[Congressional Record (Bound Edition), Volume 159 (2013), Part 13]
[Senate]
[Pages 18573-18578]
[From the U.S. Government Publishing Office, www.gpo.gov]

                                 prayer

  The PRESIDING OFFICER. Pursuant to the order of February 29, 1960, 
the hour of 12 noon having arrived, the Senate having been in 
continuous session since yesterday, the Senate will suspend for a 
prayer by the Senate Chaplain.
  The Chaplain, Dr. Barry C. Black, offered the following prayer:
  Let us pray.
  Eternal God, who gives us so much more than we deserve, when the days 
are dreary and the long nights weary,

[[Page 18574]]

we are still indebted to You for Your generous mercies. May Your 
blessings provide our lawmakers with the willingness to see and do Your 
will. Living by the principles of Your sacred revelation, may they do 
nothing to cause them shame. Give them respect for diverse viewpoints, 
open their hearts to Your love, their minds to Your truth, and their 
wills to Your service.
  We pray in Your gracious Name. Amen.
  The PRESIDING OFFICER (Mr. Coons). The Senator from North Dakota.
  Mr. HOEVEN. Mr. President, I rise to continue the discourse my 
esteemed colleague, the good Senator from Missouri, was engaged in on 
the Senate floor just a minute ago, talking about the importance--the 
importance--of bipartisanship as we work to craft policy for this 
country, policy that all Americans can support and policy that truly 
moves our country forward.
  So whether we are considering nominations or whether we are 
considering legislation, we need to find ways to come together and come 
up with solutions that the American people support across the board in 
a bipartisan way. So as we consider these nominations, we have to 
consider the fact that now the Senate will be approving these 
nominations with essentially a 1-party vote, 51 votes.
  Right now, the Democratic Party has the majority in the Senate, so 
they can put judges on the bench, confirm other nominations without any 
Republican support whatsoever. Of course, under that approach, at some 
point the reverse may very well be true, that nominees may be 
confirmed--whether it is judicial nominees or other types of 
appointments--with only Republican votes if the Republicans are in the 
majority without any Democratic votes. Why does that matter?
  Why it matters is because, again, I go back to my earlier statement 
that in crafting policy, crafting laws and making appointments, 
nominations to the bench, we need to do it in a way where we garner 
broad support across the country.
  More than 300 million people's lives are affected dramatically by all 
of these things, by who those appointees are, the offices they hold, 
what they do with the laws we pass. So if we are going to impact 
everybody in the Nation with these laws, with these appointments, we 
have to make sure there is input, consideration by and, if you will, 
from both sides of the aisle.
  That is how we get the kinds of policies and we get the kinds of 
nominees and we get the kinds of judges and Justices that truly will 
have the support of people across this great country. I believe that is 
what we need to truly build the kind of future we want for ourselves 
and for our prosperity.
  As we talk about nominees, we consider also implementation of the 
Affordable Care Act. This is a huge topic of discussion in our country 
right now, and it is going to continue to be a huge topic of 
discussion. You are talking about one-fifth to one-sixth of our economy 
engaged in health care. So this is something that touches every single 
American in their daily life in a big way. It is so important we get it 
right.
  As was the case with my esteemed colleague from the State of 
Missouri, he was presenting anecdotes, presenting stories, real 
stories, real-life stories, of people who are impacted by the 
Affordable Care Act and how they are impacted. It is very important we 
do that because we need to know how people's lives are affected by the 
Affordable Care Act and what we can do to make sure they have the best 
health care possible.
  By the way, I think of hopefully building bipartisan support to get 
the kind of health care reform we truly need. I am going to present 
some of these real-life cases, as my colleague from Missouri just did, 
and I am going to start with one that talks about the marriage penalty 
created by ObamaCare, the Affordable Care Act. This is from someone in 
Grand Forks, ND, who writes in about the marriage penalty created by 
the Affordable Care Act. This citizen writes:

       My husband and I met with the primary health insurance 
     carrier in ND and were told that our current coverage, under 
     the guidelines of the Affordable Care Act, will cost us at 
     least another $400 more a month, and our deductible will 
     increase from $2,000.00 to $12,000.00, and because we are 
     married, we cannot choose individual plans, which would be a 
     much lower deductible. In essence, we are being punished for 
     being married. We are looking at paying more than $1500.00/
     month in health care, because we are only 61 years old and 
     not eligible for Medicare for another 4 years--[that is] 
     $18,000 a year for health care!
       We were told that part of the problem is the provisions in 
     the law require us to choose a plan that has maternity 
     benefits. How does this make sense for seniors to be forced 
     to buy coverage that does not apply to them? We agree that 
     benefits shouldn't be denied to people but it is not fair to 
     be forced to buy coverage that does not apply.

