who opposed the health care bill, today we reaffirm our commitment to 
work a little harder to get it right. We can't afford to get it wrong.
  I urge my colleagues to move beyond party affiliation. Look at the 
facts before us. If everyone in this Chamber evaluated this bill for 
what it is, we would repeal it right now, and then we would begin to 
work on achieving our mutual goal of delivering health care at a higher 
quality for lower cost. Let us not miss this opportunity.


                            Amendment No. 13

  Mr. President, I send an amendment to the desk, and I ask for its 
immediate consideration.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The assistant bill clerk read as follows:

       The Senator from Kentucky [Mr. McConnell] proposes an 
     amendment numbered 13.

  The amendment is as follows:

  (Purpose: To repeal the job-killing health care law and health care-
related provisions in the Health Care and Education Reconciliation Act 
                                of 2010)

       At the appropriate place, insert the following:

            TITLE __--REPEAL OF JOB-KILLING HEALTH CARE LAW

     SEC. _01. SHORT TITLE.

       This title may be cited as the ``Repealing the Job-Killing 
     Health Care Law Act''.

     SEC. _02. REPEAL OF THE JOB-KILLING HEALTH CARE LAW AND 
                   HEALTH CARE-RELATED PROVISIONS IN THE HEALTH 
                   CARE AND EDUCATION RECONCILIATION ACT OF 2010.

       (a) Job-Killing Health Care Law.--Effective as of the 
     enactment of Public Law 111-148, such Act is repealed, and 
     the provisions of law amended or repealed by such Act are 
     restored or revived as if such Act had not been enacted.
       (b) Health Care-Related Provisions in the Health Care and 
     Education Reconciliation Act of 2010.--Effective as of the 
     enactment of the Health Care and Education Reconciliation Act 
     of 2010 (Public Law 111-152), title I and subtitle B of title 
     II of such Act are repealed, and the provisions of law 
     amended or repealed by such title or subtitle, respectively, 
     are restored or revived as if such title and subtitle had not 
     been enacted.

     SEC. _03. BUDGETARY EFFECTS OF THIS TITLE.

       The budgetary effects of this title, for the purpose of 
     complying with the Statutory Pay-As-You-Go Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this title, 
     submitted for printing in the Congressional Record by the 
     Chairman of the Committee on the Budget of the House of 
     Representatives, as long as such statement has been submitted 
     prior to the vote on passage of this title.

  Mr. McCONNELL. Mr. President, I thank the Senator from Texas, and I 
yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.
  Mrs. HUTCHISON. Mr. President, I am pleased we are starting on the 
FAA bill and having an open amendment process so everyone can be heard. 
I will finish my remarks, as the ranking member of the Commerce 
Committee, and then I know Senator Stabenow wants to speak on the first 
amendment that is going to be offered. It is probably unrelated to our 
FAA bill but nevertheless is very important for our country.
  Let me go back to where I was on the part of the FAA reauthorization 
bill

[[Page 1054]]

that addresses aviation safety. We do limit the ability of FAA 
inspectors to work for air carriers over which they have had oversight, 
and we will require the conducting of independent reviews of safety 
issues identified by employees.
  We also need to require enhanced safety oversight of foreign repair 
stations, including a minimum of two FAA inspections annually, with 
exceptions for those that have comprehensive bilateral aviation safety 
maintenance agreements with the United States, and requiring alcohol 
and drug testing at any foreign facilities that perform maintenance on 
U.S. commercial aircraft.
  Finally, the bill also provides infrastructure investment to our 
Nation's airports. As we all know, you can have the best planes and the 
best air traffic system but they mean nothing without the proper 
airport infrastructure in place.
  This bill contains many important provisions and deserves the support 
of the Senate. We have been operating under short-term extensions for 
far too long. It is also one of the reasons we need to finally address 
the DCA perimeter rule, which has impeded the passage of this bill on 
too many occasions. While I have been talking about what is in the 
bill, this is the one issue that is currently not included in the bill 
and must be addressed if we are to have a successful final passage.
  After months of negotiation last year, the chairman, the subcommittee 
chairman, western Senators, and our ranking member on the subcommittee 
and I reached a compromise agreement that we hoped would finally 
resolve the issue, but we didn't have an opportunity to bring the 
consensus version to the floor before we adjourned. It is a very 
reasonable approach. Here are the provisions of the compromise:
  It would add five new round-trip flights beyond the perimeter for new 
entrants or limited incumbents, which means airlines that have very 
small bases at National Airport now. This means we would add 
competition with the five new round-trip flights.
  It allows for conversion of 16 round-trip flights from large hub 
airports inside the perimeter to any airport outside the perimeter 
phased in over 2 years.
  The conversion concept seeks to address congestion concerns by 
replacing existing flights rather than creating more new flights. Since 
2000, there have only been 12 new flights at National Airport. That is 
since the year 2000. Now we are asking for five more new flights, which 
would increase competition. The conversion flights would have no impact 
on congestion at the airport because they will not be new flights.
  It prohibits the use of wide-body aircraft for converted flights to 
address any noise concerns from local residents. But in reality, the 
noise issue is so different today than it was when the first aviation 
authorization was passed. We have Stage 3 aircraft now, which are much 
quieter than the planes that have gone in and out in the past. And not 
to allow the use of bigger aircraft protects the residents who might 
live around the airport. In fact, I would argue it gives them an added 
convenience, because those residents would also have access to the 
long-haul flights at an airport convenient to them.
  The DOT would evaluate the proposed flights and be able to disapprove 
of the conversions if they determined they are not in the public 
interest.
  The air carriers could only convert flights currently used to operate 
flights to large hubs within the perimeter in an effort to protect 
small communities. So, in other words, you would not see conversions 
from very small airports to be able to take long-haul flights away. It 
would only be conversions from a big hub airport to another big hub 
airport. So our small communities should not feel threatened by this.
  Carriers would be prohibited from selling, trading, leasing or 
otherwise transferring the rights to fly beyond the perimeter.
  It also eliminates financial restrictions in place between National 
and Dulles that would allow for revenuesharing between the two 
airports, which is comparable to other airport systems across the 
country to address any financial impact on the airport authority.
  I lived through, dealt with, and negotiated the Wright amendment in 
Texas and the lifting of the Wright amendment that allowed an 
incremental easing of the Wright amendment restrictions at Dallas's 
Love Field. That was put in place to protect DFW Airport when it was 
first built. That was much of the reason for the restrictions at 
National Airport when Dulles Airport was built, to assure that Dulles 
would be financially secure. Dulles is financially secure. So it is 
time to deal with the issue of allowing National to have more service 
to the western half of America. The people out West deserve to have 
more access to National Airport if that is where they choose to fly.
  I think Dulles has captured the international flights, and I think 
that has been a good way for Dulles to become one of our busiest 
airports and certainly one of our most successful. So I know these are 
difficult issues, because I dealt with them in my own State, but now I 
think this modest expansion of only five new flights out of Reagan 
National should be very doable. I think the western Senators have come 
up with a compromise, with the conversions, that will not affect the 
traffic or the congestion around National but will allow better access, 
which I think is a win-win for everyone.
  So especially for you, Mr. President, with some humor, I find it a 
bit ironic that tomorrow is Groundhog Day--February 2. If ever there 
were a piece of legislation that fits the bill, this one is it. Since 
starting this legislation in 2007, 18 short-term extensions later, and 
this being the third consideration of the FAA bill on the floor, it 
does feel like Groundhog Day. And in a nod to that holiday--that 
esteemed important holiday in America--let us hope there are no shadows 
seen and winter will quickly end in a well-debated and bipartisan FAA 
bill.
  Mr. President, I thank the Senator from Michigan, the majority 
leader, the Republican leader, and my chairman for allowing us to start 
the debate on this bill and finish our remarks. I know we will have 
many amendments, but I hope in the end we have a good bill that 
satisfies everyone's needs and that we can say permanently that winter 
is over.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, first, I want to congratulate Senator 
Rockefeller and Senator Hutchison for their leadership in putting 
together what is such an important bill for 280,000 jobs that are saved 
or created as a result of this bill, and focusing on our ability to 
out-innovate and out-build in a global economy. We can't do that 
without a 21st century FAA system--airports, air traffic control, and 
so on. So I join with Senator Hutchison in hoping that--and I am sure 
it will be true--at the end of the day we will have a strong bipartisan 
vote, because they are moving forward in the spirit in which we have 
all come together in saying we want to move forward; that is, working 
hard and focusing on jobs. That is what the American people want us to 
do, focus on jobs, and find common ground, working across the aisle. 
That is evident from this bill.
  I am very appreciative of the fact they are focusing, and I want to 
thank our leader for making sure that the first bill we are bringing up 
is about jobs. We understand that too many families--certainly in my 
State--are still looking for work. They have worked hard all their 
lives, and they never thought in a million years they would find 
themselves in the situation they are now facing. They want us to be 
laser-focused on jobs and the economy and outcompeting in the global 
economy, as the President said. This bill is exactly the kind of policy 
on which we should be focused. What is concerning to me is that while 
we are doing that, we are now going to have a debate that is very 
divisive, really looking backward rather than looking forward.
  One of the things the President talked about--again, which I agree

[[Page 1055]]

with strongly--is that in the area of health care, what we passed last 
year, we know there are measures we can fix to make our system more 
competitive, to make it better for families, to put families back in 
control rather than insurance companies. We know we can make it better. 
Certainly no one has been more of a champion than our leader on this 
legislation, now the chairman of the Commerce Committee but one of the 
leaders, the No. 2 on the Finance Committee, who brought his passion to 
the issue of health care as well. We know this can be fixed, and we 
want to work together to make it better but not fight old fights, 
create old political fights and division, and certainly not roll back 
the clock where we put all the control in the insurance companies and 
we see our families losing the freedom and security to make sure their 
children, their families have the health care they need.
  Let me first talk about my amendment and then why I believe we should 
be focused on this kind of amendment to fix the bill that passed last 
year, the new law, to make it better rather than rolling the clock 
back. Certainly we have heard now, if you follow the polls, that four 
out of five Americans are saying: Don't go back and just repeal what 
was done; fix it. So the majority of people are not supporting going 
back to old political fights or going back, frankly, to a system that 
is an uncontrolled system where insurances companies can raise rates 
20, 30, 40 percent every year without some plan, some focus to be able 
to lower costs, to be able to get people out of emergency rooms and 
into the doctors' offices, and, frankly, for people who have insurance 
not to be placed into a situation where they continually see their 
rates go up to pay for people who do not, which is what we have put in 
place.
  There is a provision that has been a concern of mine and many others. 
We have debated it on the floor. We have attempted to get it fixed 
several different times. I hope today, I hope tomorrow--whenever we 
vote--that we will actually be able to get this fixed. This has been 
supported on both sides of the aisle, and it deals with eliminating 
redtape and burdensome IRS reporting requirements for our businesses, 
particularly small businesses.
  We are particularly concerned about what this means for small 
businesses. The provision that was placed into the bill that now, as we 
look at how the IRS would implement it, is clearly too burdensome--my 
amendment would repeal that. It would allow business owners to spend 
their time growing their companies and creating jobs instead of filling 
out paperwork from the IRS. We want them creating jobs. It is a 
commonsense solution to an issue that has come up. Basically, it would 
make sure that the provision that would require a 1099 form for every 
vendor when a company has a purchase of $600 or more for goods would no 
longer be in place. This is a provision that actually does not take 
effect until next year, but we want to send a very clear message to 
businesses that have expressed great concern about this, about what is 
coming for them at the end of the year. We want to let them know that 
we will not continue the new provision. We would allow small businesses 
that already create 64 percent of the jobs to be able to keep creating 
those jobs, and we would make sure we are not putting in place 
additional paperwork for them.
  It is important to note that, according to the IRS, the provision we 
want to repeal if left unchecked would impact about 40 million American 
businesses and 26 million of them are sole proprietorships--our 
smallest businesses. They would be overwhelmed with the paperwork that 
is involved. It does not make any sense.
  We passed a great small business jobs bill last fall that created 
eight different tax cuts and focused on making capital loans more 
available for small businesses. We don't want to now go in the other 
direction and see a mountain of paperwork added to the small businesses 
we have been very committed to fighting for and supporting. 
Unfortunately, if this provision were allowed to stand, it would 
require a 2000-percent increase in 1099 filings. Frankly, that does not 
make sense.
  This particular provision would repeal what was placed into the new 
health care law. We pay for the repeal by cutting $44 billion in 
unobligated spending. We do make it clear that certainly this does not 
affect Medicare or Social Security benefits in any way. I would not 
support that. I know colleagues on the floor would not as well. It 
makes it clear that the Departments of Defense and Veterans Affairs and 
the Social Security Administration are not included. But it would give 
the Office of Management and Budget the ability to look at the 
possibility in areas for cuts, and they would then report back to us in 
60 days after enactment--to the Secretary of Treasury and the 
Congress--concerning the amounts and the accounts they would be using 
in order to cut back, in order to save this particular provision.
  This is an area where we can come together, where Democrats and 
Republicans--both sides of the aisle--who care passionately about small 
businesses can come together and eliminate redtape and burdensome IRS 
reporting provisions. We would get that off the table and make it clear 
to small businesses that there is no intent or actuality that this is 
going to happen. We can do that together.
  But what we should not be doing is what the next amendment, the 
Republican leader's amendment, would do because his amendment would 
take us back to the time of uncontrolled insurance company increases, 
of no accountability, and it would put the control of health care 
coverage and costs back in the hands of insurance companies. What I 
support and what the new law allows is the freedom and security for 
families to make sure they can get the medical care they need when they 
need it.
  I have two beautiful grandchildren, a granddaughter age 3 and a 
grandson age 1, and they are the most beautiful children in the world, 
just for the record. I want my son and daughter-in-law picking up the 
phone and calling the doctor when they get sick, not fighting with the 
insurance company. If this is repealed, they go back to fighting with 
the insurance company. I want to ensure that my children, as well as my 
grandchildren, my mom, everyone else in my family, as well as everyone 
in Michigan and the country, is getting the medical care they need, not 
fighting with the insurance companies, not worrying that because their 
child has juvenile diabetes or leukemia or some other disease or 
condition, the insurance company is going to say: Tough luck, we are 
not going to cover your child even though your child needs care or you 
suddenly get sick and they say: You know, there is some fine print over 
here, and we know you are sick, but we are going to cancel your 
coverage or we have 10 treatments we will provide even though the 
doctor says you need 20.
  Right now, because of what we have done in the Patients' Bill of 
Rights that was put into place, we put those decisions in the hands of 
families and doctors instead of insurance companies. I certainly am not 
going to vote to taking it back to putting it in the hands of insurance 
companies.
  Frankly, I have had many families approach me to say ``thank you'' 
who now have the ability, the freedom, the security to put their 
child--this 22-, 
23-, 25-year-old--on their insurance. They get that first job, and it 
doesn't have health insurance, but they can go out, get started, and 
know they have the peace of mind that they have health insurance. That 
would be taken away under what the Republican leader is proposing. We 
would see young people going back to no insurance as a result of that.
  Right now, we have seniors who know they are going to have their 
freedom and security to be able to get the cancer screening they need, 
the wellness visits, even if they do not have the out-of-pocket--the 
copay and deductible they were used to being charged in the past 
because there is no co-pay and deductible now. They will be able to get 
what they need in preventive care.
  They will have the peace of mind, the security to know that if they 
use a lot of medicine and they fall in a gap in coverage, the cost in 
that gap is going

[[Page 1056]]

to be cut in half for any brand-named drugs--cut in half. What does 
that do? It means my mom, who is 84, has the security to know that her 
great-grandchildren are going to have her around longer--a lot longer, 
I hope--because she is going to be able to play with those kids. Every 
older person is going to know they have a better chance to be around 
for their grandkids because they are going to be able to afford the 
medicine that will help them get healthy. That is taken away with the 
Republican leader's amendment, the freedom and security for seniors to 
know they can stay healthy, they can stay in their homes, they can have 
the medicine they need or the doctors' visits they need to be able to 
stay healthy and live a long, healthier life. That is taken away.
  There will be the freedom and security for women to know that we are 
not going to pay twice as much as men for insurance--which, by the way, 
in the majority of policies prior to passing this legislation, if women 
went out to buy an insurance policy, in over half the policies, women 
paid as much as twice as much. We changed that.
  We have also said that things such as maternity care ought to be a 
basic part of a health insurance policy. Maybe we will not be 39th in 
the world in the number of babies who live through the first year in 
their lives if moms are able to get the prenatal care they need and 
babies are able to get it through the first year of their lives. This 
gives women the freedom and security of knowing they are going to get 
what they need to have healthy babies. Isn't that what we all want? 
That is taken away with the amendment of the Republican leader.
  Among many other things, I will just mention two others. For the 
first time, we are putting accountability on the insurance industry--
again, our chairman of the Commerce Committee led this effort and the 
Finance Committee--to say that you know that if you pay a hard-earned 
dollar out of your pocket for health insurance, and it is tough and the 
rates are high--and unfortunately, until we get this implemented, they 
keep going up, they keep having it go up until they have to stop--the 
majority of that is going to go for medical care. So, depending upon 
the size of your policy, either 80 or 85 percent that you pay out has 
to go into medical care, not executive compensation or bureaucracy but 
medical care. What does that mean? It means it will limit the rate 
increases over time and put more accountability on the company. The 
amendment of the Republican leader rolls that back. We have companies 
now that spend 60 percent of every dollar you give on medical care or 
70 percent. This would say that 80 or 85 percent, the majority of your 
hard-earned dollars--they are hard to come by in this economy--if it is 
for health care, then it should be used on health care. That is what is 
repealed in this--accountability on insurance companies.
  Finally, what is also repealed is a major focus in this bill on 
supporting small businesses to be able to get a better deal on health 
insurance, and this takes away the freedom and security for a small 
business to get the leverage they need, like a big business, to get a 
better deal on rates. This was something that took effect. If we were 
going to change something, I wish we could speed that up. That needs to 
be faster, in my judgment, and not having to wait for the next 3 years 
because we have all kinds of small businesses that are going to be able 
to band together and be able to get a better rate like a big business 
through competition in the marketplace--not government control, private 
sector competition.
  I had an opportunity to talk to a gentleman who runs a program for 
our automakers and other manufacturers for retirees. It is a health 
exchange, exactly like we passed in the new law. He said to me: I don't 
think, Senator, even you guys realize how good it is, in terms of what 
we have done in creating a marketplace and bringing rates down.
  He said: We bring rates down about 30 percent for the auto companies, 
for retirees, about 30 percent, because of competition in this bill, 
leveraged for small businesses, and tax cuts to help small businesses 
pay for it in the new law, taken away by the McConnell amendment.
  I hope in the spirit of the underlying bill, which is a great jobs 
bill, a great bill for innovation--it is about rebuilding our 
infrastructure; it is about competing in a global economy; it is about 
being the best we can be--I would hope in the spirit of the FAA bill, 
we would not succumb to this backward, divisive, political debate on 
repeal. If we want to join on something on health care, I strongly urge 
a 100-percent vote on eliminating the burdensome provision for small 
businesses, eliminate the redtape, eliminate this IRS provision on 
1099. Let's do something together that both sides agree should be done. 
Let's fix the things that need to be fixed, but let's not roll back the 
clock and put insurance companies in charge of everything, every 
medical decision, every rate increase as they were in the past.
  I urge adoption of the Stabenow amendment.
  We will have a number of colleagues in the process of joining. I 
don't have a whole list. We have a number of colleagues who will be 
cosponsors. I thank Senator Baucus for his leadership, his ongoing 
leadership on this amendment as well. I urge adoption of this amendment 
to fix what we know needs to be fixed, and then let us go on to jobs.
  The PRESIDING OFFICER (Mrs. Shaheen). The Senator from West Virginia.
  Mr. ROCKEFELLER. Madam President, I don't see any other folks who 
want to speak on the FAA bill for the moment or on much else for the 
moment. I will suggest the absence of a quorum but not yet. I am hoping 
Senator Baucus and Senator Hatch will come down to oversee the 1099 
argument and repeal of the health care bill, which is about the worst 
idea I have ever heard. I think it will be voted down, and I believe 
the minority knows that. I don't know who they are trying to speak to. 
When I think of the health care bill and all the work that went into 
it--the work that went into it is not that important, it is the product 
that came out. When he says the American people are against it, that 
was actually quite true for a year and a half, maybe almost 2 years, 
because we were in the process of making the bill and it was kind of 
like making sausage, and people turned against it. But now it is going 
in quite the opposite direction. Now as people begin to get some of the 
benefits, they understand some of the conditions they will be unbonded 
from, that they won't be slaves anymore to costs determined by others 
who don't care about their health care, I think the momentum is 
swinging.
  What we would be condemned to, if the amendment were to pass and 
health care were to be repealed, in that there aren't any particular 
ideas of note which were put forward by the other party about what we 
should do to make it better other than to repeal it, is another 2 or 3 
years trying to write a bill and not having a bill. We would be in a 
situation as follows: I recall in the year 2008--and I just happen to 
recall this because we worked on this in the Commerce Committee--the 
five largest health insurance companies in America made profits of 
$12.4 billion. I don't have a problem with that. What I do have a 
problem with is what they were doing and what will continue to happen 
if we repeal the health care bill; that is, while they were making all 
that money, they were, through the process of rescission--and that 
means a unilateral decision that because somebody has acne or has been 
through a C-section or asthma or any number of things--they actually 
insured 3 million fewer people while they were making that $12.4 
billion by the sole act, which is their right under previous law, which 
we corrected, to do rescission. That is, by their own decision to 
simply remove health care from people who made an agreement with them, 
signed up, had been sending in premiums and all the rest of it.
  I also think about a young 8-year-old I met in Charleston at a town 
meeting. He had had leukemia for a while. Without this health care 
bill, there are lifetime limits and annual limits on what

[[Page 1057]]

one can get in the way of health insurance. And when you have leukemia, 
the lid is lifted off. The boy died. He died because he couldn't get 
insurance. His family obviously couldn't afford to pay for it, and he 
couldn't get it so he died. People say that is kind of an extra 
dramatic example. Unfortunately, it is not. It is very common.
  Something else that would disappear, if the health care bill were 
repealed, is something which nobody ever talks about but which is sort 
of the philosophical basis for a lot of this, and it is called the fee-
for-service system which we now have in America on medical care, 
particularly with Medicare, but generally. That is the person who 
provides the service or the medical equipment person who provides the 
medical equipment or the hospital which provides the service, they 
provide the service, and they bill Medicare. Medicare doesn't ask any 
questions. Medicare just pays the bill. That is one of the reasons, of 
many, if the bill is repealed, we will go into hock $1.3 trillion more 
on our deficit, because our bill saves that kind of money. Their bill 
would vitiate that savings. Fee-for-service is not the way health care 
ought to work. The way it ought to work is that like anything else, 
this very bill, there is no tree on this bill. What happened in the 
Senate? It was an epiphany of some sort. We decided to be transparent 
and accountable. So anybody can offer amendments on anything. And 
indeed, they are and will. But accountability causes efficiency and 
makes better results. Under the bill that has been passed, people are 
held accountable for what they do. Hospitals, for example, or doctors 
or medical equipment people, are measured by their outcomes. In other 
words, it is evidence-based outcomes. What are the results of what you 
have been doing in health care? Are they better? Are they worse? Did 
fewer people die? MRSA is a reason hundreds of thousands of people in 
this country die. Basically that comes from relatively unclean 
bathrooms in hospitals that don't pay attention to that and 
accreditation folks who don't pay enough attention to that either. That 
is a disease which is easily cured, one, by cleaning up bathrooms and, 
secondly, it is just automatically a part of the expense part of health 
care and it should not be. Evidence-based outcomes, you prove to me 
that you are doing a better job this year than you were in the last 2 
or 3 years, or whatever the range might be. So it is not fee-for-
service. It is fee after the explanation of the efficacy and the 
lifesaving quality of the service.
  That is the direction health care has to go. That isn't discussed but 
if this whole bill is repealed, that is exactly what will happen. 
Everybody is held accountable. We are being held more accountable. The 
big three automobile companies were held more accountable. They were 
embarrassed, but they have come back pretty nicely. The way we make our 
progress in America now is to make sure that people do what they are 
meant to be doing, and they do it well, and they can show it. Actually 
some of the paperwork is you have to convince the folks from Medicaid 
and Medicare, whatever else it is, that you are doing a better job. If 
half of all Medicare is spent, as it is, in the last 6 months of life, 
that bears analysis. Why is that so? What are we doing? What are we not 
doing? Don't just pay the bill because it is sent to you. You look at 
it and you ask questions. That is the direction of the new health care. 
I think it is a fair direction. It is one which I am sure the Mayo 
Clinic does routinely. But it is not a good idea.
  I will speak on this more later. I am now waiting for Senators Baucus 
and Hatch to handle both matters since it is within their jurisdiction. 
I am on the Finance Committee. I am close to Senator Baucus, but I am 
not Senator Baucus. He needs to be down here to do that. I hope he will 
be down shortly.
  Pending that situation, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. CORNYN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CORNYN. Madam President, I wish to speak briefly on the amendment 
that has been offered by the Republican leader, Senator McConnell, that 
would, in effect, repeal the health care bill that was passed on 
Christmas Eve at 7 a.m. in the morning about 1 year ago--1 year ago 
this last Christmas Eve.
  Since the time the bill was passed, strictly along party lines, with 
60 votes--all our colleagues on the Democratic side voted for it; all 
the folks on our side voted against it--we predicted this bill would 
lead to an increase in premiums for those who have health insurance, it 
would raise taxes on everyone in order to fund this huge expansion of 
the Federal Government--some $2.7 trillion worth of extra spending--and 
it would also take a $\1/2\ trillion from Medicare--which, as you know, 
is one of our troubled entitlement programs that is sorely in need of 
reform--it takes $\1/2\ trillion from Medicare to fund yet a new 
entitlement program, this health care bill.
  We also know that on at least two occasions now a Federal judge has 
found that this bill violates the Constitution of the United States 
because both these judges have said Congress has overreached its 
authority under the Constitution.
  The arguments were made that this was within Congress's power, but 
actually I agree with a law professor, Jonathan Turley, whose comments 
I saw today, who said that if the Supreme Court of the United States 
upholds this health care bill as being within Congress's power, 
federalism is dead.
  There is no limit to the Federal Government's authority if the 
Federal Government can compel you or me or anyone else to buy a 
government-approved product. There are no limitations. The 10th 
amendment of the U.S. Constitution that says all powers not delegated 
to the Federal Government are reserved to the States and to the people 
might as well be written out of the Constitution.
  So that is why I think these decisions are very important--the one in 
Florida and the earlier one in Virginia--because they reveal a defect 
in this bill over and above the others I have already mentioned: 
raising taxes, taking from Medicare to create a new entitlement 
program, and, of course, imposing this onerous mandate.
  But the real problem with this bill is more nuanced than my remarks 
would suggest. What it does is, by imposing a mandate on employers to 
provide government-approved health insurance or pay a penalty--what 
many employers are going to find out is, it will cost them less to pay 
the penalty than it will to provide health insurance for their 
employees. Thus, many Americans who have health coverage they like, 
which the President promised them time and time again they would be 
able to keep if they liked it, will find that is not the case because 
employers will--making a rational business decision, where it costs 
less to pay the penalty than it does to provide the government-mandated 
health insurance--they will simply choose to drop their employees and, 
thus, they will have to go into the exchanges which are supposed to be 
created by 2014 under this bill.
  What is wrong with that? Well, we know this bill was gamed in all 
sorts of ways to try to provide a Congressional Budget Office score 
which actually only reflects a fraction of its true cost, implemented 
over 10 years. The most accurate estimate I have seen is this bill 
actually will cost some $2.7 trillion over 10 years as opposed to the 
roughly $1 trillion pricetag the Congressional Budget Office has given, 
in part, because it was scored over a 10-year period of time but with 
only 6 years of implementation and through various other ways. As I 
say, that score--the true cost of this bill--was gamed.
  But one of the things the bill provides is that individuals who go to 
the State-based exchanges to buy their health insurance because they do 
not have it available from their employer will be subsidized by the 
Federal taxpayers up to, I believe, $88,000 for a family of four. What 
happens if a whole lot more people drop their coverage or

[[Page 1058]]

their employers drop their coverage and they are forced to go to the 
State-based exchanges in order to buy their health care, which is 
subsidized to this degree? Well, it is going to explode the costs of 
this health care bill in ways the Congressional Budget Office score 
does not adequately reflect.
  I am not quibbling with the Congressional Budget Office. They take 
the assumptions they are asked to take and they do the best they can to 
try to predict what the costs will be. But, again, it is possible and, 
indeed, this is an example to game the Congressional Budget Office 
scoring process to make it look much cheaper than it will actually be, 
once fully and finally implemented.
  So at a time when we are going to be asked to raise the debt limit--
our credit card is maxed out, nearly maxed out at $14 trillion-plus--at 
a time when our deficits are $1.5 trillion--that is just for this 
current, last fiscal year--we are left with the question, everything 
else aside about this health care bill: Can we and can the American 
people afford it? I would say the answer to that is absolutely not. 
Because we can do so much better by making sure the government does not 
get between patients and their doctor and by leaving the flexibility 
and the choices in the hands of consumers to make decisions that are in 
their best interests.
  We could, if we tried--and I hope we will--come up with a better way 
of delivering health care because, unfortunately, this bill did not--
well, we squandered an opportunity to try to help bend that cost curve 
down. Indeed, all the evidence is, it bends the cost curve up and makes 
it more expensive.
  Let me conclude on this thought. At a time when the President's own 
fiscal commission says our fiscal situation is dire and is 
unsustainable, at a time when the President--I had hoped during his 
State of the Union Message he would say: This fiscal commission I 
appointed has come up with a report. We need to take this seriously and 
need to work, on a bipartisan basis, to try to fix what is broken about 
our Federal Government's finances. The President did not do that. He 
talked about investment, which we all know when the Federal Government 
invests money, it is code for more spending, and we have been on a 
spending binge the last 2 years, with 42 cents of every dollar borrowed 
from the next generation and beyond, and we know we cannot keep it up.
  So beyond the fundamental problems with this bill--No. 1, that it is 
unconstitutional, so held by two Federal judges; that it continues to 
make health care more expensive rather than more affordable; that it 
denies people the opportunity to keep what they have because of the 
incentives it puts on employers to dump their employees into the 
exchanges and that they will get the subsidies that Congress voted on, 
which will make this bill even more expensive than it was originally 
thought to be--this bill is one that should be repealed. We can, 
working together on a bipartisan basis, do better.
  This is what happens when one side or the other overreaches. They 
think the victory is worth it when, in fact, what we find out is, there 
is a tremendous backlash by the American people, reflected in the 
November 2 election. The more they learn about this bill, they do not 
like it more, they like it less. Now that two Federal judges have held 
that this bill is unconstitutional, it is time for us to take up this 
matter again--once we repeal this bill--and do a better job, which we 
should have done in the first place.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. KYL. Madam President, I wish to commend my colleague from Texas, 
a former Texas Supreme Court justice, for analyzing the legal issues, 
as he has just done. It is yet another indication of why it is time for 
us to start over. I join him in urging repeal and replacement of this 
health care bill.
  I would like to speak briefly about yet another reason why this needs 
to be done, and it is a very specific example. It concerns my home 
State of Arizona. There are other States that are in the same position, 
but I can speak to the specifics with respect to my own State. It has 
to do with just one of the many burdensome new mandates.
  In this bill, as we know, there are mandates on individuals to 
purchase insurance, for example, as my colleague was just saying. There 
are mandates on families and companies and mandates on States as well. 
I wish to talk about the mandate on States, with respect to the 
Medicaid provisions of the bill, which is called the maintenance of 
effort mandate or MOE mandate.
  Let me describe what that is. The maintenance of effort requirement 
forces an unfunded Medicaid mandate on States by denying them the full 
ability to manage their Medicaid Programs to fit their own budgets and 
their own unique Medicaid populations.
  This is a huge problem because Arizona, along with most other States, 
is experiencing a dire budget crisis. Our State has lost over 300,000 
jobs in the last few years, and revenue collections are down by 34 
percent since the start of the recession. In the 2010 fiscal year, 
Arizona collected about $3 billion less in gross revenues than it did 
just 3 years prior in 2007.
  During this same period, enrollment in Arizona's Medicaid Program has 
increased by 44 percent. Think of that. More than 1.3 million Arizonans 
are now covered by Medicaid. That is more than 20 percent of the entire 
population of our State.
  Ordinarily, the State would be able to dial back that coverage in 
order to fit within its budget. But believe it or not, the ObamaCare 
law that was passed prevents a State from managing its own Medicaid 
Program by determining who is going to be covered by that program.
  Right now, the Arizona Medicaid Program consumes almost 30 percent of 
the State's general fund spending. That is an increase of 17 percent 
over 4 years ago. So Arizona could, as I said, dial this back, except 
for one thing; that is, ObamaCare.
  As our Governor, Jan Brewer, noted in a recent letter to Speaker 
Boehner:

       The growth in Arizona Medicaid spending is a key cause of 
     our state budget crisis and is unsustainable. . . . We cannot 
     afford this increase without gutting every other state 
     priority such as education and public safety.

  So the Arizona legislature has taken steps to address this. They have 
now cut $2.2 billion in spending from a $10 billion budget, but that 
does not go far enough to address the rest of their budget problems. 
Despite these cuts, the budget shortfall is projected to be $1.2 
billion in the next fiscal year.
  So let me describe how this maintenance of effort requirement or 
mandate affects Arizona's budget. In 2009, the Federal Government 
imposed a mandate on States by which States could not change their 
Medicaid eligibility standards or methodologies and procedures in place 
on July 1, 2008.
  This sounds identical to the maintenance of effort requirement in 
ObamaCare, but there is one crucial difference: The Federal 
Government's maintenance of effort stimulus requirement--the 
requirement I am talking about that was in the stimulus bill--was 
funded by the Federal Government. So the State was not adversely 
affected from a budget standpoint. Under the stimulus, the States 
received an enhanced Federal share of their Medicaid costs. But under 
ObamaCare, the maintenance of effort requirement is still there, except 
that the States have to pick it up. They are stuck with an unfunded 
mandate.
  So even though States such as Arizona cannot afford their current 
Medicaid obligations, ObamaCare has forced an extension of the 
maintenance of effort requirement until 2014 but without providing any 
assistance to pay the exorbitant costs. In June of 2011, when stimulus 
funds expire, Arizona's share of its Medicaid Program will increase by 
an astounding $700 million. The annual cost of the mandate is almost $1 
billion, which is simply unaffordable. This problem is especially acute 
for Arizona and a handful of other States because we actually expanded 
Medicaid eligibility for childless adults beyond Federal requirements. 
So Arizona, in an effort to cover more people, by law, included 
additional people in the Medicaid coverage--adults without children. 
Rather

[[Page 1059]]

than allow States such as Arizona to cut back to the level of other 
States--for example, to forgo that coverage at least for now--the 
health care law, ObamaCare, freezes in all of the existing disparities. 
So there are big differences between or among the States, depending 
upon how liberal, in effect, their coverage is.
  We have tried to do our best to find ways to ameliorate the problem. 
We have devoted more resources toward Medicaid fraud prevention. There 
have been some very difficult decisions made, for example, including 
reimbursing health care providers with less money. As my colleagues can 
imagine, that hasn't gone over well. Even more controversial and very 
sad: Arizona has stopped Medicaid funding for several kinds of 
transplant surgeries effective October 1. This is actually a kind of 
rationing that is required by ObamaCare. The State cannot afford to 
provide the most expensive procedures and, therefore, it has to cut 
them back, all because they are prevented by law from dialing back the 
coverage of these adults without children. So the one place where they 
can cut is transplants--a very sad day, as I said. There is nothing 
good to say about it. Nobody is pleased with the outcome, but there is 
no other option.
  But even that option obviously doesn't save enough money to forestall 
this budget crisis. Many of those who have been critics of the decision 
with respect to transplants have failed to tell the whole story which 
is that the Governor had to make that difficult decision because the 
health care reform bill eliminated a key option that she otherwise 
would have had to dial back the coverage to the level of other States.
  Before enactment of the President's health care bill, the Federal 
Government and States were partners in health care delivery. Now States 
are merely a financing mechanism for the Federal Government's demands. 
What States need is permanent reduced Medicaid demand by way of 
authority to reduce eligibility standards for their Medicaid programs. 
As I am suggesting, all Arizona wants the authority to do is dial it 
back to where other States are.
  Governor Brewer recently made a formal request to HHS Secretary 
Sebelius for a waiver from the maintenance-of-effort provision. Since 
the administration has granted over 700 waivers to companies and labor 
unions, one can only hope that the same fairness will be provided to 
States that are much more crucial partners to the Federal Government in 
the delivery of health care. Under the terms of the waiver request, 
Arizona would preserve Medicaid coverage for 1 million Arizonans who 
represent the core of Medicaid's mission--the aged, disabled, the 
blind, pregnant women, and children.
  I support the Governor's request and I urge the administration to 
grant the waiver. But ultimately, only repeal of this law will provide 
permanent relief to all of the States such as Arizona and all of the 
other States similarly situated. So I am strongly in support of the 
amendment that provides for repeal and replacement with something that 
will work and will not punish our families, our residents, and our 
States.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. SCHUMER. Madam President, I have come to address two amendments 
that are before us. First, I wish to salute my colleagues Senator 
Rockefeller and Senator Hutchison and all of those on both sides of the 
aisle who have brought this FAA bill before us. It is something that is 
needed. It is something that is long overdue. It is sad that in America 
we don't have a GPS system--and just about every western country does--
even Mongolia does; Tibet does not--to move forward and modernize our 
airports. It is important for jobs. It is important for travelers' 
convenience, but I would say most of all it is important for America's 
productivity. When people sit and wait on a runway, when planes are 
delayed or flights canceled, the amount of output that our country 
loses is enormous. We are losing much more than France or Germany or 
England because they have these systems. It is about time we put them 
in.
  I will make one more point about it. There are some who say, Let's go 
back to the 2006 level of spending. In 2006, the budget did not have a 
GPS system. Certainly we have to cut where there is waste, but just an 
across-the-board, roll-the-clock-back approach doesn't make much sense. 
Technology advances, the world advances, and we cannot march backward. 
There are certain things we need to keep this country strong, and the 
President talked about some of those in his address. Investments--and 
transportation has always been one since the days of the Erie Canal, 
which caused my city, New York City, to become the largest city in the 
country and it still is, praise God.
  But I came to talk about the two amendments that are here before us. 
It is sort of a ``do and don't,'' in my opinion. We had a long debate 
on the health care bill. We all know how long it was. The American 
people decided--the majority did not want to repeal the bill. In fact, 
80 percent don't. Even those who want to change it, the majority say, 
Don't repeal it, just change it. That is the point here.
  Senator Stabenow is offering an amendment to change something in the 
bill that very much needs changing. The change in the reporting 
requirements to 1099 put an onerous obligation on small business 
people. My dad was a small businessman, and I know how small business 
people struggle. To ask them to file paperwork every time they bought 
something new, even at low cost, is a bit over the top. So I am glad we 
are repealing that. No one is claiming ownership. It is going to pass 
in a bipartisan way.
  None of us on this side of the aisle is saying the health care bill 
can't be improved, but just repealing it without putting anything in 
place creates a number of problems. One problem, which we will see 
tomorrow when the actual vote is called, is it would increase the 
deficit by $260 billion in the first decade and $1 trillion in the 
second, because the health care bill actually does cut some costs, and 
we know there is a tremendous amount of duplication, inefficiency, 
waste in our health care system. It is the best in the world. It is 
also probably the least efficient in the world. Our goal and our job is 
to keep that quality of care for people but at the same time reduce the 
inefficiencies that cost the government and cost businesses. So it does 
reduce the deficit.
  When our colleagues are calling for repeal, when Senator McConnell, 
the Republican leader, calls for its repeal, he is going to increase 
the deficit. So we have all this talk: ``We have to reduce the 
deficit,'' and then the first move the other side makes, whether you 
like the health care bill or not, is to increase the deficit. Why 
wouldn't they propose $260 billion in other cuts to at least keep the 
bill deficit neutral?
  The second point I would make is this: Repeal says get rid of 
everything. It is simple, it is easy, it is quick. It is wrong. There 
are many good things in this bill supported not only by the majority of 
Americans--the vast majority--many of which are supported by the 
majority of Republican voters who were polled, but even supported by 
many Members on the other side of the aisle. I have heard them speak. 
Even the new freshman class that is coming into the House--very 
militant--says, But I am not for repealing this, or I am not for 
repealing that. So why can't our colleagues on the other side of the 
aisle at least acknowledge there are very good things people like?
  When they say repeal, do they want to repeal the provision that makes 
it easier for senior citizens to pay for prescription drugs? That is 
the so-called doughnut hole that says after you--and this comes from 
the Medicare bill that George Bush put forth, not from this health care 
bill, but they didn't have enough money to pay for it. So they said 
that after $2,500, seniors would have to pay prescription drug costs on 
their own. Any of us who buy prescription drugs--I do; I am taking one 
for my back because my back went out yesterday--knows how expensive 
they are. You get up to $2,500 when you are