  Well, let's delve a little deeper into exactly what this individual 
is writing about. What is the marriage penalty that is, in fact, 
created by ObamaCare? Let's talk about that.
  The ObamaCare tax subsidies actually create a marriage penalty. They 
create a disincentive for individuals who are cohabiting to become 
legally married. From the standpoint of marriage, the subsidies 
represent a hidden tax on marriage whereby married couples purchasing 
their coverage on the exchanges will be subsidizing similarly situated 
but cohabiting single adults who earn the same or more income.
  In 2011, the House Oversight and Reform Committee held a hearing on 
the topic of ObamaCare's penalty against marriage. But since then 
little has been devoted to this topic in the House or the Senate.
  So how does it work? It works through the requirement of household 
income when calculating the ObamaCare tax subsidy.
  For those persons not eligible for Medicare earning up to 400 percent 
of the Federal poverty level, the law entitles them to a tax subsidy in 
the form of a refundable credit so long as they purchase their coverage 
on the ObamaCare exchanges.
  To calculate income, however, the law requires the reporting of 
household income rather than individual income. Household income 
includes the income of any family member residing in the household, 
such as a spouse, but not that of a cohabiting unmarried partner.
  So when a person shops on the exchange's Web site for a plan, he or 
she must first provide the financial information and identity of all 
family members in the household, even if none of those persons intend 
to purchase their insurance on the exchange because that information is 
required to calculate subsidy eligibility.
  Subsidy eligibility is then calculated using a complicated formula 
involving household income in relation to the poverty line, family 
size, and the price of plans offered through a State's marketplace.
  The value of the subsidy awarded to an eligible person adjusts on a 
sliding scale in proportion to household income, up to 400 percent--up 
to 400 percent--of the Federal poverty level. Above 400 percent of the 
Federal poverty level, no tax credit. Right.
  The marriage penalty results when a spouse's income causes an 
otherwise eligible individual to no longer be eligible for the subsidy 
and could cost a married couple in their household in excess of $10,000 
a year in lost subsidies versus two individuals who are cohabiting but 
not married.
  So let's go through an example.
  According to the Kaiser Family Foundation's health reform subsidy 
calculator, a 62-year-old individual in a high-cost area who earns 
$46,000 a year, which is equivalent to 400 percent of the Federal 
poverty level, would be entitled to $7,836 in a government tax credit. 
However, if that same individual earns an additional $22 or $46,022 a 
year--just over $46,000 a year--which is now 401 percent of the Federal 
poverty level, they lose the entire credit. They lose the entire $7,836 
credit.
  Similarly, any married couple that earns more than $62,040--400 
percent of the Federal poverty level for a family of two--earns too 
much to qualify for a subsidy. But that same couple if unmarried and 
cohabiting could earn up to $45,960 each--or $91,920 total--and they 
are still eligible for subsidies in a high-cost area such as New York 
State, for example.

[[Page 18575]]