[[Page 1060]]

a senior citizen and need eight medications--one to lower your blood 
pressure, one for diabetes, one for cholesterol, you name it. When you 
get up to that number, our seniors in my State and I am sure in the 
Presiding Officer's State and in any one of the other 48 States, are 
having real trouble paying for prescription drugs once they reach that 
doughnut hole, once they reach the level after which Medicare no longer 
pays. Well, in the health care bill, we deal with that. We reduce their 
costs 50 percent in the first year. That saves the average senior 
citizen--and this is not chicken feed--$550. By the time it is fully 
implemented, we save them $2,400 a year. They want to repeal that? 
Well, when they vote for repeal, they are voting to repeal it.
  How about this one: There are countless American families who have 
kids in their early 20s. They get out of college, they get a job, let's 
hope. It is hard to get a job these days. By the way, we should be 
focusing on job creation, not on repealing this bill, and the FAA bill 
does that, as I mentioned. They have a dilemma. These jobs are new, 
they are not paying top dollar, most of them, and they don't come with 
health care. What are these young people to do? They can't afford 
health care themselves--$800, $900, $1,000 a month. They are not making 
that much money, but they know, God forbid, if they get into a car 
accident or they get a serious disease, how can they be without health 
care? It is a dilemma that has plagued American families from coast to 
coast, from North to South and East to West. The health care bill 
corrects it. Here is what it says, very simply: Any young person 21 to 
26 can stay on their family's health care plan. It is a great idea. It 
is very popular. I wish to ask my colleagues on the other side of the 
aisle who are going to vote for repeal, are they for taking away the 
benefit of young people 21 to 26 to stay on their family's health care 
plan if they wish? I doubt it.
  How about this one: We all know preventive medicine saves billions, 
so in the health care bill every senior citizen on Medicare gets a 
wellness checkup free once a year to encourage them to go in. Why? Not 
because we want some giveaway, but the statistics show overwhelmingly 
and without doubt conclusively that when senior citizens get a 
preventive care checkup, not only are they healthier, but it saves the 
Medicare system billions and billions of dollars. God forbid someone 
has a melanoma. Before the melanoma gets into the lymph nodes, it is a 
simple operation rather than thousands and thousands of dollars and 
months and months of agony and illness. Do they want to stop those 
checkups? When people get a colonoscopy or any of these other 
preventive exams, including mammography, it saves the taxpayers much 
money. The recipient is healthier. That is why we put it in the bill. 
Do they want to repeal those? Do they want to tell every senior 
citizen, You don't get that wellness checkup which will save billions? 
I can't believe they would want to do that, I say to my colleagues on 
the other side of the aisle.
  How about this one: Small businesses. Small businesses are not 
required to have health care now, and under our bill, if they have 
under 50 employees, they won't be required to. But some of them provide 
health care for their employees. Some do it because it is a good way to 
retain a good, young employee, or a good middle-aged or a good older 
employee. Some do it because the employer is just a good guy or gal. 
Well, what we tell them is, if you have a business that makes less than 
$1.2 million and has fewer than 25 workers, we will give you a 35-
percent tax credit for that health care. It is a great thing. Hundreds 
of thousands of businesses in my State of New York will benefit. It 
started January 1. What does it mean? It means, A, more people get 
health care; B, it means businesses have more money to spend on job 
creation, small businesses, because some of their health care costs are 
being defrayed; and C, it may mean a small business that wasn't going 
to provide health care for its workers can now. Do my colleagues on the 
other side want to get rid of that tax credit for small businesses, the 
mainstay of America? I don't think they do.
  How about this one: We all have heard of people calling their 
insurance company and saying my wife, my husband, my daughter, or my 
son has gotten this terrible illness and it requires an operation that 
costs a whole lot of money. Then you get a call back from the insurance 
company and they say, You know what, your policy doesn't quite cover 
this. Or when you signed it, you were supposed to check this little box 
and you didn't. You are out. If you don't dot every I and cross every 
T--they usually let you get away with it because they are collecting 
your money, but not when somebody has a serious illness that might cost 
them thousands and thousands and thousands of dollars. Now the 
insurance company calls you and it is basically, Tough rocks, Jack. 
Under our bill, that can't happen anymore. And when the insurance 
companies decide to raise their rates dramatically, there is an 
insurance commissioner in the State and Federal authorities who can 
say, You have to show us that you needed to raise the rates as much as 
you did. Do my colleagues want to get rid of that and let insurance 
companies rule the roost? I don't think so.
  There is so much in this bill that is good, that is supported by the 
overwhelming majority of Democrats, Independents, and Republicans.
  There is so much in this bill that moves us forward. If you think 
there are things that should not be in the bill, come talk to us. Madam 
President, 1099 is a bipartisan effort. Senator Stabenow has been out 
front. Senators Klobuchar, Cantwell, and Nelson sent a letter to 
Speaker Boehner saying: Please get us a 1099 bill. Senator Johanns has 
done a good job. It is bipartisan.
  We are not saying everything is perfect in this bill and that it 
can't be improved. We are saying: Let's work together in a bipartisan 
manner to make it better. But the other side is saying: Just repeal 
it--repeal the good things, the things they don't like, create a huge 
hole in our deficit, and leave us with nothing. The slogan was going to 
be ``repeal and replace,'' but we have only heard the first part of 
that. Where is the ``replace''? I will tell you why there is no 
replace. It is hard to take this huge, unwieldy, inefficient health 
care system and shape it up. That is why it took us so long, and that 
is why it created a great deal of controversy. I will be the first to 
admit that. But I don't see a substitute.
  If you wanted to be fair and you were being straight with the 
American people about actually improving people's health care, you 
would have a replacement on the floor, and then we could compare the 
repeal of what you want to what you propose. We will wait. Maybe we 
should have a clock--the first day without repeal and replace, the 
second day, and so forth. I have a feeling we are not going to see a 
replacement. Do you know what that would say? That this is just 
political, throwing out some red meat, but don't dare show a 
replacement because, guess what, to replace is hard, and you really 
don't have a solution for replacement.
  I urge that we vote strongly against the McConnell amendment. I urge 
my colleagues on the other side to rethink it.
  I look forward to hearing the remarks of not only the chairman of the 
Commerce Committee, who is head of the FAA bill, but also the No. 2 
person, the ranking Democrat on the Finance Committee on which I serve, 
who has made so many invaluable contributions to the bill, on the cost-
cutting side, in terms of the 80 and 85 percent rule and all the other 
things we have done.
  With that, I will be happy to yield the floor so that we might hear 
my distinguished colleague, the senior Senator from West Virginia, 
speak for a few minutes.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER. Madam President, after that last sentence, I had to 
drink a little water to sort of balance myself out. To be praised at 
such length by Senator Schumer--one can't take it lightly.
  I wish to make a few comments on the health care bill, which, in and 
of

[[Page 1061]]

itself, interests me because we are here doing FAA. If I remember 
correctly, I stood here at excessive length and gave a speech about the 
importance of the FAA bill. Kay Bailey Hutchison did the same. Then, 
all of a sudden, here we are on health. That is very interesting 
because we have sort of made ourselves entirely transparent. Anybody 
can offer amendments. The leader doesn't fill up the tree, so it is 
open. And what happens is, immediately everybody pops in with their 
favorite amendment. I don't resent that; I just say it is an 
interesting phenomenon which is showing itself on the very first day. 
Whether that will last, I don't know.
  In any event, I think they are still working--Senators Baucus and 
Hatch and others--on the FAA stuff and the 1099 matter, so I wish to 
talk about a couple of things on health care.
  I think it is very important--and I mentioned this in my earlier 
comments--when you say the American people don't want this bill, there 
was a period of time when that was correct because the bill was made in 
front of everybody on C-SPAN--whoever watches it, but enough people did 
because a lot of people were interested in what was happening--and it 
wasn't a very pretty process.
  The public option, for example--Al Franken and I put a public option 
bill on the floor and thought it would save the world. Then all the 
talk shows took it up, either blasting it or loving it--in excess in 
both cases. There was one problem with the public option: It didn't 
have any votes in the Finance Committee, which means it couldn't have 
gotten far. That was based on a $50 billion Medicare benchmark. So it 
was a real cost saver and a very good--obviously, to get a nonprofit 
option as you buy your health care is very appealing--all of which is 
true but all of which was unpersuasive because it sounded like too much 
government. Maybe if we had called it the freedom option, it would have 
been different. That doesn't matter. It didn't get the votes. My 
version got 10 votes, and Chuck Schumer got 8 votes on his--or maybe it 
was the opposite. We then came up with a medical loss ratio, which 
nobody understood because of the ridiculous wording, except that it 
works.
  I want to talk about a couple of things like that until somebody 
comes, and then I will humbly and gladly yield the floor.
  Does the Senator wish to speak?
  Mr. BARRASSO. After the Senator finishes.
  Mr. ROCKEFELLER. I will not be too long.
  As it happens, on the poll, over a period of months and months, 
people saw this thing happening, and they didn't like it. People lined 
up on one side or the other--mostly one side--and they didn't like it. 
It turns out that the New York Times and CBS did a poll--I don't 
necessarily have to trust them because they took a poll; I don't trust 
polls--that says 80 percent of Americans oppose repeal. I found that in 
the cloakroom. I don't live by polls. But that is based on January 20 
of this year. Let's suppose it is off by 10 percent or 15 percent. One 
thing that becomes clear from the generalization of that number--
certainly it could go lower--is that people don't want repeal.
  Then that takes you to, well, what if we do have repeal? Does the 
repeal then lead you to a thought-out process that would then be 
substituted for what we created and the President signed? And then very 
quickly one comes to the realization that there isn't an alternative 
from the other side. There never has been. From that, it quickly 
follows that the deduction is what they want is the present system. If 
that is not true, then they can come down and tell me about that. That 
is what I have to believe because I haven't heard the new ideas or the 
alternatives to what it was we worked on and accomplished over a very 
difficult period of many months and much angst, agony, and screaming at 
townhalls and all the rest of it, which was worth it.
  The bill, although not perfect, was a real step forward. It looks at 
the fee-for-service system, which has always been a fallacy in the 
American health care system, that you automatically get paid for 
whatever you do if you are a doctor, a hospital, or you sell medical 
equipment, no questions asked. You don't save money, you don't improve 
health care by doing that. Productivity, efficiency, and excellence are 
done by oversight, by accountability, by asking questions, asking 
people to show, through the evidence of what they have done for a 
particular service, that it is better than it was the year before.
  I will mention--unpleasant probably and not fit for this floor--that 
one of the biggest problems we have in health care today is something 
called MRSA. MRSA is in almost every hospital in the country. 
Unfortunately, it emanates from bathrooms that are not kept that clean. 
So if we don't do our bill and it is repealed and hospitals then are 
not judged on MRSA and many other things, such as too many MRIs in one 
hospital, too many MRIs in one town that can only support two but has 
seven because you have to make money off of them but they are not used 
very much--all of these have to be checked and looked at carefully 
before people are paid. That is the way you save money, and that is the 
reason the health care bill that was finally signed saves $1.3 trillion 
over 20 years and $240 million or $280 million in the very first year. 
It is a cost saver.
  So, by definition, if we went back to the present system, you would 
have to start with the fact that we would be losing those savings and 
therefore adding it onto our deficit. So we would have $1.3 trillion 
more in deficit over 20 years, et cetera, et cetera. It is unwise. But 
then cost isn't absolutely everything. We understand that. The Senator 
from New Hampshire understands that. We have to use good judgment.
  Then you look at the public option, which didn't work, and then you 
look at the medical loss ratio. Folks don't know what that is--even 
some in this body. It is a simple system where you simply say--and it 
will disappear if Senator McConnell's amendment passes--that health 
insurance companies are required to spend 80 percent of all--85 percent 
if it is a large institution or, if it is a small business or an 
individual, 80 percent--they have to spend that percentage of their 
premiums they collect on health care, and then they have to show to HHS 
that it is being spent on health care that makes Americans better or at 
least keeps them where they are. The bathrooms get cleaner, to be crude 
about it but actually quite accurate about it.
  That is a very good system because it is not sort of mandating; it is 
called oversight. The American people should want to do oversight over 
their health care dollars because it is so much of their income they 
have to spend on health care. The medical loss ratio--a strange name 
but a sound principle--is where 85 or 80 percent of all premium dollars 
have to be spent on health care, and health care cannot just be health 
care but better than it was in the previous year or 2 or 3 years. 
Obviously, we are not into that system entirely yet and won't be until 
2014.
  Is it possible for me to explain that I am very disturbed that this 
bill we are now wanting to repeal will insure 32 million people who 
don't have health insurance, and then I am saying to myself that there 
are a lot more than that who are uninsured in this country, but that is 
all we could afford to do because we didn't have enough money. So let's 
say it is really 45 million and then decide there are many millions 
more than that who are underinsured. You may be dealing with 50 million 
people, and all of a sudden, their prospects for getting health 
insurance disappear. They simply disappear because we repeal the bill.
  Now, truth in telling, the 32 million people--we weren't going to be 
able to get that all done until 2020 because of the lack of funds. We 
had to do as much as we could as soon as we could, but we couldn't do 
more than that because we didn't have the money. Everything was scored 
by CBO, which is very tough. But I am astounded by the prospect of the 
excellent people who are on that side of the aisle--they are like us; a 
different party, but so what--saying that 32 million would lose their 
health insurance--or they were going to get

[[Page 1062]]

health insurance, but now they will not, so they are on their own.
  What happens then? Well, they take up the practice, which I saw first 
when I was chairman of the Children's Commission for 4 years in the 
early 1980s or the late 1980s--we went out to Chicago in one visit, to 
Cabrini-Green, and Chicago was a robust health care city, and the folks 
out there told me that in that particular year, eight emergency rooms 
in hospitals had closed down. Why? Because they were being overwhelmed 
even then.
  Secondly, they are by far the most expensive part of the hospital. 
They cost the most. They drain health care because of all the emergency 
service. People wait 5, 6 hours--we have all been through it--and they 
get their health care, maybe. It is so inefficient, so brutal, such an 
awful system where more attention, because of health insurance, would 
allow more cautious, attentive, logical work to be done on patients. 
That is gone. That is simply gone.
  Emergency rooms are important, but a lot of them are going out of 
business because they still cannot afford to stay open. They are too 
expensive for the hospital corporation that makes that decision. I do 
not blame them for that.
  I know my colleague wants to speak. I think of when I was a VISTA 
volunteer--I sometimes talk about that on the floor--a long time ago. 
There were no jobs, no health care. Nobody went to school because the 
schoolbus did not come to pick up any of the kids because we were 
considered too far away. It was kind of a bad community. I latched on 
to that community. It is the reason I went to West Virginia and then 
stayed in West Virginia.
  They depended on a rural community center. It was right next door, 
the Lincoln County Community Health Center. It was not a hospital so 
they did not have to worry about going up in an elevator because many 
of them in very rural parts of the State have not been in an elevator 
before, have not crossed a traffic light, red or green. That is new to 
them. They live in rural places. They deal with it that way. I suspect 
it is true in parts of New Hampshire, although New Hampshire has gotten 
sophisticated.
  People trust rural health centers. Why? Because they are not 
hospitals. They are on the first floor. They are an old Kroger store, 
an old Safeway store, an old hardware store. But inside are doctors, 
nurses, and now health IT, which is in this bill and heavily promoted, 
which may be coming on its own, but I doubt it.
  This bill is really important to health IT. They could communicate 
with any university, any medical center, not just in West Virginia but 
in the world. They can get experts to look at, let's say, a mole on a 
14-year-old's arm. Is that just a mole or is that cancer? I have seen 
that done. A doctor at West Virginia University--this was 20 years 
ago--I can't believe that--looking at a kid in Moscow with a physician 
assistant attending. They put the then-technology on that mole. The 
doctor in West Virginia was able to analyze it and say it is not 
cancerous. That was a wonderful event.
  People gravitate to community centers. Poor people gravitate to them. 
Rural people gravitate to them. They are easily accessible. They have 
very good doctors. There is a lot in the bill to help with those kinds 
of doctors, those kinds of nurses, the staff, those kinds of places and 
the whole health IT issue which makes the work they do there checkable, 
accessible anywhere else in the State, the country, or in the world. 
Those would be gone.
  We have $10 billion in our bill for 1,000 new community health 
centers all across America. I am excited about that. I think that is 
great for rural America, and a lot of America is rural. Most of America 
is rural. That goes.
  Then I think about subsidies for small business. I spoke to a Chamber 
of Commerce in a rural part of West Virginia, a conservative part of 
West Virginia. They did not like the bill. That is why I went there. 
They were all small business people. There are no big businesses down 
there. I spent 3 hours with them. I went through the whole health care 
bill.
  What was unusual to them is I stayed around and answered all their 
questions. That was interesting. In other words, you do not just say 
this is good, this is bad, here I am. You say: Have at me and I will 
answer you as best as I can. Where you do not agree with me, you tell 
me that.
  They had no idea that they get a 35-percent tax reduction, a tax 
credit for giving health insurance. They cannot afford to give health 
insurance. Maybe 35 percent is not enough, but they get that, and they 
get that until 2014. And then after 2014, it goes up to 50 percent. 
They did not know that. All of a sudden the possibility of keeping 
their employees and doing the right thing by their employees--people in 
New Hampshire, people in Wyoming, and people in West Virginia care 
about each other. That is one of the beauties of small States. People 
really care. They want to do the right thing because they all live 
together. They do not commute out to the suburbs. There are not a lot 
of suburbs around. That was impressive to me.
  When I left, I got a standing ovation. I am going to put that aside 
because I cannot believe that standing ovation, but what I do believe 
is that they were interested. They at that point did not know it was in 
the bill and there is no reason they should have known it was in the 
bill. Then someone who had been a major part in writing that bill talks 
to them and answers all their questions, the end point of which is 3 
hours, and I get up and leave. That perplexes me.
  If the minority leader's amendment prevails in that I do not think 
there is an alternative coming, we go back to the present system. That 
all goes. The Senator from Wyoming, when he speaks, may say, yes, there 
is an alternative, and we will have to listen to that. If we do an 
alternative, that whole negotiation may be 2 to 3 more years. I do not 
think people can wait that long.
  In any event, I worry about the doughnut hole. Madam President, you 
know that. It is so unfair that seniors pay up to a certain amount, 
they get their prescription drugs, and they keep paying the premiums. 
But then from $2,000 something to $5,000 something, they have to keep 
paying their premiums but they do not get any prescription drugs. That 
is the doughnut hole which we close, again not until the year 2020, but 
they know it is going to close. That is gone. They have to work the 
system as best they can, pay their premiums if they can, and if they 
cannot they are out of luck. They will get cut off.
  To me it would be brutally devastating if preexisting conditions, for 
children in particular, which starts right away, which is in effect 
now, disappears. I was speaking about a 9-year-old kid who had cancer. 
He was killed by the fact that he could not get any treatment because 
of annual limits. That is in effect now, and no lifetime limits is in 
effect now. Annual comes into effect in 2014. He died. I was a friend 
of that kid. I met with that kid. I met with his parents. I keep in 
touch with them. He died. He could not get health care under the 
present system. Under our bill, he would have gotten health care. One 
can say maybe it was too late, but that does not matter in the sense 
that he is just an example of somebody who is sick, who could get 
health care, and who otherwise could not get health care and he died.
  I am haunted by that because I remember his face. His name was Sam. 
He was a lovely kid. He is not around any longer because of the old 
health care system.
  Health care is a very hard subject. It uses all kinds of words and 
acronyms. It is true in the Federal aviation bill, too, if we ever get 
back to that. Acronyms are not bad, they are just not friendly. They 
still mean something, and because something is complicated it does not 
mean it is bad or wrong, it means it is complicated.
  Health care by definition has to be complicated. People have to 
understand how the parts work together. It is very hard to do. I plead 
with my colleagues to be cautious about repealing something which is in 
place which appears people do not want to see repealed. They certainly 
want to give it

[[Page 1063]]

a chance. They certainly are seeing the benefits from it. We are 
already reading about those things, and it has just literally started. 
It is a month-and-a-half old or a month old. We need to be cautious 
about that, particularly on repeal if it means going back to our 
present system or any substantial part of our present system. That 
would be a tragedy.
  I thank the Presiding Officer and yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Madam President, I ask unanimous consent that when I am 
finished with my remarks, the junior Senator from South Dakota be 
allowed to speak.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BARRASSO. Madam President, I come to support Senator McConnell's 
amendment to repeal this health care law. I listen very carefully. I 
listen to the people in Wyoming. The University of Wyoming conducted a 
survey. Sixty-eight percent of people in my home State want this law 
repealed. The people of Wyoming have great concerns about the 
unfairness of the law. Our seniors who rely on Medicare are concerned 
with the unfairness of a law that takes over $500 billion from them, 
from our seniors on Medicare, not to help Medicare, not to save 
Medicare, not to secure Medicare, but to start a whole new government 
entitlement program for someone else.
  Let's look at the specific cuts to Medicare: $155 billion from 
hospitals; $202 billion from the 11 million seniors on Medicare 
Advantage, and there is an advantage to Medicare Advantage. That is why 
so many seniors have signed up for it. Nearly $15 billion from nursing 
homes; another $40 billion from home health agencies; and $7 billion 
from hospice.
  The President the other night, in his State of the Union Address, 
said: If you have some ideas on ways to get down the cost of care and 
improve care, I want to listen. Republicans have been bringing ideas to 
the floor during the entire year-long debate, and those ideas have been 
ignored and rejected. I suggest the President listen to his own Debt 
Commission. He appointed the Commission. They had a lengthy discussion. 
What the members of the Debt Commission said is that if you cut 
Medicare, a program designed for seniors, do not do what you did, do 
not do what you suggested, Mr. President, do not do what the Democrats 
in the Senate have suggested, do not do what Nancy Pelosi wanted. If 
you cut that kind of money from Medicare, the Commission says, you 
should use that to help and save Medicare, not start a new government 
entitlement.
  The Commission also said that we should repeal the CLASS Act. That is 
a part of this health care law. It is called the CLASS Act. It has been 
described by Democrats as a Ponzi scheme that would make Bernie Madoff 
proud because of the fact they use trickery, gimmicks to say: We will 
bring in money now and the big costs will not show up until 10 years 
from now.
  I heard my distinguished colleague from West Virginia talking about 
small business and the tax credits. The small business owners in 
Wyoming looked to that. What they found is if they want to hire an 
additional worker, if they are at 10 or 11 workers and want to go to 
12, they lose part of the credits. Do you know how much low-paying jobs 
have to be to get the tax credits? The average income has to be 
$25,000. It cannot be higher than $25,000 a year. If you want to give 
someone a raise, you are going to lose your tax credits.
  Small business owners across the country who looked closely at this 
issue have said this does not help me at all. They are saying we need 
to make it cheaper and easier to create private sector jobs, and this 
health care law, with its expensive mandates and obligations, makes it 
more expensive and tougher to create private-sector jobs. We want this 
law repealed.
  Just yesterday, a court in Florida ruled that this entire health care 
law was unconstitutional. There has been a separate ruling in Virginia 
prior to the beginning of this year. I will tell you that ruling in 
Florida yesterday is a second stake in the heart of this health care 
law.
  This government, this Senate, the House does not have a right to go 
into the homes of the people of my State of Wyoming or anywhere around 
the country and say to them: You must buy a product. You must purchase 
something. If the government can tell people they have to buy health 
insurance, where does it stop? That is why I am encouraged, as are 
Americans all across this country, when I see the ruling coming out of 
Florida. People inherently understand this is unconstitutional. The 
health care law even fails to meet the President's own promise. In 
Wyoming, we have a code of the West that says: If you give your word, 
keep it. The President promised this health care law would actually 
bring down the cost of care, he said by $2,500 a family. What are we 
seeing with insurance costs? The costs continue to go up and up and up. 
The President said: If you like what you have, you can keep it. That 
hasn't been true either. In terms of the insurance people have, they 
are losing what they have, if they like it. And even though several 
pages of the health care law may have implied that, when the Secretary 
of Health and Human Services came out with over 100 pages of 
regulations, it was clear that if you get your insurance through work--
big company, small company--the majority of Americans will not be able 
to keep the health insurance they have and that they like.
  A recent poll, released today, said that 58 percent of Americans 
would like to have this health care law repealed. The interesting thing 
about this was that this recent polling went further to say that when 
you poll people who have actually talked to a nurse or talked to a 
doctor or talked to a physician's assistant or an EMT or people 
involved in the health care area, even more of those people who have 
talked to a health care provider want this health care law repealed.
  As Nancy Pelosi said, first you have to pass it to find out what is 
in it. And as more and more people become aware of what is in it, more 
and more people want this health care law repealed. The mandates are 
excessive and they are expensive, and States--with Governors of both 
parties--are being impacted by these huge expenses.
  It is interesting. There was an article in Saturday's New York Times 
entitled: ``For Governors, Medicaid Looks Ripe for Slashing.'' That is 
Governors of both parties. Well, what is Medicaid? They are going to 
slash Medicaid. The article states:

       Hamstrung by Federal prohibitions against lowering Medicaid 
     eligibility, governors from both parties are exercising their 
     remaining options in proposing bone-deep cuts to the program.

  I have just heard other colleagues on the Senate floor talk about 
this huge expansion of Medicaid. That is the solution; that is the 
President's solution; that is the Democrats' solution; to cram more 
people onto Medicaid, a program initially designed for the poor, with 
low reimbursements rates and where over half of the doctors in the 
country won't see Medicaid patients. That is their solution.
  I listened to my colleagues on the other side of the aisle talk about 
coverage and talk about care and they use the words interchangeably. 
That is misleading to the American people. You can get a Medicaid card 
but that doesn't mean you can get in to see a doctor in the way that 
you might think. Half of the doctors don't want to see patients. Why? 
Because the reimbursement is so low.
  The New York Times article of Saturday speaks to U.S. aid running dry 
and States proposing Medicaid cuts, and the first person they cite is 
Governor Jerry Brown of California, a Democrat, and under him, Andrew 
Cuomo, a Democrat of New York. What does it say? It says:

       The shrinking of Medicaid programs, if approved by the 
     state legislatures, would come at a tenuous moment for the 
     Obama administration. Starting in 2014, the health care law 
     calls for an enormous expansion of Medicaid eligibility that 
     is expected to add 16 million beneficiaries by 2019.

  The health care law puts in place a program that will hire IRS agents 
to

[[Page 1064]]

make sure people buy health insurance, but it doesn't pay to train the 
doctors and the nurses needed to take care of those patients. As the 
article goes on, it says:

       States have already cut payments to health care providers 
     and scaled back benefits over the last few years, so these 
     new proposed cuts are much more painful.

  I will tell you, the people of Wyoming want this law repealed. The 
chairman of our health committee in our State Senate--and I served 
under him for 5 years when I was a member of the Wyoming State Senate--
whose name is Charles Scott, has been in the State Senate over two 
decades and has studied this extensively. He had an article in the 
Caspar Star Tribune on January 30 speaking to this.
  Mr. President, I ask unanimous consent to have printed in the Record 
this article.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               Repeal of ``Obamacare'' Would Help Wyoming

                           (By Charles Scott)

       Contrary to the assertions made in Barb Rea's and Jan 
     Drury's Jan. 22 Star-Tribune guest column, ``Repealing health 
     care law doesn't help Wyoming,'' repeal of Obamacare would 
     help Wyoming because that law is a disaster for our country 
     and especially for Wyoming.
       We need health care reform. Our American health care system 
     costs too much. There are too many uninsured. On average, 
     Americans die earlier than citizens of any other developed 
     country. Unfortunately the Obama reform makes these problems 
     worse. The Obama strategy for controlling costs is to attack 
     the health insurance companies. There is much to dislike 
     about insurance companies. Too often their strategy's to make 
     money by not insuring anyone who might get sick and not 
     paying for it when they do. However what they are telling us 
     with their high prices is that our health care system is out 
     of control. We pay for too many medical tests and procedures 
     that do us little good. The Obamacare strategy amounts to 
     shooting the messenger and doesn't solve the underlying cost 
     problem.
       The Centerpiece of the Obama effort to insure the uninsured 
     is to expand the Medicaid program, the existing program for 
     poor people. This is the most expensive way available to 
     insure the uninsured. The Medicaid program is designed to be 
     a high-cost program. The federal government has required a 
     set of Medicaid benefits that are richer than any insurance 
     the rest of us can buy. The feds forbid most of the effective 
     cost controls the rest of us face. One consequence is that 
     Medicaid clients are free to use the hospital emergency room 
     for things most of us take care of at home. The health care 
     costs for an adult in Medicaid are one and a half times 
     larger than for a comparable adult insurance by our largest 
     private insurer and a child costs two and a half times as 
     much. The federal government cannot afford the Medicaid 
     expansion without a massive tax increase and neither can the 
     state government once the law is changed so we have to pay 
     our normal share.
       So what is the Legislature doing to deal with the problem?
       Last year, three weeks before Obamacare passed, we passed 
     the Healthy Frontiers pilot project. It is an effort to 
     insure the working uninsured using incentives for cost 
     control. It has an expanded prevention package and a health 
     savings account. The individual pays part of the cost on a 
     sliding scale according to income. The strategy is to spend 
     more up-front on everyone to save by reducing the need for 
     very expensive care later. Right now it is funded for only 
     about 200 people and only through June 30. We have 
     legislation this time to expand the numbers to 3,000 so we 
     can find out if it really will save money. Our computer 
     models say it will, but there is no substitute for trying it 
     with real people. If Obamacare is not repealed this will give 
     us an alternative to the expensive Medicaid expansion. If it 
     is repealed, then Healthy Frontiers is an alternative way to 
     solve the problem of the uninsured and could be imitated by 
     private insurance to reduce costs for everyone.
       Obamacare will make our existing shortage of doctors, 
     particularly primary care doctors, even worse. To help solve 
     this problem my committee is proposing expanding the 
     community health centers. They can recruit doctors better 
     than anyone else in the state because they are not subject to 
     our tort liability system. They are under the federal tort 
     claims act so their doctors are not bothered by our 
     malpractice problems. Our failure to reform our tort 
     liability system makes it too hard to recruit enough doctors 
     to the state otherwise.
       Obamacare mandates organizations called insurance exchanges 
     which can either be ways to improve competition among private 
     insurance companies (the Utah model) or pass out government 
     subsidies (the Massachusetts model). To work effectively 
     these may require more people to spread the costs of running 
     the exchanges than Wyoming has. We are examining this concept 
     and the federal requirements to see if they can work in 
     Wyoming.
       Obamacare requires federal agencies to write several 
     hundred sets of new federal regulations. We fully expect some 
     of these rules to be impractical for a small state like 
     Wyoming or to go beyond what the federal law allows in very 
     expensive ways. My committee has proposed a litigation fund 
     so we can fight these regulations in court when need to. I 
     have also proposed a constitutional amendment to keep the 
     state from participating an any attempts to explicitly ration 
     care which I expect to eventually be part of the effort to 
     have the government take over our health care system.

  Mr. BARRASSO. Mr. President, the headline of the article is: ``Repeal 
of `Obamacare' Would Help Wyoming.'' I want to cite a few excerpts:

       Repeal of Obamacare would help Wyoming because that law is 
     a disaster for our country. Our American health care system 
     costs too much. There are too many uninsured. Obama reform 
     makes these problems worse. The centerpiece of the Obama 
     effort to insure the uninsured is to expand the Medicaid 
     program, the existing program for poor people. This is the 
     most expensive way available to insure the uninsured.

  This is from someone who has studied this for 20 years. He goes on to 
say:

       The Medicaid program is designed to be a high-cost program. 
     The Federal Government has required a set of Medicaid 
     benefits that are richer than any insurance the rest of us 
     can buy. The Feds forbid most of the effective cost controls 
     the rest of us face. One consequence is that Medicaid clients 
     are free to use the hospital emergency room for things most 
     of us take care of at home. The health care costs for an 
     adult in Medicaid are one and a half times larger than for a 
     comparable adult insurance by our largest private insurer and 
     a child costs two and a half times as much.

  Those are the things we are dealing with. That is the solution the 
Democrats have presented to the country. That is what has been passed. 
This solution is not a solution. What we need to do is repeal and 
replace this health care law.
  The American people notice when month after month the Secretary of 
Health and Human Services rolls out more waivers for people under this 
health care law. Last week, she granted 500 new waivers. We now have 
2.2 million Americans to whom this law does not apply. They have gotten 
their waivers, so it doesn't apply to them.
  You might say: Who are these people? Well, they are people with 
friends in high places, because 166 of these are union benefit funds--
166 entities covering 860,000 Americans. These are some of the same 
union members who lobbied Congress, who contributed in ways to say we 
need this health care law. Yet they say: Oh, once we have looked at 
it--followed Nancy Pelosi's idea and actually read the bill to see what 
was in it after it got passed--we don't want it to apply to us.
  So 40 percent of all the waivers have gone to unions, even though 
union workers only account for 7 percent of the private workforce in 
this country. Well, if this health care law is so great for the 
country, why should companies and unions need waivers? And why can't 
the rest of America receive a waiver and get the same treatment?
  That is why I come to the floor today, to tell my colleagues this 
health care law is bad for patients, it is bad for providers--the 
nurses and the doctors who take care of those patients--and it is bad 
for the taxpayers. By voting to repeal this health care law, we will 
give these waivers to every American and give them the opportunity and 
the freedom they request, and the flexibility they need to get the 
health care that works best for them, not a one-size-fits-all approach 
that comes out of Washington loaded with Washington wasteful spending.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Casey). The Senator from South Dakota.
  Mr. THUNE. Mr. President, I wish to add to the comments made by my 
colleague from Wyoming, who in his former life was a physician, and so 
he understands this issue probably better than any of us here in the 
Chamber. I think he very eloquently pointed out why this amendment we 
are hopefully going to be voting on, which will repeal the health care 
law, is so important.
  Obviously, there is a big debate that has been raging in the country 
over the