  So the limit for a married couple is just over $62,000. OK. So for a 
married couple, you can earn up to $62,040 before you lose the credit, 
but it is almost $30,000 higher for two people living together who are 
not married. They can earn $91,920 for an unmarried cohabiting couple. 
So if you have two people living together, they each get the individual 
exemption, which is more than $45,000. So they can earn $91,000-plus 
together--they still get the credit--but for a married couple, just 
over $60,000. Mr. President, $62,000 is the limit. So you can earn 
$30,000 more if you are living together and still get the credit than 
you can if you are married. That is the marriage penalty. So why would 
we design a health care program that discourages or penalizes marriage?
  Further, according to the Congressional Budget Office, the tax 
subsidies are projected to be the biggest deficit-increasing component 
of ObamaCare, and CBO estimates they will add $100 billion to the 
deficit by 2018 and grow even more thereafter. By 2019, CBO estimates 
that about 19 million people will be receiving the subsidies to 
purchase their insurance through the exchanges.
  As I say, I became aware of this problem when I was contacted by a 
North Dakota couple. I read that short vignette. We looked into it, and 
it is, in fact, true. This is just one of the many problems created by 
ObamaCare, or the Affordable Care Act, which is why Republicans have 
said: Look. We need to replace this with a comprehensive, step-by-step, 
market-based approach that truly is focused on competition and choice, 
that empowers individuals, empowers people across this great Nation to 
choose their own health care insurance and their own health care plan.
  We can absolutely do that. That is why I am here on the floor and 
others are here on the floor continuing to talk about Americans and 
their everyday lives and the challenges they face because of ObamaCare.
  I have more of these stories from North Dakotans, people in my State 
who are facing real challenges because of ObamaCare.
  So often we hear: Well, wait a minute, if we are not going to do the 
Affordable Care Act, if you do not like the Affordable Care Act, then 
what is your solution?
  We continue to put solutions forward, solutions such as expanded 
health savings accounts, which, combined with high-deductible policies, 
can create tremendous incentives for young people to purchase health 
care; more competition across State lines, which can help give citizens 
more choice and reduce costs; tort reform, which can help bring down 
cost; reforming Medicare to create the right incentives; giving States 
more control over Medicaid. The list goes on. We will continue to 
advocate for those types of solutions--real solutions that empower 
Americans to choose their own health care insurance and their own 
health care providers.
  Let me read some more letters from North Dakotans who talk about the 
challenges they are facing because of ObamaCare, the Affordable Care 
Act.
  This individual from Hankinson writes:

       I am writing about the health care mess ObamaCare is 
     creating. I am a retired teacher running a daycare with my 
     wife. Hence, I am self-employed. I buy my own health care 
     through Medica. Under the new ObamaCare rules, my monthly 
     premium is going from $302 to over $500 per month.
       I am 58 years old, not on any medications and have no 
     illnesses. Because of this forced health care, I am supposed 
     to pay a 60-percent increase in health care coverage. If I 
     drop my health care coverage, the government will hunt me 
     down and fine me. Please stop this ObamaCare boondoggle.

  From Harvey, ND, a disgruntled grandpa who has to pay for maternity 
care:

       The Affordable Care Act is an excellent example of an 
     oxymoron. Since the Affordable Care Act was passed, my 
     insurance rate has escalated an additional $4,000 per year, 
     not the $2,500 reduction that President Obama speculated. I 
     have yet to find anyone whose health care costs have 
     declined. Oh, yes. I just received my cancellation notice 
     from Blue Cross Blue Shield. Thank you very much. I was happy 
     with my Blue Cross Blue Shield plan. I had a low deductible, 
     prescription and hospital coverage, everything that I needed.
       Now, as a grandfather, I will be paying for maternity, 
     pediatric dentistry, contraception, drug, alcohol recovery, 
     et cetera. The government has bloated my policy with useless 
     fluff so my premiums will support others' subsidized 
     policies.
       The President said, ``If you like your health care plan you 
     can keep it. Period.'' The truth is, if you can't afford 
     health insurance, you can afford ObamaCare if someone else 
     pays the premium for you. Also all of these years I have paid 
     taxes on things that I possess or purchase. Please explain 
     why I have to pay a tax if I choose not to purchase 
     ObamaCare.
  From Fargo, ND, a retired couple faced with canceling their own 
wellness center membership to pay for ObamaCare. This individual 
writes:

       Last week Blue Cross Blue Shield of North Dakota sent my 
     wife and I a letter stating that the health insurance 
     coverage we carry is no longer acceptable or allowable under 
     the new health care law. It was a health insurance package 
     that we had selected after retiring from the field of 
     education 2 years ago. It was a great package for us since we 
     are both in good health. It offers us lower premiums, a 
     higher deductible, which, by the way, we wanted, and more 
     than adequate coverage for us.
       Now, we have to look at other more expensive health care 
     packages which we do not want, some of which will include 
     wellness center coverage. Well, we go to a wellness center 
     here in Fargo, pay for it ourselves, and it costs us 
     considerably less than any of the new packages that include 
     it.
       So if I have this right, the following needs to take place 
     for us. 1. We can no longer keep our present insurance that 
     we wanted to begin with. 2. We can, however, select another 
     package that will cost us, at the very least, an additional 
     $1,800 in premiums per year. Remember, this is being paid for 
     out of our retirement check. 3. The plans include a wellness 
     center option, which we currently have at our own expense at 
     a cost of $600 a year.
       So based on the law's requirements, it will cost us another 
     $1,200 if we discount our current $600 wellness cost over and 
     above what we now pay. All of this for insurance we do not 
     want. There is an old saying from our neck of the woods: If 
     you want something screwed up, give it to the government. 
     Sorry, but this new law makes that old saying prophetic.