[[Page 1065]]

past year about this legislation as it was being considered here in the 
Congress, and I think the one thing that is clear about the public's 
view of this is that they think it was a bad idea. And that hasn't 
changed. That was true a year ago, that was true 6 months ago, and that 
is still true today.
  I think the administration had tried to argue they had merely done a 
poor job of communicating to the American people how great this health 
care reform idea was. But that excuse misses the point entirely. The 
American people are not clueless. They know a bad idea when they see 
one, and they understand that the Democratic health care plan was a bad 
idea. So despite the administration's full court PR press in trying to 
reverse the public opinion, the health spending law remains unpopular 
in the polls.
  In fact, as was quoted by my colleague from Wyoming, there was a poll 
that came out today where 58 percent of likely voters in a recent 
Rasmussen poll favor repeal. In fact, if you drill down a little 
further into that survey, it says 47 percent strongly favor repeal, 38 
percent oppose repeal, and 29 percent strongly oppose repeal. But you 
have a decisive majority in this country--58 percent of the 
population--saying they wish to see this repealed, and nearly half are 
strongly committed to that position.
  So notwithstanding efforts by the administration to reverse the 
public's view, the American people still get it. I think the 
administration had hoped this would get behind them, that people would, 
once they were educated about the benefits, come to a different 
conclusion, but I think they see clearly now that hasn't happened. That 
hasn't been the case.
  This whole health care law has failed the test of being something the 
American people think is important and something they want to see done. 
I don't doubt for a minute they want to see the issue of health care 
addressed in this country--health care reform. Unfortunately, this 
particular proposal didn't do anything to reform health care. It 
expanded health care dramatically and expanded the cost most people are 
going to bear when it comes to paying for their health insurance 
premiums. So it failed the test of public support of the people in this 
country who have been following this debate very carefully, because it 
affects them in a very personal and profound way. Health care is 
something every American understands. It is something they get, and it 
is regrettable we passed it. I think the American people have turned a 
thumbs down on it, and that should speak to the importance of this 
amendment and our trying to go back and do this the right way.
  The other test it failed--which everybody here talks about, and there 
is a great deal of lip service and a great deal of rhetoric paid to 
it--is the issue of jobs. Honestly, I think if there was a message 
coming out of November's election it was this: The American people want 
us focused on three things. They want us focused on jobs, they want us 
focused on spending, and they want us focused on the debt.
  On the issue of jobs, this also fails the test. Why? Because it 
raises taxes so dramatically. If you look at the tax increases in the 
bill--$569 billion in taxes on virtually every sector of the American 
economy. For instance, the measure penalizes employers for hiring more 
workers by raising the Medicare payroll tax by $210 billion, levying 
new taxes on many small businesses that will serve as the engine of 
economic growth and job creation.
  If we want to get this economy recovering again and creating jobs, 
the one thing you don't want to do is to impose new mandates, new 
burdens, new taxes, new regulations on the economic engine, the job 
creators in America today, and that is our small businesses. So if we 
are serious about the issue of jobs, this certainly didn't do anything 
to create jobs.
  I think the American people made it plain, and it is clear, they want 
us focused on jobs. They want us exclusively focused on getting this 
economy back on track, creating jobs and getting the American people 
back to work. So it failed on that test.
  How about on the test of spending? I think the American people 
understand that very basic sort of adage--if you want to call it that--
which says when you are in a hole, you don't keep digging. What we have 
done is we have dramatically expanded the size of government at a time 
when we are running year-over-year trillion-dollar deficits. So what 
did this do? When it is fully implemented, it will increase spending by 
$2.6 trillion. That is the 10-year score between 2014 and 2023. That is 
a massive expansion--the most dramatic expansion we have seen in 
government, literally, since the 1960s.
  So this doesn't do anything to address the issue that the American 
people spoke loudly about, and that is getting Washington spending 
under control.
  Arguably, as I said before, I think they care deeply about the issue 
of health care and getting health care costs under control. As I will 
get to in a minute, this does little, if anything, to address health 
care costs. But it certainly increases Federal spending and increases 
the role and the size of government at a time when most Americans are 
saying we want the government reined in. We want less government. We 
want the government to start living within its means. Instead, we have 
increased and expanded the size of government dramatically.
  How about the issue of debt? A lot has been made by our colleagues on 
the other side that if we were to repeal this, it is going to add to 
the deficit. Let's go back to the reason why they can make that 
argument. The reason they can make that argument is because of all the 
gimmicks, all the phony accounting that was included when this bill was 
passed in the first place.
  We have all referenced and talked about the double counting of 
Medicare savings, to the tune of about $400 billion, new payroll taxes, 
savings that are supposed to be achieved by reductions in Medicare 
spending double counted, counted both as a ``paid for,'' an offset to 
pay for the new health care entitlement program, and as a credit to the 
Medicare trust fund. You cannot double count. You cannot score these 
things in a way that dips into the same revenues twice. That was one of 
the great ironies of this legislation, when it was being debated here, 
that issue did not become more fully discussed, the way this thing was 
accounted for and the way in which the trust funds were credited with 
saving or extending the lifespan of Medicare at the same time the same 
dollars were being used to pay for this new health care entitlement. 
You cannot spend the same money twice and that is exactly what 
happened.
  The American people get that. I cannot feature any other place in 
America where you could get away with what happened here during the 
health care debate. So you had the $400 billion--$398 billion, to be 
exact--that was double counted on Medicare. You also had $29 billion in 
Social Security revenues that was double counted as well. The Social 
Security trust fund was credited with $29 billion at the same time the 
revenue that was coming in from higher Social Security payroll taxes 
because some changes that were made in the legislation were counted to 
pay for the new health care entitlement. So you had Social Security and 
Medicare payroll taxes that were double counted, that were essentially 
scored twice, to credit the Social Security trust fund and the Medicare 
trust fund, at the same time they were being used to finance the new 
health care entitlement.
  Add in the $70 billion that was listed as revenues to pay for this 
from yet another new entitlement program called the CLASS Act, which is 
a long-term care entitlement program. As was described by my colleague 
from Wyoming, even the Senate Budget Committee chairman, the Senator 
from North Dakota, described the CLASS Act as a Ponzi scheme of the 
highest order, something Bernie Madoff would be proud of. Yet $70 
billion was scored as being a revenue raiser to pay for the new health 
care entitlement program, knowing that full well, at some point in the 
future, the people who paid premiums into this new program were going 
to demand some sort of payment

[[Page 1066]]

when it came time to stake a claim against that, against that trust 
fund, those benefits were going to have to be paid out. So in the 
outyears it dramatically expands and explodes the deficit, even though 
in the near term it was counted as revenue that was used to shield the 
true cost of the health care bill.
  If you add in the cost of implementation, which turned out to be $115 
billion, something that was not discussed nor included in the debate 
nor was it included in the initial CBO score, you have about a $208 
billion cost to do the doctors fix, to take care of the physician fee 
issue, which will be coming to us, which was left out of this bill to 
understate the true cost of this bill to put it into balance, my point 
simply is, by any objective measure, if you look at the games that were 
played, the gimmicks that were used, the phony accounting that was used 
to claim that somehow this was going to be a positive impact on the 
deficit, it does not pass the smell test. No rational American would 
look at this and say this makes any sense at all.
  In fact, if you add up everything I just said, if you take all these 
accounting gimmicks, all the phony accounting that was used, and you 
offset that against what is claimed as a budget savings, you actually 
get not a $143 billion savings, you get about a $700 billion deficit. 
That is what we would be looking at over the 10 years.
  Remember also that you have the 6 years of spending in this bill in 
the first 10-year window, which is what the CBO used to score this, and 
about 10 years of revenues. So the tax increases start right away, the 
revenues are counted immediately, but the spending doesn't come until 
later. You front-load the revenue, you back-end load the spending in 
that decade and try to claim that somehow this thing balances out. 
Again, the American people see through this. They get it, which is why 
they have taken the position they have on the health care bill in the 
first place. On the test of debt, on the test of how does this impact 
the deficit, how does this impact America's long-term fiscal standing, 
this bill is a failure.
  One other point I would like to make--I wanted to come back to it 
earlier--I think a lot of Americans were hoping that when Congress took 
on this issue of health care, it actually would be with an eye toward 
reducing the cost of health care insurance premiums for most Americans. 
What we are seeing is the contrary. Actually, what we predicted would 
happen is coming true. Many of us who were involved in that debate 
said, at the time, this was going to lead to higher health care costs 
for most Americans, and it is actually true. Actually, the CBO said the 
same thing. They said the individual health insurance premiums would 
increase by about $2,100 per family as a result of the new law and that 
some consumers would face total premium increases of more than 20 
percent. Those are things we are seeing come to fruition now. A lot of 
people are seeing their health insurance premiums go up. That is a 
fact. It is a reality. It is a complete contradiction of what was 
promised when this bill was being debated.
  You have not only higher taxes on small businesses that are costing 
us jobs, that are destroying jobs, you have this massive expansion of 
spending, you have the debt and the deficit which, in the outyears, are 
going to explode because of all these accounting gimmicks, and then 
when all is said and done, you still have not done anything that lowers 
health care costs for most Americans. I believe, for most Americans, 
that is what they wanted to see come out of the health care debate in 
the Congress. They wanted to see reforms passed that put downward 
pressure on health care costs to them and their families rather than 
increase it. In fact, what we have seen is the opposite. It has not 
decreased cost; it has increased costs. I think we are going to 
continue to see costs go up because as these tax increases kick in, a 
lot of businesses around the country obviously are going to pass these 
costs on to the American consumer. So it fails the test of doing 
anything to lower costs for most Americans.
  Finally, it is also now failing the legality test, as we are seeing 
these courts coming out and determining that this whole exercise was 
unconstitutional. That triggers a whole other debate in this country, a 
debate that I think we are going to watch probably for a while, but I 
hope, as this moves through the courts, it does engage the American 
public about what is the role of the government and how intrusive 
should it be and what kind of mandates can it impose on the American 
people. There was a very well-reasoned decision that came out of the 
Florida court yesterday which says this legislation is 
unconstitutional. Again, that makes the argument that many of us were 
making as this was being debated last year.
  The bottom line is, we are in a position to do something about it. 
This is not the end. This should not be the end of the debate. We 
should look at this as an opportunity. If the amendment that was 
offered by the Senator from Kentucky, Mr. McConnell, actually were to 
pass and we were to repeal this, we could start over. We could go about 
this in a way that actually does reform health care in this country in 
a way that lowers costs rather than raises costs for most Americans. I 
think that would be a welcome thing for the American people.
  The other side is going to argue we do not need to do this. We do not 
need to repeal this. We just need to ``repair'' it. We can make these 
little modifications to it. But the fundamental fact is, this was a 
mistake in the first place and we should acknowledge it. I think, 
again, the fact that it passed last year on a total party-line vote, a 
total partisan vote--there was not a single Republican in the Senate 
who voted for this. Usually, when you are doing big, bold things, when 
you look historically in the country, it is done in a bipartisan way. 
It is done in a way that incorporates the best thoughts, best ideas, 
best inputs from both sides, and you generally get a bipartisan vote in 
support of something such as that. This was passed on a party-line 
vote. It is now facing a challenge--and I think a very direct 
challenge--in the courts, which is going to play out in the course of 
the next several months. But we in the Senate could do something by 
repealing this law and starting over and going about this the right 
way. That is not to say for a moment there are not issues that need to 
be addressed with regard to health care in this country. Many of them 
have been touched upon by speakers who have come down here before me. 
But there is a better way to do it. There is a way to do this that does 
not dramatically expand, increase the size of our Federal Government, 
that does not add and explode the debt in the outyears, that does not 
raise taxes on our small businesses when we are asking them to create 
jobs, that actually does lower the cost of health care insurance for 
most people in this country rather than increasing it and is done in a 
way consistent with what our Framers intended, in terms of the basic 
parameters that are allowed by our Constitution.
  I hope the McConnell amendment will be voted on. I think it is 
important for all of us, obviously, to be on record. But I hope my 
colleagues on the other side may reconsider the position they took when 
this was voted last year and conclude with many of us that this was a 
failure and that starting over is the very best solution for the 
American people, if we are serious about giving them a health care 
system in this country that is affordable, that delivers the high 
quality they expect, and enables them to have the maximum amount of 
choice and decisionmaking authority when it comes to something that is 
so personal and so important to them; that is, their health.
  I yield the remainder of my time.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, I listened to my friend from South Dakota. 
I was thinking about how long we have been debating health care reform. 
If we were to repeal the bill we enacted last year, how long would it 
be before we would be able to get back to serious health care changes?
  It took us 1 year to debate and pass the bill that was ultimately 
signed by

[[Page 1067]]

the President, but it took us 30 years to get to this subject and 
several administrations, both Democratic and Republican, that offered 
proposals where we could bring down the cost of health care and make it 
more available to the people of this country.
  We brag, and rightly so, that we have the highest quality, most 
technologically advanced health care in the world in the United States. 
I look at my own State of Maryland, and I know people come from all 
over the world to get their health care needs met and get their doctors 
trained, whether it is at Johns Hopkins University or the University of 
Maryland Medical Center or what is happening at NIH. I know the 
Presiding Officer can tell us about the great institutions in the State 
of Pennsylvania, and that is true.
  The problem is, it is out of the reach for too many Americans. It is 
too expensive. We don't have access to care in too many communities in 
America. The Congress last year did something about that. We took major 
steps forward to help the people of our Nation.
  I have gotten hundreds of letters and phone calls from people in 
Maryland who told me their stories about fighting health insurance 
companies or their stories about trying to get access to preventive 
health care and how they were denied under our current system. I have 
talked to seniors in Maryland. I know how expensive health care is to 
them.
  Seniors are very fortunate in that they have Medicare. But seniors, 
as an age group, have the highest out-of-pocket costs of any group of 
Americans. There are too many gaps in the system. We have to improve 
the system.
  The problem I have with the amendment of Senator McConnell is, if we 
repeal what we did last year, we have to understand what consequences 
that will mean. We are not sure when Congress will be able to deal with 
this subject again. It might be 30 years from now. If we just repeal 
the bill, as suggested by Senator McConnell, the consequences of that 
action will be very damaging to the seniors in Maryland and around the 
Nation.
  Let me tell you why. The bill we enacted last year started to deal 
with the gap in coverage for prescription drugs. Seniors last year 
received $250. This gap--after you spend a couple thousand dollars on 
prescription medicines, you then have to pay 100 percent of the costs 
of your prescription medicines under current law, until you spend 
another couple thousand. For many seniors, they cannot afford that. 
That means doing without prescriptions, cutting pills in half, 
compromising their own health care.
  I have received many letters from seniors in Maryland telling me: I 
had to leave a prescription on the counter because I couldn't afford it 
and I have Medicare and I have coverage under Medicare D, but I could 
not afford it because I fell within the coverage gap. Do something 
about it.
  It is not fair. Taking medicine to keep me healthier--I should be 
able to get that coverage here in the wealthiest Nation in the world. 
We did something about it last year, and repeal would eliminate that 
protection. We are going to close totally that coverage gap, that so-
called doughnut hole. This year, the benefits are going to be worth 
about $500 to seniors who fall within that coverage gap. That would be 
lost if the McConnell amendment were adopted and became law. We can't 
let that happen. Next year, it will even be a better benefit because it 
gets up to about $2,400. That would be lost if we were to repeal the 
legislation.
  It goes beyond that. We are now providing a wellness exam every year 
to seniors. They will be able to get covered for their preventive 
health care. They don't have that today. We expand their benefits. We 
guarantee their benefits will be provided, but we go beyond that. We 
eliminate a lot of the copayments on preventive health care. We make 
the program stronger, increasing the benefits for seniors.
  At the same time, we do something which is extremely important: We 
make the program safer for tomorrow. We extend the solvency of the 
Medicare trust fund for a decade. That is what we did last year.
  If we repeal the bill, if the McConnell amendment becomes law, the 
Medicare system will be on much weaker ground, making it much more 
vulnerable to the types of attacks some of my Republican colleagues 
have been talking about, much more likely that would become a reality. 
That is what this bill means for the seniors of Maryland and the 
seniors of West Virginia and the seniors of Pennsylvania.
  That is what we did. We strengthened the program. That would be lost 
if the McConnell amendment were to become law.
  It goes beyond seniors. It goes to all families. I can't tell my 
colleagues how many families I have run into who have said to me: 
Senator Cardin, we want to cover our children, but under the old law, 
once they became 21 or 22, they lost coverage, even though they still 
needed insurance coverage.
  We changed that to the age of 26. Under this law, one is allowed to 
be on their parents' policy until age 26. That is the law of the land 
right now. The McConnell amendment will repeal that. It will tell these 
young people who perhaps have graduated from college, who may be in 
their first job but they don't have insurance available, that they will 
not have an affordable option for health coverage. They can't be on 
their parents' policy. Do we want to do that? That doesn't help 
American families. That moves us in the wrong direction.
  We have told the private insurance marketplace that your premium that 
you pay, whether you do it through work and your employer and your own 
contributions or the premium you pay, that most of that premium should 
go for health benefits. It should not go for bonuses for insurance 
company executives. It should not go for nonmedical expenses. Most of 
it should go for benefits. The bill we passed last year says that now 
80 to 85 percent of the premium you pay for your health insurance must 
go for benefits. If it doesn't, you will get a rebate. The money will 
actually come back to you in your pocket. That is taking on the private 
insurance companies, telling them they have to work within at least 
acceptable ranges. That is going to provide real benefits, improved 
coverage for the people. If the McConnell amendment were to become law, 
that would be lost. We would be at the mercy of private insurance 
companies.
  How many constituents have we heard from who have told us examples of 
insurance companies using preexisting conditions to block their 
coverage? I could tell you about a family in Montgomery County. A 
husband and wife with two children had to take out two insurance 
policies because the insurance company said that one of their children 
had a preexisting condition. They had to take out two insurance plans, 
paying two premiums and two deductibles. That is outrageous. We have 
done away with preexisting conditions for children.
  We are going to do away with preexisting conditions for all 
Americans, as we should. You buy insurance to protect you. I was 
surprised to learn how many Americans, if they try to buy insurance 
today without government protection, would run into an insurance 
company that tells them they have a preexisting condition. If you have 
high blood pressure, even if it is under control--preexisting 
condition. God forbid you should need to see a cardiologist--not 
covered. If you have high cholesterol, take a pill, it is under 
control. You think you are in good shape. Your cholesterol numbers are 
still good. Not for the insurance company; that has been considered a 
preexisting condition. If you are a victim of domestic violence, that 
is considered a preexisting condition. Quite frankly, some insurance 
companies consider women to be a preexisting condition, the way they 
write their policies. We do away with that. If the McConnell amendment 
were to become law, all that protection is gone.
  If you think we will be able to pass it again quickly in this 
Congress, come down here and watch the way Congress works. Thirty years 
it took us to bring this bill up and get it passed. These are 
protections that are critically important to families. We need to make 
sure these are protected.

[[Page 1068]]

  Caps. You buy an insurance plan and find out you have annual caps and 
lifetime caps which you thought you were buying protection against in a 
catastrophe. It is not there. We have done away with the caps to 
protect American families. That would be gone if the McConnell 
amendment were to become law.
  I have heard a lot of discussion about small businesses. One of the 
reasons I worked so hard for passage of the Affordable Care Act is to 
help small businesses. They are discriminated against. It costs a small 
business owner more for the same coverage for its employees than a 
large company. On average, it is about 20 percent higher for smaller 
companies to insure their employees. That is just wrong. We take steps 
to correct that immediately by giving small businesses a credit. We 
help them by making it more affordable for them to cover their 
employees.
  I heard my colleagues complain that premiums are going up. Yes, they 
are, because of the current system, the one we have changed or are in 
the process of changing. It is going to take some time for us to get 
full implementation of that law. That is understandable. It is wrong. I 
wish we could do more to bring it down quicker. But for this bill the 
premiums would be even higher. We know that.
  This bill helps us to start to get a handle on helping small 
businesses have affordable coverage for their employees. Once again, if 
the McConnell amendment were adopted and became law, that protection, 
that help for small businesses would be lost.
  Let me talk about taxpayers for a moment. There is a lot of 
discussion on both sides of the aisle--and I hope we are able to reach 
agreement--about bringing down the deficit. We need to do that for the 
sake of our economy and for our children and grandchildren. It is wrong 
for us to pass on our debt to future generations. We need to be serious 
about deficit reduction. I hope we do come up with a game plan in order 
to bring that about, but you don't do that by repealing the health 
reform bill.
  Our own Congressional Budget Office, our independent evaluators, 
tells us that repealing this bill will add about $1.5 trillion to the 
national deficit over the next 20 years. I know people who are 
listening to me may not believe what I say. I understand that. I 
understand there has been a lot of misinformation given out. My 
colleagues on both sides of the aisle have tried to oversell this.
  The Congressional Budget Office is our independent evaluator.
  I remember when Senator Rockefeller was working on this bill, and we 
thought we had a pretty good understanding on how to bring the bill 
out. But, unfortunately, the CBO said: We can't give you all the 
savings you think you are going to get by keeping people healthy. 
Senator Rockefeller and the Finance Committee had to go back and find 
some additional savings in order to meet the CBO's requirement so that 
we made sure we didn't add to the deficit. In fact, we reduced the 
deficit with this bill.
  So what do my colleagues in the House do? They say the CBO doesn't 
mean anything. If we do that with every bill we pass here, we will 
never attack the deficit. We have to have objective rules for 
evaluating what we do and its impact on the deficit.
  One thing is clear by the objective scorekeepers: The McConnell 
amendment will add $1.5 trillion to the national debt because of what 
we were able to do in the Affordable Care Act.
  We could argue this from many different sides. I am always amazed 
that my friends on the other side of the aisle say this is what the 
American people want us to do. I have looked at the polls. They go back 
and forth. Americans are divided on this issue, but most Americans want 
us to move forward. They want us to deal with job creation and job 
growth.
  The bill my friend from West Virginia has brought forward, the FAA 
bill, is a very important bill for the American people. It is going to 
make our air traffic safer, but it will also create more jobs in 
communities--the exact type of bill we should be bringing forward. We 
should be working today to create more jobs and keep more jobs. That is 
what this underlying bill does, not the McConnell amendment. That won't 
help us create jobs. That will add to the deficit and make it more 
difficult for Americans to keep and get affordable health care. That is 
not what we should be doing.
  I invite my Republican friends, we should be working together on this 
bill. We should be looking at ways to improve health care. We never 
said, when we completed our work last year, that we know there is no 
more work to be done. We know there are ways we can improve health 
care. Let's work today to do that, but let's not go backward. Let's 
move forward for the American people. Let's create the jobs we need for 
our economy. Let's continue to make health care accessible to more and 
more Americans and affordable to more and more Americans. Let's provide 
the quality of care that is befitting of this great Nation to all of 
our citizens.
  In my State of Maryland, we have a person whom we will never forget--
Diamante Driver, a 12-year-old who lived in Prince George's County. In 
the wealthiest Nation in the world, in 2007, he needed to see a dentist 
but had no health insurance. So his mom tried to get him to a dentist. 
No dentist would treat him because he had no money. So he went to a 
social worker. His mom took him there. They made a lot of calls. No one 
would treat him. His condition got worse. He went to an emergency room, 
which is what happens with a lot of people who have no health 
insurance. Talk about saving money. One of the ways we save money under 
the Affordable Care Act is to bring people out of the emergency rooms 
and into our clinics and get them the health care they need. Diamante 
Driver went to an emergency room months after he should have seen the 
dentist. Because his tooth had become abscessed and had gone into his 
brain, he had severe headaches. He went to the emergency room because 
of his headaches. They found that the only way they had a chance to 
save his life was through emergency surgery.
  Two surgeries later, $\1/4\ million spent, where it would have cost 
$80 to take care of his need, Diamante Driver lost his life in 2007 in 
the wealthiest Nation in the world.
  I understand that health care is personal to every person. Everyone 
looks at how they are going to be taken care of in this health care 
bill. That is what they should do. We think the overwhelming majority 
of Americans benefit by the bill we passed last year. But I would hope 
every American wants to make sure we have no more Diamante Drivers, 
that every person has access to affordable quality care. That was the 
signature accomplishment in the last Congress. We did it in a way that 
helped seniors, that helped families, that helped small businesses, 
that helped taxpayers and helped America to become at long last a 
Nation that said health care is a right, not a privilege. All that is 
lost if the McConnell amendment were to become law.
  I urge my colleagues to think before they vote on this amendment as 
to whether they want to be on the right side of an issue that has 
helped define the Nation. I urge my colleagues to reject the McConnell 
amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER. Mr. President, that was a magnificent speech.
  For the information of all Senators, there will be no rollcall votes 
this evening. I will continue to work with my ranking member, Senator 
Hutchison, and the leadership on both sides of the aisle on an 
agreement to dispose of the pending amendments tomorrow. Actually, it 
is on the FAA bill. Remember that? We sort of started out the day doing 
that. That is a very important bill, as the Senator from Maryland 
pointed out.
  I ask unanimous consent that there be debate only on the FAA 
authorization bill for the remainder of the evening.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ROCKEFELLER. Mr. President, I suggest the absence of a quorum.

[[Page 1069]]

  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. COBURN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Bennet). Without objection, it is so 
ordered.
  Mr. COBURN. Mr. President, I have come to the floor today to talk 
about the amendment Senator McConnell brought forward in terms of 
repealing the health care bill. I am probably going to approach this 
differently than a lot of my colleagues have. I do not doubt that the 
intent of what was passed a year ago last December was well 
intentioned, with the thought of solving health care problems in this 
country.
  My experiences, as a physician for 25 years, and as a manufacturer in 
the medical device field for the 10 years before that, gives me a 
little bit different take on what the consequences are associated with 
this bill.
  During that hardy debate we all had, I made some claims that people 
doubted in this Chamber which have become absolutely apparent and true. 
Costs are going through the roof, faster than we thought; portions of 
people cannot tolerate the plans, so we are giving them exemptions 
because it will not work in the business model to keep people covered 
but, most importantly, what is getting ready to happen is what happens 
between a patient and their access and their care and their provider. 
As well meaning as the bill was, the destruction of that aspect of 
health care will cause us to rue the day we put into motion what we are 
putting into motion.
  Let me explain. Most of the doctors in this country became very 
interested in this health care bill, and rightly so. They are the ones 
who are going to be impacted, along with their patients, because they 
are the ones delivering the care. When you poll those doctors, what do 
you find, now that they actually know what this bill is going to do?
  Well, some pretty significant statistics have come out--one by 
Thomson Reuters--where two-thirds of the doctors in this country 
absolutely believe the care of their patients is going to suffer as a 
consequence of this legislation.
  Think for a minute if you are an individual needing to access care 
and we are in 2014, 2015, and the Advisory Payment Board of Medicare is 
intact. We also know what the Medicare trustees have said about that, 
that when this is fully impacted, the payment under Medicare--this is a 
very important point--the payment under Medicare will be less than the 
reimbursement for Medicaid.
  So all of a sudden who was your family physician or who was your 
surgeon is no longer there. You see, this bill is about whether you can 
walk in and have the attention and care of somebody dedicated to you, 
who has your best interests at heart in terms of your health. What we 
are moving to is somebody who is going to have their best interests of 
survival at heart and your interests second.
  That is the real tragedy of what is happening with this bill and the 
implementation of it. Not only are we going to have payments reduced in 
Medicare--that is the only way the bill works, by the way; it is the 
only way we can ever get out of the jam until we address fixing 
Medicare--but 55 percent of the specialists in this country today will 
not see Medicaid patients at the reimbursement rate we have, and we are 
going to have a reimbursement rate for Medicare lower than Medicaid.
  Let me give you another example. What we know on Medicaid is, if you 
have no insurance and you go to an emergency room with a significant 
illness versus if you have Medicaid and you go to an emergency room 
with the same illness, the outcome for you with no insurance is better 
than the outcome for you with Medicaid. That has been repeated in four 
different studies now, and we are putting 18 million people into a 
system who are not going to have access to the best doctors because the 
payment is so low that there is a loss every time you see a patient.
  So describe to yourself for a minute what happens to the mother who 
has three young children and has their 4-year-old all of a sudden sick 
with a fever, and there is no primary care doctor available under the 
18 million new people who are going into Medicaid, and this child does 
not get seen for 72 hours. The mother thinks: Well, I will wait the 
fever out. I don't have a doctor I can call. I will wait the fever out.
  When the child gets to the emergency room, because there was not a 
primary care doctor for that Medicaid patient to call, what do they 
find? They find the 4-year-old not with otitis media any longer, but 
with the early stages of meningitis. What was a simple, treatable 
disease--because access, even though guaranteed, was denied because 
there are not the available resources to care for that child--the child 
ends up with a very complicated hospital stay and potentially the loss 
of hearing or brain damage. Those are the real consequences of what we 
are talking about as we put 18 million people into a Medicaid system.
  We have had several Senators today talk about the cost and the 
gimmicks. I am not going to do that. But I want to talk about the real 
issues. The one place we failed in health care is we did not fix the 
real problem. The real problem is, everybody's health care costs too 
much. We did not ask the right question: How do you drive costs down? 
Even when you go through all the numbers that have been given by CBO, 
Medicare trustees, Medicaid trustees, and outside studies, what we know 
is, what we did not do is drive any costs down. In fact, in the short 
term we have actually driven costs up.
  So how do we do that? The way we do that is put some responsibility 
on both the physician and the purchaser of health care for the cost. It 
is human nature. If I gave you an insurance card for your groceries, 
and once your deductible was met all you had to pay was 20 percent of 
that cost from then on out, your diet would significantly improve in 
terms of the quality and price of the products you buy. That is all in 
our human nature.
  What we have failed to do is to address the real cost drivers. That 
cost driver is: There is no connection with my purchasing of health 
care with the actual payment of health care. How do we know if we 
connect it, it works?
  Go to any place in the country that has Amish folks. They do not have 
health insurance--none of them. They do not buy health insurance. What 
do they do? They are grand consumers and very discretionary consumers 
of health care because they come forward and they want to know what 
they are getting and what it costs before they buy it, every time. I 
have delivered over 500 Amish babies, and there was not one time I 
wasn't asked at the time the patient came to see me: What is the price 
for this? Will you take a cash payment up front so I can buy for 
cheaper? Are there some other places where I can get the tests done? 
Every test I ordered, I would be questioned on whether they absolutely 
needed the test. They were discretionary purchasers and very sharp in 
their discretion on how they wanted to pay for health care. 
Consequently, their cost for the same thing was 40 percent less than 
anybody who walked in with insurance.
  So we have totally missed this connection of market forces allocating 
scarce resources by making discerning consumers out of the purchasers 
of health care. We have gone exactly the other way. We have taken 
people who are at 133 percent of poverty and said: You are going into 
Medicaid, and by the way, you can't buy private insurance even if you 
want to. You have to be in Medicaid--a far substandard health care 
system. All the studies show the outcomes are poor, even after you 
equate for social disparities. We are going to put 18 million into that 
program, and we are going to have a shortage of over 100,000 primary 
care doctors in this country in the next 10 years. So who is going to 
see them?
  Let me give another example. It happened this weekend. A patient--90 
years of age--severely bent over from kyphoscoliosis, bad aging and 
kyphoscoliosis, is running a fever and can't breathe well. She goes to 
the ER. She had seen a physician on Friday. She

[[Page 1070]]

had a chest x ray, and no pneumonia showed. She goes to the ER that 
night. She has a pulse ox of 81 percent. Normal is 93, 94 percent. They 
put her on oxygen, change her antibiotics, and send her home.
  Well, what happened? Had we not interceded--I personally as a 
physician making a call to another physician--she would be dead by now 
because what she had was a full-blown, raging pneumonia and restrictive 
lung disease, but she was sent home from the ER because a physician--
not a doctor--a physician did not see her. So consequently she goes 
back to the ER the same night and is admitted to the hospital. They 
take a chest x ray, and all of a sudden they see this full-blown 
pneumonia. She had all the symptoms, but the person seeing her in the 
ER didn't have the experience to make the judgment. So is that really 
what we want? We want substandard care, so somebody can go home and die 
versus coming to the hospital? Today, she is 200 percent better. She is 
eating. Her pulse ox, now on room air, is 91 percent.
  We actually saved her life because a real physician put hands on a 
patient and made the right diagnosis. But we are going to put people 
into a system where that doesn't happen because we are going to use 
physician extenders. That doesn't mean they are bad; they just don't 
have the same experience, and people die when they don't have the same 
experience. But we are going to inflate the utilization of less than a 
physician to care for the vast majority of these people who are going 
into Medicaid.
  These are real examples of what the consequences are of what we have 
done.
  As I started, I said I don't doubt the intent of my colleagues in 
terms of what they were trying to get to, but the biggest disease 
Washington has is fixing the wrong problem. We have expanded health 
care access under this bill, but access doesn't mean you are going to 
get care. And when you add 18 million people to the Medicaid rolls, let 
alone what is going to happen to the States, ultimately, with the cost 
on the maintenance of effort where they have Medicaid now and we are 
going to go to 133 percent, what you have done is put the States in a 
pinch, and they are in a pinch already.
  So my question to my colleagues is, Where are the things that drive 
the costs down? Where is the discerning consumerism that allocates 
scarce resources in the most effective way? In this bill, it is not 
there. Nowhere is it there.
  Now, what is there? What is there is a tremendous amount of new 
taxes. There is $52 billion over 10 years on employers who fail to 
comply with the insurance mandate; 40 percent excise tax on high-cost 
health plans, $32 billion; ban on purchase of over-the-counter drugs 
from somebody's health savings account, $5 billion; increased Medicare 
tax on wages of small businesses, nine-tenths of 1 percent; a 3.8-
percent surtax on investment income, and that is $210 billion; increase 
from 7.5 percent to 10 percent of income the threshold after which you 
can make a medical deduction; $2,500 annual cap on flexible spending 
account contributions--and I could go through this and through this. 
The point is, we are increasing spending on health care by $2.6 
trillion after this is truly in play. Also, the gimmickry in terms of 
accounting and the problems associated with that have been discussed on 
the floor.
  One of the things that is there that concerns me as a physician, 
getting back to talking about patients, is cost comparative 
effectiveness. It was really cheap to send that 90-year-old person 
home. There was an ER visit, a little bit of oxygen, a change in 
antibiotics. That was really cheap. Comparative effectiveness would 
have said: Oh, that is OK--except she would have been dead in 24 hours.
  Every physician who is maintaining their license or their specialty 
certification studies comparative effectiveness every day. They read it 
in the journals. They do it to get recertified. They know the 
comparative effectiveness. What they don't know is that we are going to 
mandate what they will do, what is the cheapest--not what is the best, 
what is the cheapest.
  Well, I will tell my colleagues, if you look at heart disease in our 
country, if you look at cancer cure rates in our country, if you look 
at recovery rates from massively serious illnesses in our country from 
both trauma and otherwise, what you will see is the highest rate of 
recovery in the world. We have the highest 5-year survival rate on 
almost every cancer by 20 or 30 percent over every other system in the 
world. Do we really want to take that away?
  In 2003, I was diagnosed with colon cancer. I had metastatic colon 
cancer. I am so thankful for the health care system we had that 
generated new devices, that incentivized great care, and after a major 
surgery where half of my colon was taken out, radical lymphadenectomy 
was carried out, and 6 months of chemotherapy, I stand before you 
today, 7 years after that. I want to tell you, had I been in England or 
Canada, my cure rate would have been about 35 percent. Do we know what 
it is in this country for somebody with metastatic colon cancer? It is 
nearly 70 percent. Now, what created that? What gave us the technology 
to do that? It is because we looked at the best clinical effectiveness, 
not the best price. We said: How do we best and most effectively get an 
outcome of cure?
  This bill goes the other way. This bill is going to be a mandate from 
Washington on what your doctor can do for you, and it is also going to 
mandate from Washington what price should be paid. There is no question 
that, according to the trustees for Medicare, for us to maintain what 
has been put in this bill, Medicare reimbursement rates will fall below 
Medicaid rates. Do we really want that to happen? I will tell my 
colleagues, for those in my condition, those people who are diagnosed 
today with colon cancer, you don't want that to happen.
  Now, how do we get the cost down? There is no question that there is 
tons of waste in our health care system. We have not attacked in the 
way we should attack--and I can say as a practicing physician that I 
wasted money caring for people because I didn't concentrate on that 
individual because that individual wasn't paying the bill. Some 
nebulous insurance company was paying the bill. Some government program 
was paying the bill. But when somebody such as an Amish patient looks 
you in the face and you know that what you spend of their hard-earned 
money is going to come directly out of their pocket, all of a sudden 
the other obligation of a physician jumps up: How do I do this in the 
most efficient and effective way that still gives the best outcome? And 
we have totally missed that.
  The most personal of all interchanges between humans besides those 
within a family are between patients and their physicians, and we are 
going to interrupt that. We are going to undermine it, and we are going 
to undermine it because somebody from Washington is going to be looking 
and saying: Did you do it the way we said to do it, Doctor?
  Now, what is the doctor's oath? Is it to do what Medicare says or is 
it to do what is in the best interests of the patient? So that is the 
rub. That is where we are going with this program. So what we are going 
to have is, first of all, we are going to have tens of thousands of 
physicians retire over age 55--our best, most experienced physicians. 
They are leaving. They are not going to play this game. And then we are 
going to give physician extenders the role as primary care. They are 
very good in what their limited knowledge will give them but not 
anywhere compared to a full 8 years of medical training, including 
residency. They have 2 years. And then we are going to treat all of 
these people. What do we think the cost of that is going to be in terms 
of lost lives, in terms of delayed diagnosis? Delayed care is denied 
care. What good is it if I have Medicaid and I can't see a doctor?
  So the problems are very real with this bill, and I don't say that as 
a fiscal hawk. I want to fix health care, and I want to drive the costs 
down. And we can drive the costs down $300 billion or $400 billion a 
year.
  Thomson Reuters did a study. I talked about it in our debate last 
year.