  From Bottineau, ND, a couple faces cancer treatment and tripling 
costs with ObamaCare. This individual writes:

       Here is my story on ObamaCare. I have a Blue Cross Blue 
     Shield policy that I have had for many years.
       In 2008 my wife was diagnosed with a very aggressive breast 
     cancer. We did all of the treatments, surgeries, et cetera. 
     The insurance paid all but the deductible and the 
     coinsurance, just as it was supposed to. We had no problems. 
     Our deductible has been $500, with an 80/20 copay up to an 
     out-of-pocket maximum of $5,000.
       Now my wife's cancer has reoccurred and we are starting all 
     over. On the Affordable Care Act policy, to keep my premium 
     close to what we have had, our deductible will be $4,000 
     each, and our out-of-pocket maximum will be $12,500 per year. 
     By the way, the premium will be over $1,200 per month, an 
     increase of over 140 percent. That is not affordable care.

  So which policy is more substandard?
  A retired couple from Fargo, ND, writes:

       Upon visiting with my Blue Cross Blue Shield rep, he 
     informed me that our present affordable plans--we currently 
     have two single plans, one for each of us--will no longer 
     exist under the Affordable Care Act. We will have to switch 
     over to Blue Direct, which does not allow single plans, but 
     family plans only. This will then force us to pay $1,200 per 
     month, or $14,400 per year, compared to our present cost of 
     $6,000 per year.

  Let me repeat that.

       This will then force us to pay $1,200 a month or $14,400 
     per year compared to our present cost of $6,000 per year. 
     What sense does that make? Why do I want to give up a plan 
     that is one I selected for us, and is very affordable, and 
     change it over for one that will cost us another $8,400 per 
     year? I can definitely see where this is headed. It will send 
     both my wife and I back to the workforce to be able to pay 
     for a health insurance policy that we do not want.
       So why can't I keep my health insurance policy that I 
     already have? I like it. I want to keep it. But Uncle Sam 
     says no. Why? I understand the need to take care of those who 
     do not have insurance and cannot get insurance for medical 
     reasons. But why take away from millions of us that do have 
     insurance and want to keep it?

  You have seen that in the numbers, right? I believe Secretary of 
Health and Human Services Kathleen Sebelius testified in front of the 
House either yesterday or the day before and indicated that there are 
something like 360-some-

[[Page 18576]]

thousand signups for ObamaCare. But the statistics are in the range of 
4 to 5 million as far as the number of policies that have been reported 
as canceled so far since ObamaCare came into effect. These are the real 
stories behind those statistics. These are the real-life stories of 
people who have been impacted behind these statistics.
  From Bismarck, ND, a young working family has seen their costs 
skyrocket.