[[Page 1071]]

The fact is, we know that over $580 billion a year is blown in health 
care. That is enough to cut everybody's health care costs 20 percent. 
But we didn't address any of those issues. Not one of the issues that 
Thomson Reuters has brought up that said, here is what is wrong, here 
is why health care is more expensive--we didn't address those in the 
health care bill that was passed. Yet we wonder why we are out here 
wanting to change this bill. It is not so we can say: You did it wrong; 
it is because we really care, as you do, that we have to fix the real 
problem, and this bill didn't fix the real problem.
  So I hope my colleagues will take in the spirit that it is intended--
that we don't believe we have done anything except expand coverage 
under a very broken system that is highly inefficient, that tells 
people they are going to have care, but they are not going to have 
care, and those who have a doctor are going to be told by the Federal 
Government what care they are going to have. It is exactly the opposite 
of what we should have done, and we did it in haste.
  We know there are 1,600 new sets of rules coming, of which about 100 
are through. We have another 1,500 to go.
  CBO says that is $100 billion in costs just to implement all this, 
which was never even considered in the cost of this bill. That doesn't 
consider the cost of complying with all of the new rules and 
regulations.
  My time is up. I will be back to talk on this again. My hope is 
that--now we have three physicians in the Senate and we have all seen 
the same thing. I am a primary care OB, one is an ophthalmologist, and 
one is an orthopedist. We pretty well have it covered.
  What we have done is not going to work. We are going to be sorry we 
did it. But do you know who will be the most unfortunate receivers? It 
is the people who think they have care but don't, the people who get 
seen by less than qualified individuals for the care they need, and we 
are going to pay twice what it should cost.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Alabama is recognized.
  Mr. SHELBY. I ask unanimous consent that I may proceed as in morning 
business for 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Mr. Shelby and Mr. Udall pertaining to the 
introduction of S.J. Res. 4 are located in today's Record under 
``Statements of Introduced Bills and Joint Resolutions.'')
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. BLUNT. Mr. President, I have the opportunity to speak on the 
floor of the Senate for the first time as part of the work of the 
Senate. I am pleased to be here on a day when the Senate is addressing 
the topic of health care because clearly it was a major topic on the 
minds of Missourians and all Americans last year.
  I support the amendment the Senator from Kentucky has offered that 
would repeal the health care bill and make us start again looking at 
how we make the health care system work better.
  This is my first speech to the Senate, so let me say a couple things 
about that.
  As I look in the desk drawer, I understand the tradition of the 
Senate is that people who have used this desk, the desk I get to use on 
the Senate floor--and coming from the House where nobody had a desk, it 
is quite an accomplishment just to get a desk--but the desk I will use 
on the Senate floor has names carved in it by other Missourians who 
have used that desk before: Senator Truman, Senator Eagleton, Senator 
Danforth, and Senator Bond.
  I am honored and humbled to get to sit at the same desk those 
individuals used as they served our State, and they all served our 
State in a dedicated way. In fact, the collective service of those 
Senators, in various jobs working for Missourians, probably totals 
about two centuries of collective service, where they worked hard for 
Missourians and worked hard to advance the views they believed were so 
important.
  Senator Bond, whose place I am taking on the Senate floor this year, 
for 24 years in the Senate, I think, showed an unmatched understanding 
of our State and in recent years a real understanding of the national 
security issues we face and what is necessary to protect the country. 
He was a great competitor on the Senate floor and in all other ways a 
great friend of mine, and certainly my wife Abby and I value the 
friendship we have had with Senator Bond and his wife Linda.
  In fact, as I campaigned last year all over our State in 931 events, 
I never had a single person tell me they thought I would be a better 
Senator than Kit Bond and for good reason.
  I am here today thinking about those events all over our State last 
year. At first, I was surprised, having campaigned in Missouri before, 
at the level of engagement on the domestic issues the country was 
facing. I truthfully had never seen anything like it, where people were 
ready to talk about the specifics of the issues about which the country 
was talking.
  As I thought more and more about it, it occurred to me why wouldn't 
they be engaged. This is not like we are trying to decide what your 
family's position is going to be on the missile defense system. This is 
not like we are trying to decide your family's position about foreign 
policy toward the Middle East. This was an election about jobs and 
health care and taxes and, in our State, whether your utility bill 
might double in 10 years. Why wouldn't people be engaged in ways that 
were extraordinary? They were.
  They said they want government to move over and allow them the chance 
to get the economy back on the right track. They understood that 
government jobs, while some of them are necessary--and I am glad to 
have one--do not pay the bill; government jobs are the bill. We need to 
be focused on private sector jobs and how to create those jobs. The 
questions were: Why is the Federal Government spending so much more 
money than it has ever spent before? Where are the private sector jobs? 
Frankly, I would have thought that would be the overriding topic of the 
first speech I had a chance to give on the Senate floor.
  But as I think about those two questions, I do not know that anything 
is a bigger issue in this health care discussion than the impact the 
health care bill has had on private sector job creation and on our 
estimates of future government spending.
  The biggest single deterrent to job creation is uncertainty. We have 
certainly done great things in the last few years to create a sense of 
uncertainty. If you do not know what your tax liability is going to 
look like, if you do not know what your utility bill will be, if you do 
not know what your health care expenses are going to be, you are less 
likely to take that risk that anybody takes when they create a private 
sector job than you would be if you had a greater sense of those 
questions.
  In health care, for every job they create or every job a job creator 
would think about continuing, this is a time they have to wonder: What 
is the obligation going to be? What is the cost going to be?
  I was with a group of small businesspeople in northwest Missouri one 
day last year, right after the health care bill passed, about 30 days 
after the health care bill passed. I was at Rock Port, MO. Somebody at 
that meeting said: I have 47 employees. I have looked at the health 
care bill and my accountants have looked at the health care bill. I 
need 4 or 5 more people right now, but I am not going to hire them 
because I am not going to get 1 employee closer to 50 than I am now 
because 50 creates new obligations that 49 or 48 or 47 does not. I am 
not going to hire those people. What am I going to do? I am going to 
pay overtime in the short term, but in the long term I am going to look 
at what I am doing that is not making much money, and I am going to 
quit doing that.
  There is somebody telling me a handful of jobs ready to be created 
that he believed he needed to create are not going to happen because he 
does not want to get any closer to this health care moment. He does not 
want to get any closer to where the government comes in and says: We 
are going to

[[Page 1072]]

make you do things you do not have to do if you do not create these 
jobs.
  People I talked with in Columbia, MO, in the middle of the State, in 
the fast food industry, said: We are going to try to figure out how not 
to have full-time employees. What he said was the person who gives you 
your breakfast sandwich in the morning may be the same person who, 
across the street, gives you your fast food lunch because we are not 
going to have that person as a full-time employee if we can figure out 
how not to have that obligation.
  Real, sustainable private sector job creation does not happen in an 
environment of uncertainty. We need to be focused on jobs that are 
family supporting. We need to be focused on economic growth that 
includes letting American families keep more of what they earn, which 
includes economic incentives for small businesses and employers, and 
encourages the government to get out of the way so employers of all 
sizes can create self-sustaining, stable, private sector jobs.
  We need a government that meets the requirements of the Constitution. 
Rarely do we have a chance to revisit a misguided decision. In fact, 
this decision and this bill was the result of a set of circumstances 
that nobody would have anticipated.
  When this bill was passed by the Senate with the 60 votes the Senate 
required at that moment, nobody thought this bill would be the final 
product. Not a single person who voted for that bill thought that is 
the bill that will go to the President's desk. Everybody who voted for 
the bill thought this will be a bill that gets the Senate to conference 
with the other part of the Congress, and we will work out all the 
things in the conference that need to be worked out between the two.
  What happened was, suddenly the 60 votes that passed that bill were 
not there anymore. That became the only bill that could become law. The 
plan the Republican leader, the minority leader, advances lets us go 
back and revisit this discussion and do this the right way.
  Two Federal courts have already ruled that the law, one said, did not 
meet the constitutional standard and could not go forward. Why was 
that? That was because of the way the bill was put together, in a way 
that did not have the normal legislative language that would allow 
severability, that would allow if something is unconstitutional.
  Nobody thought this was going to be the bill, and the American people 
are the victims of having to rush forward with a bill that was not 
ready to become law.
  Another Federal judge said part of the law is unconstitutional, that 
which makes people buy a commercially available product. I, along with 
a lot of other people, have thought from day one that there is nothing 
in the Constitution that allows that to be a requirement.
  Voters in the State of Missouri, my State, on the primary election 
day--the second biggest election we have had; we had hundreds of 
thousands of people vote--were faced with a question the legislature 
put on the ballot that essentially said: Do you want to be part of this 
process? Do you want to be part of the mandatory obligation to buy 
insurance? Do you want to be part of the health care bill?
  Over 70 percent of the voters who voted that day said no. They were 
the first voters anywhere in the United States to go to the polling 
place and have a chance to say at the ballot box how they felt about 
this law that would go forward. They said they did not want to be part 
of it. Those voters understood that this was a misguided plan, that it 
put government between people and their doctors in ways Dr. Coburn 
talked about earlier today, in a meaningful way that he and other 
doctors who join us as Members of this body would understand.
  It puts government between people and their doctors. It implodes the 
current health care system. I believe the current health care system 
will not survive this bill, not that the current health care system is 
perfect. But it certainly produces great results for people who come 
here from all over the world.
  This is a bill that cuts Medicare to pay the bill. Missourians 
understood that. I heard it over and over at the ballot box. They said 
they did not want to be part of it. I thought, for three election 
opportunities--2004, 2006, and 2008--that health care would become the 
biggest domestic issue. It maybe is too complicated, maybe too 
difficult to deal with, maybe too personal and people did not want to 
engage and they did not engage.
  This law gives us the opportunity now to go back and get it right. We 
needed to deal with health care for a long time. When I worked in this 
Capitol on the other side of the building, we sent medical liability 
reform to the Senate seven times in 10 years. We sent plans half a 
dozen times where people could join together in what we were calling 
associated health plans and get their insurance that way and become 
part of however big a group they could figure out to associate with.
  It is not as if nobody was doing anything, but there was not enough 
pressure. This bill very likely creates the pressure we need to go back 
and look for better solutions. They are there, such as this idea of 
associated health plans, where you can join other individuals who are 
somehow similar to you or other small businesses similar to your small 
business. Medical liability reform saves the most money of anything 
that can be done for taxpayers, but it also saves money for taxpayers 
who are paying for their own health care because it takes a lot of 
expense out of the whole system.
  Certainly, we want people to have access to insurance coverage who 
have preexisting conditions. In fact, I proposed in the past and will 
propose again this year, along with other ways, to expand risk pools so 
people can have access to coverage but not coverage they wait for until 
they are in the ambulance and need it, coverage they get because they 
want it.
  We need to empower families. One of the reasons government-designed 
anything does not work very well is the one-size-fits-all concept does 
not fit very well. In fact, the so-called one size fits all almost 
never fits anybody. That is what I think this bill does for the health 
care that means so much to American families.
  Somebody told me one time that when everybody in your family is well, 
you have lots of problems, and when somebody in your family is sick, 
you have one problem. This discussion of health care focused 
Missourians and Americans on one problem: How do we have access to 
health care that is the best health care we can have and also is health 
care that is affordable? There is no real competition in this system, 
so I am for buying across State lines.
  You aren't going to see anybody on television tonight advertising 
health care insurance, but it is pretty hard to watch television for a 
couple hours in the evening and not see people competing for your 
business in every other area of insurance. There is no little green 
lizard for health care. There are all kinds of other people competing 
to get your other insurance business, but this hasn't really had a 
marketplace. It hasn't been transparent, it hasn't been competitive. We 
can achieve all those things, and we need to achieve all those things. 
Choice plus competition equals quality and price. And in health care, 
we haven't had enough choice or competition, so we haven't seen that 
reflected in quality and price.
  I don't believe the government has the authority to penalize citizens 
for refusing to buy private health insurance. I don't believe taxpayers 
will benefit from this bill that is built on too many false premises. 
The idea that we are going to cut compensation to doctors back to 
levels of a decade ago is not going to happen, and it is $\1/4\ 
trillion of the so-called pay-fors in this bill. It is not going to 
happen. It is almost equally unlikely that $500 billion of Medicare 
costs are not going to happen. And if we can find savings in Medicare, 
we should find them and use them to save Medicare. Only in Washington, 
DC, would you say: Look, we have one program that is about to get in 
really big trouble in a handful of years, so let's cut that program to 
start another

[[Page 1073]]

program. I don't think those pay-fors are going to happen, either, Mr. 
President.
  When employers are telling us they are not hiring because of the 
uncertainty created by this new law, when courts are ruling the law 
unconstitutional, when voters are overwhelmingly rejecting it, we need 
to understand why. Americans deserve a country where the people are 
bigger than the government. This health care bill opens the door to a 
future where the government is bigger than the people, and I think we 
should reject the law, repeal it now, move forward with more 
competition, more transparency, and better health care.
  Better health care at a lower cost is achievable if we do the right 
things. I believe this bill does the wrong things, and the more the 
American people look at it, the more they are convinced that it leads 
us to a future that is not the health care future they want.
  So, Mr. President, I am pleased to be able to speak on the Senate 
floor, and I am pleased to be able to represent Missourians.
  I yield the floor.
  The PRESIDING OFFICER. The Republican leader.
  Mr. McCONNELL. If I may, Mr. President, I believe this is the first 
opportunity the new Senator from Missouri has had to address the Senate 
and his colleagues, and he certainly has chosen a most important topic 
to begin his career here in the Senate. I wish to express my admiration 
not only for the comments he just made on what many of us believe is 
right near the top of the list of America's priorities but also his 
extraordinary service in the House of Representatives over the last 14 
years and also to welcome the Senator from Missouri to the Senate. As I 
indicated, he certainly picked an appropriate topic on which to make 
his maiden speech to the Senate.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN of Ohio. Mr. President, I appreciate Senator Blunt's maiden 
speech, too. I had the honor of listening to it. Of course, I disagree 
with his comments.
  I have heard all this before. I have heard Republicans say this is a 
bad law, that we have to deal with all these issues. I hear that over 
and over. But I also notice, by even a cursory observation or a look 
back at our Nation's recent history, that when President Bush was in 
office, when our Republicans controlled the House of Representatives 
and they controlled the Senate, the only thing they did on anything 
relating to health care or pensions was try to privatize Social 
Security. They didn't really do anything to try to provide health 
insurance for people who did not have it. They passed no real consumer 
protections in terms of eliminating preexisting conditions. They did 
nothing for a 23-year-old to stay on their parents' health insurance 
plan. They were woefully inadequate in their efforts to assist small 
businesses in providing health insurance for their employees.
  So, Mr. President, it really is the same kind of empty rhetoric we 
have heard from Republicans for years. They do not like doing it this 
way, they want to repeal and fix it, but they don't really want to fix 
it because they haven't really offered anything to fix it, particularly 
when they had the ability to pass something through both Houses and get 
it signed by the President. They really don't ever stand up to the 
insurance interests. The Republican Party receives huge contributions 
from the insurance industry. The Republican Party receives huge 
contributions from the pharmaceutical industry and the medical device 
industry. So they really have shown little interest in providing for 
the kind of people whose letters I am about to share.
  We hear Republicans say: Well, we will provide insurance by selling 
across State lines and enacting malpractice reform. Well, even the most 
optimistic estimates reveal that might insure 2 or 3 million more 
people and cut costs in health care by a minuscule--I don't even know 
if it is 1 percent but nothing substantive that really matters in 
people's lives or to any degree, not to mention that it takes away a 
person's ability to get redress when they have been injured by a 
negligent hospital or provider.
  So this is mostly empty rhetoric from Republicans in this whole 
debate. But I want to bring it back and put a human face on it. The law 
of the land today--much of what we passed a year ago--will affect 
people's lives.
  I am particularly troubled when I hear people stand on the House and 
Senate floor--or people in attorneys general offices in Columbus and 
around my State or around the country--and say they are in favor of 
bringing a suit against this health care bill. When I think about that, 
I think about conservative politicians who have been the beneficiaries, 
they and their families have been the beneficiaries of taxpayer-
financed health insurance for their whole careers, but now they want to 
take benefits away from voters and citizens and families in my State. 
They want to take benefits from seniors--some of their Medicare 
benefits. They want to take benefits away from families. And it just 
strikes me as rank hypocrisy.
  But I can illustrate this better by reading these letters than I can 
just by talking.
  Megan, from Summit County, is a college student. Megan is from the 
Akron area, and she says:

       Being a 22-year-old college student, it can be very 
     demanding trying to keep a successful schedule going to 
     maintain health care under my parents. As for my brother, who 
     does not attend college, health care is nearly impossible 
     because of costs. This law will allow both of us to remain 
     under our parents for a little while longer while we get our 
     feet planted.

  Megan knows even when she graduates how difficult it will be to find 
a good job with good-quality health insurance, so she knows she has the 
option, because of this law, to stay on her parents' health insurance 
until her 27th birthday. When Republicans talk about repealing this 
health insurance law, what are they going to tell Megan or promise 
Megan in return? I assume nothing.
  Rose, from Cuyahoga County in the Cleveland area, northeast Ohio, is 
a small business owner. She says:

       As a small business owner, I do not want the new health 
     care bill to be repealed. We are excited at the small 
     business tax credit for health care and also the new plans 
     being rolled out that will give us more choices. This bill 
     will help us to continue to offer health care to our 
     employees.

  Rose, if she has fewer than 50 employees, is not required to buy them 
health insurance, but she will have available to them a 35-percent tax 
credit, beginning last fall, which she can use to insure her employees, 
and most small employers want to do that. Most employers, period, want 
to do that. Also, by 2014, Rose will be able to benefit in her small 
business with a 50-percent tax credit.
  Richard, from Huron County, west and south of where I live in the 
Norwalk area, writes:

       I've been reading where Mitch McConnell wants to force a 
     vote in the Senate on the repeal of the health care law. If 
     he does this, when you are allotted the time to speak, will 
     you ask all the Republicans if they will give up their 
     Federal health care since they are so opposed to this bill? 
     Ask them if they are willing to keep the insurance provided 
     by the government, but yet at the same time take away the 
     help for seniors toward their prescriptions or the preventive 
     checkups. Or ask them to tell all the families that their 
     sons and daughters aren't covered under their family's 
     policies.

  Richard understands there are a bunch of people in this town and a 
bunch of conservative politicians who do not believe in government but 
who are enjoying their taxpayer-financed insurance. Yet they are 
willing to take Medicare benefits away from seniors, and they are 
willing to take benefits away from families.
  Tawnya, from Warren County, southwest Ohio near Cincinnati, writes:

       Please fight the repeal of the Health Care law. Please 
     don't let them take away pap smears and mammograms from being 
     part of preventive health. People with pre-existing medical 
     conditions need insurance, too. There is a lot of good in 
     this bill that will be erased if it is repealed. Please fight 
     so all Americans can have basic care.

  Craig, from Cuyahoga County, has children who are college-aged, and 
he writes:


[[Page 1074]]

       A number of years ago, my 23-year-old daughter was in a bad 
     car accident. She had no health insurance because her 
     employer did not offer it. Since she had no good access to 
     good health care, she received substandard care and she 
     continues to suffer. Contrast this to the present. My 21-
     year-old son is taking a year off to earn money to return to 
     school. We cannot afford his tuition and living expenses as 
     he pursues a double major in physics and economics. In the 
     past, he would be uncovered by insurance unless he could 
     afford his own. In case of an accident, his prognosis is much 
     better than his sister's. Now, he is covered under my 
     insurance until he either gets a job or turns 26. Thank 
     goodness. My point with all this is to beg you to keep the 
     health care bill intact and fight for it.

  This is the last letter I will read. This is from Sue of Franklin 
County, the center of the State, the capital of Columbus, where the 
Presiding Officer lived for a little while. Sue writes:

       Please do not let the Republicans take away my daughter's 
     health insurance. My husband and I are retired civil servants 
     on a fixed income. I was overjoyed when my health insurance 
     company informed me that my 21-year-old daughter could remain 
     on my policy until she is 26. Currently, she is a senior at 
     the Ohio State University and under the old regime, would 
     have been dropped from my policy in April 2011, when she 
     turns 22. This may not seem like a big deal to you, but my 
     daughter has a preexisting condition that requires her to 
     take three prescriptions a day, not to mention doctor 
     appointments and blood work. I paid for private insurance for 
     my older daughter for 3 years until her husband's employer 
     covered her. By the end of the 3 years, I was paying almost 
     $200 a month for my daughter's policy and she was a healthy 
     25-year-old without preexisting conditions.

  We know the kinds of hardships the repeal of this health care bill 
will inflict on all kinds of Americans--the college student, the recent 
graduate, the child with a preexisting condition, the senior who wants 
to be able to have access to mammograms and a checkup and an 
osteoporosis screening. We know the small businessperson really needs 
this tax credit so she can cover her 5 to 10 employees, not because the 
law tells her to but because she wants to. All these reasons just 
underscore to me how outrageous it is that a bunch of people dressed 
like this--who get elected to offices and who enjoy government 
insurance, so they and their families have benefited from taxpayer-
funded insurance--are willing to continue to take their insurance, 
continue to enjoy those benefits, but are willing to take them away 
from so many seniors, so many families, so many small businesspeople, 
so many people who are working hard and playing by the rules and trying 
to achieve the American dream, but in many cases this just stops them 
cold in their tracks.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. GRAHAM. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Udall of Colorado). Without objection, it 
is so ordered.
  Mr. GRAHAM. Mr. President, the country is debating a lot of issues. 
We passed the health care bill last year. Now there is an effort in the 
House to repeal and replace it. I join my House colleagues with the 
idea that we should start over and come up with some product that is 
truly bipartisan that will lower costs. All the information we received 
about this bill since it was passed is showing it is going in the wrong 
direction. In May 2010, CBO Director Doug Elmendorf stated:

       Rising health care costs will put tremendous pressure on 
     the Federal budget during the next few decades. In CBO's 
     judgment, health legislation enacted earlier this year does 
     not substantially diminish that pressure.