       Dear Senator Hoeven, I am a young pharmacist in Bismarck 
     who graduated from North Dakota State University in 2011. I 
     have the job I have always wanted, although it is with a 
     small pharmacy, so my employer cannot afford health insurance 
     for the seven employees who work there. So my family and I 
     went out and did the responsible thing: Qualified medically, 
     back when you had to, and bought what I thought was the 
     perfect health insurance plan.
       For the whole family, it was this easy. High deductible. No 
     coverage except preventative, until we paid $2,500 per person 
     or $5,000 per family. My premium started out at an amazing 
     $666 a month in 2011, went up a few dollars in 2012, and 
     increased by 12 percent in 2013 to $762.30 a month. Still 
     quite affordable.
       This year we had our third child, along with experiencing 
     some health issues with one of our other children. My wife 
     obviously met her $2,500 maximum and ended up needing surgery 
     and nearly died from complications, and spent a couple of 
     nights in the hospital. My insurance worked just like it was 
     meant to. That meant that $7,000 was paid 100 percent. As of 
     now, we have only paid $4,100 in out-of-pocket costs. I think 
     that is pretty darn good coverage for that premium.
       My policy does not qualify for the new Affordable Care Act 
     regulations. So it will end at the end of April, according to 
     Blue Cross Blue Shield. Fine. Whatever. But what really 
     upsets me is that my current coverage, which assumes a lot of 
     responsibility on myself, falls into the ``gold'' category on 
     the ObamaCare exchange based on the maximum out-of-pocket 
     limits.
       We are a young, generally healthy family. I do not need to 
     save nickels and dimes throughout the year to cover copays 
     and whatnot. I need a responsible limit that I know I am not 
     going to spend over. On the exchange, if I match my same 
     premium, then I end up with a maximum out-of-pocket limit of 
     $12,700--$12,700. How affordable is that?
       If I want a plan similar to the plan I have now, then I 
     have to spend over $900 a month, or $150 a month more. That 
     is $2,000 per year more for coverage I do not like. This is 
     very frustrating. Please fix this mess.

  From Kensal, ND, this is from a family who is unable to afford the 
rising premiums.

       I just got an insurance letter that said my family's 
     monthly premium was going from $385 to $840 per month. I 
     cannot afford that and keep the heat on this winter. That 
     represents over half of my take-home pay. I am now thinking 
     that I will have to get divorced just to keep my health 
     insurance for my three children and my wife. Keep the 
     government shut down forever if this is how you want to treat 
     the hard-working class.

  From Donnybrook, ND, self-employed family business owners see rising 
costs. They write:

       My husband and I farm and have three children, ages 4, 2, 
     and 7 months old. Because we are self-employed, we carry our 
     own health insurance. Last week we received notice that our 
     premium will be increasing by 43% due to the Affordable Care 
     Act. We will also be losing the freedom to cater our health 
     plan to meet our individual needs. We are very healthy non-
     smokers, and our children have yet to see a physician for 
     anything more than a well-child check-up. Our health history 
     is spotless. Our previous premiums were anything but 
     ``cheap,'' making this 43% premium increase unbelievable [to 
     us, and unaffordable].

  From Argusville, ND, self-employed face canceled policy. They state:

       About a year ago, my husband left his job and started his 
     own computer software consulting company. Contrary to what we 
     have been led to believe, we were able to find affordable 
     insurance for our family. We have three children under 18. We 
     found a family policy for about $480/month. This past year 
     (2013), it was moderately increased to about $520/month, 
     which we thought was a reasonable increase. We were very 
     happy with the insurance.
       However, today, I received a letter stating that due to the 
     new healthcare law, our insurance premium for the next year 
     would go up to $918.21.

  They are going from $520 a month to $918.21 a month.
  Continuing:

       This means we are facing a $400/month increase in our 
     insurance premium. This amounts to a $4,800 tax increase for 
     our family. We are a middle income/small business-owning 
     family. This is an outrageous intrusion by the Federal 
     Government into an area that it had no business going. It WAS 
     possible for the self-employed to get their own insurance. 
     There WAS a safety net through state and Federal programs for 
     people who couldn't get insurance. The Affordable Care Act is 
     not affordable, and was not ever necessary.

  What we are seeing is people in all different walks of life in 
different situations, some working for themselves, some working for 
small businesses, some working for large companies, some retired, some 
with kids, and some elderly, but what is the consistent theme? What is 
the consistent theme? Higher costs, less choice, and not being able to 
get policies that fit their needs because of this standardization.
  From Enderlin, ND, small business loses employee coverage. This 
constituent writes:

       My husband is a Veterinarian who has been in practice for 
     over 40 years. We have 5 employees for which we provide the 
     best health coverage that money can buy. We pay all their 
     premiums. Last week, we received a cancellation letter from 
     the insurance company. We believed President Obama when he 
     said that because we had insurance for our employees, and 
     because we have less than 50 employees, we could keep our 
     insurance. At no time did we receive information by letter or 
     email or on the Internet about the fact that if you changed 
     anything in your policy you would not be grandfathered in. We 
     had one person retire, hired a new employee, and an 
     employee's husband came onto the policy, changing the 
     deductible, which has meant that we have now lost our 
     insurance. This will mean a much larger premium! We work! We 
     are not happy about this situation. The President lied! This 
     will mean no raises and we will not be able to hire anyone.

  Park River, ND, rising costs for the young invincibles.

       Our family has had health insurance all of our adult lives. 
     My son, aged 28, also had his own health insurance with Blue 
     Cross Blue Shield of ND. He is single. His policy was 
     cancelled because of ObamaCare. His premiums are now tripled 
     and his deductible will be over $6,400.00. That is 
     unacceptable. No person can afford to pay a $6,400 
     deductible. If he fell into the poverty level to be eligible 
     for the tax subsidy, then he could get better coverage for 
     less money under this law. That is also unacceptable. We all 
     have worked to afford health insurance on our own . . . and 
     now it is not affordable, nor are the deductibles affordable. 
     He was happy with his own policy, one that he could afford, 
     and with better coverage for him. And now the government is 
     mandating what he can afford. How is this acceptable?

  I have one more I am going to read from a young family in Thompson, 
ND. In this case, the family's policy was canceled just before their 
baby was to be born.
  They write:

       My daughter and her husband are expecting their first child 
     in January, and on Friday they received a letter from their 
     insurance carrier stating that due to the new health law 
     reform they would no longer be covered. So, in January, when 
     the baby is to be born, they may have no health insurance. 
     Our president stated on more than 28 different occasions that 
     if you liked your health insurance, you could keep it. My 
     question to you is: What are you going to do about it? Will 
     you hold him accountable to his word?

  We listen to all these real-life stories from people in my State--and 
they reflect stories from people across this country--and that is why 
it is so important that we do get the kind of health care reform that 
this country needs and that these citizens so very much want. It truly 
makes a difference. As we debate this important issue, I think it makes 
an incredible difference.
  This isn't me saying ``OK, we need to do it'' or any one of us saying 
``OK, this is what we need to do.'' We are hearing from Americans--in 
this case, from my State of North Dakota. But as Members come down and 
speak on the floor on this issue, we are hearing from 300 million 
Americans across this free country. We are hearing real stories about 
real hardship and what they are going through.
  I go back to where I started this discussion; that is, why it is so 
important that as we approach these issues we take a hard look at 
ObamaCare and the Affordable Care Act. It was passed with only 
Democratic votes, no Republican votes whatsoever.
  It is as I said before: If we are going to get the kinds of policies 
that truly work for the American people, we have to come up with 
policies that can garner bipartisan support, support from both sides of 
the aisle. I truly believe

[[Page 18577]]