  We are getting more and more input about the effect this bill has on 
cost because there are over 700 waivers now in terms of the mandates. 
Forty percent of all the waivers given are to union health care plans, 
and the union workforce is 7 percent of the total workforce. The idea 
that more and more people are asking for waivers indicates that the 
cost component of this bill is a real problem for the country.
  The whole goal of health care reform is lower cost and improved 
quality. I am afraid what we have done with the health care bill is we 
have increased costs, consolidated power in the Federal Government, and 
Medicare and Medicaid already are unsustainable when it comes to 
Federal financial obligations. The Obama health care bill, if fully 
enacted by 2014, would extend Medicaid coverage in the State of South 
Carolina to 29 percent; 29 percent of South Carolinians would be 
covered by Medicaid. That is a substantial increase over the number of 
people on Medicaid today. That would require my State to come up with 
$1 billion more of State matching money, in the next 7 years, to get 
the Federal Government Medicaid dollars.
  The second largest expense in South Carolina today is the State's 
matching requirement to get existing Medicaid dollars from the Federal 
Government. If you expand Medicaid, you are going to bankrupt South 
Carolina.
  I think there is a better way to deliver health care to low-income 
Americans. I was on a bipartisan bill with Senators Wyden and Bennett 
that did cover everyone, but it allowed people to buy health care in 
the private sector with tax credits that took deductions away from 
employers. That is a lot of money. It took that pool of money and 
allowed individuals to buy their own health care in a more competitive 
environment.
  At the end of the day, it looks like we are going to be taking a vote 
here soon in the Senate, I hope, to repeal and replace the health care 
law that was passed last year. If it is repealed, it should be 
replaced. The way you replace something this complicated, that affects 
one-fifth of the economy, is you do it deliberately, you do it in a 
bipartisan manner. Let's remember how this bill became law. It got 
exactly 60 votes, a party-line vote in the Senate. It was passed on 
Christmas Eve more than a year ago.
  At the end of the day, the process I thought was not befitting of the 
Senate. There were a lot of provisions given to Senators in particular 
States. Such as in Florida, the Medicare Advantage participants had a 
lot more Medicare Advantage availability than other States. Ohio, 
Michigan--some health care companies in those States got special deals.
  At the end of the day, it was done in a backroom, partisan fashion, 
not transparent, not negotiated before C-SPAN, as President Obama 
promised. It reinforced the worst of politics, and it is no surprise to 
me that something that came out of that process is not going down well.
  What I say today with Mr. Barrasso, a physician, a Senator from 
Wyoming, is allow States to opt out if they choose to. If this is such 
a good deal, let the State legislatures throughout the country decide 
whether they want to be covered by the individual mandate, the employer 
mandate or Medicaid expansion. I know the answer in South Carolina. My 
Governor, my legislators, want to opt out of expanded Medicaid because 
it will bankrupt the State, and they do not want any part of the 
employer mandates. I will challenge the Congress, if repeal and replace 
doesn't work, let the individual States have a say about whether they 
want to be in the system.
  I do hope we can repeal it and replace it. That vote is coming up 
soon. But the amount of tax increases in this bill--$17 billion in 
individual penalties, $52 billion in employer penalties, $500 billion 
taken out of Medicare to help pay for the uninsured--at the end of the 
day, the formula, the construct of this bill I think is going to grow 
the size and scope of the Federal Government when it comes to health 
care at a time we need more private sector competition in medicine. It 
is going to increase taxes on businesses at a time when we should lower 
their taxes. It is going to make it very hard in the future for senior 
citizens to find doctors to take Medicare because, at the end of the 
day, the more you consolidate power in the Federal Government, the more 
obligations the Federal Government has when it comes to health care, 
the less we can pay because we are so broke.
  I hope this vote will happen soon. To my colleagues who want to keep 
this bill, I respectfully disagree, but that is

[[Page 1075]]

what debate is all about. We can have a civil debate about the future 
of health care. I think the Congress would be wise to start over and 
come up with a new product. It does put pressure on Republicans, if we 
do repeal this bill, to replace it with something that makes sense. 
What makes sense to me is to lower cost and make sure people have 
access to health care and that the uninsured are taken care of. But one 
size does not fit all.
  I look forward to casting my vote to repeal and replace. If that does 
not work, I look forward to having my amendment, along with Senator 
Barrasso, on the floor of the Senate, allowing States to opt out if 
they choose.
  My guess will be that a majority of the States would opt out of the 
individual mandate, the employer-mandated Medicaid expansion, and some 
Democratic Governors are going to be talking to the Members of this 
body about how their States will be devastated by Medicare expansion. I 
think you are going to have some big States in the hands of Democratic 
Governors that are going to feel the impact of this Medicaid expansion. 
They are going to petition this Congress to do something about it, and 
I hope we listen to them.
  This vote should happen soon. We are in a new Congress. There are new 
people here with new ideas and now is the time to allow the American 
people to participate because most of this bill was passed in secret, 
without a whole lot of bipartisan give and take. Now is the time to 
start over, take the idea of health care reform, a blank sheet of 
paper, and see what we come up with in a bipartisan, incremental 
fashion. The only way we can do that is to replace the bill we have 
before us.
  I look forward to this debate. I look forward to the vote. This issue 
is not going away. Between now and 2012 we are going to have a very 
serious debate about the future of health care in America. I would 
argue that anybody running for Governor between now and 2012 should be 
asked the question: If you could, would you opt your State out of the 
provisions I just described, the individual mandate, employer mandate, 
and Medicaid expansion? Those are good questions to ask and answer and 
maybe they would have a good answer why they would say no. But anybody 
running for the statehouse throughout the country should have a genuine 
debate about whether their State should be included in Obama health 
care. That is why I hope, if we do not repeal and replace the bill with 
the current amendment that will be offered by Senator McConnell, that 
we not abandon this debate.
  Debating policy in a civil way is the essence of democracy. At the 
end of the day, I do believe there is a better way to come up with 
health care reform than that chosen by our Democratic colleagues in the 
last couple years.
  Having said that, the status quo is unacceptable. I am very much for 
eliminating the preexisting illness exclusion that denies Americans the 
ability to buy health care when they get sick. I am very much for 
shopping around and buying a plan that is best for you and your family 
and, if you are a low-income person, helping you make that purchase but 
I don't want to consolidate any more power in the Federal Government 
when it comes to health care because the health care obligations of the 
Federal Government, Medicare and Medicaid alone, in 20 years, are going 
to cost as much as the entire Federal Government does today. This is an 
unsustainable course. Entitlement reform has to be embraced. But until 
we get to that day, I would like to restart the debate, have a new 
dialog with new Members of Congress who heard, loudly and clearly in 
the last election, the displeasure the American people have for the 
process--a bill that was passed in the dead of night on Christmas Eve, 
with a lot of chicanery, replace it with a new process that leads to a 
better bill.
  That puts us all on the hook to try to find middle ground. There was 
no middle ground found last time. Frankly, I don't think a lot of 
people looked for middle ground. Those days are behind us. There is a 
new Congress. If this election said anything to us in Washington, it 
ought to be that the country does not like what we are doing--
Republicans or Democrats--and the health care bill, the way it was 
passed, is the worst of Washington, not the best. I look for better 
days.
  I know the Senate president tonight has genuinely tried to reform 
this institution to make it more reflective of the American people's 
hopes and dreams. The health care bill was passed in a way that none of 
us, quite frankly, should be proud of. If we start over, the obligation 
exists for all of us to find some middle ground to move the debate 
forward.
  The vote will be soon. It will probably be less than 60, but that 
doesn't mean the debate ends. There are other ways to address this 
issue. I can assure the people in South Carolina that this fight will 
continue, that I will do the best I can as a Senator from South 
Carolina to make sure the Obama health care bill, President Obama's 
plan that was passed by the Democratic Congress, is dramatically 
changed and altered before it takes hold and becomes irreversible.
  We have a chance, in the next year or so, to fix this before it gets 
out of control. I hope we will take advantage of it. I look forward to 
the debate. I look forward to offering solutions. I look forward to 
more than just saying no, but I do look forward to a genuine debate, 
where I do have a say and hopefully people on the other side will 
listen.
  With that, I yield. The Senator from Pennsylvania is next.
  The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
  Mr. CASEY. Mr. President, I ask to speak as in morning business, ask 
unanimous consent to do that.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                       Honoring our Armed Forces

  Mr. CASEY. Mr. President, I rise tonight to speak about the conflict 
in Afghanistan from one perspective; that is, of those who have given 
their lives in the service of our country. I do so, knowing we have a 
lot of work to do this year, to debate and discuss and spend a good 
deal of time this year talking about the policy, what is happening in 
Afghanistan, whether it is our policy as it relates to security or 
governance or development. But tonight I just wish to focus on those 
who gave, as Lincoln said, ``the last full measure of devotion to their 
country.''
  At times such as this, we have to ask maybe one threshold question. 
For me, it is this question: How do we adequately pay tribute to our 
fighting men and women serving in Afghanistan or anywhere around the 
world? I guess the other part of that question is, How do we adequately 
express our gratitude for those who are serving, those who served and 
came back with no injury or were able to get back to some semblance of 
a normal life, those who served and came back but are suffering 
grievously from an injury, and finally how do we adequately express our 
gratitude to those who were killed in action and express gratitude to 
their families as well?
  The answer to all those questions is we cannot adequately express our 
gratitude. But even though it is inadequate, even though it falls short 
of what we hope it could be, we still have to thank them--we still have 
to--and should express our gratitude. I do that tonight, with a healthy 
dose of humility, with recognition it is very difficult to express our 
altitude.
  We are a nation at war. As we pay tribute to the troops who are 
fighting for us, we should also never forget the sacrifices of their 
families, the families who support those fighting men and women--and of 
course, by extension, support all of us--an enormous sacrifice when a 
loved one goes overseas. Even, as I said before, if they serve and come 
back and are OK at the end of that service, just the time away, the 
things they miss in their families' lives, month after month, year 
after year--they miss family celebrations, birthdays and weddings and 
literally the birth of a child is sometimes missed because of their 
deployment. That is nowhere near an exhaustive list. We do want to pay 
tribute, in a very personal way, to the families as well.
  Sometimes--when we talk about our troops and talk about our country, 
we

[[Page 1076]]

search for language and stories and meaning--we look to the Scriptures. 
As I have often done, we quote Abraham Lincoln. We can also look to 
some of our more modern and current artists, and there are plenty of 
them we can cite. I am thinking a lot about some words from the great 
recording artist Bruce Springsteen.
  He wrote a series of songs that connected to or were inspired by the 
horrific events of 9/11. Most of the songs on that, what we used to 
call an album, ``The Rising,'' were connected to the events of 9/11. 
But he wrote one song, of which I think the words and the theme of the 
song have direct application to folks who are serving our country and 
who are, in fact, missing from their families. There is a repetition of 
some lines in that song where he says: You are missing. At one point 
the song goes like this. He says: You are missing. When I shut out the 
lights, you are missing. When I close my eyes, you are missing. And he 
finally says: When I see the sunrise, you are missing.
  I always thought that made a lot of sense to me in terms of trying, 
as best I can, to understand what our families are going through when a 
loved one is deployed, that that family is missing that family member 
when they are serving in Iraq or Afghanistan or anywhere around the 
world.
  Of course, it is especially meaningful and poignant and sad and 
moving when it means you are missing because you have been killed in 
action. And every day they are missing, when someone is turning out the 
lights at night, when they are sleeping, and when they see the sun rise 
in the morning.
  So we think of those words and the fact that there are a lot of 
people missing today from their families, because of their deployment, 
or because of their death.
  I have read the names of those who were killed in action in Iraq over 
time, in 2007, 2008 and 2009. We got through that list of those who had 
lost their lives in Iraq. In that conflict to date, 197 Pennsylvanians 
lost their lives. As we remember those who were killed in action, 
from--in this case I will be referring to Pennsylvanians--we also must 
remember the wounded warriors who have returned from the battlefield. 
In Pennsylvania that is, to date, 398 brave men and women who have been 
wounded in this war, the war in Afghanistan.
  Last week I met two courageous young men, Army CPL Russell Carter of 
Springfield, PA, Delaware County, right outside of the city of 
Philadelphia, and Marine CPL David Noblit of Herndon, PA. That is in 
North Umberland County in the middle of our State. They had just 
returned from Afghanistan, both wounded, remarkably strong and capable 
soldiers fighting for us, and not a word--the Presiding Officer knows 
from the soldiers he has spoken to--not a word of complaint about what 
happened to them, not a word of complaint about their care. And they 
are getting great care at Walter Reed.
  I salute obviously their bravery and their valor, but we also, of 
course, salute the sacrifice of their families at this time. We commend 
the efforts of the Walter Reed staff who take care of them, remarkable, 
almost miraculous care and treatment of our soldiers. They work every 
day to make sure that those soldiers not only are cared for but that 
they are progressing because of that care, because of that dedicated 
care at so many facilities, whether it is Walter Reed or veterans 
hospitals or whatever across the country.
  One of the reasons they do that is to ensure that the future choices 
of those young service members are not determined by an IED blast or by 
the bullet from a sniper; that because of the rehabilitation, because 
of the healing and hope that comes from that work, that that soldier's 
future is determined and will be determined by that soldier and not by 
the enemy.
  The rehabilitation work done at Walter Reed is remarkable. We are 
reminded when we see those soldiers in that care of their strength, we 
are reminded of their skills, the dignity that comes as a result of 
that care and treatment over time. And they, in fact, will determine 
their own future because of that care.
  So what I will do now for the next couple of moments is I will read 
the names of Pennsylvanians who have been killed in action in 
Afghanistan in Operation Enduring Freedom. I will do so in alphabetical 
order and read their hometown. But the alphabetical order, of course, 
will be based on the last name of the soldier. I will start with 
someone actually from my home county:

       SGT Jan Argonish of Scranton, PA; SFC Scott Ball of 
     Carlisle, PA; LTC Richard Berrettini of Wilcox, PA; CPT David 
     Boris of Pottsville, PA; PVT Matthew Brown of Zelienople, PA; 
     SGT Douglas Bull of Wilkes-Barre, PA; SGT Joseph Caskey of 
     Pittsburgh, PA; 1LT Jeffrey Deprimo of Pittston, PA; PFC 
     James Dillion, Jr., of Grove City, PA; PFC Michael Dinterman 
     of Littlestown, PA; SSG Troy Ezernack of Lancaster, PA; LCPL 
     Ralph Fabbri of Gallitzin, PA; SGT Louis Fastuca of West 
     Chester, PA; SFC Robert Fike of Conneautville, PA; SSG Sean 
     Flannery of Wyomissing, PA; SGT James Fordyce of Newtown 
     Square, PA; PO3 John Fralish of New Kingstown, PA; LCPL 
     Michael Freeman of Fayetteville, PA; A1C Austin Gates Benson 
     of Hellertown, PA; SGT Christopher Geiger of Northampton, PA; 
     2LT Michael Girdano of Apollo, PA.
       CPL Joshua Harton of Bethlehem, PA; SGT Michael Heede, Jr., 
     of Delta, PA; SGT Brett Hershey of State College, PA; SP 
     Derek Holland of Wind Gap, PA; SFC Bryan Hoover of West 
     Elizabeth, PA; LCPL Abram Howard of Williamsport, PA; SSG 
     Matthew Ingham of Altoona, PA; PFC David Jefferson of 
     Philadelphia, PA; LCPL Larry Johnson of Scranton, PA; SGT 
     Nathan Kennedy of Claysville, PA; CPL Jarrid King of Erie, 
     PA; SP Dale Kridlo of Hughestown, PA; PFC Serge Kropov of 
     Hawley, PA; SSG Patrick Kutschbach of McKees Rocks, PA; SGT 
     Ryan Lane of Pittsburgh, PA; MSG Arthur Lilley of Smithfield, 
     PA; CPT Ronald Luce, Jr., of Wayne, PA; SP Jonathan Luscher 
     of Scranton, PA; MSGT Thomas Maholic of Bradford, PA; SGT 
     Jonathan McColley of Gettysburg, PA; SGT Andrew McConnell of 
     Carlisle, PA.
       1SG Christopher Rafferty of Brownsville, PA; SP Jesse Reed 
     of Orefield, PA; SGT Joshua Rimer of Rochester, PA; GYSGT 
     Justin Schmalstieg of Pittsburgh, PA; SGT Derek Shanfield of 
     Hastings, PA; SFC Michael Shannon of Canadensis, PA; CWO4 
     Michael Slebodnik of Gibsonia, PA; SSG Marc Small of 
     Collegeville, PA; SSG Glen Stivison, Jr. of Blairsville, PA; 
     CPL Sascha Struble of Philadelphia, PA; PFC Brandon Styer of 
     Lancaster, PA; SSG Paul Sweeney of Lakeville, PA; SSG Richard 
     Tieman of Waynesboro, PA; CPL Eric Torbert, Jr. of Lancaster, 
     PA; LCPL Joshua Twigg of Indiana, PA; SP Anthony Vargas of 
     Reading, PA; SSG William Vile of Philadelphia, PA; SGT David 
     Wallace III of Sharpsville, PA; SGT Jonathan Walls of West 
     Lawn, PA; SSG David Weigle of Philadelphia, PA; CPT Bryan 
     Willard of Hummelstown, PA; and CPL Anthony Williams of 
     Oxford, PA.

  Those are the names of those Pennsylvanians who have been killed in 
action in Afghanistan. We now have a total of 64 brave servicemembers 
from the Commonwealth of Pennsylvania, who as I said before, quoting 
Lincoln, gave the last full measure of devotion to their country.
  Twenty-seven of these young men came from towns with less than 5,000 
people. You notice in that list some came from big cities such as 
Pittsburgh and Philadelphia and other big cities such as Erie and 
Allentown. But 27 of the 64 came from very small communities where the 
death of one soldier in a town of 5,000 or less has a seismic impact, a 
searing impact, first and foremost on that soldier's family and on 
their relatives and loved ones, but obviously even on the community 
itself.
  All we can do at times like this, when it comes to paying tribute, is 
to do our best to convey a sense of gratitude, a sense of respect, and 
also to commit ourselves not only to helping the living, to help those 
who come after them, who have been wounded, their family and others.
  Lincoln also talked about ``him who has borne the battle,'' and 
talked about those who have been wounded and their families. But all we 
can do for those who have been killed is, as best we can, to help their 
families and to pay tribute to their service and their memory, but also 
to make sure we are doing everything possible to get this policy right, 
to make sure that our policy is commensurate with their sacrifice.
  In one sense, as my father said a long time ago, in reference to the 
gulf war of 1991: We pray for them who serve. We pray for them and we 
pray for ourselves that we may be worthy of their valor.

[[Page 1077]]

  So tonight we do that, not only for those killed in action that I 
have read from Pennsylvania, but for those who have lost their lives 
from States across the country, including the State of Colorado that 
our Presiding Officer represents.
  I yield the floor and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. CASEY. I ask unanimous consent that the order for the quorum call 
be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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