they have to be the kinds of policies that empower our people, that 
empower our people to choose their own health care provider, that 
empower them to choose their own health care insurance.
  I go back to the types of solutions I talked about earlier. These are 
the kinds of solutions that we have put forward in legislation, that we 
will continue to put forward in legislation, and we ask for Members of 
this body and the House to join us on a bipartisan basis and pass 
market-based solutions that truly empower people. These are such things 
as expanded health savings accounts combined with high-deductible 
policies.
  Think about young people going out into that market and buying health 
care insurance, maybe for the very first time. Maybe they have been 
operating without health care insurance and they say: You know what. I 
have to get health care insurance.
  Think about it. Think about what works for them. If we take a health 
savings account, a high-deductible policy, low premium--they are 
healthy, don't think they are going to get sick--that is the kind of 
thing that will encourage them to buy health insurance. If they have 
more choice and more competition, not only are they going to get it at 
a more affordable price, but they are going to have more options from 
which to choose. Likewise, let's make sure we provide for more 
competition across State lines so they are not only then looking at 
companies in their State but companies from across the country. More 
choice and more competition brings down prices.
  As we look at health care costs, let's look at tort reform. There is 
no question that lawsuits are driving the cost of health care higher. 
We can do something about that.
  Affordability is a huge issue we have to address as part of the right 
kinds of reforms for health care. When we talk about reforms, we have 
to reform Medicare to create the right incentives.
  What do I mean by that? Now, under Medicare, if someone lives in a 
State where they have high costs, regardless of outcome, the Federal 
Government provides more reimbursement under Medicare in that State 
than they do in a State that has lower costs even though they may have 
better outcomes. Does that make sense? Think about it. Think about that 
for a minute.
  A person has Medicare--and it is vitally important health care for 
seniors across this Nation, but the incentive is not to reduce costs. 
The way the program works, it actually increases cost because States 
with higher costs, regardless of outcome, get more reimbursement under 
Medicare than States with lower costs even if the States with the lower 
costs have better outcomes.
  Let's reform Medicare to have the right kinds of incentives, to 
encourage savings, to encourage better outcomes, and to encourage 
preventive care. We can do that. That is a win-win. We get better care 
at a more affordable price, and we help address the debt and deficit of 
this Nation. Those are the kinds of reforms that work for Americans.
  For Medicaid, Medicaid provided for individuals with low income, 
let's empower the States. Let's give the States more flexibility, more 
control. Rather than a Federal one-size-fits-all, give those States 
more control to truly not only improve health care outcomes but to do 
so at affordable costs, and reward them for controlling costs.
  These are the kinds of solutions that will not only produce better 
health care that I believe our providers can get behind and support 
because it rewards them for managing costs and good outcomes, which is 
what we want, but it also truly is how we address the deficit and make 
sure we save these programs--Medicare and Medicaid--and keep them sound 
for the future so that we not only can rely on them today but for years 
to come. We make sure that we save and protect those programs by 
creating the right kinds of reforms. Those are the kinds of reforms 
that truly empower people and give them the opportunity--which I think 
we all want--to choose their own health care providers and their own 
health care insurance.
  As we go through these issues, again, I want to emphasize the need--
and I come back to the reason I am on the floor--not only to talk about 
the right kind of health care reform but to go back to the issue before 
the Senate today: the nominations that we face and determining how we 
come together as a Senate, as a body, and we get Members on both sides 
of the aisle who come together and say: OK, how do we make sure that we 
have bipartisan solutions, that we create a bipartisan Senate where we 
are making sure that, as we look at confirmation of these nominees, 
there is an investment from both sides in getting it right and that 
there is input, deliberation, consideration, and debate on getting it 
right for the American people?
  Whether it is health care, whether it is energy, whether it is good 
ag policy, whether it is law enforcement, whether it is support for our 
military, whether it is anything else, how do we make sure that all of 
us--because it is incumbent upon all of us--how do we make sure we have 
protected what this institution has provided for since the inception of 
our country; that is, bipartisan consideration, deliberation, and 
debate that produces the best outcome for the American people.
  We have nominations that we are going through now and that we will 
continue to go through. We have important policy matters we need to get 
done now for the American people, such as a budget, Defense 
reauthorization for the defense of our Nation, a farm bill that needs 
to be passed, and an energy policy that we need to address--all things 
that can truly move our country forward. As we do that, we need to come 
forward with solutions that will truly be bipartisan. To do that, we 
need to have a very sincere and direct dialog as a body and Member to 
Member to come up with solutions to determine how we are going to make 
sure we are doing the very best job for the American people. That is 
what this is all about. We are here to do the work of the American 
people.
  And you know, we look across this vast, wonderful Nation, and there 
are people who are Democrats and people who are Republicans and people 
who are Independents, and we serve that whole spectrum. We serve them 
all. We are faced with a real challenge right now to make sure that 
bipartisanship continues in this Senate and in this Congress.
  I am going to turn to another matter before us that is incredibly 
important. It is a matter that is truly bipartisan. It is bipartisan, 
and I am going to use this as an example of how bipartisanship can and 
does work in this body and in the House. It is a matter we should be 
voting on right now, and I sincerely hope we will be voting on it in a 
few short weeks when we return, and that is the farm bill.
  I am a member of the Agriculture Committee, a member of the 
agriculture appropriations subcommittee, and I am also a member of the 
conference committee that is working to reconcile the differences 
between the farm bill that has been passed in the House and the farm 
bill that has been passed in the Senate. I bring up this example 
purposely, because we are focused on how we operate in a bipartisan 
manner to meet the challenges this Nation faces, and we are at a point 
where we need to redo the farm bill. We need to put a new long-term, 5-
year farm bill in place. Right now we are operating under an extension. 
I use this as an example of a truly bipartisan approach.
  I use the farm bill for another reason too. As we go through this 
process, where confirmation of nominations are now being done 
essentially on a partisan basis--not a bipartisan basis but on a 
partisan basis--and as we talk about ObamaCare, which was passed on a 
partisan basis--not a bipartisan basis--I want to bring up an example 
of how things should work on a bipartisan basis.
  When we look at the farm bill, the breakdown in terms of how the 
votes have gone, it hasn't been Republican and Democrat. We have had 
both. We have had some Republicans and Democrats voting against it and 
some Republicans and some Democrats voting

[[Page 18578]]

for it. It really is focused on what is the policy and what best serves 
this great Nation.
  Here is the other reason I bring it up right now. We are trying to 
address the deficit and the debt this country faces; right? This year 
CBO says the deficit is going to be somewhere between $650 billion and 
$700 billion--the deficit. The debt is $17.3 trillion. We must address 
the deficit and the debt. So as we work on a new farm bill, we are not 
only reforming the current farm bill, which is operating under an 
extension, we not only make reforms that make for a better farm 
program, but we are going to save on the order of $25 billion to $30 
billion to help reduce the deficit and the debt.
  Isn't that what we should be doing across government on a bipartisan 
basis--coming up with better policy that actually reduces the deficit 
and the debt, controls spending, reduces spending and helps our economy 
grow? That is what we are doing with the farm bill, and that is what we 
should be doing in these other areas as well.
  So as we continue to work on the farm program, I had hoped we could 
be to the point where we would be voting this week or next on the 
Senate floor and in the House as well. It doesn't look like that is 
going to happen, but we are very close. We can have a framework in 
place this week or next so that we can vote on it as soon as we return 
in January, and that is what we need to do.
  The current farm bill, the current extension, expires at the end of 
the year, meaning we need to get a new farm bill in place--not an 
extension but a new farm bill. We have put the framework in place. We 
are there. We now just need to get people to agree and we need to get 
the bill to the House and to the Senate floor. I believe we are 
absolutely there. We just have to have the will to make it happen and 
to make it happen on a bipartisan basis. Not only is it vitally 
important we pass this farm bill, but it truly can be an example in 
terms of how we approach other policy as well on a bipartisan basis.
  At this point, Mr. President, I see the leader is here and I would 
ask of the Chair as to my time allotment and also the time for the next 
vote.
  The PRESIDING OFFICER. All time has now expired.
  The question is, Will the Senate advise and consent to the nomination 
of Landya B. McCafferty, of New Hampshire, to be United States District 
Judge for the District of New Hampshire.
  Mr. WICKER. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. CORNYN. The following Senators are necessarily absent: the 
Senator from Mississippi (Mr. Cochran) and the Senator from Illinois 
(Mr. Kirk).
  The ACTING PRESIDENT pro tempore. Are there any other Senators in the 
Chamber desiring to vote?
  The result was announced--yeas 79, nays 19, as follows:

                      [Rollcall Vote No. 262 Ex.]

                                YEAS--79

     Ayotte
     Baldwin
     Baucus
     Begich
     Bennet
     Blumenthal
     Booker
     Boxer
     Brown
     Burr
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Coburn
     Collins
     Coons
     Corker
     Cruz
     Donnelly
     Durbin
     Feinstein
     Flake
     Franken
     Gillibrand
     Graham
     Grassley
     Hagan
     Harkin
     Hatch
     Heinrich
     Heitkamp
     Heller
     Hirono
     Isakson
     Johnson (SD)
     Johnson (WI)
     Kaine
     King
     Klobuchar
     Landrieu
     Leahy
     Lee
     Levin
     Manchin
     Markey
     McCain
     McCaskill
     Menendez
     Merkley
     Mikulski
     Moran
     Murkowski
     Murphy
     Murray
     Nelson
     Paul
     Portman
     Pryor
     Reed
     Reid
     Rockefeller
     Rubio
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Thune
     Toomey
     Udall (CO)
     Udall (NM)
     Warner
     Warren
     Whitehouse
     Wicker
     Wyden

                                NAYS--19

     Alexander
     Barrasso
     Blunt
     Boozman
     Coats
     Cornyn
     Crapo
     Enzi
     Fischer
     Hoeven
     Inhofe
     Johanns
     McConnell
     Risch
     Roberts
     Scott
     Sessions
     Shelby
     Vitter

                             NOT VOTING--2

     Cochran
     Kirk
       
  The nomination was confirmed.

                          ____________________